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Article clinically reviewed by Haley Collins, NP
Depression, a pervasive mood disorder, shows up like persistent sadness, a lack of interest in activities you used to enjoy, and a range of physical and emotional symptoms that hinder daily functioning. It may impact your social life, your work, and/or your relationships. It's more than just a bout of the blues; it's a deep, enveloping shadow that alters how you feel, think, and handle daily activities.
Depression affects many of us. In fact, half of LGBT people ages 18-29 report symptoms of depression. That means either you or someone you love probably has dealt with this now or in the past. Approximately 280 million people in the world have depression. Individuals who have experienced stress or trauma are more likely to develop depression; this is one reason why it is so common in our community.
Depression impacts emotional and physical well-being. If you find feelings of depression overwhelming your life for extended periods, it is a good time to consider treatment. (Ideally, we are in conversation with a trusted clinician about our mental health before it gets this bad, too!) Treatment for depression can include antidepressants, talk therapy, lifestyle changes (like exercise and nutrition), mindfulness and more. Most likely effective treatment will include more than one of these options.
When to Consider Treatment
Consider seeking treatment if you experience:
- Persistent sadness or worry
- Changes in sleep or appetite
- Difficulty concentrating
- Loss of interest in activities once enjoyed
- Feelings of guilt, worthlessness, or helplessness
- Fatigue or low energy
These symptoms, especially when lasting more than two weeks, might indicate depression. It's essential to consult with a healthcare provider to discuss your experiences and explore the best treatment path for you. Remember, reaching out for help is a sign of strength and self-awareness, not weakness.
Getting an Antidepressant Prescription
Antidepressants are prescribed following a thorough evaluation by a healthcare provider, who considers your specific symptoms, medical history, and any other medications you might be taking. This personalized approach ensures that the chosen medication aligns with your unique health profile, maximizing efficacy while minimizing potential side effects. Prior to prescribing an antidepressant your health care provider may complete labs or other tests to rule out any other medical causes for your symptoms. This could include testing for vitamin deficiencies, anemia, metabolic issues or sleep disorders. You may also be screened for other mood disorders like bipolar disorder.
Some people might not know that you don’t have to see a psychiatrist for a depression medication prescription! Primary care providers can prescribe and manage antidepressant medications for you. All of our FOLX clinicians can work with you to prescribe or manage most depression medications, as well as help guide you to other treatment options you may want to explore.
Time for Antidepressants to Work
Once you start, it's important to understand that antidepressants typically take some time to manifest their full effects. Generally, most people take at least 4 weeks to notice improvements, but it could take 6+ weeks, sometimes longer, to experience significant relief from depressive symptoms. Patience and open communication with your healthcare provider during this period are essential to adjust the treatment plan as needed for optimal outcomes. FOLX Clinician Haley Collins, NP, says “During this time it can be a good idea to keep a journal of your symptoms and experience. Sometimes bringing more awareness to your emotions and body can help you identify the changes and see improvements more clearly.”
Commonly Prescribed Medications
Medications used to treat depression, or antidepressants, work by shifting chemicals in your brain called neurotransmitters that affect mood and emotions. While not a cure-all, they can significantly alleviate symptoms, helping you regain your zest for life. Here's a rundown of commonly prescribed types:
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs like fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa) are often the first line of treatment for depression (and multiple other mood disorders). They are favored for their targeted action and lower side effect profile compared to some other antidepressants. These medications work by enhancing the levels of serotonin, a neurotransmitter pivotal to mood regulation, in the brain. This increase of serotonin helps alleviate depressive symptoms and improve mood. SSRIs are often preferred for their relatively mild side effects, which may include headache, nausea, dizziness, insomnia, and sexual dysfunction, but these are generally less severe than those associated with older antidepressants and medications in other classes. Some side effects may also just be temporary. If you are prescribed an SSRI and it doesn’t seem to work for you, that doesn’t mean the entire class of medications is off-limits. It is common practice to try a different medication in the same class as the effectiveness can differ depending on the person and chemical makeup of the medication.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
Expanding on the mechanism of SSRIs, SNRIs such as venlafaxine (Effexor XR) and duloxetine (Cymbalta) also increase norepinephrine alongside serotonin, offering a broader approach to treatment. This dual-action can be particularly beneficial in treating depression accompanied by chronic pain or anxiety, as norepinephrine is associated with alertness and energy. While SNRIs share some side effects with SSRIs, they may also lead to increased blood pressure, highlighting the need for regular monitoring.
Atypical Antidepressants
This diverse group, encompassing medications such as bupropion (Wellbutrin) and mirtazapine (Remeron), operates through mechanisms distinct from those of other antidepressants. Bupropion, for instance, targets dopamine and norepinephrine, offering an alternative for those who may not respond to or tolerate SSRIs and SNRIs. Typically bupropion can be prescribed if sexual dysfunction has been a problem with other medications as it is least likely to cause this side effect. Mirtazapine increases neurotransmitter levels by a different pathway and is noted for its sedative effects, which can be beneficial for patients with insomnia related to depression.
These medications may also be given in conjunction with an antidepressant in a different category.
Tricyclic Antidepressants (TCAs)
TCAs like amitriptyline and nortriptyline, once the standard in depression treatment, offer potent efficacy but with a higher risk profile. Their mechanism involves blocking the reuptake of serotonin and norepinephrine, along with effects on other neurotransmitter systems, which can lead to more pronounced side effects such as dry mouth, blurred vision, and weight gain. Due to these considerations, TCAs are typically reserved for cases where newer antidepressants are ineffective.
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs, including tranylcypromine (Parnate) and phenelzine (Nardil), represent one of the oldest classes of antidepressants. This class of medication is often last in line when it comes to treatment options. They work by inhibiting the enzyme monoamine oxidase, responsible for breaking down neurotransmitters like serotonin and norepinephrine. While effective, MAOIs require strict dietary restrictions to avoid potentially life-threatening interactions with certain foods and medications, making them a less common choice in the modern therapeutic landscape. Each class of antidepressants brings its own set of benefits and considerations, underscoring the importance of personalized treatment plans developed in close collaboration with healthcare providers. As our understanding of depression and its treatment evolves, these medications remain vital tools in the broader strategy to support mental health and well-being.
Finding the Right Medication
It's crucial to remember that finding the right medication is often a process of trial and error. Open and honest communication with your healthcare provider will help tailor a treatment plan that aligns with your unique needs.
It is also important to discuss with your health care provider if a medication is not working for you. Some medications shouldn’t be discontinued abruptly, so you may need a plan for stopping the medication.
Dealing with Side Effects
Anytime you experience side effects when starting a new medication it is also important to bring it up to your health care provider as some side effects could be a sign of something more complicated or something that needs swift treatment, like serotonin syndrome.
Less serious side effects like nausea, headache, or sexual dysfunction can be treated by adjusting the time, dose, or switching to a different medication in the same class. Sometimes additional medications can be taken temporarily or long-term to help with specific side effects or persistent symptoms. It may not be necessary to stop the medication altogether.
If you ever experience an increase in suicidal ideation when taking a medication, you should reach out to your provider right away, as this can be a risk for some people when starting a new antidepressant (And if you ever find yourself in crisis, please contact a resource like Crisis Text Line for immediate support.)
FOLX: Your Partner in Mental Health
At FOLX, we understand the intricacies of mental health, especially within the LGBTQIA+ community. Our approach to care is holistic, empathetic, and deeply rooted in the understanding that everyone's journey is unique. We're here to support you, offering virtual consultations that provide a safe, affirming space to discuss your mental health, including depression, anxiety, sleep issues, or anything on your mind. Our network of LGBTQIA+ specialized providers is equipped to work with you in managing your mental health, exploring medication options, and developing a treatment plan tailored to your needs.
Embarking on the path to better mental health is a courageous step. If you're considering medication for depression or anxiety, FOLX is here to guide you through with compassionate, comprehensive care that respects your identity and experiences. Together, we'll navigate the complexities of mental health treatment, ensuring you feel supported at every turn. You’ll be joining a community of other LGBTQIA+ people on health and wellness journeys who are here for you too.
FAQs about depression medications
How do I know if I need antidepressants?
If you're experiencing persistent sadness, loss of interest in activities you once enjoyed, or other depression symptoms for more than two weeks, it may be time to discuss treatment options with a healthcare provider. They can assess your specific situation and determine if antidepressants could be beneficial for you.
Are there any side effects to antidepressants?
Like all medications, antidepressants can have side effects, which vary depending on the specific medication and the individual. Common side effects may include nausea, dizziness, headaches, sleep disturbances, and sexual dysfunction. However, many people find these side effects manageable or notice them diminishing over time.
How long do antidepressants take to work?
Antidepressants typically take about 4-6 weeks to show noticeable effects, although some people might start to feel better within 1-2 weeks. It's important to give the medication time to work and to keep in close contact with your healthcare provider during this period to monitor your progress.
Can I stop taking antidepressants if I feel better?
It's crucial not to stop taking antidepressants without consulting your healthcare provider. Abruptly discontinuing medication can lead to withdrawal symptoms or a relapse in depression. If you're feeling better, it might be a sign that the medication is effective, and your provider can help you determine the best course of action.
How does FOLX support individuals with depression?
At FOLX, we offer compassionate, personalized care tailored to the LGBTQIA+ community's unique needs. Our specialized providers can work with you to explore depression treatment options, including medication management, in a safe and affirming virtual environment. We're here to support you every step of the way on your journey to mental wellness.
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FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!
