An antidepressant is a medicine that alleviates depressive symptoms by regulating the balance of the neurotransmitters serotonin, norepinephrine, and dopamine in the brain. Our brain consists of billions of nerve cells. These cells "talk" to each other via neurotransmitters. The most important ones regarding depression are:

• Serotonin: ensures composure, emotional balance, and good sleep.
• Norepinephrine: supports drive, concentration, and energy.
• Dopamine: helps with motivation and joy.

Between the cells lies a tiny contact point, the so-called synaptic cleft. One cell releases a neurotransmitter, and the next receives it. Excess neurotransmitters are reabsorbed or broken down. An antidepressant targets exactly this point and can—depending on the composition of its active ingredients—achieve one or more of the following effects:

It slows down the reuptake of serotonin, allowing it to act longer. This leads to more composure, balance, and better sleep.

• It slows down the reuptake of serotonin and norepinephrine, which leads to increased drive.
• It increases norepinephrine levels, which makes you more alert.
• It blocks certain receptors like a brake pedal, thereby exerting a calming and sleep-inducing effect.

In any case, patience is essential because the effect always builds up gradually. This usually takes between one to four weeks. As a rule, restlessness and brooding ease up first, followed by a lifting of the mood.

People are different, the causes of their depression are different, and accordingly, so are their symptoms. To accommodate these differences, there are several types of antidepressants available: some have a more activating effect to counter a lack of energy, while others have a more calming effect to combat restlessness and sleep problems. Your doctor will choose the appropriate option based on your specific symptoms, pre-existing medical conditions, and, if applicable, other medications you may be taking.

The following overview of the various types of antidepressants outlines the class of drug (or active ingredient group), its effects, prevalence, and common side effects. Example names of medications are also provided for each group.

Selective Serotonin Reuptake Inhibitors (SSRIs)

• How it works: Stabilizes mood, reduces anxiety.
• Prevalence: Very frequently prescribed (standard).
• Common side effects (Selection): Nausea, headaches, sleep and sexual problems, occasional internal restlessness.
• Example preparations: Citalopram, Escitalopram, Sertraline, Fluoxetine, Paroxetine.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• How it works: Promotes drive.
• Prevalence: Often.
• Common side effects (Selection): Nausea, sweating, increase in blood pressure, sleep problems.
• Example preparations: Venlafaxine, Duloxetine.

Norepinephrine Reuptake Inhibitors (NARIs)

• How it works: Makes you more alert.
• Prevalence: Less common.
• Common side effects (Selection): Restlessness, heart palpitations, sleep problems.
• Example preparations: Reboxetine.

Noradrenergic and Specific Serotonergic Antidepressants (NaSSAs)

• How it works: Calming, sleep-inducing, appetite-increasing.
• Prevalence: Frequently used for sleep problems.
• Common side effects (Selection): Fatigue, weight gain, dry mouth.
• Example preparations: Mirtazapine.

Tricyclic Antidepressants (TCAs)

• How it works: Lifts the mood.
• Prevalence: Less common, used for special cases.
• Common side effects (Selection): Constipation, dizziness, dry mouth; cardiac risks (requires ECG monitoring).
• Example preparations: Amitriptyline, Clomipramine, Doxepin.

Monoamine Oxidase Inhibitors (MAOIs)

• How it works: Stabilizes mood.
• Prevalence: Rare (special cases).
• Common side effects (Selection): Strict diet/interaction requirements (e.g., restricted intake of aged cheese); potential for blood pressure crises.
• Example preparations: Tranylcypromine, Moclobemide.

Many affected individuals or their relatives wonder whether antidepressants actually work. A very large analysis in 2017 and 2018 evaluated a total of 522 studies on the effects of antidepressants involving 116,477 adults. The result: All 21 tested antidepressants work better than the placebo, which contains no active medicinal substance. The differences between the individual drugs were rather small.

Despite this, not every affected person takes antidepressants—depending on the severity, a combination of psychotherapy, exercise, and other everyday support is sufficient for some people. Or they deliberately decide against them. Medical experts also continue to have objective discussions regarding how great the daily benefit truly is, who profits the most, and how to properly weigh the advantages against the side effects. Therefore, an individual decision made together with your doctor is crucial: you look together at what fits you, your symptoms, and your preferences.

In Summary:

• Effectiveness: Antidepressants work better than placebos in adults; differences between individual drugs are smaller than expected. Tolerability and personal fit are what matter most.
• Combination works best: Antidepressants plus Cognitive Behavioral Therapy (CBT) often yield the best results and protect against relapses.
• Time and duration: Initial effects are noticeable after 1 to 2 weeks, with the full effect occurring after 4 to 6 weeks. After improvement, the medication is usually continued for another 6 to 12 months.

Digital health applications (DiGA) can provide additional help. deprexis is an effective, innovative therapy that has been used worldwide for many years for adults with depression. The goal of the treatment is the sustainable improvement of depressive symptoms and an increase in activity. DiGAs are prescribed by doctors and the costs are covered by health insurance.

The most important cornerstone of any depression treatment is psychotherapy. Antidepressants can provide additional help or enhance the effects of psychotherapeutic treatment. Alongside plenty of exercise, daylight, regular sleep, and support from one's social environment, herbal active ingredients and nutrition can also help in daily life.

There are a number of herbal remedies, known as phytopharmaceuticals, which have a proven effect on mild to moderate depression—however, not as a standalone therapy.

• St. John's Wort: This plant contains substances such as hypericin and hyperforin. They slow down the rapid "cleanup" of mood neurotransmitters (e.g., serotonin) in the brain. With St. John's wort preparations (e.g., tablets), these messages remain active a little longer—similar to some antidepressants. After a few weeks, daily life feels brighter: there is less brooding, more inner calm, and sleep comes easier. However, the change is gentle, not like a "happy pill" kick. But: St. John's wort can make the skin more sensitive to light. Therefore, strong sunlight or visits to solariums should be avoided.
• Omega-3 Fatty Acids: These are building blocks of nerve cell membranes and dampen inflammatory signals in the body. Both functions can stabilize signal transmission in the brain and boost drive. Omega-3 fatty acids are useful as a supplement, but not as a standalone treatment.
• Vitamin D3: Vitamin D is important for stable bones and the immune system. It is mostly formed through the skin via sunlight (UV-B radiation). Especially during the winter months, many people develop a deficiency, which can manifest as fatigue, exhaustion, and susceptibility to infections. Vitamin D is only effective against depression if such a deficiency exists. After taking vitamin D3 tablets, affected individuals notice more energy, less exhaustion, and a slightly better mood after a few weeks. Without a deficiency, these effects are barely noticeable.

A good diet cannot cure depression, but it reduces stress in the body and can noticeably support therapy. The effects of a Mediterranean diet—with plenty of vegetables and fruit, whole grains, legumes, nuts, olive oil, and fish—have been particularly well studied. As a rule of thumb: choose foods that are unprocessed or only minimally processed. Accordingly, sausage, ready-made meals, fast food, and sugary drinks should be avoided.