Trigger warning: this article mentions depression and suicide.
Starting new antidepressants, decreasing or increasing their dose, or introducing a new one alongside the first one can alter the chemical dynamics and balances of the body, leading to the possibility of experiencing a multitude of symptoms.
How Antidepressants Work
There are multiple classes of antidepressants that include, but are not limited to, tricyclic antidepressants, tetracyclic antidepressants, monoamine oxidase inhibitor antidepressants, selective serotonin and norepinephrine reuptake inhibitors, and atypical antidepressants. For the sake of simplicity, let us start by understanding how SSRIs (selective serotonin reuptake inhibitors), which are the most commonly prescribed class of antidepressants, work.
Serotonin is a neurotransmitter responsible for multiple functions such as appetite, sleep, and mood. Low levels of serotonin are correlated with depression, but the actual cause of depression remains unknown. SSRIs work by preventing the reuptake of serotonin back into the neurons. To understand what this means, let us clarify a few terms and concepts.
Neurons communicate with each other by sending chemical messengers known as neurotransmitters. Neurotransmitters transmit messages by binding to the receptors of another neuron. Between the two neurons is a small gap called a synapse. Thus, the neuron sending the neurotransmitter is termed as the pre-synaptic neuron, while the neuron receiving the neurotransmitter is termed as the post-synaptic neuron.
When neurons release neurotransmitters, a lot of them bind to receptors on the post-synaptic neurons, but some of them remain in the synaptic gap. When this happens, pre-synaptic neurons reuptake the remaining neurotransmitters, decreasing their amounts, and thus their effects. In the case of SSRIs, the neurotransmitter is serotonin.
Black Box Warnings
Apart from side effects like nausea, vomiting, diarrhea, headaches, drowsiness, dry mouth, insomnia, nervousness, agitation, or sexual problems, antidepressants are required to have black box warnings. Black box warnings or boxed warnings are the most serious class of warnings put on prescription drugs. The use of antidepressants in youth and adults under the age of 25 increases the risk of suicide.
While it might seem contradictory that medications for treating depression can trigger suicidal and self-harm thoughts and urges, antidepressants work by improving mood in the long run. The period of time in which one might experience such symptoms is mostly during a transition period, when an antidepressant dose is being changed. Experiencing such side effects varies on a case-by-case basis and should not stop anyone from seeking help. Psychiatrists can change the drug or dosage accordingly, and over time, the patient can get better.
Dealing with a Changed Dosage
Regardless, it can be an incredibly trying time. If you know someone who is changing the dose of their medication, look out for signs of agitation or nervousness. Such times can alter perception of the world to a point where everything is distorted, and they may not see things right. They might feel like they are going crazy and, hence, panic. Be there for them as much as you can, and make sure that they do not feel alone. Things are already in a haze for them, and the last thing they need is for someone to make them feel bad about their situation. Needing medication is not their fault, and no one should be shamed for going through such circumstances. All they need is compassion. The pain will come to an end, but until then, they need your care and support to cope with it all.