Mental Health Medication: Frequently Asked Questions

Antidepressants are among the most commonly prescribed medications in the United States. About 1 in 8 adults takes one each month. First developed in the 1950s, they have been studied for decades and are considered both safe and effective for treating depression, anxiety, and several other mental health conditions. 

Like all medications, antidepressants can have side effects. Most are mild and manageable, especially with close follow-up from a healthcare provider, who can adjust the dose or try a different medication if needed. 

For most people with moderate to severe depression, the benefits of taking an antidepressant outweigh the risks of leaving the condition untreated. As with all medications and treatment options, you should talk to your healthcare provider about what options are best for you. 

Current research suggests that antidepressants are generally safe for long-term use when monitored by a healthcare provider, and many people take them for years without serious problems. 

It’s completely normal and healthy to experience the full range of human emotions, including sadness. Antidepressants don’t take those feelings away; they’re meant to reduce symptoms so you can function better and feel more like yourself. 

When sadness lasts more than a couple of weeks and starts to interfere with your ability to function, like it’s affecting your sleep, energy, appetite, concentration, work or school performance, or relationships, that’s when it may be more than typical sadness. 

Antidepressants help support the brain’s natural chemical systems that regulate mood. They work by reducing the intensity of symptoms that are interfering with your ability to function. They are not designed to change your personality. 

That said, if you do feel numb, flat, or apathetic, this can sometimes be a side effect that your clinician should monitor for, often referred to as SSRI-related apathy. In those cases, adjustments can be made, and these symptoms typically improve once the medication is reduced or stopped.

It is reasonable to be concerned about the impact of taking a medication during pregnancy. The good news is that the research suggests that taking medication during pregnancy is both safe for you and your baby. 

Studies have determined that taking SSRIs is the safest first line option when it comes to which medication to take during pregnancy. The SSRIs, sertraline and escitalopram are associated with having the safest profile compared to other antidepressants since they are less likely to be transferred to the placenta.   

While some early studies raised concerns about risks like birth defects or developmental problems, these studies didn’t account for the effects of depression itself. More rigorous research shows that these risks are largely not caused by medication and, if present, are very small. It is important for people to know that there are risks associated with not treating your depression during pregnancy. Studies have found that undertreated depression is associated with preterm birth, low birth weight, pregnancy related complications and maternal suicide.   

It’s completely understandable to have concerns about starting your child on any medication. Overall, antidepressants, particularly SSRIs, are considered safe and effective for children and adolescents when prescribed and monitored by a qualified clinician. 

In 2004, the U.S. Food and Drug Administration added a “black box warning” for people under age 25. This was based on studies showing a small increase in suicidal thoughts during the first 1–2 weeks of treatment. Because of this, close monitoring of medications early on is important. At the same time, untreated depression carries a higher risk of suicide, and over time, antidepressants are associated with a reduction in suicide risk. 

Several antidepressants are FDA-approved for use in children and adolescents: 

• Fluoxetine and escitalopram for depression  

• Sertraline and fluvoxamine for obsessive-compulsive disorder (OCD)  

• Duloxetine for generalized anxiety disorder in children age 7 and older  

When it comes to growth and development, studies have looked at physical growth, brain development, and thinking skills. The overall findings are reassuring since there is no strong evidence that these medications negatively impact height, growth, or cognitive development, including executive functioning. 

If you’re looking for more resources to navigate your child’s mental health journey, check out NAMI’s You Are Not Alone: A Guide for Parents and Caregivers.

Deciding whether to start or stop an antidepressant is individualized and should always be done in close conversation with your healthcare provider. You and your provider can review your specific situation and make a thoughtful plan for how long to continue treatment. 

Several factors go into this decision. These include how severe the depression was (for example, whether there were suicidal thoughts or significant impact on daily functioning), whether you’ve had multiple episodes over time, how well you tolerate the medication, and your personal preferences. 

In general, it is recommended that people continue an antidepressant for about 6–12 months after their symptoms improve to help reduce the risk of having another depressive episode. 

For some individuals, particularly people with a strong family history of depression or more severe episodes (such as suicide attempts, psychosis, or hospitalization), longer-term or even ongoing treatment may be recommended. This is because the risk of symptoms returning can be higher after stopping medication. 

Before you abruptly discontinue your medication, please have an honest and direct conversation with your healthcare provider regarding your desire to stop. Your provider will want to gain a better understanding about what is influencing your decision to stop.  Whether it be due to side effects, you no longer feel like it is necessary or simply that you no longer want to take a medication every day, it is still important to be open and honest as to your reasons why. 

What you should NOT do is stop them suddenly. It is possible that you may experience what is referred to as discontinuation symptoms. Discontinuation symptoms can include dizziness, nausea, headaches, fatigue, trouble sleeping, irritability, anxiety, and “electric shock” sensations (sometimes called brain zaps). These symptoms are usually mild and short-lived, but for some people they can be more noticeable. Symptoms typically begin within a few days of stopping the medication and improve over 1–2 weeks, though occasionally they can last longer. 

The term withdrawal is usually used for substances that can cause dependence or addiction, like opioids or alcohol. Antidepressants do not cause cravings, loss of control, or compulsive use as typically seen when using substances, so they are not considered addictive. 

When people stop antidepressants, the symptoms they may feel are due to the brain adjusting to the absence of the medication, not because the body is “dependent” on it in an addictive sense. 

That’s why clinicians often use the term “discontinuation symptoms,” as it more accurately reflects what’s happening. Antidepressants cause a change in the chemicals in your brain, and it takes a little while for your brain to adjust to not having the same balance of chemicals. That’s why when people stop them suddenly, they are more likely to experience these symptoms since their body doesn’t have enough time to readjust  In order to reduce the risk of developing these symptoms, we recommend that your provider tapers you off of the medication which means that you gradually take less of it over a period of time. Typically, these medications are tapered off over several weeks with ongoing follow up after you’ve stopped.

No, there is no strong evidence that antidepressants cause people to become violent or aggressive. In fact, for many individuals, these medications help reduce symptoms like irritability, impulsivity, and emotional distress, which can lower the risk of harmful behaviors. 

There have been some studies suggesting a possible association between SSRIs and increased agitation or restlessness in younger individuals, particularly early in treatment. This is why close monitoring, especially in the first few weeks, is important. 

At the same time, untreated depression and other mental health conditions are themselves associated with a higher risk of irritability, impulsivity, and, in some cases, harmful behavior. Treating these conditions is an important part of reducing overall risk. 

Overall, the evidence suggests that antidepressants are more likely to reduce, not increase, risk when used appropriately and with proper follow-up.