If you’ve been struggling with feeling depressed and anxious, you’ve got options. You don’t have to feel this way forever! You may know people who are taking medication for their depression or anxiety. But how do you know if it’s right for you? In this article, we’ll discuss how to know when you need medication and what your choices are.
When do you need medication for depression or anxiety?
First, you’ll need a diagnosis from your doctor or mental health provider. Make sure you tell your provider if you’ve been dealing with any of the following:
- Frequent (or constant) sadness or anxiousness.
- Trouble sleeping (or oversleeping).
- Lack of pleasure in things you used to enjoy.
- Changes in appetite.
- Irritability or restlessness.
- Feelings of worthlessness, hopelessness or guilt.
- Racing or intrusive thoughts.
- Difficulty concentrating.
- Gastrointestinal problems or aches and pains without a clear reason.
- Strong urges to avoid certain situations that make you nervous.
- A sense of panic or doom.
- A racing heart or rapid breathing.
- Overwhelming fear of specific situations.
Your provider will likely ask you some questions (sometimes in the form of a worksheet) about what you’re feeling and how long it’s been going on. They may also conduct or recommend a physical examination or lab tests. This will help them make sure there’s not an underlying medical condition contributing to your symptoms.
Once you’ve been diagnosed, your provider will likely give you some choices for treatment. If your disorder is very mild, they may only recommend therapy rather than medication for depression or anxiety. For any medication, the benefits need to outweigh the risks, and this might not be the case for mild disorders.
However, if you have moderate to severe depression or anxiety, you will likely be given the option of using medication alone or in combination with therapy.
What kinds of medications are there for depression and anxiety?
Many of the same types of medications are used to treat both depression and anxiety. These overlapping drugs include:
- Selective serotonin reuptake inhibitors (SSRIs) — These are generally the first-prescribed medications for depression and anxiety. They work by stopping the movement of the mood-boosting molecule serotonin back into neurons for recycling. SSRIs are effective for many people and generally have mild side effects. Some of the most common SSRIs are fluoxetine, paroxetine, sertraline, citalopram, and escitalopram.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) — These are also fairly commonly prescribed, particularly if SSRIs aren’t effective. Like SSRIs, SNRIs block serotonin transport; however, they also block the transport of norepinephrine. Frequently prescribed SNRIs include venlafaxine, desvenlafaxine, levomilnacipran and duloxetine.
- Tricyclic antidepressants — These older drugs have more severe side effects than SSRIs and SNRIs, so they’re not prescribed as frequently. However, they may still be an option if the other types don’t work for you. They work by blocking serotonin and norepinephrine transport as well as by inhibiting various brain chemical receptors. Common tricyclics include amitriptyline, nortriptyline, protriptyline, desipramine, doxepin, imipramine, amoxapine and trimipramine.
- Atypical antidepressants — This category lumps together drugs that don’t fit in the other categories. For that reason, these medications for depression/anxiety work through a variety of mechanisms. Some examples are bupropion, trazodone, vilazodone, mirtazapine, vortioxetine and agomelatine.
- Monoamine oxidase inhibitors (MAOIs) — These drugs inhibit the enzyme monoamine oxidase, which breaks down mood-boosting chemicals in the brain. They’re very rarely prescribed because they have severe side effects and can interact with lots of other medications or even foods. Some examples of MAOIs are isocarboxazid, selegiline, phenelzine and tranylcypromine.
There are also additional classes of medications that can help with anxiety but aren’t typically prescribed for depression, such as:
- Beta-blockers — These are typically used to lower blood pressure because they help relax the arteries and slow heart rate. However, they’re also useful for anxiety, because these physical effects can help you feel calmer by taking you out of “fight-or-flight” mode. Helpful beta blockers for anxiety include propranolol, metoprolol and atenolol.
- Benzodiazepines — These drugs, sometimes called “benzos,” are sedatives that help your body relax when you’re feeling anxious. While antidepressant drugs can take a few weeks to be effective, benzos are usually very fast acting, achieving their effects within 30 minutes to a few hours. They also wear off quickly, though, and they can be habit-forming. For these reasons, they’re usually only used in the short term or for specific situations that make a person fearful. Some of the most commonly prescribed benzos are lorazepam, diazepam and alprazolam.
- Buspirone — Like benzos, buspirone can be used for short-term anxiety treatment. However, it’s not habit-forming, so it can also be used over the longer term. It’s believed to work by affecting serotonin signaling in the brain, but the exact mechanism is a bit of a mystery.
What if medication doesn’t work for my depression or anxiety?
If you try a medication and it doesn’t alleviate your depression or anxiety symptoms, your provider may advise you to increase your dose, try a different medication or try a combination of medications. They may also recommend that you try therapy if you haven’t already.
If you have depression and it’s proving hard to treat, your provider could recommend adding esketamine. This FDA-approved medication is delivered in a nasal spray and can help boost the efficacy of oral antidepressants. You may also be given the option to try transcranial magnetic stimulation (TMS). This FDA-cleared, non-invasive, medication-free technique uses pulses of magnetic energy to stimulate areas of the brain that may be underactive in people with depression.
Active Path Mental Health can help you manage your depression or anxiety
At Active Path Mental Health, we offer short-term cognitive behavioral therapy for depression or anxiety to help retrain your brain. Or, if you have hard-to-treat depression, we offer esketamine and TMS.
Contact our team today for more information or to schedule an initial appointment.
