Selective Serotonin Reuptake Inhibitors (SSRIs) for Depression

SSRIs are the most widely prescribed type of antidepressants. They're usually preferred over other antidepressants, as they cause fewer side effects. An overdose is also less likely to be serious. Fluoxetine is probably the best known SSRI (sold under the brand name Prozac). Other SSRIs include Citalopram (Celexa), Cipralex (Escitalopram) and Zoloft (Sertraline).

How SSRIs Work

Medicines known as reuptake inhibitors increase the amount of particular neurotransmitters in the brain by preventing unused neurotransmitters from moving back into the pre-synaptic neuron. Selective serotonin reuptake inhibitors, or serotonin-specific reuptake inhibitors - as they are also known - increase the amount of the neurotransmitter serotonin in the brain. Serotonin has many roles in the body, including the regulation of your appetite, your sleeping patterns, your body temperature and your memory. It also plays a primary role in regulating your mood, which is the main reason why supplemental serotonin, the most common form of antidepressant, is prescribed for people experiencing anxiety or depression. People of both the male and female gender with anxiety disorders exhibit lower levels of serotonin than normal.

How effective are SSRI antidepressants?

About 5-7 in 10 people with moderate or severe depression have an improvement in symptoms within a few weeks of starting treatment with an antidepressant. However, up to 3 in 10 people improve with dummy tablets (placebos), as some people would have improved in this time naturally. So, if you have depression, you are roughly twice as likely to improve with an antidepressant compared with taking no treatment. But, they do not work in everybody. As a rule, the more severe the depression, the greater the chance that an antidepressant will work well.

People who should take extra care with SSRIs
Make sure you tell your doctor if you have, or have had in the past, any of the following conditions (you might need to take extra precautions, or another medicine might be more suitable):
- epilepsy or reduced seizure threshold
- bipolar disorder
- stomach bleeding
- liver problems
Get advice about the risks of taking antidepressants, directly from your doctor or from a specialist information line, if you are pregnant, breastfeeding or thinking about becoming pregnant.

Why Antidepressants Take So Long To Work?

A common treatment for clinical depression is a type of medication called an antidepressant. Antidepressants come in a variety of forms, but all of them work by impacting certain neurochemicals in your brain, such as serotonin and norepinephrine. Antidepressants are most commonly prescribed by a psychiatrist, but may also be prescribed by a family physician or general practitioner to treat depression.

Antidepressants do not work immediately for many individuals hoping to get relief from their depression symptoms. In fact, the general consensus is that they take 4 to 6 weeks to kick in and for the antidepressant effect to take place. This basically means that most people should not get any relief from their depression until about a month into treatment.

Below are some factors that may influence the ability of an antidepressant to work immediately.

Reasons why antidepressants take so long to start working / kicking in

1. Low dose – Taking a low dose of an antidepressant may be part of the reason that it hasn’t kicked in yet. Many times it is actually a good idea to start low and work your way up via a process called titrating. So if you are in the early stages of titrating your medication upwards, the reason that it’s taking longer for you to feel the effects is due to the strength (usually in milligrams) of the dosage that you are taking.

2. Out of shape – If you are a bigger individual, out of shape, or bigger, any drug is usually going to take longer to kick in. This is simply because you have more mass and more overall body for the drug to be distributed. Additionally, the fact that you are out of shape may result in you having a slower baseline metabolism in comparison to someone who is in good shape and works out. Therefore the drug may not be cycling through your body at as quick of a rate for you to feel the effects.

3. Other drugs – If you do other drugs, you may not be able to feel the effects of the antidepressant medication compared to people that are pure (i.e. not doing anything else). Other drugs can affect brain chemistry as well as other bodily functions and change your natural homeostatic state of functioning. If you don’t do other drugs, the likelihood is greater that you will feel an antidepressant sooner than someone who gets a buzz from other substances.

4. Alcohol – Drinking alcohol is a personal preference and many people do it to socialize. At the same time, many individuals don’t realize that it does affect mental performance and cognition. It can increase irritability and slow mental performance in certain situations even far after the alcohol has been consumed.

5. Chemistry – How your body reacts to the drug has a lot to do with your chemistry. One antidepressant may work well for your friend, but not for you. Additionally, something that works within the first week for one person may take another 3 weeks. A lot of this has to do with how your body responds to the medication.

Men and Depression

Depression is an illness that affects both men and women. But people working in mental health services see far fewer men with depression. It seems likely men suffer from depression just as often as women, but they are less likely to ask for help. Male depression is treatable and best treated as early as possible. 

Signs and symptoms of depression in men

Depression has a number of signs and symptoms. Men are each affected in different ways, but three of the most common signs are pain, risk taking, and anger.

Pain. 

Depression may show up as physical signs like constant headaches, stomach problems, or pain that doesn’t seem to be from other causes or that doesn’t respond to normal treatments.

Risk Taking. 

Sometimes depressed men will start taking risks like dangerous sports, compulsive gambling, reckless driving, and casual sex.

Anger. 

Anger can show itself in different ways like road rage, having a short temper, being easily upset by criticism, and even violence. 

Here are some other common signs, especially if they last for a few weeks or months: feeling guilty, worthless, or that you always fail; feeling restless and/or irritable; having no energy; problems sleeping (not sleeping or sleeping too much); feeling angry or violent; feeling like you can’t work or get things done; using alcohol or drugs to feel better; sexual inability; losing interest in hobbies, work, and/or sex; having problems focusing, remembering, or making choices; always feeling sad or nervous; feeling alone; being negative about everything; thinking about death or suicide.

Treatments for depression

There are effective treatments for depression. In fact, more than 80% of men respond to treatment for depression. Your primary care doctor or a psychiatrist can create a treatment plan for you. That plan for treating depression may include:

- Antidepressants. The medicines most often used for depression treatment today are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These antidepressants increase the levels of specific chemicals in the brain.

- Talk therapy. Many kinds of psychotherapy or talk therapy are effective in treating depression. Cognitive therapy, also called cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and "insight-oriented psychotherapy" are frequently used.