Do You Need an Antidepressant? That Depends

Healthy Living

January 9, 2018

In America, major depression affects about 16 million adults each year, representing nearly 7% of the population. If you or someone you know has depression, you know that this mental health condition can leave you feeling empty, hopeless, irritable, sad or even anxious. Although depression can often develop for no apparent reason, there are several factors that may contribute to its onset, including:

  • Biological changes in brain chemistry
  • Cognitive issues like negative thinking patterns
  • Side effects from certain medications
  • Major life changes

Men and women both suffer from depression, but women are more likely to develop this condition, as are people with a family history of depression. Unfortunately, like many other medical and mental health diagnoses, there is no one therapy that works for everyone. A one-size-fits-all approach cannot be used when it comes to depression. Psychotherapy or antidepressants are the most common treatments, with some patients turning to both. While finding the right medication can be time-consuming and frustrating, antidepressants work well for many people suffering from depression.

Research in Antidepressants

Some professionals in the field of mental health believe that patients and clinicians rely too much on medications to be a quick fix to depression, despite their laundry list of side effects. However, the use of antidepressants is growing. From 2011 to 2014, 13 percent of Americans age 12 and up noted taking antidepressants, up from 11 percent between 2005 and 2008.

Researchers at Stanford University recently investigated if there was a link between the success of antidepressant medications, exposure to childhood stress, and amygdala brain activity. Spearheaded by Drs. Leanne Williams and Andrea Goldstein-Piekarski and funded in part by the NIH’s National Institute of Mental Health (NIMH) and National Institute of Biomedical Imaging and Bioengineering (NIBIB), the full results of this study can be found in the Proceedings of the National Academy of Sciences from October 18, 2016.

For this study, researchers analyzed data taken from 70 patients with major depressive disorder from the International Study to Predict Optimized Treatment for Depression (iSPOT-D). Study participants were asked how many life stressors they had experienced prior to turning 18. These stressors included:

  • Abuse
  • Neglect
  • Family conflict
  • Illness or death
  • Natural disasters

Brain activity was measured through functional MRI while patients viewed pictures of emotional faces. These MRI scans were done before patients started treatment with antidepressants and at eight weeks after starting. Patients were selected at random to receive one of the following antidepressants: sertraline (Zoloft), escitalopram (Lexapro) or venlafaxine-XR (Effexor-XR).

Researchers then compared patient recovery correlations with early life stressors and the brain responses on MRI to positive or negative facial expressions. They created a model that included all three factors and were able to predict how likely antidepressants would be to help in the treatment of depression with an accuracy rate of 80 percent. To do this, patients were grouped into three different categories related to childhood stress – low, medium or high.

  • High: For patients in the high-stress group, antidepressants were less likely to work. But if the same patients had a high rating of brain response to happy facial expressions on MRI, they had a greater chance of benefiting from antidepressant use than those who had a low rating.
  • Low: As you might predict, patients who had low levels of childhood stress were the most likely grouping to respond to antidepressant use. Interestingly, in this grouping, those who were less sensitive to happy and fearful facial expressions had an even better chance of success when placed on an antidepressant.

Through this study, researchers were able to show a correlation between brain function and past personal experience while using the findings to provide recommendations for specific treatment choices.

Choosing the Right Drug

Additional research is necessary, however, to see if the same model could be used to predict the likelihood that a specific antidepressant would help certain patient groupings. Currently, clinicians and patients choose an antidepressant based on the following factors:


Depression affects people differently, manifesting in a wide array of symptoms depending on the type of depression it is and what else is going on in your life. Some antidepressants are better than others at addressing your specific set of symptoms. If you’re experiencing anxiety with your depression, for instance, Lexapro may be a good choice for you.

Side effects

While some patients on antidepressants will experience little, if any, side effects, others may have their world turned upside down. Common side effects of these medications include weight gain, dry mouth, low libido, and brain fog or sleepiness. Some patients will need to experiment with several different medications – or varying doses – before finding one that works well for them without intense negative side effects.

Out-of-pocket costs

Unfortunately, cost can be a factor for many people with depression when it comes to choosing a medication. Generic versions of antidepressants are usually less expensive. But some generics don’t work as well as the brand name counterparts for all patients.

Other health concerns and conditions

Certain antidepressants are also known to help with co-occurring conditions and will be more attractive because of this. For example, bupropion (Wellbutrin) is a well-known antidepressant that can also help in the treatment of ADHD; duloxetine (Cymbalta) can also help treat fibromyalgia; and amitriptyline (Elavil) may alleviate headaches. On the other hand, you might have a health condition, like being pregnant, that prevents you from using certain antidepressants, or your current prescriptions and/or allergies might bar you from taking an effective antidepressant.

Before starting a new medication, talk to your doctor about the risks and benefits. It may also be helpful to pursue psychotherapy first, where you may uncover childhood trauma or abuses that could be driving your depression. Working through this trauma can make use of antidepressants more beneficial in your overall treatment, or you may find that you don’t need to take an antidepressant at all. You should discuss all of your treatment options, including their pros and cons, with your psychiatrist, counselor or doctor in order to select the best ones for you. Antidepressants can be effective and useful – and safe – but you need to know what you’re working with first to make the best use of them.