# Will antidepressants work if you aren't depressed? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [January 26, 2014, 3:18am UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724 "2014-01-26T03:18:44Z")\ **Posts on this page:** 16\ **Page:** 2
**Author:** ![JayRx1981](https://avatars.discourse-cdn.com/v4/letter/j/71e660/32.png) [@JayRx1981](https://boards.straightdope.com/u/JayRx1981)\ **Post date:** [January 27, 2014, 9:39am UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/21 "2014-01-27T09:39:28Z")
> [@Fuzzy\_Dunlop](#): > > I still take Wellbutrin even though I haven’t been depressed for years, because I like how it makes me feel. My life is pretty amazing but when I tried dropping the anti-depressant, I found it harder to appreciate how great I have it. I was still happy and satisfied with my life, and if that was my baseline I’d never consider seeing a doctor about it. But when I take Wellbutrin I walk around all day elated, feeling grateful for all the good in my life. > > In short, it’s a noticeable effect for me, even though I’m not depressed with or without it. Bupropion (the active ingredient in Wellbutrin) is a substituted cathinone and substituted amphetamine (chemical name is 3-chloro-N-tert-butyl-Beta-ketoamphetamine, iirc), and as such has a chance of causing euphoria as one of it’s effects. As far as amphetamines go, it’s a fairly weak one, but that and it’s potential entactogenic effects could account for your reaction. ---
**Author:** ![JayRx1981](https://avatars.discourse-cdn.com/v4/letter/j/71e660/32.png) [@JayRx1981](https://boards.straightdope.com/u/JayRx1981)\ **Post date:** [January 27, 2014, 10:12am UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/22 "2014-01-27T10:12:38Z")
> [@WhyNot](#): > > No, that’s actually a pretty common way to do it. Is it the best way to do it? I don’t know. I’d be more comfortable if we had a sure fire method of diagnosis, not just of Clinical Depression, but of the precise neurotransmitter lacking or excess, but we don’t. And so the majority of the time when a primary care provider is faced with a patient who appears to be suffering from depression, they pick an SSRI and try it. And if it doesn’t work, they try another, or another category. It is essentially “diagnosing” through trying the medication and seeing if it works. Some prescribers also try to take the patient’s specific symptomatology into account when making an initial selection. A patient experiencing insomnia as well as depression, may benefit from a tricyclic antidepressant, for example, or a patient who presents with fatigue/daytime sleepiness may benefit from bupropion, or a patient with comorbid anxiety might get put on an SSRI. The default, in my experience, isn’t usually a completely random choice on the part of the prescriber, although I’ve run across some who certainly give that impression. As to neurotransmitters and deficiency, we were taught that while we call the drugs SSRIs, or SNRIs, the reality isn’t necessarily that the brain is deficient in synaptic neurotransmitters, but that the initial increase in synaptic transmission, over a period of weeks, results in alterations in the signaling pathways, both proximally (usually down-regulation of serotonin and/or norepinephrine receptor subtypes), and distally. We were told the distal mechanism was unknown, although I’ve since come across a couple of studies indicating that SSRIs, for example, seem to increase the concentration of certain neuroactive steroids (allopregnanolone and tetrahydrodeoxycorticosterone), which are usually, but not always, found to have positive effects on mood/anxiety. ---
**Author:** ![choie](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/choie/32/7829_2.png) [@choie](https://boards.straightdope.com/u/choie)\ **Post date:** [January 27, 2014, 10:17am UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/23 "2014-01-27T10:17:46Z")
> [@WhyNot](#): > > No, not necessarily true. For a single episode of Depression, it’s suggested that drug therapy be continued for six months to a year after the symptoms have gone away. For a second episode, at least a full year. Only if you’ve had Depressive episodes more often that that or have a very strong family history, then they do suggest you remain on them indefinitely. [How Long Should You Take Antidepressants?](http://www.webmd.com/depression/features/antidepressants?page=3) That’s what I meant by clinical depression, though I should have specified chronic, the long-lasting kind, as opposed to shorter episodes. The latter are more typically due to some event or series of events (something(s) one can eventually point to, like: “I started feeling unlike myself when I left my job and went to another one, which turned out to be a mistake; I lost my confidence, and then I lost that job, and everything seemed to spiral downwards after that…” etc.). But that’s not always the case; some vitamin deficiencies can actually spur depression and anxiety, such as B12 and I believe D as well. If you’ve been depressed since adolescence or childhood, without some instigating event – and especially, as **WhyNot** says, if there’s a family history of depression – then lucky you, you’ve been blessed by the depression fairy, and that’s a gift that isn’t gonna go away from a few months of medicine or years of talk therapy. That’s chronic and it’s your pal for life. (Sadly that’s the one I’ve got.) ---
**Author:** ![Sleel](https://avatars.discourse-cdn.com/v4/letter/s/73ab20/32.png) [@Sleel](https://boards.straightdope.com/u/Sleel)\ **Post date:** [January 27, 2014, 1:18pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/24 "2014-01-27T13:18:36Z")
Probably as well as a [sugar pill](http://www.salon.com/2013/08/03/big_pharmas_placebo_problem/singleton/), which is not saying all that much since SSRIs are barely above a placebo in effectiveness. If you believe it helps, then it helps. If you don’t, then it doesn’t. ---
**Author:** ![MsWhatsit](https://avatars.discourse-cdn.com/v4/letter/m/eb8c5e/32.png) [@MsWhatsit](https://boards.straightdope.com/u/MsWhatsit)\ **Post date:** [January 27, 2014, 1:22pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/25 "2014-01-27T13:22:40Z")
> [@Sleel](#): > > Probably as well as a [sugar pill](http://www.salon.com/2013/08/03/big_pharmas_placebo_problem/singleton/), which is not saying all that much since SSRIs are barely above a placebo in effectiveness. If you believe it helps, then it helps. If you don’t, then it doesn’t. They are “barely above a placebo” for mild to moderate depression. For severe depression, they have a clinically significant effect. ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [January 27, 2014, 1:24pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/26 "2014-01-27T13:24:41Z")
And there are other classes of drugs used as antidepressant therapy outside of SSRIs. ---
**Author:** ![Sleel](https://avatars.discourse-cdn.com/v4/letter/s/73ab20/32.png) [@Sleel](https://boards.straightdope.com/u/Sleel)\ **Post date:** [January 27, 2014, 1:43pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/27 "2014-01-27T13:43:41Z")
But all of them — and to be fair other medications that actually produce measurable physical effects — leverage the placebo effect. There isn’t even a proven mechanism behind any of them, which is why finding an effective one for a particular patient is pretty much trial and error. If there was a valid theoretical framework, this guesswork wouldn’t be necessary. ---
**Author:** ![MsWhatsit](https://avatars.discourse-cdn.com/v4/letter/m/eb8c5e/32.png) [@MsWhatsit](https://boards.straightdope.com/u/MsWhatsit)\ **Post date:** [January 27, 2014, 2:05pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/28 "2014-01-27T14:05:40Z")
I have actually thought for a long time that they should market a sugar pill as the “side-effect-free antidepressant.” If it works, then awesome: the placebo effect is pretty strong, and if it can help someone with their depression, that’s great, particularly if you can avoid side effects. If it doesn’t work, you can escalate to actual medication. This would probably be really unethical, though, I suppose. (It bothers me a little bit when I see people dismiss the use of antidepressants because “pfft, they are no better than placebos,” because a) for severe depression they are better, and b) the placebo effect is no joke. If you experience significant relief from a problem that has been negatively affecting your life, that doesn’t mean your problems were fake, it means that the placebo effect is pretty freaking amazing.) ---
**Author:** ![Fuzzy\_Dunlop](https://avatars.discourse-cdn.com/v4/letter/f/848f3c/32.png) [@Fuzzy\_Dunlop](https://boards.straightdope.com/u/Fuzzy_Dunlop)\ **Post date:** [January 27, 2014, 2:13pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/29 "2014-01-27T14:13:06Z")
> [@choie](#): > > Sorry, just gonna go off-topic for a bit: > > Of course. Because antidepressants don’t _cure_ depression. I don’t know if your depression was situational or clinical. But if you have clinical depression, the right medication, if you can find it, will (hopefully) alleviate the symptoms–it’ll clear your head, things that seemed impossible will seem possible again, you’ll get to enjoy things you couldn’t before, etc. But if you stop taking them, once the meds are out of your system, you’re back where you started: the basic depression is still there. Just like someone who’s diabetic and is helped by, say, Metfornin, shouldn’t expect to go off the meds and suddenly not be a diabetic anymore. > > (This is more true for clinical depression; for situational depression–i.e., depression that’s a direct reaction to some trauma in your life–is a different story. Situational depression has an external cause, such as a major life change like a death, a stressful job situation, a break-up, etc. It’s very possible to work through this sort of depression with both meds and talk therapy and be ‘cured.’) > > So if you’re clinically depressed, when you say you haven’t been depressed for years, it’s likely because of the medication. Stopping the meds may bring you back to baseline (eventually). Don’t do it! > > Unfortunately, a lot of people w/depression will take meds, start feeling better, and decide they don’t need the meds anymore. So they stop taking them, and boom, they’re depressed again. The danger here is that going back on the same medication may _not_ have the same success as before. This happened to me with Prozac back in 19noneofyourbusiness. 😃 Went on it, felt better, went off it, felt worse, went back on it, not a damn thing happened. I’ve been searching for something that’d help me ever since, without much luck. > > To hurl myself somewhere in the realm of the OP. There are certainly many off-label uses for antidepressants. Wellbutrin (generic name: Bupropion) is known to be helpful in quitting smoking, for example (it’s marketed as such under the name Zyban). Nortriptyline (Pamelor), one of the older forms of antidepressants as mentioned above (and the one I’m on, though hopefully not for very much longer because it’s doing Jack shit for me), can be used to help insomniacs. Topiramate (Topomax) is used for bipolar disorder but also used off-label for weight loss. > > But a non-depressed person isn’t going to get “high” or filled with elation by taking Paxil or Pristiq or whatever. They’re not happy pills. Mind you, a benzo like Xanax or Klonopin or Valium or Ativan will certainly have an affect–Xanax can calm down a freakin’ horse. But those aren’t usually prescribed as antidepressants, they’re primarily anti-anxiety meds. > > I am not a doctor, just a nutcase with depression/anxiety. That’s a great point. When I was originally treated for depression it was entirely situational. My father had suffered a traumatic brain injury which exacerbated a preexisting neurological disorder. So I was overwhelmed with everything that goes along with that, including trying to find a suitable permanent home for him and a way to pay for it. On top of that, I knew that genetically I had a 50% chance of having the same neurological disorder he was, so seeing my own likely future in him every day was understandably depressing. But I had been taking care of him on a less intensive basis since I was 21, and knew since I was 16 about the genetic disorder. Both were stressful and had pretty dramatic negative impacts on my life, but I didn`t think I was depressed that entire time and I don’t think so now either. It wasn’t until his head injury made his condition so much worse that everything became too overwhelming and I sought help. Years later, my father has passed away, which was appropriately sad at the time but he had no chance of any improvement in his condition. I’m glad he’s not suffering more. The mutation that causes my family’s disorder was identified and I was tested and don’t have it. I’m even in a happy relationship with a step-son and can safely have children of my own, which seemed impossible. So my life has become better than I ever thought possible, but still when I tried going off the Wellbutrin I felt my mood impacted negatively. Is it that underneath all the legitimate situational factors, my brain chemistry is off too, and the anti-depressant helps that? Or is it like **JayRx1981** says and I’m inducing a mild amphetamine like euphoria? Frankly, my doctor and I don’t really care because I’ve never had any negative side effects. ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [January 27, 2014, 2:24pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/30 "2014-01-27T14:24:51Z")
> [@MsWhatsit](#): > > I have actually thought for a long time that they should market a sugar pill as the “side-effect-free antidepressant.” Sadly, placebos aren’t free of side effects, because you expect to have some; it’s called the nocebo effect. ---
**Author:** ![MsWhatsit](https://avatars.discourse-cdn.com/v4/letter/m/eb8c5e/32.png) [@MsWhatsit](https://boards.straightdope.com/u/MsWhatsit)\ **Post date:** [January 27, 2014, 2:25pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/31 "2014-01-27T14:25:45Z")
> [@Ferret\_Herder](#): > > Sadly, placebos aren’t free of side effects, because you expect to have some; it’s called the nocebo effect. I did not know that. That’s actually kind of impressive. Seriously, though, I bet that marketing it as “the antidepressant with no measurable side effects” would help a lot with this. ---
**Author:** ![Annie-Xmas](https://avatars.discourse-cdn.com/v4/letter/a/ecc23a/32.png) [@Annie-Xmas](https://boards.straightdope.com/u/Annie-Xmas)\ **Post date:** [January 27, 2014, 3:02pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/32 "2014-01-27T15:02:50Z")
If you get involuntarily committed to a psychiatric facility, you will be forced to take anti-depressants for three days. I would love to see how taking one of those things can help you in three days. Just one. Until then, I’m giving those stupid things a very bad rap. ---
**Author:** ![AHunter3](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ahunter3/32/368_2.png) [@AHunter3](https://boards.straightdope.com/u/AHunter3)\ **Post date:** [January 27, 2014, 4:35pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/33 "2014-01-27T16:35:46Z")
> [@Annie-Xmas](#): > > If you get involuntarily committed to a psychiatric facility, you will be forced to take anti-depressants for three days. I would love to see how taking one of those things can help you in three days. Just one. Until then, I’m giving those stupid things a very bad rap. Presumably only if they decide you’re “depressed”? As far as forcing the new involuntary committed to take psych meds of any time for three days, they would dearly love to do that as a matter of course everywhere, I’m sure, but in New York it’s illegal to make even the involuntarily committed take psych meds against our will until/unless there’s what’s called a _Rivers_ hearing, where it is determined that the psych patient lacks capacity to make that decision. I was sort of hoping that similar judicial decisions or laws has percolated through other states. ---
**Author:** ![Annie-Xmas](https://avatars.discourse-cdn.com/v4/letter/a/ecc23a/32.png) [@Annie-Xmas](https://boards.straightdope.com/u/Annie-Xmas)\ **Post date:** [January 27, 2014, 4:39pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/34 "2014-01-27T16:39:08Z")
Antidepressants are for chronic, long term depression. Even if you are currently depressed in their opinion, how do they determine if it’s long term and will be help with drugs? ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [January 27, 2014, 6:28pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/35 "2014-01-27T18:28:06Z")
Antidepressants work for _severe_ depression; for anything less than severe, they’re no better than water pills and any effects seen can be attributable to placebo effect. ---
**Author:** ![LibrarySpy](https://avatars.discourse-cdn.com/v4/letter/l/f9ae1b/32.png) [@LibrarySpy](https://boards.straightdope.com/u/LibrarySpy)\ **Post date:** [January 27, 2014, 8:09pm UTC](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724/36 "2014-01-27T20:09:47Z")
> [@Annie-Xmas](#): > > I would love to see how taking one of those things can help you in three days. Just one. Until then, I’m giving those stupid things a very bad rap. The drug you were given, citalopram, changed my life the FIRST TIME I took it. At the lowest dose, 25% of recommended strength. My brain did a complete 180. It altered me significantly. It stripped away utter, torturing dread and paranoia that I had been living with my whole life. I had been crying nearly every waking minute for months before I took it, and it turned that off like a light switch. I also took it by choice. I still think what happened to you was terrible, unorthodox, and frankly, utterly weird, and I wouldn’t want it to happen to anyone. [Previous page](https://boards.straightdope.com/t/will-antidepressants-work-if-you-arent-depressed/679724.md?page=1)