Have you ever had the feeling that the world feels a little heavier than it should? That getting out of bed requires more energy than you seem to have? If these moments sound familiar, you’re not alone. As a psychiatric nurse practitioner for more than 15 years, I hear these experiences almost daily. The truth is, depression touches many of us, and understanding our treatment options—both conventional and natural—can be the first step toward feeling like ourselves again.

Let’s talk about something that affects millions of people: Depression and the various ways we can address it, from traditional medications to the healing power of herbs that nature has provided for centuries.

What Are Antidepressants and How Do They Work?

Antidepressants are medications designed to ease depression symptoms by working with neurotransmitters—the chemical messengers in your brain that influence mood, sleep, and how we experience life. They typically cause fewer side effects than older medications and are also used for anxiety.

Think of neurotransmitters like a gentle symphony in your brain. When depression occurs, certain instruments in this orchestra—particularly serotonin, norepinephrine, and sometimes dopamine—aren’t playing in harmony. Antidepressants help restore this balance, allowing your brain’s natural music to flow more smoothly.

Here’s something important to remember: antidepressants take up to several weeks before they have their full effect. Depression treatment tends to have the best results when it’s combined with counseling and lifestyle changes, such as getting regular exercise.

The Amazing Science Behind SSRIs: How They Promote Brain Healing Through Neurogenesis

One of the most fascinating discoveries in recent years is how SSRIs actually help heal your brain at the cellular level. This process, called neurogenesis, is essentially your brain’s ability to grow new neural connections and even new brain cells throughout your life—something scientists once thought impossible in adults.

Recent groundbreaking research using advanced brain imaging has shown that SSRIs increase synaptic density in the brain areas critically involved in depression over the first few weeks of treatment. This means your brain is literally building new pathways and connections, creating a more resilient neural network.

Here’s what happens in your brain when you take an SSRI: The medication doesn’t just increase serotonin levels temporarily. Instead, it triggers a cascade of healing processes that unfold over weeks. Studies show that SSRIs increase synaptic density in brain areas critically involved in depression, and synapses build up over a period of weeks, which explains why the effects of these drugs take time to kick in.

This neurogenesis primarily occurs in the hippocampus—the brain region responsible for learning, memory, and emotional regulation. When you’re depressed, this area often shows reduced activity and fewer neural connections. SSRIs promote proliferation, differentiation and survival of progenitor cells of the hippocampus, essentially giving your brain the tools to rebuild itself.

What makes this even more remarkable is that antidepressants increase both immature, doublecortin (Dcx)-positive neuroblasts (+16%) and mature, microtubulin-associated protein-2 (MAP2)-positive neurons (+26%). In simpler terms, your brain is creating both new baby neurons and helping them mature into fully functional brain cells.

This process of neuroplasticity—your brain’s ability to reorganize and form new neural connections—continues throughout treatment. Brain synaptic plasticity evolves over 3–5 weeks in healthy humans following daily intake of an SSRI, offering a plausible biological explanation for the delayed treatment response commonly observed in patients treated with SSRIs. See: Effects of escitalopram on synaptic density in the healthy human brain: a randomized controlled trial

Think of it this way: when you plant a garden, you don’t see flowers the next day. First, seeds must germinate underground, roots must establish, and stems must strengthen. Similarly, your brain needs time to grow these new connections and pathways that will support better mood, clearer thinking, and emotional resilience.

Types of Antidepressants: Understanding Your Options

SSRIs (Selective Serotonin Reuptake Inhibitors)

SSRIs are the most commonly prescribed antidepressants because they are effective at improving mood and tend to be less likely to cause side effects than some other types. Common SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

These medications work by preventing your brain from reabsorbing serotonin too quickly, leaving more of this “feel-good” chemical available to support your mood. SSRIs have relatively fewer side effects than older antidepressants because they have little effect on other neurotransmitters like dopamine or norepinephrine.

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

SNRIs affect both serotonin and norepinephrine. Together, these two neurotransmitters regulate many of your body functions, such as your mood, how well you sleep, and your social behavior. Common SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq).

SNRIs help ease depression symptoms and some also help with anxiety disorders or long-term pain. They may work well if depression and pain occur together. This can be particularly relevant for women in their 60s and beyond who may be dealing with both emotional and physical challenges.

Tricyclic Antidepressants (TCAs)

These are older medications that were one of the first approved antidepressants. Although they are effective, they have been replaced by newer antidepressants that generally cause fewer side effects. Tricyclic antidepressants are occasionally used as second-line antidepressants for people who don’t respond well to SSRIs or SNRIs.

MAOIs (Monoamine Oxidase Inhibitors)

MAOIs are another older class of antidepressants first introduced in the 1950s. They generally aren’t prescribed as first-line treatments for depression today due to their risk of side effects and drug interactions.

Atypical Antidepressants

These medications don’t fit neatly into other categories but can be effective for certain individuals. Examples include bupropion (Wellbutrin), trazodone (Desyrel) and mirtazapine (Remeron).

Benefits of Antidepressant Medications

Studies involving adults with moderate or severe depression have shown that about 50 out of 100 people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks, compared to about 30 out of 100 people who took a placebo.

The benefits can include:

• Improved mood and energy levels
• Better sleep patterns
• Reduced anxiety and worry
• Enhanced ability to engage in daily activities
• Decreased thoughts of hopelessness

For many patients, antidepressants provide the stability needed to engage more fully in therapy and make the lifestyle changes that support long-term wellness.

Understanding the Risks and Side Effects

Let’s be honest about this—every medication comes with potential side effects, and it’s important to be fully informed. Commonly reported side effects that may occur with either SSRIs or SNRIs include gastrointestinal issues, sexual dysfunction, and sleep pattern changes.

Common side effects across different antidepressants may include:

• Nausea or digestive upset
• Headaches
• Dizziness
• Changes in appetite or weight
• Sexual side effects
• Sleep disturbances
• Dry mouth

Something particularly important as well: Some SSRIs and most SNRIs have been associated with a discontinuation syndrome when they have been stopped suddenly. This does not mean that once you starting taking an antidepressant you can never stop. However, in order to avoid discontinuation syndrome it is best to withdraw all antidepressants slowly.

Herbal Medicine: Nature’s Gentle Support for Mild Depression

Now, let’s explore something close to my heart—the healing wisdom that plants have offered humanity for thousands of years. I’ve witnessed the remarkable support that certain herbs can provide, especially for mild depression and seasonal mood changes.

Here’s what’s important to understand: herbs work beautifully for mild depression and seasonal depression, but they typically don’t provide sufficient support for moderate to severe depression. Think of herbs as gentle allies that can support your emotional well-being when you’re experiencing life’s natural ups and downs, but may not be strong enough for more serious depressive episodes.

St. John’s Wort (Hypericum perforatum)

This sunny yellow flower has been used for centuries as nature’s mood lifter. St. John’s wort has the strongest evidence of all herbs for depression, with 27 clinical trials involving 3,808 subjects in the latest meta-analysis. The conclusion was that St. John’s wort is comparable in efficacy to SSRIs but with fewer side effects.

A 2008 study showed that St. John’s Wort is at least as effective in managing depression symptoms as most regularly prescribed antidepressants in the United States.

Important considerations: St. John’s wort can interact with many medications, such as birth control pills, HIV medicines, and heart or transplant drugs, making them less effective. This herb is particularly known for interfering with medication effectiveness, so it’s crucial to discuss with your healthcare provider before using it.

Saffron (Crocus sativus)

This precious spice, worth its weight in gold, offers more than culinary delight. About 17 small, randomized controlled trials have tested saffron in mild to moderate depression. It worked as monotherapy and as augmentation. In six trials it was compared head to head with an SSRI or tricyclic, and saffron worked just as well.

Taking saffron supplements for eight weeks led to a reduction of depressive symptoms and improved the resilience of study participants against the development of other psychiatric disorders.

Rhodiola (Rhodiola rosea)

Sometimes called Arctic Root or Golden Root, Rhodiola is an adaptogenic herb that’s particularly well suited to managing depression caused by stress and stressful situations, or that caused by PTSD. Its main purpose is to help the body fight off stress reactions and to support healthy mood balancing.

Adaptogens like rhodiola contain steroid-like phytochemicals that buffer the effects of glucocorticoids, which are released in excess under stress. They modify the brain and body’s resistance to high levels of stress hormones.

Turmeric/Curcumin

Like saffron, curcumin has anti-inflammatory, antioxidant, and neurotrophic effects. Unlike St. John’s wort, it does not affect the monoamines, so in theory it should not cause mania. There are no reports of mania on curcumin in the literature.

Other Supportive Herbs

• Ashwagandha: An adaptogen that helps the body manage stress
• Lemon Balm: Calming and mood-supporting
• Holy Basil: Helps with stress adaptation and emotional balance
• Lavender: Soothing and anxiety-reducing
• Chamomile: Gentle mood support and relaxation

Creating Your Tea Ceremony for Emotional Wellness

One of my favorite ways to incorporate mood-supporting herbs is through daily tea rituals. Here are some gentle blends I often recommend:

Morning Clarity Tea:

• Green tea (natural mood support)
• Ginkgo biloba (cognitive support)
• A touch of holy basil

Afternoon Calm:

• Chamomile
• Lemon balm
• Rose hips (vitamin C support)

Evening Wind-Down:

• Passionflower
• Lavender
• A pinch of saffron (if you have it)

The ritual itself—taking five quiet minutes to steep your tea, inhaling the gentle aromatics, feeling the warmth in your hands—becomes part of the healing. It’s a moment to pause, breathe, and reconnect with yourself.

When Herbs Aren’t Enough: Recognizing the Need for Stronger Support

While I’m passionate about herbal medicine, I must be clear about its limitations. Herbs work wonderfully for:

• Mild depression
• Seasonal affective patterns
• Life transition sadness
• Stress-related mood changes
• Supporting overall emotional resilience

However, moderate to severe depression typically requires the stronger support that pharmaceutical antidepressants provide. If you’re experiencing:

• Thoughts of self-harm
• Inability to function in daily activities
• Severe sleep disturbances lasting weeks
• Significant weight loss or gain
• Feelings of worthlessness or hopelessness that persist

…it’s time to work with a healthcare provider and consider prescription medications alongside therapy.

Integrating Both Approaches: The Best of Both Worlds

In my practice, I often see beautiful results when we combine the gentle support of herbs with the stability that antidepressants can provide. With the exception of St. John’s wort, most herbs can be safely added as augmentation to antidepressant therapy.

This might look like:

• Taking a prescribed SSRI for foundational mood support
• Adding adaptogenic herbs like ashwagandha for stress resilience
• Using lavender tea for evening relaxation
• Incorporating meditation and gentle yoga
• Creating nourishing rituals around herbal teas

Common Questions About Antidepressants

Q: How long do antidepressants take to work?

An antidepressant can already have an effect within one or two weeks, but it may take longer for symptoms to improve. Antidepressants usually take 1 to 2 weeks to start having an effect and can take up to 8 weeks to work fully.

Q: How long will I need to take antidepressants?

Antidepressants are usually taken for one to two years, and sometimes longer, to prevent relapses. If you’re prescribed antidepressants, you’ll usually take them for at least 6 months after you feel better. This isn’t a sign of weakness—it’s allowing your brain the time it needs to build new, healthier patterns.

Q: What if the first antidepressant doesn’t work?

You may need to try two or more medicines before you find one that works for you. If a person’s depression has not responded at all after 4 weeks of antidepressant medication, options include switching to another antidepressant in the same class or switching to a different class entirely. This is completely normal, and I encourage my patients to think of it as finding the right key for their unique lock.

Q: Can I take antidepressants if I’m on other medications?

This is where working with a knowledgeable healthcare provider becomes essential. Some antidepressants can cause problems if you take them with certain medicines and herbs. I always do a thorough medication review to ensure safety and effectiveness.

Q: What about side effects?

Not everyone has side effects from antidepressants. But if you do have them, they’re usually mild and may get better over time as your body gets used to the new medicine. I work closely with my patients to manage any side effects while we wait to see the medication’s full benefits.

Q: Can I stop antidepressants suddenly?

Never stop antidepressants abruptly. The speed and duration of withdrawal should be led and agreed to by the patient, and withdrawal may take weeks or months to complete successfully. We always create a gradual tapering plan when it’s time to discontinue.

Q: Are antidepressants safe for people over 60?

Absolutely, with proper monitoring. In fact, many antidepressants can be particularly helpful for seniors who may be dealing with multiple life transitions, health changes, and loss. We just need to be mindful of interactions with other medications and any age-related considerations.

Q: Can I combine antidepressants with herbs?

Some combinations are safe and beneficial, while others (like St. John’s Wort with prescription antidepressants) can be dangerous. With the exception of St. John’s wort, most herbs can be safely added as augmentation. Always discuss herbal supplements with your healthcare provider.

A Gentle Path Forward

Whether you choose the support of modern antidepressants, the wisdom of herbal medicine, or a thoughtful combination of both, remember that seeking help for depression is an act of courage and self-compassion. There is no shame in needing support—there is only the gentle strength that comes from honoring your mental health and taking steps toward feeling better.

Your mental wellness journey is uniquely yours. Some days will feel lighter, others heavier. What matters is that you keep moving forward, one small step at a time, with the support that feels right for you.

If you’re struggling with depression, please reach out to a healthcare provider. And remember—it’s perfectly okay to ask questions, seek second opinions, and advocate for the care that feels most aligned with your values and needs.

Here’s to your journey toward greater emotional wellness, supported by both the advances of modern medicine and the timeless wisdom of nature’s pharmacy.

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This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider before starting, stopping, or changing any medication or herbal supplement, especially if you’re currently taking other medications.

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