Antidepressants are a common treatment for depression. More than one in ten people in the United States take prescription medicine for depression, according to the Centers for Disease Control and Prevention.

These medicines are now in the spotlight amid an ongoing debate over how well they work and their possible side effects.

In this Q&A, Amirhossein Modabbernia, MD, PhD, Assistant Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, explains how antidepressants can help. He also explains what you can do if they do not seem to be working, including how to talk with your doctor about stopping your medication.

“I think people should know that depression is real, common, and treatable, and that needing medication is not a weakness or a moral failure,” he says. “At the same time, antidepressants are not magic, and they are not the right answer for every person or every situation.”

How can antidepressants help people with depression?

Antidepressants can help many people. They may be most helpful when depression is moderate or severe, lasts a long time, or keeps coming back. These medicines can lower symptoms enough so a person can sleep, think clearly, connect with others, work, enjoy life, and start dealing with life’s problems again.

In my work with patients, people often describe the change by saying, “Something has lifted,” “I can think and function again,” or “There is a little more space between me and the depression.” Large studies do show that antidepressants outperform placebo on average, though the benefit varies substantially from person to person. Medication is not the whole answer for everyone. But for many people, it can create the mental and emotional space needed for recovery, therapy, relationships, and meaningful life changes.

Amirhossein Modabbernia, MD, PhD

What if I am taking an antidepressant but do not feel better?

The first thing I would say is: Please talk honestly with your doctor. A poor response does not mean treatment has failed forever. It also does not mean you should stop the medicine suddenly. It is  important to have realistic expectations. Antidepressants usually do not create instant happiness. They do not take away all emotional pain. Early signs of improvement can be small. You may sleep better, have more energy, feel less weighed down, think more clearly, feel less irritable, or find it easier to get through the day.

What can I do if my antidepressant does not seem to be working?

If the medicine is not helping enough, that is useful information. It may mean:

• The dose is not right.
• The medicine needs more time to work.
• Side effects are getting in the way.
• The diagnosis needs to be looked at again.
• Other issues are playing a role, such as sleep problems, substance use, medical problems, trauma, or major life stress.

Sometimes psyhotherapy needs to be added. Sometimes the medicine needs to be changed. Sometimes the whole treatment plan needs to be adjusted. The important point is this: If you are not improving, that is not a dead end. It is a reason to talk with your clinician and decide what to do next. If you feel worse, have side effects you cannot tolerate, or have suicidal thoughts, talk with a clinician right away.

What should I do if I want to stop taking my antidepressant?

Do not stop suddenly unless there is a clear medical reason and a clinician is guiding you. Stopping an antidepressant can be a reasonable choice. But it should be done with care. Before stopping, you and your clinician may want to talk about questions such as:

• Why do I want to stop now?
• How long have I been feeling well?
• How stable is my life right now?
• What happened the last time I stopped, if I stopped before?
• What symptoms should we watch for?
• How slowly should I lower the dose?
• What is the plan if depression comes back?

Withdrawal symptoms are real. They can include dizziness, nausea, trouble sleeping, irritability, anxiety, vivid dreams, flu-like symptoms, and sometimes “brain zaps,” which can feel like electric shocks. This does not mean people should be afraid to stop. It means stopping should be planned. It should be done slowly, with a clear follow-up plan.

How do you decide if someone is ready to lower the dose?

I usually want to know if the person has been well—not just a little better—for a steady period of time. I also look at whether the person is functioning well again. I want to know if major stressors are stable, if the person has support, and if there is a plan to prevent depression from returning. That plan might include therapy, steady sleep routines, exercise, social connection, awareness of early warning signs, and a clear plan for what to do if symptoms return.

I also look closely at the person’s history. Someone who had one mild episode of depression is different from someone with depression that keeps coming back, or someone with long-term depression, suicidal thoughts, a history of hospitalization, severe anxiety, trauma, substance use, or possible bipolar disorder. Past attempts to stop medicine also matter.

Many guidelines recommend staying on antidepressants for several months after symptoms improve after a first episode. They recommend staying on them longer when depression has come back, lasted a long time, or been severe. So tapering is not only about preference. It is also about timing and safety. Is this a good time to try? And do we have a plan if symptoms get worse?

Are some antidepressants harder to stop than others?

Yes. Some antidepressants are more likely to cause symptoms when they are stopped, especially if they are stopped too quickly. In general, medicines that leave the body quickly can be harder for some people to stop. Examples include paroxetine, brand name Paxil, and venlafaxine, brand name Effexor. Fluoxetine, brand name Prozac, often causes fewer symptoms when stopping because it stays in the body longer. But every person is different. That is why the taper needs to be personalized.

Are there options other than antidepressants?

Yes. Antidepressants are only one part of depression treatment. Therapy can be very helpful. This can include cognitive behavioral therapy, also known as CBT; interpersonal therapy; behavioral activation; psychodynamic therapy; and mindfulness-based approaches. For many people, therapy is as important as medicine, and sometimes it’s more important.

It is also important to look at the full picture. Sleep, substance use, exercise, social isolation, daily routine, trauma, medical issues, and the person’s life circumstances all matter. Depression does not happen in a vacuum. For more severe depression, or depression that has not improved with treatment, other options may be appropriate. These can include transcranial magnetic stimulation, electroconvulsive therapy, or ketamine or esketamine. The right approach depends on the person. It depends on the severity of depression, safety, past treatment response, preferences, access, and what is realistic in that person’s life.

Why should I talk with a clinician?

Good treatment should be a partnership. People should feel able to ask questions and speak honestly about what they are experiencing. Tell your clinician if your medicine is not helping, if side effects are affecting your life, if you feel emotionally numb, or if you want to stop taking the medicine. These are all valid things to discuss. The goal is not just to lower symptoms on a checklist. The goal is to help people return to a life that feels more livable, connected, and meaningful.

Avoiding other people from time to time is normal. But if you isolate yourself out of fear of embarrassment or rejection, you may have social anxiety disorder.

Charissa Chamorro, PhD

In this Q&A, Charissa Chamorro, PhD, a Mount Sinai clinical psychologist, explains how to know if you might have social anxiety disorder and what you can do to be more confident around others.

“Treatment isn’t about getting rid of anxiety—it’s about learning you can feel anxious and still engage meaningfully. The more you approach instead of avoiding, the more confidence you build,” says Dr. Chamorro, Assistant Clinical Professor, Psychiatry, Icahn School of Medicine at Mount Sinai.

What is the difference between being shy and having social anxiety disorder?

Social anxiety disorder is a diagnosable mental health condition. Shyness is considered a personality trait that can be shaped by temperament and experiences. While shyness usually involves mild discomfort in social settings, social anxiety involves a persistent, intense fear of being judged, embarrassed, or rejected.

Unlike shyness, social anxiety interferes with your life. If you avoid situations you actually want to be part of or cancel plans because of discomfort, you may have social anxiety disorder.

What causes social anxiety disorder?

The causes are thought to be a combination of biological and environmental factors, but not necessarily due to bullying or poor parenting. Some people are more prone to anxiety, and experiences like negative social feedback can reinforce that.

What are signs I might have social anxiety disorder?

• Avoiding social interactions: Not just avoiding parties, but isolating yourself at work or having a hard time starting conversations with co-workers.
• Going blank in conversations: You may blame yourself—thinking, “Why can’t I think of something to say?”—but this can be part of your body’s fight, flight, or freeze response to anxiety.
• Over-apologizing and deferring to others instead of stating your own preferences: People with social anxiety often seek social approval.
• Rumination: Replaying past conversations, focusing on something you think went wrong, or feeling that you were really embarrassing. Thinking about social interactions is normal, but if it causes distress and is hard to control, you may have social anxiety.
• Perfectionism: Feeling that you have to know the perfect thing to say before you can speak.
• Hiding behind your phone in public: Not for work or enjoyment, but to avoid engaging with others.

How can I become more confident in social situations?

Here are three tips you might find useful:

• Remind yourself that everyone feels awkward sometimes. That normalizes the experience and helps you feel less alone.
• Vocalize your feelings. For example, if you’re giving a speech, you might say, “I’m feeling nervous because I really want this to go well.” Naming it can disarm others and help you feel more confident.
• Reframing your thoughts can build confidence. Instead of telling yourself, “I’m so awkward,” tell yourself, “A part of me feels anxious, and that’s okay. I’m going to do my best.” Coaching yourself with more balanced, supportive thoughts can make a difference.

How can a mental health professional help me with social anxiety?

Social anxiety is highly treatable, and cognitive behavioral therapy (CBT) is the gold standard. CBT helps you identify thoughts contributing to anxiety and use cognitive restructuring to examine them.

How does a therapist use cognitive behavioral therapy to treat social anxiety?

I would ask you to recall positive social experiences to challenge self-critical thoughts, like “I can never connect with people.” Cognitive behavioral therapists work on helping you create more balanced thoughts—for example, “Sometimes I feel awkward, but I’ve also connected with others before.”

Therapists also assign gradual behavioral exposures—small tasks like ordering coffee and making eye contact with the cashier, then building up to things like attending a party. The goal is to break the cycle of avoidance and create opportunities to approach social situations.

Are there medications that treat social anxiety?

CBT is often very effective, but if symptoms remain or access is limited, medication may be a helpful additional support. Depending on how severe your anxiety is—especially if generalized anxiety is also present—we may refer you to a psychiatrist to discuss medication options.

What happens if I continue to avoid social situations?

Avoidance makes anxiety stronger. When you avoid a social situation, anxiety goes down short-term, but you don’t get the chance to learn that you can manage it.

Treatment isn’t about getting rid of anxiety—it’s about learning you can feel anxious and still engage meaningfully. The more you approach instead of avoiding, the more confidence you build.

Phones have become a necessary part of life, but if you find yourself mindlessly scrolling or constantly reaching for your phone out of boredom, you may have a phone addiction.

“Addiction isn’t just about substances—it can also be behavioral,” says Naomi Dambreville, PhD, a licensed clinical child and adult psychologist at The Mount Sinai Hospital. “Phone addiction is compulsive and excessive phone use, feeling out of control, or distressed when away from your phone. If you feel withdrawal when not online or fear missing content, you may have a problem.”

Naomi Dambreville, PhD

In this Q&A, Dr. Dambreville, Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, explains how to know if you might have an unhealthy relationship with your phone, and tips for using it in healthier ways.

What are some signs that I spend too much time on my phone or social media?
We live in a digital society and rely on phones for many everyday activities. It can be hard to realize phone use is a problem because it’s so convenient, but signs include:

• Everything revolves around your phone. You shop, socialize, get news, and do almost everything through your phone—and rarely engage in real-life alternatives.
• You have an automatic relationship with your phone. Every notification prompts an instant reaction, you check every direct message, constantly scroll, or have FOMO (fear of missing out)—especially if being offline makes you feel sad or out of the loop.
• Trouble focusing. If you’re multitasking—watching TV and scrolling, talking to someone but still on your phone—or always reaching for your phone at work or in class.
• Low tolerance for boredom. Your instinct is to grab your phone the moment you have nothing to do. Scrolling becomes a default time filler with no real purpose.
• Physical symptoms—headaches, fatigue, sleep disruption, eye strain, and “digital thumb” (thumb, hand, or wrist pain from holding your phone for long periods).
• Phone-related conflicts. Your phone causes conflicts in your relationships because your loved ones feel ignored.

How can I use my phone in healthier ways?

Here are three ways to create healthier phone habits:

• Train your social media algorithms: Block unwanted content, use filters, and control what you see. Choose not to view certain images or videos.
• Create rules around phone use. No phones at dinner, during conversations, or bedtime. For families, agree on time limits, app access, and talk about uncomfortable content.
• Use the phone for connection, but notice when it causes discomfort. Align phone use with your values and make space for real-world experiences.

How does phone addiction, including doom scrolling, affect mental health?
Doom scrolling refers to consuming large amounts of news, often bad—for example, catastrophic storms, conflicts, or negative political content. We grab our phones to search for updates and end up exposed to real-time traumatic or distressing information.

This behavior becomes mindless. You might scroll to stay informed but end up feeling worse. Bad moods lead to more scrolling, which worsens the mood further. It affects attention, mood, self-esteem, and can trigger irritability, anxiety, or anger.

Do “digital detoxes” reduce phone addiction? How?
A digital detox helps reduce or stop phone use. It’s about breaking the cycle of compulsive use. Detoxing gives your mind and body a break and allows space to build new habits. Here’s how:

• Start by building awareness. Notice what you use your phone for—shopping, paying bills, etc. Try doing some of those activities in real life. Spend an hour off your phone, and see how it feels.
• Notice withdrawal reactions—thinking about your phone, missing notifications, or feeling uncomfortable without it. Use app limits and be intentional: “I’m checking my bank app” vs. “I ended up scrolling Instagram.”
• Replace phone time with real-life activities—reading a book, joining a club, socializing in person, or trying a new hobby.

How can a mental health professional help?
People often seek help for anxiety, low self-esteem, or conflict—and phone use may be a factor. Therapists can help with behavior changes, digital detox plans, and social skills. They can also address phone-related issues like gambling, shopping, and excessive social media use, helping reduce dependency and improve well-being.