10 things you need to know about antidepressants
Dr Cathy Stephenson is a GP and forensic medical examiner.
Tragically, depression is incredibly common, with figures showing that 1 in 6 of us will be affected at some point in our lives.
The effects on the individual, and their support network can be devastating, not to mention the huge impact on work, family and social life. Not everyone with depression will need antidepressants, but for many they can be quite literally life-saving.
Despite how frequently they are prescribed, I still find a lot of confusion out there about what these drugs are, how they work, and what some of the more common issues might be when using them. So here are a few things that you might want to know:
1. Antidepressants were first developed in the 1950s, and have been used extensively since then. There are more than 30 different kinds of antidepressants available today, from five main groups: SSRIs (serotonin selective reuptake inhibitors, by far the most commonly used), SNRIs (serotonin and noradrenaline reuptake inhibitors), NASSAs (noradrenaline and specific serotoninergic antidepressants), tricyclic antidepressants, and MAOIs (monoamine oxidase inhibitors).
2. One "size" or type definitely doesn't fit all when it comes to antidepressants. It is not uncommon to have to try three or four different types, at varying doses, before finding the one that works best, and has the least side effects. Occasionally, people may require two antidepressants at once to improve their depression.
3. How they work: We still don't fully understand how antidepressants seem to work, or why they are more effective for some people than others. However, their effect is probably caused by an increase in the activity of certain chemicals in the brain known as neurotransmitters. These chemicals are associated with our emotions, and the most common ones associated with depression are serotonin and noradrenaline. A lack in these neurotransmitters seems to predispose people to depression, but undoubtedly lots of other factors, both environmental and familial, come into the equation as well.
4. They don't work immediately – all antidepressants take up to four weeks to have their full effect. Some people will report an initial small benefit, but the full impact will be felt from two weeks to a month after starting them. After a month, you are unlikely to get further benefit from the medication alone, but obviously all the other positive actions you can put into place (exercise, counselling, mindfulness) will continue to hasten your recovery.
5. Side effects: All antidepressants can have side-effects, but the likelihood of experiencing them varies hugely from individual to individual. If side effects are mild and occur from the first few days of treatment, they are likely to be transient, and should settle as you continue taking the drug. However, other side effects (such as sexual problems) are more likely to persist, and you should consider switching to another type that might suit you better. Very rarely, people can become suicidal on antidepressants – this usually occurs shortly after starting them, and stops when the antidepressant is withdrawn or changed. If this occurs, it is important to avoid that antidepressant again in the future.
6. Antidepressants can interact with other things, often in an unpredictable way. This can include other medications, recreational drugs and alcohol. Make sure your doctor knows what else you are taking when they do your prescription and check with them whether it is safe to drink alcohol or not. This is also one of the reasons why it is really important not to share your medication – how things react will vary depending on the individual, so its not safe to share your tablets with anyone.
7. Don't stop them suddenly or "skip" doses. As they work by creating a steady level of neurotransmitters in the brain, missing doses or suddenly stopping them can make you feel awful, as well as being quite dangerous. They are not addictive in the scientific sense, but if you want to stop your antidepressant it is always advisable to wean down the dose very slowly, over weeks or months as your doctor suggests, to avoid any horrible side effects.
8. Postnatal depression is really common, especially if you have had depression before. But the good news is many of the newer antidepressants are safe to use whilst pregnant or breast-feeding. Talk to your doctor about which ones are the best.
9. Antidepressants are very necessary for severe depression, and some people need to remain on them for life. But if your symptoms are at the mild end of the spectrum, it is equally effective to use "non-drug" treatments, such as talking therapies, exercise, grounding and mindfulness.
10. Although they are called antidepressants, the same medications are actually used to treat other conditions too – primarily anxiety disorder, obsessive compulsive disorder and some eating disorders.
Written by Dr Cathy Stephenson. First appeared on Stuff.co.nz.