Antidepressants are medications that can help relieve the symptoms of depression and are used in the treatment of some other conditions. They were first developed in the 1950s and have been used regularly since then. There are almost thirty different kinds of antidepressants and five main categories:
* SSRIs (Selective Serotonin Reuptake Inhibitors)
* SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)
* NASSAs (Noradrenaline and Specific Serotoninergic Antidepressants)
* MAOIs (Monoamine Oxidase Inhibitors).
What are antidepressants used for?
Antidepressants should not usually be prescribed for mild depression but are recommended, usually in combination with psychotherapies, for adults with moderate to severe depressive illness.
They should not normally be used for children and adolescents, unless their depression has not responded to other treatments or is particularly severe.
Antidepressants may also be prescribed for some other conditions:
* Severe anxiety and panic attacks
* Obsessive compulsive disorder
* Chronic pain
* Eating disorders
* Post-traumatic stress disorder (PTSD)
Your doctor should explain why they are suggesting an antidepressant for you, and should go through the potential benefits and risks of taking an antidepressant.
Do antidepressants have side-effects?
Yes – your doctor should discuss these with you before you agree to starting using them. You should tell your doctor about any medical conditions you have or have had in the past – this can affect type of antidepressant they recommend for you.
Here are some common side effects you might experience with the different types of antidepressants:
* Feeling agitated, shaky or anxious (this is often why people stop taking their antidepressant, especially if they have not been warned about it – but it usually passes off a few days after starting the antidepressant)
* Being sick
* Indigestion and stomach aches
* Diarrohea or constipation
* Loss of appetite
* Not sleeping well (insomnia), or feeling very sleepy
* Low sex drive
Difficulties achieving orgasm during sex or masturbation
* In men, difficulties obtaining or maintaining an erection (erectile dysfunction).
While the list of side effects looks worrying, they will be mild for most people and will usually wear off over a couple of weeks as your body gets used to the medication.You should talk to your doctor if you are worried about any of the side effects, if they persist longer than a few weeks or if they are or become unbearable.
What about pregnancy and breastfeeding?
it is always best to take as little medication as possible while you are pregnant – and antidepressants are not usually recommended for most pregnant women. However, if you are already taking antidepressants, or feeling unwell to the extent that you may need to do so, you should discuss how this might affect your baby with your doctor.
Antidepressants are also not usually recommended if you’re breastfeeding. However, there may be times where the benefits of breastfeeding for your baby, and the benefit of antidepressant treatment for you, need to be weighed up against the risks of taking an antidepressant. Again, it’s really important to discuss this with your doctor.
How should Antidepressants be taken?
Keep in touch with your doctor when you start treatment. They will monitor you for side effects and how you feel. They may advise you to change the dose. It doesn’t help to increase the dose above the recommended levels. If you are being given the drug for anxiety, your doctor may suggest that you start on a very low dose for the first few weeks.
Try not to be put off if you get some side effects. Many of them wear off in a week or so. Don’t stop your antidepressant unless the side effects are unbearable. If they are, get an urgent appointment to see your doctor. If you feel worse it is important to tell your doctor so that they can decide if that antidepressant is right for you. Your doctor will also want to know if you have noticed increased feelings of restlessness or agitation.
Take them as prescribed by your doctor – if you don’t, they won’t work.
Wait for them to work. Most people find that they take 1-2 weeks to start working and maybe up to 6 weeks to give their full effect.
Persevere – stopping too early is the most common reason for people not getting better and for the depression to return.
Try not to drink alcohol. Alcohol on its own can make any depression worse, but it can also make you slow and drowsy if you are taking antidepressants.
Keep them out of the reach of children.
If you are struggling, and have thought about taking an overdose, tell your doctor as soon as possible – and give your antidepressants to someone else to keep for you.
Tell your doctor about any major changes in how you feel when the dose of antidepressant is changed.
There is no justifiable rationale for combining antidepressants with benzodiazepines or other medications in what are known as Fixed dose combination preparations where in you get an antidepressant and a Benzodiazepine /some other medication in single tablets. If the need to co-prescribe is deemed necessary by a clinician, both the drugs may be prescribed separately as antidepressant use may continue for a longer period while benzodiazepines may be tapered off completely in 4-6 weeks.
How long will I have to take them for?
How long you take an antidepressant for depends on why you were prescribed them and whether you have had to take them before. The guidelines advise that it is best to continue to take antidepressants for at least six months after you start to feel better. If you stop the medication before then, the symptoms of depression are more likely to come back. It is worthwhile thinking about what might have made you vulnerable, or might have helped to trigger your depression. There may be ways of making this less likely to happen again.
If you have had two or more periods of depression then you should carry on taking the antidepressant for at least two years.
What will happen if I don’t take them?
It’s difficult to say – so much depends on why they have been prescribed, on how bad your depression is and on how long you’ve had it for. Sometimes depression gets better without any treatment or with other treatments, such as psychotherapies.
Your doctor should talk this through with you before they are prescribed so that you fully understand the benefits and risks of taking and not taking antidepressants.
(The author is a Consultant Psychiatrist)