Russians are buying more antidepressants every year. Doctors say that doesn’t necessarily mean more Russians are depressed.

Antidepressant sales in Russia have been growing steadily, a trend the media covers regularly. We decided to look at what may be behind it — and at what people who are about to start taking antidepressants, or to stop, need to know.

Not necessarily. Specialists say several factors are at work here.

• It may in fact be that more people are developing depression: the events of recent years have contributed to that. But antidepressants are also prescribed for other mental disorders — for post-traumatic stress disorder, for example, which can be triggered by war.
• Over time, more and more people are learning that the symptoms they have are a sign of a mental disorder, and they no longer find it shameful to see a psychiatrist or to take antidepressants. Doctors say the stigma around psychiatry is gradually lifting, and that as a result more people are getting the right diagnosis.

Either way, depressive disorder was already being diagnosed more and more often in Russia before the full-scale invasion of Ukraine began, and the trend held in 2022. (We were unable to find more recent official data.)

Doctors suggest that demand for antidepressants may be climbing for other reasons as well.

• Because good psychotherapy is expensive, people with a mild depressive episode go for the cheaper treatment: antidepressants. Even though psychotherapy is the recommended first-line treatment for them.
• Russia’s latest clinical guidelines correctly point out that antidepressants are used to treat, among other things, bed-wetting in children, migraine, irritable bowel syndrome, and chronic pain. That may be why doctors who aren’t psychiatrists prescribe the drugs more and more often.

You can, but you have to do it slowly (there are exceptions). Sometimes very, very slowly. And sometimes even that doesn’t help, and people develop extremely unpleasant symptoms. But the latest data indicate that things go fine for the overwhelming majority of people — 85% of those taking antidepressants.

Problems mostly arise in people who try to stop too fast and in those who were on high doses or on certain drugs, among other cases.

That happens not only when someone stops taking antidepressants but also when they switch abruptly to an antidepressant that works by a different mechanism.

Usually the symptoms are fairly nonspecific: dizziness, headache, nausea, insomnia, irritability. But there are dozens of other effects that turn up less often. Most of the time they clear up within a few days, though they can cause problems for weeks and months. In any case, expect to feel bad for a while and to have trouble functioning normally.

If symptoms appear and it doesn’t look as though the cause is, say, the depression coming back, a doctor may suggest tapering the dose more slowly, over several months, or switching to a different drug that causes unpleasant symptoms less often when it’s stopped.

Not exactly. There are antidepressants that cause fewer side effects and ones that cause more, ones that work better or worse for different conditions, and ones that are or aren’t contraindicated for certain illnesses and conditions (high blood pressure or pregnancy, say).

For chronic pain, for example, duloxetine has performed best. For depression, a doctor will weigh several factors. Different antidepressants are known to be more likely to cause particular side effects, and to work better on insomnia, anxiety, and other symptoms that come with depression.

So if a patient can’t fall asleep, the doctor will suggest a drug that can fix that. And if someone’s sex life matters to them, the doctor may prescribe an antidepressant less likely to affect libido.

For mild or moderate depression, doctors now usually prescribe drugs from the selective serotonin reuptake inhibitor class. Those include escitalopram (best known under the brand name Cipralex), sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil, Rexetin).

For severe depression, a doctor may start by suggesting antidepressants from the serotonin and norepinephrine reuptake inhibitor class — venlafaxine (Velaxin) and duloxetine (Cymbalta), for instance. Or an antidepressant such as mirtazapine (Remeron, Calixta), which doesn’t fall into any of the major known classes.

Tricyclic antidepressants (amitriptyline, imipramine) and monoamine oxidase inhibitors (pirlindole) are prescribed less often. They’re older drugs, they lead to side effects more often, and taking them means accounting for more factors. With some monoamine oxidase inhibitors, for instance, a long list of foods is off limits; eating them can cause a spike in blood pressure.

Side effects early on — they occur in about half of cases. They usually go away with time, most often within a few weeks. But not all of them do. With sexual side effects, for instance, it’s better not to count on that: if they’re bothering you, the dose will have to come down, or you’ll need additional medication, or you’ll need to change antidepressants. After talking to a doctor, of course.

It’s important to tell a specialist about side effects and about how much they matter to you. It’s especially important to work out a plan with your doctor in case you start having suicidal thoughts: that risk goes up during the first weeks on antidepressants.

And of course, stopping the drug or changing the dose on your own is a bad idea.

Russia has no nationwide hotline for people in crisis, though individual cities have their own. A list of some hotlines is here. These links (one, two) collect contacts for helping professionals in other countries.

It isn’t recommended (though you couldn’t say it’s strictly forbidden).

For antidepressants in general, alcohol can intensify their side effects — drowsiness and dizziness, for instance. Individual antidepressants can produce specific effects when they’re taken with alcohol. Duloxetine combined with heavy drinking, in particular, can damage the liver.

So it’s a good idea to look at the package insert and see whether the manufacturer warns about anything serious.