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How Do Antidepressants Affect the Brain?
Laurence Lippsett
Medically reviewed on 9/21/2020 by
Dr. Geoffrey Grammer
Chief Medical Officier
If you're struggling with major depressive disorder, obsessive compulsive disorder, or another mental health condition, you've probably thought about using antidepressants. It's not uncommon for people considering, or even currently taking, antidepressants to ask questions like, "What do antidepressants do to the brain?" and "Do antidepressants permanently alter brain chemistry?" Knowing how antidepressants work with your brain chemistry can help you better understand how these medications may help you.
Many people have found relief from their symptoms by taking antidepressants. Scientists think antidepressants enhance the brain's ability to transmit signals that regulate moods. However, scientists still don't know precisely how the medications work. One theory is that people with depression have low levels of chemicals called neurotransmitters. Antidepressants may correct these chemical imbalances. Or, they may improve brain signaling by promoting the growth of new cells and connections in the brain.
How Does the Brain Transmit Signals?
Human brains are made up of approximately 100 billion cells. Between each cell are gaps called synapses. To transmit signals across synapses, brain cells secrete neurotransmitters. Neurotransmitters ferry across the synapses and are absorbed by neighboring brain cells. That stimulates these brain cells to secrete neurotransmitters of their own, which, in turn, activates their neighbors. In this way, messages are relayed through the vast network of brain cells. But brain cells also need to shut off signals. They have two ways of doing that: they can reabsorb excess neurotransmitters floating in the synapses, or they can break down and get rid of excess neurotransmitters. There are several kinds of neurotransmitters, including serotonin, dopamine, and norepinephrine. To work as efficiently as possible, different types of antidepressants have been developed to act on different neurotransmitters.
How Do Antidepressants Affect the Brain?
Many antidepressants are so-called "reuptake inhibitors." Ordinarily, brain cells make molecules that bind up excess neurotransmitters in synapses and recycle them. The neurotransmitters fit perfectly into these molecules, like keys into locks. Uptake inhibitors slip into molecules first, blocking neurotransmitters from getting in. As a result, more neurotransmitters remain in the synapses and increase the chances of stimulating neighboring cells. As their names suggest, selective serotonin reuptake inhibitors (SSRIs) block the reuptake (breakdown) of serotonin in the brain. Serotonin and norepinephrine reuptake inhibitors (SNRIs) block the reuptake of both neurotransmitters. NDRIs are norepinephrine and dopamine reuptake inhibitors. Tricyclics and tetracyclics (TCAs) work similarly, but they are used less frequently because they have more potential side effects.
Other types of antidepressants work differently. Serotonin antagonist and reuptake inhibitors (SARIs) not only block the reuptake of serotonin, but they also help prevent serotonin from binding at certain sites, leaving more to act as messengers between neighboring brain cells. Monoamine oxidase inhibitors (MAOIs) maintain higher levels of neurotransmitters by inhibiting an enzyme that breaks them down.That said, emerging studies suggest that antidepressants may improve brain signaling by stimulating new growth of brain cells and expanded brain cell networks. Like cities and the roads connecting them, parts of the brain and networks linking them are continually evolving. Over time, they deteriorate and get repaired, re-routed, or expanded. This continual rebuilding and rewiring of the brain is a natural process called neuroplasticity. Antidepressants may aid this process.
Do Antidepressants Permanently Alter Brain Chemistry?
Antidepressants are designed to alter brain chemistry to alleviate symptoms—thus, they do so while you are taking them. They may promote potentially beneficial structural brain changes, as well. As impressive as it may be, the brain's neuroplasticity isn't always positive. It's important to realize that depression itself has been shown to alter brain chemistry and cause structural brain changes. Antidepressants are intended to improve your brain chemistry and help reverse those structural changes. Doctors caution that it can take many weeks or months before patients begin to feel better and see improvements from taking antidepressants. The experience varies from person to person. Many individuals try different kinds of antidepressants to find what works well for them and what doesn't produce unpleasant side effects, such as dizziness, nausea, sexual dysfunction, or fatigue. For one in three people, antidepressants don't provide any relief.
As with all medications, you should explore the benefits and risks of using antidepressants in consultation with your doctor. And remember that other non-medication options exist that may relieve your symptoms. One such treatment is called transcranial magnetic stimulation (TMS). It is a noninvasive, non-drug treatment that uses magnetic pulses to stimulate nerve cells to improve the brain signaling that helps regulate moods. All in all, antidepressants have helped many people live more fulfilling lives. But if they don't provide relief for you, or if their side effects prove too detrimental, talk with your doctor to see if TMS therapy might be right for you.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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