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Treating Co-occurring Disorders with Antidepressant Medications

Depression, also known by the diagnostic term major depressive disorder (MDD), is a common mental health condition that negatively impacts the way people think, feel, and behave.1 Depression typically causes feelings of sadness and a lack of interest in activities that a person once enjoyed.1

As many as 1 in 15 people in the U.S. are affected by depression in any given year, and as many as 1 in 6 Americans will experience depression at some point during their lives.1

Depression and other mental health disorders are also common in people with addiction, also known as substance use disorders (SUDs).2 Multiple national studies show that approximately half of the people who experience mental health disorders will also experience a substance use disorder.2 Depression and addiction are both treatable conditions, often with the help of FDA-approved antidepressant medications.3

This page will provide information about the different types of antidepressant medications, how they work, potential side effects, and how to get help if you or someone you know is suffering from depression and addiction.

What Are Antidepressants?

Antidepressants are medications designed to alleviate symptoms of depression.3, 4 Symptoms may include changes in appetite or sleep patterns, lack of interest in activities, persistent sadness, feelings of worthlessness, difficulty concentrating, or thoughts of death and suicide.1 Some antidepressants help to alleviate feelings of anxiety and restlessness as well.4

There are many different types of antidepressants, and what works for one person may not work for everyone. If an antidepressant has been prescribed and isn’t working, you may need to work with your doctor to find one that works for you.4, 17

Antidepressant medications don’t always work immediately. Some people may feel the relief from symptoms of depression in 1 to 2 weeks, but it often takes 6 to 8 weeks to feel the full effects of prescription antidepressants.4

Generally, the more severe someone’s depression is, the greater the benefits of antidepressants. This can make an enormous impact on a person’s life by alleviating symptoms of depression, which are interfering with their day-to-day lives.4

Between 2015 and 2018, it was reported that more than 13% of adult Americans used prescription antidepressants, with use being twice as high in women than men.5

How Do Antidepressants Work?

Antidepressants work by targeting the way your brain uses chemicals that affect emotions, such as serotonin, dopamine, and norepinephrine.4, 7, 16 Different antidepressants have different mechanisms of action since they target different neurotransmitters in the brain.4, 7

Medication can be an important part of treatment for depression and anxiety disorders, especially when combined with behavioral therapy.17

Types of Antidepressant Medications

There are several different types of antidepressants available to help treat depression, which include:

  • Selective serotonin reuptake inhibitors (SSRIs): These medications work by inhibiting the reuptake of serotonin, thereby increasing serotonin activity in the brain.8 SSRIs have little effect on other neurotransmitters besides serotonin.8 Common SSRIs include Zoloft, Paxil, Lexapro, Prozac, and Celexa.3
  • Selective serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs inhibit the reuptake of both serotonin and norepinephrine.9 Common SNRIs include Effexor and Cymbalta.3
  • Tricyclic antidepressants (TCAs): These medications were some of the first antidepressants, and TCAs act on approximately 5 different neurotransmitter pathways to achieve their desired effect.10 They have been proven as effective as SSRIs. However, they carry more severe side effects.10 Some commonly prescribed TCAs include Elavil, Vivactil, Norpramin, and Asendin.3
  • Monoamine oxidase inhibitors (MAOIs): These medications are in a separate class from other antidepressants. They not only treat various forms of depression but also other nervous system disorders such as social phobias, depression with atypical features, and panic disorders.11 Like TCAs, MAOIs were some of the first antidepressants introduced but can also have serious side effects and are typically only prescribed when other antidepressants have failed to be effective.11 Common MAOIs include Emsam, Marplan, Nardil, and Parnate.3
  • Aminoketone: Aminoketone antidepressants are chemically unrelated to tricyclic, SSRI, or other known antidepressant agents and inhibit the reuptake of norepinephrine and dopamine.12 Wellbutrin is a commonly prescribed aminoketone antidepressant.

How Do I Know Which Antidepressant Is Right for Me?

The most important step in finding the right antidepressant is to have a full evaluation by a medical professional for a proper diagnosis. A biopsychosocial and lifestyle assessment will explore all aspects of a person’s life.13

Doctors and clinicians should assess factors such as additional, co-occurring physical or mental health conditions, lifestyle factors including substance use, employment, legal issues, interpersonal relationships, and home environment.13 After that, you can discuss with your doctor if the medication is right for you. Ideally, psychological treatment should be offered first, before medication.13

Indications for drug therapy may include:13

  • Major depression, characterized by specific symptoms and functional impairment.
  • Melancholia, characterized by significant psycho-motor symptoms, that can include extreme agitation or a decrease in mental and physical activities.
  • Psychotic depression, characterized by hallucinations or delusions.

It’s important to remember that even when medication is prescribed, counseling or therapy are also strongly recommended.13

Anyone taking medication for a mental health or substance use disorder should be a proactive participant in their treatment process. Adherence to antidepressants is essential, not only to manage one’s condition but also because there can be dangerous side effects when a medication is stopped abruptly or taken inconsistently.13

Risks and Side Effects of Antidepressants

Like any medication, antidepressants come with potential risks and side effects to be aware of.4 In fact, over 50% of people who take antidepressants report some side effects that typically occur in the first few weeks after someone begins taking them and are less common over time.4

Side effects may include:4, 17

  • Dry mouth.
  • Headaches.
  • Dizziness.
  • Restlessness.
  • Sexual problems.

These effects may be caused by depression itself but are often associated with antidepressant medications. Side effects may vary depending on the type of medication, the dosage, or any interactions between the antidepressant and other medications a person may be taking.4

A small percentage of people taking these medications may experience heart problems, epileptic episodes, or heart damage as a result.4 Some studies show that teenagers taking antidepressants are more likely to have thoughts of suicide when taking SSRIs or SNRIs.4

Medications are powerful agents that should not be taken without proper consideration and oversight by a physician and/or therapist.4

Get Help for Depression and Addiction

Over 7 million adults in the U.S. have co-occurring substance use and mental health disorders.15 The prevalence of depression and addiction is an issue that must be addressed. Treatment can be extremely beneficial, yet more than 50% of people diagnosed with co-occurring disorders do not receive treatment for either condition.15

About 34% of people with co-occurring disorders receive treatment for mental health issues alone and less than 4% receive treatment exclusively for substance use disorders.15 Unfortunately only about 9% of people receive treatment for both conditions.15

Addressing co-occurring mental health and substance use disorders simultaneously may produce more successful outcomes for those who enter addiction treatment.6

Common treatment interventions for adults with depression and addiction often include:

  • Behavioral therapy like cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT), which focuses on recognizing the relationship between thoughts, feelings, and behaviors.6, 14
  • Inpatient treatment, in which a person lives at a facility during the duration of treatment. Interventions may include therapy, antidepressant medication or other treatment medications, clinical care, and special amenities.
  • Outpatient treatment, in which a person visits a treatment facility on a regular schedule to receive care and support for their co-occurring disorders.

If you are considering treatment for co-occurring disorders, American Addiction Centers specializes in treating both substance use and mental health disorders. We have facilities across the U.S. with caring clinicians and staff who are ready to help you start on a new path. Call us free today at to learn more about treatment options and check your insurance to see if you’re covered at our facilities.

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