|
| Home | Feeling Crap? | Getting Help | Staying Well | Resources | Families & Friends |
| Self-help | Web and phone | Complementary therapies | Doctor | Antidepressants | Group support |
Antidepressant medication |
There are always a lot of questions about medication - do they work?, what are the side-effects?, how long do I need to be on them? We put some questions to Dr Sarah Kennedy and our colleagues at Depression Alliance Scotland and included their answers here. If we’ve missed something out, email us your question at ask@lookokfeelcrap.org. There isn’t detailed information about each kind of antidepressant. If you have specific questions about the medication you have been prescribed you can:
The general position is:
Frequently asked questions about antidepressants
What are anti-depressants?Antidepressants have been around since the 1950s, and now there are over 30 kinds available in the UK. They work by re-balancing the chemicals in the brain, called neurotransmitters, which are affected by mood, including serotonin and noradrenaline. There are 5 main types of anti-depressants – check out the What’s the difference? question below to find out more about each type and what they do. <<back to top>> Are they addictive?No. Antidepressants do not cause addiction that can happen with tranquilisers (or with nicotine, alcohol or herion) whereby there is a need to keep increasing the dose to get the same effect. However, up to a third of people who stop SSRI or SNRI medication do have withdrawal symptoms. These will be mild in most people, but sometimes these symptoms can be quite severe. Read the answer to What happens when I stop taking medication? to find out more information about withdrawal symptoms. <<back to top>> Do they work?There’s been heaps of talk about anti-depressants in the media recently – words like effectiveness, placebo, trials… The issue has been about drug companies only publishing selected studies and questions have been raised about how helpful anti-depressants really are. There are many studies that show that anti-depressants do help a large number of people. But as with any treatment, they work better for some people and not so well for others. Some people choose not to take medication for their depression. The general position is that anti-depressants are helpful for people with moderate to severe depression, ideally in combination with psychological treatment. This means that as the chemicals in the brain are changing the person also has the opportunity to work through any issues they have which is affecting their depression. Anti-depressants are not recommended for people with mild depression. Instead, people with mild depression will typically be offered other types of support such as talking therapy or self-help options. <<back to top>> What else do they treat?Antidepressant medicines, despite the name, are also known to be effective for the following conditions:-
If you are unclear why an antidepressant has been suggested for you, ask your doctor. <<back to top>> There seem to be lots of different kinds. What’s the difference?Most anti-depressants fall into one of five main categories. Within each of the categories, the individual anti-depressants work in a similar way and have similar side-effects. The following list includes most of the commonly prescribed antidepressants with typical side-effects. Ask you GP or pharmacist if you have any specific questions about your medication. For full details on side-effects you should study the data sheet provided with your medication. Tricyclics: Tricyclics were the first antidepressant to be used, and have been in use since the 1950s. This class of drugs includes Amitriptyline (Tryptizol), Imipramine (Tofranil), Clomipramine (Anafranil), Lofepramine (Gamanil), Nortriptyline (Allegron), and Dosulepin (Prothiaden). Common problems with Tricyclics include a dry mouth, constipation, a slight tremor, a more rapid heart beat, sleepiness, and increased appetite. Men may experience difficulties either getting an erection or delayed ejaculation. Tricyclics are very dangerous in overdose. SSRIs (Selective Serotonin Reuptake Inhibitors): SSRIs are a type of antidepressant marketed in the UK since 1989. They block the re-uptake of serotonin into the nerve cell that released it, thereby prolonging its action. These drugs include Fluoxetine (Prozac), Paroxetine (Seroxat), Citalopram (Cipramil), and Sertraline (Lustral). Particularly in the first week or two SSRIs may cause nausea or even sickness and sometimes they may increase feelings of anxiety. They can cause problems with sexual function in both men and women. Overall the SSRIs are less prone to unpleasant side-effects than the Tricyclics and they are much less dangerous in overdose. MAOIs (Monoamine Oxidase Inhibitors): MAOIs are an older type of antidepressant which are not prescribed so much these days because of dietary restrictions. MAOIs include Phenelzine (Nardil), and Tranylcypromine (Parnate). Moclobemide (Manerix) is a newer “reversible” MAOI that has less stringent dietary restrictions. These are now rarely prescribed because of the dietary restrictions they impose. They can cause dangerous increases in blood pressure when taken with cheese, yeast (including beer), red wine and meat that isn’t fresh. SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors): These drugs slow the re-uptake of both noradrenaline and serotonin and thus prolong their action. Venlafaxine (Efexor) was the first SNRI and Duloxetine (Cymbalta) is the most recently licensed anti-depressant, which was released in Scotland in 2006. Venlafaxine is similar in its side effects to the SSRIs. It should not to be used in the presence of severe heart problems and it can increase blood pressure which should therefore be monitored. (It can cause weight gain and some problems with sex.) NASSA's (Noradrenaline and Selective Serotonin Antagonists): Mirtazapine (Zispin) is similar to the tricylics but has fewer side effects than the older drugs (and doesn’t cause problems with sex like the older drugs. It can be quite sedative and can cause weight gain.) Others: Reboxetine (Edronax) is a Selective Noradrenaline Reuptake Inhibitor (NARI). Mianserin and Trazadone (Molipaxin) are related to TCAs. Until the 1990s Tricyclics were the most commonly prescribed antidepressants but now the substantial majority of antidepressant prescriptions are for SSRIs. <<back to top>> What are the side-effects?Like all medicines, antidepressants can cause side effects. Unfortunately it is not possible to predict who will get these side-effects or how bad they will be, but most people respond well to the first antidepressant they are prescribed. Side effects can vary considerably between individuals and will usually go away after about 3 weeks. Do not be put off the drug your doctor has prescribed simply because a friend or relation had a problem with it. There is a good chance that you will not have the same problem. But tell your doctor if you have any concerns. They may decide that you need to change the dosage to be more effective or change to another type of antidepressant to find one that works best for you.
We have listed some typical side-effects in the question above, What’s the difference? If you are worried about any side effect, speak to your doctor or pharmacist. <<back to top>> How soon will I feel better?All antidepressants work slowly. The benefits tend to be felt over weeks rather than days and different symptoms will get better at different times. Most people start to feel some improvement after 2-3 weeks, however the full effect usually takes around 4-6 weeks. It is important to continue taking your antidepressant so that the full benefit can be felt. Unfortunately, side effects commonly occur before mood starts to improve. Some people will not experience any side effects whereas other may experience them more extremely. You should be made aware before starting your tablets which side effects might be expected, but if you are uncertain about anything when starting the tablets, you should consult your doctor, nurse or pharmacist. <<back to top>> Can I stop taking them when I feel better?No, you should keep taking your medication for the whole course of treatment as discussed with your doctor. If you stop taking an antidepressant, your original symptoms may return. To reduce the chance of becoming depressed again, they should be taken for at least a further 6 months after you start to feel better and often longer. You should not stop or reduce medication without speaking to your doctor first. <<back to top>> What if I miss a dose?Never change your dose without checking with your doctor. If you forget a dose, take it as soon as you remember as long as it’s within a few hours of the usual time - if it is not, wait until the following day and take it as you would normally. <<back to top>> Can I still drink alcohol?It is generally recommended that anyone taking an antidepressant should not take alcohol. The combination of any antidepressant with alcohol may cause drowsiness and increase the risk of falls and accidents. Also, very importantly, drinking alcohol usually makes depression worse. Excessive drinking is especially likely to do this. Once people are used to their medication, they can sometimes drink alcohol in small amounts without any problems. Avoid alcohol for the first 1-2 months, after this, if you want to drink, try a glass of your normal drink and see how you feel - if it doesn’t make you feel drowsy then it’s probably OK to drink small amounts. It pays to be cautious as alcohol affects different people in different ways, especially when they are taking medication. Never stop your medication because you fancy a drink at the weekend and never drink any alcohol and drive when on an antidepressant. <<back to top>> What if I am pregnant?It is always best to take as little as possible in the way of medication during pregnancy, especially in the first 3 months, however some mothers do take antidepressants when they are pregnant. There is some evidence that babies of mums on these medications may experience withdrawal symptoms after birth. Paroxetine (Seroxat) seems to be the antidepressant most likely to do this. Doctors are advised to consider alternative treatments in pregnancy but for some people, the risk of becoming depressed or remaining depressed may outweigh the possible risks associated with the medication. This is a very personal decision and is something your doctor and you should discuss together. For breastfeeding mums on antidepressants babies will only get, at most, a small amount of antidepressant from their mother’s milk. Some antidepressants are better than others in this regard. On balance, bearing in mind all the advantages of breastfeeding, it may be best to carry on whilst taking your antidepressant. Again this is a decision which should be thoroughly discussed with your doctor. <<back to top>> What happens when I stop taking medication?Some people do experience withdrawal symptoms when coming off antidepressant medication, but this will vary from person to person; up to one-third of people who stop their SSRI or SNRI have withdrawal symptoms. Usually these are mild but they can be severe for some people. Paroxetine (Seroxat) and Venlafaxine (Efexor) are most likely to be associated with withdrawal problems. The symptoms include: anxiety, dizziness, vivid dreams and bodily sensations like electric shocks. Other common symptoms include: nausea, stomach problems, loss of appetite, problems sleeping and headaches. Withdrawal symptoms are typically worse if you stop taking antidepressants suddenly. To reduce the risk of withdrawal symptoms you should plan to reduce you dose slowly over a number of weeks so that your body gets used to the change gradually. Your doctor will talk this over with you, It’s important that you always consult with your doctor about stopping taking any medication. <<back to top>>
|
|
Copyright: DAS, 2008; Last updated: 16/6/08 |
