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Types of Antidepressants: A Guide for Therapists to Understand Medications Clients May Be Taking

Stanley Efrem

Mar 11, 2025

Major Depressive Disorder affects between 2% to 21% of people worldwide. Antidepressants have become one of the most prescribed medications in mental health treatment. The right medication helps 70% to 80% of people achieve substantial symptom reduction.

A therapist's ability to understand their client's antidepressant medications is a vital part of providing detailed care. Different classes of antidepressants, from Selective Serotonin Reuptake Inhibitors (SSRIs) to dual-acting medications like SNRIs, come with unique benefits that need careful consideration. SSRIs remain the most common first-line treatment option. Other antidepressants might work better in specific cases and typically take 1-2 weeks to show their original benefits.

This piece helps you grasp the various types of antidepressants, how they work, their common side effects, and ways to support your clients through their medication experience.

Understanding Different Types of Antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs) dominate the antidepressant market. They make up 63.71% of all prescriptions [1]. Sertraline stands out as the leader in this category with 24.65% of SSRI prescriptions [1].

Major classes of antidepressants

Modern psychiatric treatment relies on five main types of antidepressants:

Selective Serotonin Reuptake Inhibitors (SSRIs): Doctors choose these as their first option because they're safer and patients tolerate them better than other antidepressants [1].
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): These drugs work well for patients who don't respond to SSRIs and help treat both depression and anxiety symptoms [2].
Tricyclic Antidepressants (TCAs): These powerful medications work best for severe melancholic depression. Doctors prescribe them less now due to safety concerns [2].
Monoamine Oxidase Inhibitors (MAOIs): These oldest antidepressants still work well but need strict dietary restrictions [3].
Atypical Antidepressants: These drugs use unique approaches. Bupropion regulates dopamine while mirtazapine triggers norepinephrine release [4].

How each type works in the brain

Different antidepressants use unique methods to control mood-affecting neurotransmitters. SSRIs target only serotonin reuptake and cause fewer dangerous side effects [1]. SNRIs block both serotonin and norepinephrine reuptake, though their impact on norepinephrine varies with clinical doses [2].

TCAs block serotonin and norepinephrine reuptake while affecting acetylcholine receptors [5]. MAOIs stop several neurotransmitters from breaking down, including serotonin, norepinephrine, and dopamine [3].

Typical prescribing patterns

Prescribing practices have changed a lot recently. Psychiatrists write about half of all antidepressant prescriptions (49%), with general practitioners and other doctors handling the rest [1]. Patient demographics play a big role too. Women are more likely to receive TCAs (OR: 1.17) and SNRIs (OR: 1.18) [1].

Age affects medication choice significantly. Patients between 40-64 years old get SSRIs more often (OR: 1.12) [1]. Specific conditions drive doctors' choices. They prescribe trazodone for sleep problems, amitriptyline for headaches, and bupropion to help quit smoking [1].

Doctors usually start with a single medication, typically SSRIs or SNRIs for mild to moderate depression [1]. They only try combination therapy after the first treatment doesn't work well enough [1]. The landscape keeps changing as SNRIs and newer antidepressants become more popular, especially among younger patients [1].

Common Side Effects Therapists Should Know

Antidepressants can affect your clients both physically and emotionally. You can support them better during their treatment by understanding these effects.

Physical side effects

Studies show that more than 80% of patients experience at least four different adverse reactions [6]. Stomach problems are common at the start - about 25% of patients feel nauseous when they begin treatment [6]. Around 15% of patients also get diarrhea [6].

Sleep problems create another big challenge. Your clients might feel drowsy in the first few weeks of treatment, while others can't sleep well. Sexual dysfunction remains one of the most common side effects and affects up to 80% of patients [6]. Patients often report lower sex drive, orgasm difficulties, and erectile problems.

Weight changes worry many clients because antidepressants can change their body mass over time. About 20% of patients deal with excessive sweating [6]. Older patients, especially those over 80, face higher risks of stomach bleeding [7].

Emotional and cognitive changes

Antidepressants don't just cause physical changes - they also affect how people process emotions and think. About 46% of users experience emotional blunting [8]. Patients in this state often:

Feel emotionally numb or detached
Can't laugh or cry easily
Show less empathy and motivation
Don't feel pleasure or sadness as much

Research shows that antidepressants change how people process emotional information before their mood gets better [9]. These medications can boost divided attention, executive function, and processing speed in people with depression [10].

Cognitive problems affect 85-94% of depression cases [11]. Patients struggle with executive functioning, learning, and memory. Some cognitive issues might stick around even after depression symptoms improve, which can affect their daily life and work [12].

Recognizing Treatment Progress

Patients and healthcare providers must monitor antidepressant effectiveness by watching early indicators and warning signs. Research shows that 40-60% of individuals notice symptom improvements within 6-8 weeks of starting SSRIs or SNRIs [13].

Early signs of improvement

Positive changes usually emerge within 1-2 weeks after starting medication [13]. Sleep patterns, appetite, energy levels, and concentration show improvement before mood changes become noticeable [5]. Studies indicate that early improvement within the first two weeks predicts better outcomes [14].

Some patients achieve response or remission after 4-12 weeks of treatment without early progress - about 20-30% [14]. Patience throughout the adjustment period makes a difference. Pharmacogenomic-guided treatment shows a 31% reduction in symptom severity after eight weeks, compared to 26.8% with standard treatment approaches [15].

Warning signs to watch for

Daily monitoring becomes vital during medication changes or dosage adjustments [16]. Watch for these warning signals:

Increasing agitation or restlessness
New or worsening anxiety
Rising irritability
Extreme changes in energy or activity
Trouble sleeping or worsening insomnia
Social withdrawal
Sudden mood shifts [16]

When to refer back to prescriber

Some situations need immediate consultation with the prescribing physician. Reach out if your client:

Shows no improvement after 4-6 weeks of consistent medication use [17]
Experiences severe or persistent side effects [5]
Shows limited progress despite multiple psychotherapy attempts [2]
Reports previous success with different medication [2]
Exhibits severe depression with suicidal thoughts [2]

Starting new antidepressants requires regular follow-up appointments within two weeks [17]. Weekly reviews should happen for clients aged 18-25 or those at suicide risk. Check-ins must occur no later than four weeks after starting [17]. Treatment might continue for six months or longer after symptom remission, based on relapse risk [17].

Supporting Clients Through Medication Journey

Research shows that about 26% of adults get psychiatric drug prescriptions each year [18]. Mental health professionals need to know how to support clients through their medication experience, since more than 80% of therapists work with clients who take prescribed psychiatric drugs [18].

Starting medication conversations

A strong therapeutic alliance forms the foundation of medication discussions. Instead of giving direct medication advice, therapists should help clients make informed choices. More than 85% of therapists get questions about how psychiatric drugs affect therapy [18].

Metaphors work well to explain combined treatment approaches. You might describe depression as a river with psychological, biochemical, and environmental tributaries. Medication takes care of the biochemical parts while therapy handles the psychological aspects.

Addressing medication concerns

About 92% of therapists say their clients talk about stopping their medications [18]. Instead of direct advice, therapists should point clients to appropriate resources and services. Clients worry most about:

Not knowing enough about their prescribed medications
Wrong ideas about drug effects
Worries about side effects
How long they'll need treatment

Studies show that therapy and medication together create better results [1]. Therapy helps clients learn ways to handle side effects and gives them emotional support as they adjust to medications [1].

Integrating medication with therapy

Medication and therapy create a powerful combination. Research shows that adding therapy to antidepressant treatment makes patients less likely to stop taking their medications [19]. The therapeutic relationship also makes antidepressants work better [19].

The best ways to combine treatments include:

Setting clear professional limits while supporting medication use
Helping clients understand and question their treatment
Working with other healthcare providers to coordinate care [18]
Looking at psychological factors that might affect how well patients take their medications

Patients who get both treatments show better emotional control and coping abilities [1]. Therapy helps with psychological issues that medications alone can't fully address [1].

Conclusion

Therapists need to know how antidepressants work to help their medicated clients better. SSRIs top the prescription list, and each type of antidepressant brings its own set of benefits to match specific patient needs.

Good treatment depends on watching both physical and emotional side effects closely. Patients need to track their progress too. Most people start feeling better within 6-8 weeks. Some might notice positive changes as early as two weeks into their treatment.

Open talks between therapists and clients about their medication experiences build stronger therapeutic relationships. Studies keep showing that mixing medication with therapy leads to better results. This mix tackles both the body's chemistry and the mind's emotional state.

Therapists do much more than just counsel. They help patients stick to their medications, handle their worries, and work with doctors when needed. This detailed knowledge helps create better treatment plans and supports clients throughout their mental health trip.

FAQs

What are the main types of antidepressants?

There are five primary classes of antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs), Monoamine Oxidase Inhibitors (MAOIs), and Atypical Antidepressants. Each class works differently in the brain to regulate mood-affecting neurotransmitters.

How long does it typically take for antidepressants to show effects?

Most people notice initial improvements within 1-2 weeks of starting antidepressants. However, significant symptom reduction usually occurs within 6-8 weeks for 40-60% of individuals taking SSRIs or SNRIs. It's important to maintain patience during the adjustment period, as some patients may still achieve response or remission after 4-12 weeks of treatment.

Can therapists prescribe antidepressants?

No, therapists cannot prescribe antidepressants. Only medical professionals with prescribing authority, such as psychiatrists, primary care physicians, psychiatric nurses, or physician assistants, can legally prescribe antidepressant medications. Therapists, counselors, and social workers are not authorized to write prescriptions.

What are common side effects of antidepressants?

Common side effects of antidepressants include gastrointestinal issues like nausea and diarrhea, sleep disturbances, sexual dysfunction, and weight changes. Emotional side effects such as feeling emotionally numb or experiencing reduced empathy may also occur. It's important to note that side effects can vary between individuals and different types of antidepressants.

How does combining therapy with antidepressants affect treatment outcomes?

Combining therapy with antidepressant medication often leads to better treatment outcomes. Therapy can help patients develop coping strategies for managing side effects, provide emotional support during medication adjustment, and address psychological factors that medication alone cannot fully manage. This combined approach has been shown to decrease medication discontinuation rates and enhance emotional regulation and coping skills.