Here’s what experts say about antidepressants and safely managing depression symptoms.

It may be hard to believe that antidepressants can cause depression, but it could be true. The very reason you take depression medication can sometimes make symptoms worse.

Depression is a mood disorder that can cause feelings of sadness and lack of energy, among other symptoms. According to the National Center for Health Statistics, an estimated 4.7% of the population in the United States reported having regular feelings of depression in 2019.

And because many people experience symptoms of depression and don’t seek help, the number of those affected is likely much higher.

If you’re experiencing symptoms of depression, there are some important things to know about taking antidepressant medications, including their potential side effects.

In October 2004, the Food and Drug Administration (FDA) placed a black box warning on antidepressant medications after research studies found an increased risk of suicidal thoughts and behaviors among children and teens. The FDA issued the same warning to young adults 2 years later.

The FDA based this decision on clinical trials that showed study participants with major depressive disorder and other mental health conditions had increased suicidal thoughts and behaviors when taking antidepressants.

However, according to a 2019 review, some experts have suggested that the black box warning could do more harm than good by preventing young people from receiving needed treatment.

A 2019 review of studies on the adverse effects of antidepressants suggests a link between antidepressant use and suicidal thoughts. Still, there isn’t enough consistent evidence to conclude that young people should altogether avoid antidepressants.

When looking at studies and trials in this area, it’s important to note that participants may already have depression and suicidal thoughts.

It can be hard to tell if the antidepressants cause suicidal thoughts, if their depression is not being treated sufficiently, or if they are not responding to the medication and their symptoms are becoming worse.

More research is needed to identify a proven relationship between antidepressants and the risk of suicidal thoughts and actions.

How antidepressants lead to thoughts of suicide is unclear. One or several of the following biological factors may be at play:

  • Suicidal thoughts are separate from your symptoms of depression. Findings from a 2018 study suggest that depression and suicidal behaviors and thoughts are independent of one another and can result from two different mental health conditions.
  • Biological markers may be an indication. One 2020 study identified indicators that may increase the likelihood of suicidal ideation, including being assigned female at birth or developing depression in childhood.
  • Your glands may overproduce stress hormones. The hypothalamic-pituitary-adrenal (HPA) axis is your body’s main system for regulating your stress response. In some people, it may release too much cortisol in response to stress, leading to increased thoughts of suicide.

There are different types of antidepressants, and each class of medications works to relieve symptoms in different ways.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the most commonly prescribed antidepressants since they lead to fewer side effects. A doctor may also prescribe them if you’re experiencing symptoms of both anxiety and depression.

Some SSRIs include:

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

This class of antidepressants works on more than one neuron messaging system in your brain. 2021 research suggests SNRIs may be more effective than other classes of antidepressants for moderate to severe depression.

Some SNRIs include:

Tricyclic antidepressants (TCA)

TCA antidepressants are not usually the first line of treatment because they often produce more intense side effects. But, doctors may use TCAs in people with pain and associated depression, since they can help with both.

TCAs include:

  • amitriptyline (Elavil)
  • nortriptyline (Aventyl HCL)

Learn more about the different types of antidepressants, how they work, and their side effects.

Antidepressants can take up to 6 to 8 weeks to start working. As your body adjusts to the medication, you’ll want to speak to your doctor if:

  • You notice that your sleep and diet improve before your mood improves. This is a good sign that the drug is working, but you may need a higher dose.
  • Your symptoms return after seeing initial relief. This may mean you need to adjust the dosage or consider another medication to help manage your symptoms.
  • You’re experiencing side effects that negatively impact your daily life. You can expect side effects from antidepressants, but some are more serious than others, such as suicidal thoughts, high blood pressure, and serotonin syndrome.
  • The drug isn’t helping. Everyone is different, and some antidepressants work better for some than others. It’s best to discuss your options with your doctor. They may recommend other medications or behavioral therapy to help supplement treatment.

In the United States in 2020, an estimated 21 million adults experienced an episode of major depression. If you are also experiencing symptoms of depression, it’s important to know you’re not alone, and help is out there.

Some evidence suggests that antidepressants may increase the risk of suicidal thoughts and behaviors in children and young adults. But, it does not mean you should avoid treatment.

Your doctor will monitor you closely for signs of concerning side effects and adjust the treatment plan if needed.

If you’re still unsure if antidepressants are a good next step, you may consider nonpharmaceutical treatment methods like therapy to help with your depression symptoms. Consider reading about how to choose the right therapist for you.

You may also find lifestyle changes, like exercising regularly or practicing mindfulness techniques, to be helpful for managing depression symptoms.