posted on Oct, 25 2003 @ 04:32 PM
Ok folks, calm down, calm down Doctor Nerdling is here.
What are antidepressants?
Antidepressants are drugs that relieve the symptoms of depression. They were first developed in the 1950s and have been used regularly since then.
There are several different types, but this leaflet will concentrate on the older "tricyclic" antidepressants and the newer "SSRIs" (Selective
Serotonin Reuptake Inhibitors). These two types account for 95% of antidepressants prescribed. There is a newer group called "SNRIs" (Serotonin and
Noradrenaline Reuptake Inhibitors), but these are not yet so widely-used.
How do they work?
There are almost thirty different kinds of antidepressants available today. They all work by altering the way in which certain chemicals work in our
brains. These chemicals are made by our body and are called neuro- transmitters.
Neuro-transmitters are the chemicals which transmit signals between the cells in our brains. In depression, some of the neurotransmitter systems,
particularly those of Serotonin and Noradrenaline, don't seem to be working properly. We think that antidepressants work by increasing the activity
of these chemicals in our brains.
What are antidepressants used for?
They are used to treat moderate to severe depressive illnesses. They are also used to help the symptoms of severe anxiety, panic attacks and
obsessional problems. They may also be used to help people with chronic pain, eating disorders and post-traumatic stress disorder. Don't assume that
because you have been prescribed an antidepressant that this means you are suffering from depression. If you are not clear about why you have been
given them, ask your doctor.
How well do they work?
Studies have found that after 3 months of antidepressant treatment between 50% and 65% of the people who take them will be much improved (see
references). This compares with 25 - 30% of people given an inactive "dummy" pill, or placebo. It may seem surprising that people given placebo
tablets improve, but this happens with all tablets that affect how we feel - the effect is similar with painkillers. Antidepressants do seem to be
helpful but, like many other medicines, some of the benefit is due to the placebo effect.
Are the newer ones better than the older ones?
Yes and no. The older tablets (Tricyclics) are just as effective as the newer ones (SSRIs) but, on the whole, the newer ones seem to have fewer side-
effects. A major advantage for the newer tablets is that they are not dangerous if someone takes an overdose of them.
Do antidepressants have side effects?
Your doctor will be able to advise you here. You should always remind him or her of any medical conditions you have or have had in the past.
These commonly cause a dry mouth, a slight tremor, fast heatbeat, constipation, sleepiness, and weight gain. Particularly in older people, they may
cause confusion, slowness in starting and stopping when passing water, faintness through low blood pressure, and falls. If you have heart trouble, it
may be best not to take one of this group of antidepressants. Men may experience difficulty in getting or keeping an erection, or delayed ejaculation.
Tricyclics are dangerous in overdose.
During the first couple of weeks of taking them, you may feel sick and more anxious. Some of these tablets can produce nasty indigestion, but you can
usually stop this by taking them with food. More seriously, they may interfere with your sexual function. There have been reports of episodes of
aggression, although these are rare.
The list of side effects looks worrying - there is even more information about these on the leaflets that come with the medication. However, most
people get a small number of mild side-effects (if any). The side effects usually wear off over a couple of weeks as your body gets used to the
medication. It is important to have this whole list, though, so you can recognise side effects if they happen. You can then talk them over with your
doctor. The more serious ones - problems with urinating, difficulty in remembering, falls, confusion - are uncommon in healthy, younger or middle-aged
It is common, if you are depressed, to think of harming or killing yourself. Tell your doctor - suicidal thoughts will pass once the depression starts
What about driving or operating machinery?
Some antidepressants make you sleepy and slow down your reactions - the older ones are more likely to do this. Some are fine to take when driving.
Remember, depression itself will interfere with your concentration and make it more likely that you will have an accident. If in doubt, check with
Are antidepressants addictive?
Antidepressant drugs don't cause the addictions that you get with tranquillisers, alcohol or nicotine. You don't need to keep increasing the dose to
get the same effect. You won't find yourself craving them if you stop taking them.
However, studies have shown that up to a third of people have withdrawal symptoms for a short time when they stop antidepressants. These include
stomach upsets, flu like symptoms, anxiety, dizziness, vivid dreams at night or sensations in the body that feel like electric shocks (see
They seem to be most likely to happen with an SSRI antidepressant called Paroxetine (Seroxat), but can be prevented by slowly reducing the dose of
antidepressant rather than stopping it suddenly.
What about pregnancy?
It is always best to take as little as possible in the way of medication during pregnancy, especially during the first 3 months. However, some mothers
do have take antidepressants during pregnancy. The evidence so far is that their babies don't show any harmful effects from this.
What if the depression comes back?
Some people have severe depressions over and over again. Even when they have got better, they may need to take antidepressants for several years to
stop their depression coming back. This is particularly important in older people, who are more likely to have several periods of depression. For some
people, other drugs such as Lithium may be recommended. Psychotherapy may be helpful in addition to the tablets.
So what impact would these tablets have on my life?
Depression is unpleasant. It can seriously affect your ability to work and enjoy life. Antidepressants can help you get better quicker. They can be
prescribed by your GP and, apart from the side effects listed overleaf, should have very little impact on your life. People on these tablets,
particularly the newer ones, should be able to socialise, carry on at work, and enjoy their normal leisure activities.
If you have been depressed for a long time, others who know you well (for example your partner) may have got used to you being like this. Some people
in this situation have reported that, as they get better and developed a more lively outlook, their partners had difficulty in adjusting to the
change. This can cause friction in a relationship and is something that people need to be aware of and discuss openly if it happens.
What will happen if I don't take them?
It's difficult to say - so much depends on why they have been prescribed, on how bad your depression is and how long you've had it for. It’s
generally accepted that most depressions resolve themselves naturally within about 8 months. It is quite possible to get through a mild depressive
episode using some of the other treatments mentioned later in this factsheet. If you are in doubt, then you should talk to your doctor.
Courtesy: Royal college of Psychiatrists.