Columbia University Health Services

Medications for depression are not simply ‘happy pills’. If you are not depressed and take antidepressants, they will not improve your mood or functioning. People who are depressed often lack the perspective and energy to deal with the underlying problems causing their depression. When treating depression with drugs, many therapists report that patients make more progress in ‘talk therapy’ or counseling because they are better able to grapple with emotional and practical problems.

Some common fears are that taking medication means you are ‘crazy’, that it will sedate you into being a zombie, or will change your identity as a person. These fears are unrealistic. Psychoactive drugs are useful for people with a wide range of problems and do not mean you are ‘crazy’. Even people who are generally psychologically healthy can have transient periods of depression. There is no reason to suffer through distress when safe, effective medication can reduce the burden you have to carry.

Are drugs only for people who don’t know what is causing their depression?
Being able to identify the source of your distress (such as academic problems, medical illness, family problems, difficulty in a relationship), may make you feel your depression is inevitable, and that medication-oriented treatment would be inappropriate. However, even when a source of depression is known, treatment can still be helpful and effective. Working with a professional will help you distinguish between proportionate sadness, worry, or anxiety, and depression that should be treated medically.

Will I feel like a zombie if I go on medication?
Most regularly prescribed drugs for depression are not sedating and do not act by to robbing you of emotion or passion. Drugs used to treat depression generally restore you to normal mood and range of emotions. A small number of people do experience a sense of apathy or ‘flatness’ on some antidepressants. In this case, they may respond better to a different antidepressant.

Will I experience any side effects?
Like any drug, psychoactive medications have some side effects. Many of these side effects are noticeable at first, but disappear or diminish after a few weeks, though some may be more persistent. When prescribed correctly, psychoactive drugs do not dull your intelligence or your ability to perceive reality. Depression is what inhibits your ability to see the world clearly and act effectively. By reducing anxiety and depression, drugs help some people clarify their thinking and become more active.

How fast do these drugs work and how long should I take these them?
Antidepressants are usually started at low dosage and then increased.  You should experience significant improvement two to six weeks after starting the drug. Some people feel better within a few days, but do not expect it to work immediately. If one antidepressant does not work, another may be effective. Inadequate dosage or inadequate length of time on the drug is the most common cause of treatment failure. Antidepressant medications are usually taken for four to six months. If depression recurs when the medication is stopped, these antidepressants may be taken on an indefinite basis.

What if I want to stop taking my antidepressant?
Consult with your physician about how best to terminate medication. Usually it is best to taper off medication (take smaller and smaller doses over time). This is especially true of Paxil and Effexor which may cause extremely uncomfortable side effects if terminated abruptly.

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