Can antidepressants cause depression?

  • Yes, but there is no guarantee that they will in any particular instance.

    All antidepressants have the potential to cause new or worsening depression and suicidality, regardless of someone’s age, gender, or reason for using antidepressants. Antidepressant pharmaceuticals also have very common (as well as less common) physical and neuropsychological side effects which can be mistaken as “symptoms of depression”, like insomnia, dysphoria, amotivation, loss of interest, flattened emotions, lethargy, cognitive problems, nightmares, violent thoughts or inclinations, lack of sexual interest or functioning, etc. These effects are more particular to individuals than to specific drugs and doses, so aside from rough estimates of how often certain drug effects occur on average, it is fairly unpredictable what might happen.

    Additionally, trying to reduce or quit an antidepressant can lead to drug effects that were not previously present, oftentimes as part of a withdrawal syndrome. Neuropsychological side effects (such as anxiety, mood swings, irritability, or depression), are the generally most common withdrawal symptoms after nausea. Withdrawal symptoms can last days, weeks, months, years, or longer, depending on the person and situation. Changing doses up or down can prompt new or intensifying drug effects, and these effects may last indefinitely or gradually diminish as someone adjusts to their present dose (or being off a drug completely).

    Antidepressants are far more likely to cause or worsen depression and ‘signs’ of depression than they are to lead to someone recovering from depression, which is why proper screening and responsible prescribing and monitoring are absolutely essential to reducing preventable patient harms and deaths. But at this point, antidepressants are probably more often used for non-depressive concerns, whether psychological difficulties like chronic anxiety or physical health conditions like neuropathic pain, migraines, irritable bowel, and so forth. They are even used in pets, zoo animals, and other fuzzy or not-so-fuzzy creatures.

    The reason for someone being prescribed antidepressants is does not determine or limit what side effects someone may experience. Depression and related side effects of antidepressants can happen to people regardless of why they are taking drugs, and also occur when completely healthy people take antidepressants, such as they have in clinical trials. Encountering neuropsychological drug effects does not imply that someone has a secret and heretofore completely invisible pre-existing psychological problem, and all situations of use are likely to involve one or more neuropsychological problems, whether during use, discontinuation, or both.

    All that said, there has been the suggestion that drugging either fails to offset recurring episodes of depression, on average, or is a factor which actually increases the average rate or intensity of depressive episodes. Though this largely applies only to persons taking it to help with depression, it is a special, longer term risk that often goes unmentioned. Many people experience a lifetime with additional or worse depression as a result of using or having used antidepressants, however this is not a guaranteed outcome and most people only have one or two instances of depression ever (whether or not they took any drugs, or sought therapy at all, for that matter).

    In summary:

    • Antidepressant use increases the net occurrence of depression, suicidality, and many difficulties commonly associated with depression
    • Antidepressant use may lead to worse average longer term outcomes in persons who are using drugs to help with a pre-existing depression
    • Antidepressants are usually inadequately effective or entirely ineffective in helping someone with depression, making these kinds of ‘side effects’ even more relevant
    • Individual responses vary, so statistical trends should not be confused for determinations of what individual patients will experience

    Some basic drug information can be accessed in these psychiatrist-written guides linked below. In any case, discussing concerns with a high quality professional consultant cannot be replaced by online reading or hearing from people that are not acquainted with your own personal history and set of difficulties.

    Trusting a prescriber should not be what makes the difference between using or not using antidepressants, though, so staying informed may yet require gathering more information than a professional will be offering you. We are all the custodians of our own health, and should seek additional resources when necessary.

    Antidepressants: A Guide to Depression Medication

    Side Effects of Antidepressants

    Stopping Antidepressants

    This post was modified from a previous answer located here: Mark Dunn’s answer to Can antidepressants cause depression?

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