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AntidepressantsThis factsheet is for people who would like information about taking medicines available to treat depression. Antidepressants are used to treat depression. This factsheet concentrates on the two types of antidepressants that doctors prescribe most - tricyclics and selective serotonin re-uptake inhibitors (SSRIs).
Why would I take them?Your doctor may prescribe antidepressants if you have clinical depression. Clinical depression is also known as major depression. It usually means you have a low or depressed mood, plus a range of other symptoms for at least two weeks. For more information, please see the separate BUPA health factsheet, Depression. Doctors divide major depression up into mild, moderate and severe depression. Antidepressants are often not needed for mild depression. Psychological therapies ("talking treatments") such as counselling or cognitive therapy can be effective for this type of depression. Some types of antidepressant can make you sleepy. This can be a nuisance, but if you also have anxiety or you are not sleeping well, it can be an advantage. Some other conditions that are treated with antidepressants are panic disorder, obsessive-compulsive disorder and social phobia. Some antidepressants are also used to treat bedwetting in children and for chronic pain, even for people who aren't depressed. What are the main types?The main types of antidepressants are tricyclics and SSRIs. Both types work well for moderate or severe depression. These have different side-effects, and your doctor will normally prescribe you with the one that will cause you the least problems. How do antidepressants work?Doctors and scientists don't fully understand what happens in the brain during mood problems, such as depression. Nor do they know exactly how the treatments that are effective actually work. But it is known that people who are depressed usually have reduced levels of certain brain chemicals called neurotransmitters, such as noradrenaline and serotonin. Drugs that boost levels of noradrenaline and serotonin work as treatments for depression. Neurotransmitters are released by nerve cells and work by creating a "chemical ferry" that carries a burst of information across the tiny gap between the nerve and its neighbour. Once they've done their job, neurotransmitters are re-absorbed into the nerve cell. This is also called re-uptake. Drugs that boost levels of neurotransmitters work by either encouraging cells to make more of them, or by preventing their re-uptake. In both cases, there are more neurotransmitters in the gap between cells, so information can travel more effectively. Tricyclic antidepressants increase levels of both noradrenaline and serotonin in the brain by blocking their re-uptake into nerve cells. The SSRIs specifically block the re-uptake of serotonin. How to take an antidepressantTricyclics and SSRIs are only available on a doctor's prescription. They come as tablets or capsules, and sometimes in a liquid form. Antidepressants usually take about 10 to 14 days before they start having any effect, and it may take about six weeks before they start working fully. Unfortunately, many of the side-effects caused by these drugs occur immediately, but may also stop after a few weeks. You will probably need to carry on taking an antidepressant that works for you for at least four to six months, once your symptoms have cleared up. You may need to carry on taking a "maintenance" dose of antidepressant continuously if you get repeated bouts of depression. At the same time as a course of antidepressants, you may be offered some psychological treatment (eg counselling or cognitive therapy) as well, which may work better than antidepressants on their own. Always read the patient information leaflet that comes with your medicine.Special careYou should use an antidepressant with care if you have heart problems or reduced liver function. Tell your doctor or pharmacist if you are pregnant or breastfeeding before taking any antidepressant. Side-effectsCommon side-effects with the tricyclic antidepressants are drowsiness or tiredness, a dry mouth, blurred vision, constipation or difficulty passing urine. Some side-effects settle down with time. An overdose can cause dangerously abnormal heart rhythms. The SSRIs also have side-effects but they may be less troublesome. In particular, they don't cause drowsiness. Other possible side-effects include:
Less commonly, SSRIs can cause:
SSRIs, except for fluoxetine, are not recommended for people under 18, because of concerns that they may increase the risk of self-harm in this age group. Antidepressants are not addictive but withdrawal symptoms can occur if they are stopped suddenly. Symptoms of sudden withdrawal include nausea, vomiting, loss of appetite, headaches, dizziness, chills, insomnia, anxiety and panic. Discuss stopping antidepressants with your doctor first. He or she may suggest you reduce the dose gradually, as this can prevent withdrawal symptoms. Taking some antidepressants can interfere with skilled activities such as driving. Don't carry out such tasks until you know how you react to your medicine. Interactions with other medicinesCheck with your doctor or pharmacist before you take any other medicines or herbal remedies at the same time as your antidepressants. St John's Wort, which is sold as a herbal antidepressant, can interfere with many drugs (including SSRIs), making the normal dose stronger or weaker than usual. Other antidepressantsAlternatives to tricyclics and SSRIs include venlaflaxine (Efexor), reboxetine (Edronax) and mirtazapine (Zispin). These also work by affecting the levels of neurotransmitters in the brain and may work better for specific symptoms. They may also be an option if a tricyclic or SSRI hasn't worked. Another group of antidepressants known as monoamine oxidase inhibitors (MAOIs) is also available. Drugs in this group include phenelzine (Nardil) and moclobemide (Manerix). MAOIs can have lots of interactions with other drugs and foods such as cheese, increasing the risk of side-effects. They are not commonly prescribed, but may be worth trying if other types of antidepressants have not worked. Names of common antidepressantsExamples of the main types of antidepressants are shown in the table. The generic name is the chemical name of a medicine. If a manufacturer has rights over a medicinal compound, it is given a brand name. Often there is more than one brand name associated with a generic name. Generic names are normally written with a lower-case initial letter and brand names normally start with an upper-case letter. There are many different products marketed for constipation. Some have more than one ingredient, or different ingredients sold under the same brand name. Ask your pharmacist for advice.
Further information
Sources
Published by BUPA's health information team, healthinfo@bupa.com, February 2007.
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