Chances are high that if you don’t take an antidepressant yourself, you know someone who does. Depression makes you substantially older—every study shows that people who are depressed and do not get treatment have a RealAge 8 to 16 years older than their calendar age. It also increases your odds of developing cancer, many other chronic diseases, and unhealthy habits like using tobacco. So treatment of depression makes sense for many. This recognition helped propel an increase in antidepressant use in the U.S.A. to over 8 percent of the population from one-fourth that in the early 1990s. So maybe it is logical that antidepressants were the third most common prescription medications taken in the U.S. between 2005 and 2008. Women, in fact, are 2.5 times more likely to take antidepressants than men, which makes it ever more important to ask how to avoid the risks of taking these drugs so they make you younger, not older.

While treatment of depression makes you younger, antidepressants may not, as you can’t boost serotonin in the brain without doing so in the rest of your body as well—which can have adverse effects. Research suggests that the risk of developmental problems, abnormal bleeding, stroke, digestive problems, headaches, and problems with sexual function all increase with antidepressant use. In fact, antidepressants even increase the risk of death in elderly patients! But, conversely, there is a risk of premature aging from leaving depression untreated, too. So let’s discuss some specifics.

Studies have revealed that taking antidepressants can have some surprisingly dramatic risks. In pregnant women, certain antidepressants—but not all—increase the risk of birth defects. The study focused on selective serotonin reuptake inhibitors, or SSRIs, which increase the levels of the neurotransmitter serotonin in the brain by blocking neurons from reabsorbing it. In particular, taking fluoxetine (Prozac) or paroxetine (Paxil) in the month before you get pregnant through the first trimester poses a risk, increasing the chances of some birth defects by 2-3.5 times. Sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro) weren’t shown to increase the risk of birth defects. (Taking a prenatal multivitamin with the omega-3 DHA for three months prior to conception actually and substantially decreases the risk of autism and many other birth defects.)

A study analyzing South Korea’s national health database of 4.1 million who had taken NSAIDs within 30 days of antidepressants suggested that these common painkillers after or during antidepressant treatment increases the risk of intracranial bleeding—that is, bleeding inside your skull—by about threefold.

Besides the more dramatic risks, the side effects of antidepressants, which differ based on the medication and the person, can include dry mouth, weight gain, and sexual side effects. Some, including SSRIs, can lower testosterone. Some research shows that placebos are just as effective as antidepressants form mild depression. But for serious and severe depression, antidepressants are substantially more effective than placebos. Other research has found that placebos were 75 to 82 percent as effective as certain antidepressants.

But the biggest problem with taking antidepressants is that depression is actually an incredibly useful signal that something in your mind or body just isn’t quite right. Given depression’s adverse effects, it makes complete sense that you’d want to eliminate those symptoms—but they could also be a powerful cue that it’s time to delve deeper into what’s going wrong. The symptoms of depression can be subtle, like feeling helpless and bored for an extended period of time or even waking up really early in the morning (say, 3:30a.m.). If you suspect that you might be depressed, talking with your doctor is the best first step. Your doc will take a thorough inventory of your situation (be honest!) and can help you figure out a treatment plan that makes sense for you.

If you’re thinking of starting antidepressant treatment, get a second opinion and carefully consider all treatments, and whether the rewards outweigh the risk. If you’re on antidepressants but thinking of quitting, don’t do it cold turkey! Again, talk to your doctor about the best way to ease off the drugs slowly. And if you’re looking to treat depression, anxiety, or other mood symptoms another way, rest assured that they are out there. We think starting an exercise program, start budding with a positive person, and talking to a therapist are great places to start.