Antidepressants are drugs that relieve the symptoms of
depression. There are almost thirty antidepressants available today
and there are four main types:
- SSRIs (Selective serotonin reuptake
inhibitors)
- SNRIs (serotonin and noradrenaline
reuptake inhibitors)
- Tricyclics
- MAOIs (Monoamine oxidase
inhibitors)
- The tricyclics and the MAOIs are less
commonly used these days – usually by specialists - you can
find more information about these in our main leaflet.
Antidepressants can be used
for:
- Moderate to severe depressive illness
(Not mild depression)
- Severe anxiety and panic attacks
- Obsessive compulsive disorders
- Chronic pain
- Eating disorders
- Post-traumatic stress disorder
How well do they work?
Research suggests that after three months of
treatment, around 50-65% of people with moderately severe
depression given antidepressants will be much improved compared
with 25-30% of the people given an inactive ‘dummy pill’ or
placebo.
What are the side effects of
antidepressants?
SSRIs
During the first couple of weeks of taking
them, you may feel sick and more anxious. Some of these tablets can
produce nasty indigestion, but you can usually stop this by taking
them with food. They may interfere with your sexual function.
SNRIs
These have similar side effects are similar to
the SSRIs. Venlafaxine can increase your blood
pressure, so this should be monitored.
This may all sound worrying, but most people
only get mild side-effects which usually wear off over
a couple of weeks.
What about driving or operating
machinery?
Some antidepressants make you sleepy and slow
down your reactions - the tricyclics are more likely to do this.
Some can be taken if you are driving. Remember, depression itself
will interfere with your concentration and make it more likely that
you will have an accident. If in doubt, check with your doctor.
Are antidepressants addictive?
Antidepressant drugs don't cause the
addictions that you get with tranquillisers, alcohol or nicotine.
They don't act quickly, you don't need to keep increasing the dose
to keep getting the effect and you don't find yourself craving
them.
However, some people who stop SSRIs and SNRIs
do get withdrawal symptoms. These include stomach upsets, flu like
symptoms, anxiety, dizziness, vivid dreams at night or sensations
in the body that feel like electric shocks.
In most people these withdrawal effects are
mild, but in a small number of people they can be quite severe. It
is generally best to taper off the dose of an antidepressant rather
than stop it suddenly.
What about feelings of suicide?
There is evidence of increased suicidal
thoughts (although not actual suicidal acts) and other side effects
in younger people taking SSRIs. So, apart from fluoxetine,
SSRIs are not licensed in the UK for use in people under 18.
There is no clear evidence of an increased
risk of self-harm and suicidal thoughts in adults – but individuals
mature at different rates. Young adults are more likely to commit
suicide than older adults, so any young adult needs close
monitoring if they take an antidepressant.
How long will I have to take them for?
Antidepressants don't necessarily treat the
cause of the depression or take it away completely. Without any
treatment, most depressions will get better after about eight
months. If you have had two or more attacks of depression then
treatment should be continued for at least two years.
If you stop the medication before eight or
nine months is up, the symptoms of depression are more likely to
come back. It is suggested that it is best to take antidepressants
for at least six months after you start to feel better. During this
time, it is worth thinking about what might have triggered off your
depression and ways to prevent it happening again.
What if the depression comes back?
Some people have repeated severe depressions
and may need to take antidepressants for several years to control
these episodes. Sometimes other drugs such as
lithium may be recommended. Psychotherapy may be helpful in
addition to the tablets.
What other treatments for depression are
available?
- Talking treatments some of these are now
available as self-help books or as self-help courses on the
internet
- Herbal
remedies
- St John’s
Wort
- Light boxes for seasonal affective
disorder
How do these other treatments compare with
antidepressants?
Recent studies have suggested that over a
period of a year, many talking treatments are as effective as
antidepressants, particularly in mild to moderate depression. It is
generally accepted that antidepressants work faster. Some studies
suggest that it is best to combine antidepressants and
psychotherapy.
For more in-depth
information see our main leaflet.
This leaflet is made available through the
generosity of the 
Charitable Monies Allocation Committee of the mental
health charity St Andrew's, Northampton
February 2009. This is an
abridged version of our main
leaflet.
Copyright (2008) Royal College
of Psychiatrists www.rcpsych.ac.uk.
You can link to, download, print, photocopy and distribute this
leaflet free of charge. But you must not change it or repost it on
a website.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
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