Medications/Prescription Trends

The use of antidepressant medications has demonstrated success in working to calm neurotransmitters (brain chemicals such as norepinephrine and serotonin), while other antidepressant medications focus on dopamine, which is responsible for controlling mood instabilities. Combined treatment of psychotherapy and medication is the usual and preferred treatment of choice for depression.¹¹⁵

Depression affects millions of individuals globally, with the World Health Organization ranking it as a leading cause of disability worldwide.¹¹⁶ While antidepressants have been shown to be helpful, there is some concern they are being overused. In a US population-based survey study held between 2005 and 2014, the estimated overall prevalence of US adults using medications with depression as a potential adverse effect was 37.2%.¹¹⁷ Use of multiple medications was associated with greater likelihood of concurrent depression.¹¹⁷

Antidepressant use has increased in recent years, both in the United States and internationally. Across multiple authoritative sources, the trend is clear: more adults are using antidepressant medications now than they were even a few years ago. Antidepressant use rose from 9.8% in 2019 to 11.4% in 2023 among U.S. adults.¹¹⁸ Approximately 21 million adults experienced at least one major depressive episode in 2021, representing 8.3% of all adults, with higher rates in females (10.3%), young adults aged 18-25 (18.6%), and multiracial individuals (13.9%). Males had a lower prevalence of 6.2%. From 2019 to 2023, there was a steady increase in the overall use of antidepressant medications among the population. This steady increasing trend implies an growing reliance on, or improved access to, mental health care and antidepressant prescriptions during this period.¹¹⁸

Sex-based analysis discovered a substantial discrepancy in antidepressant usage, with women consistently exhibiting higher rates than men. Antidepressant usage showed age-related differences, with incidence commonly increasing with age, particularly up to the 65-74 years’ category.¹¹⁸

According to the National Institute of Mental Health, the most popular antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. Other widely prescribed antidepressants are serotonin and norepinephrine reuptake inhibitors, or SNRIs. Bupropion, a third type of antidepressant, is also used to treat seasonal affective disorder (and to help with smoking cessation).¹²⁰

To fully understand how antidepressants work and the specific classifications of each is significant when trying to avoid side effects, negative interactions from other prescriptions, over-the-counter medications, herbal nutriceuticals, and nicotine replacements. The awareness of coexisting medical conditions, recognition of clinical signs and symptoms, and a history of any depressive disorders and/or treatments aide in determining the best antidepressant based on the individual’s disorder.¹¹³

St. John's wort may help with mild to moderate depression but is not consistently effective for severe depression and can interact with many medications. St. John's wort (Hypericum perforatum) is an herbal supplement used for centuries to treat mood disorders. Research indicates it may be beneficial for mild to moderate depression, with some studies showing effects comparable to standard antidepressants and fewer side effects.¹²¹ However, for moderately severe or severe depression, large studies have found it no more effective than a placebo. The effectiveness can also vary depending on the formulation and country of study, with German studies often reporting more positive outcomes than U.S. studies.¹²¹

There are numerous classifications of antidepressant medications with the latest and most commonly used antidepressants falling into two classifications: selective serotonin reuptake inhibitors (SSRI) and serotonin and norephinephrine reuptake inhibitors (SNRI).¹²⁰ SSRIs include: fluoxetine (Prozac); citalopram (Celexa); sertraline (Zoloft); paroxetine (Paxil); and escitalopram (Lexapro). Examples of SNRIs are venlafaxine (Effexor) and duloxetine (Cymbalta).¹²⁰

Fewer side effects have been reported from SSRIs and SNRIs than tricyclics and tetracyclics, older classifications of antidepressants such as (Elavil) and (Pamelor) and monoamine oxidase inhibitors (MAOI) such as (Nardil) and (Marphan). Not all medications will prove effective and some may produce intolerable side effects; consequently, physicians will alter between categories of antidepressants, or prescribe antipsychotic medications that potentially improve the efficacy of the antidepressant.¹²⁰

Those taking MAOIs require a thorough understanding of the medication’s ability to interact negatively with certain foods; particularly the chemical tyramine, found in wines, pickles and many cheeses, and over-the-counter (OTC) medications such as decongestants.¹²² For example, Wellbutrin, a commonly prescribed antidepressant used to treat SAD symptoms, should not be taken while using Zyban or other nicotine replacement alternatives intended for use in smoking cessation protocols. Wellbutrin is not advised for those with eating disorders or in combination with a MAOI;¹²³ negative interactions can increase blood pressure and potential stroke conditions can develop.¹²⁴

It is vitally important that all health care professionals understand the potentially fatal interactions between antidepressants and prescription medications. Since 2003, the Food and Drug Administration (FDA) has warned that antidepressants may be associated with suicidal thoughts and behaviors among youth.¹²⁵ An FDA advisory in 2003 and a black-box warning in 2005 focused on children and adolescents younger than age eighteen. The FDA expanded the black-box warning in 2007 to include young adults. Both warnings were intended to increase physician monitoring of suicidal thoughts and behaviors. After the FDA warnings, multiple studies reported substantial reductions in physician visits for depression and depression diagnoses, reductions in antidepressant treatment and use, and increases in psychotropic drug poisonings and suicide deaths among pediatric patients. These results provide evidence of substantial, immediate changes in unintended outcomes after the FDA warnings across different pediatric subpopulations and data sources.¹²⁶ The outcomes of a 2024 systematic review suggest a reduction in access to care among pediatric patients and fewer opportunities for suicide prevention.¹²⁶