Medications in the form of antidepressants are generally taken in combination with psychotherapy—following a mutual consultation with the treating physician or psychotherapist. Depending on the specific active ingredient, antidepressants have different mechanisms of action and vary in their side effects.

SSRI (Selective Serotonin Reuptake Inhibitors)

• Mechanism of Action: Increase the neurotransmitter serotonin in the brain and are often considered the first-choice treatment.
• Typical Side Effects: Nausea, sleep disturbances, and sexual dysfunction.

SNRI (Serotonin-Norepinephrine Reuptake Inhibitors)

• Mechanism of Action: Additionally act on the neurotransmitter norepinephrine, which can boost drive and motivation.
• Typical Side Effects: Blood pressure problems, nausea, and headaches.

NaSSA (Noradrenergic and Specific Serotonergic Antidepressants)

• Mechanism of Action: Often promote sleep and appetite.
• Typical Side Effects: Daytime fatigue and weight gain.

NDRI (Norepinephrine-Dopamine Reuptake Inhibitors)

• Mechanism of Action: Tend to have an activating effect. They can be useful in cases of pronounced fatigue.
• Typical Side Effects: Not ideal for anxiety disorders, restlessness, and insomnia.

Tricyclics (Tricyclic Antidepressants)

• Mechanism of Action: They are effective but have a complex mechanism of action and more side effects.
• Typical Side Effects: Dry mouth, constipation, and cardiac arrhythmias.

The decision regarding which medication is suitable for depression in your specific case is always made together with your doctor. You will discuss which symptoms are most prominent, which side effects you absolutely want to avoid, and what previous experiences you might have had.

It is completely normal if you do not feel better immediately after taking the medication. Many people notice the first slight improvements after one to two weeks. Significant changes often do not become apparent until several weeks have passed. If no clear improvement is noticeable after four to six weeks, switching medications may be necessary. Once improvement has occurred, the treatment is usually continued for six to twelve months to prevent relapses. Stopping the medication thereafter is always done gradually and in close consultation with your healthcare team.

Especially at the beginning of antidepressant treatment, issues such as restlessness, nausea, headaches, sleep disturbances, or sexual problems can occur. Even though this is challenging, these side effects are often temporary. If the side effects restrict you severely, your doctor will adjust the dosage or switch you to a different antidepressant.

The so-called serotonin syndrome is a rare but serious reaction. It can occur when you combine multiple medications that increase serotonin levels—for example, an SSRI taken together with certain migraine medications or another antidepressant. Warning signs in such a case include restlessness, severe tremors, excessive sweating, fever, or diarrhea. If these occur, seek medical help immediately.

Important: Alcohol intensifies the side effects of many antidepressants and should be strictly reduced or avoided whenever possible.

The Digital Health Application (DiGA) deprexis is officially listed with the Federal Institute for Drugs and Medical Devices (BfArM). It offers interactive exercises, knowledge sharing, and practical help for everyday life. You can receive a prescription for it from your doctor, and the costs are generally covered by your health insurance. deprexis can usefully supplement therapy or help bridge waiting times for a treatment spot.

The most important form of treatment remains psychotherapy—supplemented by antidepressants if necessary. Lack of sleep or pain can further intensify depression. Therefore, it is important to target and treat these accompanying symptoms. Non-pharmacological approaches should always be the primary focus, and medications should only be taken for a short duration.

Poor and restless sleep often makes the situation worse. Your doctor can prescribe sedating medications for a few days or weeks to provide relief. Additionally, fixed bedtimes, a break from your phone before going to sleep, and plenty of daylight after waking up in the morning can help.

Severe inner restlessness can be agonizing. In some cases, short-term sedatives (for example, benzodiazepines) may be used while the antidepressant is still building up its effect. Due to the risk of dependency, doctors only recommend taking small doses over a very limited period. Breathing and mindfulness exercises, and especially daily movement, are much healthier alternatives.

Many people quickly reach for ibuprofen when in pain. But be careful: if you take ibuprofen together with serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), the risk of gastrointestinal bleeding increases. If needed, be sure to speak with your doctor about alternatives that protect your stomach and intestines. Never take painkillers long-term without medical consultation.

Are you wondering if there are gentle remedies available before turning to prescription medications? Especially during mild depressive episodes, herbal remedies can be a helpful option to lift your mood.

The most well-known herbal mood enhancer is St. John's wort (Hypericum perforatum). It can be effective for mild depression. However, there is a major catch: it has strong interactions with a wide variety of other medications.

Important: St. John's wort can massively affect the efficacy of other drugs. For example, it can weaken the effectiveness of birth control pills or alter the effects of blood thinners. Therefore, you should only take it after consulting your doctor's office or pharmacy.

In addition to St. John's wort, there are other botanical substances frequently used for accompanying restlessness and sleep problems, though they are not pure antidepressants themselves:

• Valerian and hops (often combined) are traditionally used for calming and for difficulties falling asleep.
• Lavender (Lavandula) in capsule form is used to treat states of anxiety and restlessness.
• Passionflower (Passiflora) is also utilized for calming nervous restlessness.

With the exception of St. John's wort, there is no over-the-counter remedy that can reliably treat moderate or severe depression. Over-the-counter sleep aids, such as the previously mentioned doxylamine (e.g., Hoggar Night), are at best short-term aids for falling asleep. They do not treat the underlying depression itself.

If your symptoms persist or worsen, please speak to your doctor about a guideline-based therapy, which may also include prescription antidepressants.

As previously mentioned, an emergency medication for depression is frequently requested—but it does not exist. If you are feeling very poorly and find yourself in a crisis, what helps most are real people and a structured treatment plan. Therefore, keep important contact numbers within reach, speak with a person you trust, and utilize professional support services.