Antidepressants are among the most commonly prescribed and yet most widely misunderstood medications in psychiatry. "They cause addiction," "you'll have to take them for life," "they change your personality" — these are common misconceptions. This article provides evidence-based answers.
Types of antidepressants
SSRIs (selective serotonin reuptake inhibitors) — first-line therapy. Sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro). Relatively mild side-effect profile.
SNRIs (serotonin-norepinephrine) — venlafaxine (Effexor), duloxetine (Cymbalta). More effective for fatigue and pain symptoms.
Tricyclic antidepressants — older generation (amitriptyline, imipramine). Effective, but heavier side-effect profile.
MAOIs — require dietary restrictions, rarely used.
Myth 1: "Antidepressants cause addiction"
Incorrect. Antidepressants do not cause addiction — they do not require dose escalation, do not produce a "high," and do not create compulsive drug-seeking behavior.
However, after prolonged use a discontinuation syndrome may occur — dizziness, headache, nausea, "electric shock" sensations. This is not narcotic withdrawal — it is simply a rebalancing of brain chemistry. It is prevented by gradual dose reduction.
Myth 2: "Antidepressants change your personality"
Incorrect. Antidepressants do not change your personality — they restore the original personality "blocked" by depression. Patients often say: "I feel like myself again."
Emotional blunting as a side effect occurs in 10–15% of patients. In this case, dose adjustment or switching medication helps.
Myth 3: "Once you start, you'll have to take them forever"
Incorrect. Standard course:
- First episode: 6–12 months (after achieving remission)
- Second episode: 1–2 years
- 3+ episodes: long-term (but regularly reviewed)
Most patients gradually discontinue treatment.
Myth 4: "They work quickly"
Incorrect — partly. Side effects appear quickly (gastrointestinal, headache, sleep disturbances) — within 1–2 weeks. But the therapeutic effect requires 4–6 weeks. This is why many patients stop the medication thinking it is not working — and that is a mistake.
Effectiveness
Research (Cipriani et al., 2018, meta-analysis, 522 studies):
- Antidepressants are significantly more effective than placebo (effect size 0.30)
- For mild depression, effectiveness is limited — psychotherapy is preferable
- For moderate to severe depression — CBT + medication together produce the best results
- For severe depression — medication intervention is necessary
When is an antidepressant needed?
- Severe depression (suicidal thoughts, functional collapse)
- Moderate depression not fully responding to CBT
- Patient preference (as an alternative to therapy)
- Recurring episodes (relapse prevention)
- Combination of severe anxiety and depression
The correct plan
- Psychiatric evaluation
- Selection of a first medication (usually an SSRI)
- 4–6 weeks of use — evaluation of results
- If no effect — dose increase or switch to a different medication
- 6–12 months after achieving remission
- Gradual discontinuation (4–8 weeks)
- In combination with CBT psychotherapy
An antidepressant is a tool, not a "solution." Psychotherapy trains the brain; medication manages the condition. Together they produce the best results.
