Antidepressants: key facts

Under Review April 2018 

Everyone has days when they feel low, but when these symptoms persist and impact on someone's life, then antidepressants are used to relieve the symptoms. They are 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

Types of antidepressants

There are four types that may be prescribed: 

How does it feel to take antidepressants?

Overall: After three months of treatment, 5-6 out of 10 people with depression will feel much improved.

Side effects of antidepressants?

Most people only get mild side-effects which wear off over a couple of weeks, but you should be aware of them.

SSRIs and SNRIs: for the first couple of weeks, they can make you feel sick and anxious. This can cause indigestion, but this improves if you eat. They can also cause diarrhoea, constipation and tiredness. They can interfere with your sexual function.

Venlafaxine is an SNRI and it can increase your blood pressure, so this should be monitored regularly.

Are antidepressants addictive?

Antidepressants are not addictive like tranquillisers, alcohol or nicotine. You don't need to keep increasing the dose for them to work and you don't find yourself craving them.

But, one third of people who stop SSRIs and SNRIs can 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. These withdrawal effects are usually mild, but for some people they can be quite a problem.

 It is best to reduce the dose gradually rather than stop it suddenly.

What about driving or operating machinery?

Some antidepressants (especially the tricyclics) make you sleepy and slow down your reactions.  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.

Do people experience feelings of suicide?

Evidence suggests that young people who take SSRIs have increased suicidal thoughts (but not actual suicidal acts). Therefore, in the UK, SSRIs are not licensed for people under 18, although specialists may use Fluoxetine in some cases.

There is no clear evidence that adults have an increased risk of self-harm and suicidal thoughts if they take antidepressants. It is known that younger adults are more likely to commit suicide than older adults, so a 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. If you stop the medication too soon, the symptoms of depression are more likely to come back. It is  best to take antidepressants for at least six months after you start to recover. During this time, it is worth thinking about what might have triggered off your depression and ways to prevent it happening again. If you have had two or more attacks of depression, then you should take an antidepressant for at least two years.

What if the depression comes back?

Some people have repeated depressions and need to take antidepressants for several years to control them. Sometimes other drugs, such as lithium, may be used. Psychotherapy can help alongside to the tablets.

What other treatments for depression are available?

• Talking treatments are best for mild depression. Over a year, many talking treatments are as affective as antidepressants in moderate depression. However, antidepressants and psychotherapy (talking treatment) are often used together. Some talking treatments are now available in book form or as Internet modules.
• St John’s Wort:  Herbal remedies.
• Light boxes for seasonal affective disorder.

For more in-depth information see our main leaflet: Antidepressants.

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Dr Sophie Swinhoe

Under Review April 2018 Royal College of Psychiatrists.

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