Skip to main content

Cautions - Antidepressants

There are several important things to consider when taking antidepressants. You should discuss these with a GP or mental health professional.

Interactions with other medicines

Antidepressants can react unpredictably with other medicines, including some over-the-counter medicines such as ibuprofen. Always read the patient information leaflet that comes with your medicine to see if there are any other medicines you should avoid.

If in doubt, your pharmacist or GP should be able to advise you.

Pregnancy

As a precaution, antidepressants are not usually recommended for most pregnant women, especially during the early stages of a pregnancy.

This is because there might be risks for you or your baby.

But it's important that depression is well treated because it can affect both you and your baby's wellbeing. Depression and anxiety can sometimes get worse during pregnancy and after your baby is born.

Speak to your doctor, who will help you understand the risks and benefits so you can decide on the best treatment for you and your baby.

Breastfeeding

Some antidepressants can be taken while breastfeeding if your doctor or health visitor says your baby is healthy.

Speak to your doctor, who will help you understand the risks and benefits so you can decide on the best treatment for you and your baby.

Children and young people

The use of antidepressants is not usually recommended in children and young people under the age of 18. This is because there is some evidence that, in rare cases, they can trigger thoughts about suicide and acts of self-harm in this age group.

Antidepressants are not recommended for the initial treatment of mild depression in children and young people.

For moderate to severe depression, antidepressants may be used if both the following apply:

  • the person being treated will also receive talking therapies in combination with antidepressants
  • the treatment is supervised by a child and adolescent psychiatrist (a doctor who specialises in treating mental health conditions in children)

Alcohol

You should be wary of drinking alcohol if you're taking antidepressants, as alcohol is itself a depressant and drinking alcohol can make your symptoms worse.

If you drink alcohol while taking types of antidepressants called tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs), you may become drowsy and dizzy.

You're less likely to experience unpleasant or unpredictable effects if you drink alcohol while taking an SSRI or a serotonin-noradrenaline reuptake inhibitor (SNRI) antidepressant, but avoiding alcohol is often still recommended.

Illegal drugs

The use of illegal drugs is not recommended if you're taking antidepressants, particularly if you've been prescribed a tricyclic antidepressant (TCA). This is because they can cause unpredictable and unpleasant effects.

In particular, you should avoid taking:

  • cannabis – smoking cannabis while taking a TCA can make you feel very ill
  • amphetamines (speed)
  • cocaine
  • heroin
  • ketamine

As with alcohol, illegal drugs can make symptoms of depression or other mental health conditions worse.

Other antidepressants

You should only take 2 different types of antidepressants, such as an SSRI and a tricyclic antidepressant (TCA), if a doctor advises you to. This is because taking certain combinations of antidepressants can make you feel very ill and can be life-threatening.

If a decision is taken to switch you from a particular type to another, the dosage of the first antidepressant will usually be gradually reduced before the second is started.

St John's wort

St John's wort is a popular herbal remedy promoted for the treatment of depression.

While there's evidence of its effectiveness, many experts advise against its use, because the amount of active ingredient varies among individual brands and batches, making the effects unpredictable.

Taking St John's wort with other medicines, such as antidepressants, anticonvulsants, anticoagulants and the contraceptive pill, can also cause serious health problems.

You shouldn't take St John's wort if you're pregnant or breastfeeding, as it's unclear whether it's safe.

Driving and operating machinery

Some antidepressants can cause dizziness, drowsiness and blurred vision, particularly when you first start taking them.

If you do experience these problems, you should not drive or use tools and machinery.

Cautions for specific antidepressants

SSRIs

SSRIs may not be suitable if you have:

  • bipolar disorder and you're in a manic phase (a period where you're extremely excitable), although they can be useful for depressive phases
  • a bleeding disorder
  • type 1 diabetes or type 2 diabetes
  • epilepsy – SSRIs should only be taken if your epilepsy is well controlled, and the medicine should be stopped if your epilepsy gets worse
  • kidney disease

SNRIs

SNRIs may not be suitable if you have a history of heart disease or you have poorly controlled high blood pressure (hypertension).

Tricyclic antidepressants (TCAs)

TCAs may not be suitable if you have:

Page last reviewed: 4 November 2021
Next review due: 4 November 2024