Will antidepressants work if you aren't depressed?

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.

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.

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.)

Probably as well as a sugar pill, 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.

And there are other classes of drugs used as antidepressant therapy outside of SSRIs.

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.

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.)

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.

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.

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.

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?

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.

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.