Antidepressants May Not Work The Way We Think They Do

Antidepressants may not work the way we think they do—but how much does that matter? Initially scientists and researchers thought the drugs worked to correct a “chemical imbalance” in the brain, especially a balance of the chemical serotonin, which was linked with mood. It’s now recognized that the mechanics of antidepressants are much more complex than we originally thought. It’s still not entirely understood how they work, but one newer theory is that they may actually help form new connections between cells in the brain, and they may also increase other chemicals in the brain that aid in that cell growth.

Most people who take antidepressants—and not surprisingly, the numbers have gone up recently—have to cycle through a few until they find one that works well for them. And then, that particular drug usually takes some time to start working. It also may cause unpleasant side effects that interfere with your sleep, appetite, or suicidal ideation—all things you are probably trying to use the antidepressant to treat.

There is still hope, though. In a clinical trial studying the effects of antidepressants, half of the participants had significantly improved after using either the first or second medication they tried, and nearly 70 percent of people had become symptom-free by the fourth antidepressant. Trial and error and perseverance are often key to getting antidepressants to work for you.

Of course, no matter how they work, or which one works best for your personal “brain chemistry,” antidepressants aren’t a magic bullet. Important factors like sleep, diet, and exercise are also necessary, and can work just as well as antidepressant drugs for mood balance. The catch-22 I always find is that depression itself often makes these cures for depression impossible. Depression can interrupt your sleep and make you too fatigued to exercise or cook well, for example. Severe depression can even make it a chore to get out of bed, shower, or get dressed. I had one doctor describe it to me this way: Antidepressants can sometimes help “cut through the fog” long enough to give you the motivation to make the other lifestyle changes you need to treat your depression.