Antidepressants are medicines that treat the symptoms of depression. There are almost 30 different kinds of antidepressant available.
Most people with moderate or severe depression benefit from antidepressants, but not everybody does. You may respond to one antidepressant, but not to another, and you may need to try two or more treatments before you find one that works for you.
The different types of antidepressant work about as well as each other. However, side effects vary between different treatments and people.
When you start taking antidepressants you should see your GP or specialist nurse every week or two for at least four weeks to see how well they are working. If they are working, you'll need to continue taking them at the same dose for at least four to six months after your symptoms have eased.
If you've had bouts of depression in the past, you may need to continue to take antidepressants for up to five years or longer.
Antidepressants aren't addictive, but be prepared to get some withdrawal symptoms if you stop taking them suddenly or you miss a dose.
Selective serotonin reuptake inhibitors (SSRIs)
If your GP thinks you would benefit from taking an antidepressant, you'll usually be prescribed a modern type called a selective serotonin reuptake inhibitor (SSRI). Examples of commonly used SSRI antidepressants are Seroxat (paroxetine), Prozac (fluoxetine) and Cipramil (citalopram).
They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a ‘good mood’ chemical.
SSRIs work just as well as older antidepressants and have fewer side effects.
They can, however, cause nausea and headaches, as well as dry mouth and problems having sex. However, all these negative effects usually improve over time.
Some SSRIs aren't suitable for children under the age of 18. Research shows that the risk of self-harm and suicidal behaviour may increase if they're taken by under-18s. Fluoxetine is the only SSRI that can be prescribed for under-18s, and even then only when a specialist has given the go-ahead.
Tricyclic antidepressants (TCAs)
This group of antidepressants is used to treat moderate to severe depression.
TCAs, which includes Dosulepin (dothiepin), Imipramil (imipramine) and amitriptyline, have been around for longer than SSRIs.
They work by raising the levels of the chemicals serotonin and noradrenaline in your brain. These both help lift your mood.
They're generally quite safe, but it's a bad idea to smoke cannabis if you are taking TCAs because it can cause your heart to beat rapidly.
Side effects of TCAs, which vary from person to person, may include dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness.
The side effects usually ease after 7 to 10 days, as your body gets used to the medication.
Monoamine oxidase inhibitors (MAOIs)
MAOIs, such as Nardine (phenelzine sulphate) are sometimes used to treat depression.
If you are taking MAOIs, you need to avoid food that contains the chemical tyramine, such as cheese, pickled meat or fish. Your GP will give you a more detailed list of food and drink to avoid.
You should also avoid drinking any alcohol or fermented liquids (even if they are alcohol free). Steer clear of smoking cannabis if you are taking MAOIs because it may affect the way these medicines work, and it's not clear what effect it may have on you.
Common side effects of MAOIs include blurred vision, dizziness, drowsiness, increased appetite, nausea, restlessness, shaking or trembling, and difficulty sleeping.
The dietary restrictions and potential for side effects mean that MAOIs are used very rarely, and are normally only prescribed when other treatments have not been effective.
Other antidepressants
New antidepressants, such as Effexor (venlafaxine) and Zispin Soltab (mirtazapine), work in a slightly different way from SSRIs and TCAs.
These drugs are known as SNRIs (serotonin-norepinephrine reuptake inhibitors). Like TCAs, they change the levels of serotonin and noradrenaline in your brain.
Studies have shown that an SNRI can be more effective than an SSRI, though they're not routinely prescribed as they can lead to a rise in blood pressure.
Withdrawal symptoms
Antidepressants are not addictive in the same way that illegal drugs and cigarettes are, but when you stop taking them you may have some withdrawal symptoms, including:
- upset stomach
- flu-like symptoms
- anxiety
- dizziness
- vivid dreams at night
- sensations in the body that feel like electric shocks
In most cases these are quite mild, but occasionally they can be quite severe. They seem to be most likely to occur with paroxetine (Seroxat) and venlafaxine (Effexor).
Common questions about antidepressants answered:
How long does it take for antidepressants to work?
Can I drink alcohol if I'm taking antidepressants?
How should antidepressants be stopped?
