In this blog, I am going to discuss medication that is used to treat depression. I am not medically trained so a lot of this information I have gained through research – however I have got personal experience of taking anti-depressants so I will also draw on this while writing this post.
Antidepressants are a type of medicine used to treat clinical depression. They can also be used to treat a number of other conditions, including:
Obsessive compulsive disorder (OCD)
Generalised anxiety disorder
Post-traumatic stress disorder (PTSD)
Antidepressants are also sometimes used to treat people with long-term (chronic) pain.
Scientists aren’t sure exactly how antidepressants work. But it is thought that they work by increasing levels of certain chemicals in your brain called Neurotransmitters. Certain neurotransmitters, such as serotonin and noradrenaline, are linked to mood and emotions so taking antidepressants can help lift the individuals’ mood. Neurotransmitters may also affect pain signals sent by nerves – hence they can also be used to relieve long-term pain.
Some doctors and patients have doubts over whether antidepressants work at all and point to the big placebo effect – in trials, those given dummy pills also improve to some degree. However a study published in the Lancet in early 2018 finally puts to bed the controversy on antidepressants - clearly showing that these drugs do work. The study took six years and included all the published and unpublished data that the scientists could find. It was carried out by a team of international experts. They looked at results after eight weeks of more than 500 trials involving either a drug versus placebo or comparing two different medicines. The study can be read on the following page https://www.thelancet.com/action/showPdf?pii=S0140-6736%2817%2932802-7
There are several different types of antidepressants:
Selective serotonin reuptake inhibitors (SSRIs) – The most widely prescribed type of antidepressants. The National Institute for Health and Clinical Excellence (NICE) suggests that SSRIs have fewer side effects than the other types of antidepressants so they are usually the preferred choice. An overdose is also less likely to be serious. Fluoxetine is probably the best known SSRI (sold under the brand name Prozac).
Other SSRIs include citalopram, peroxetine and sertraline.
Serotonin-noradrenaline reuptake inhibitors (SNRIs)
SNRIs are similar to SSRIs. They were designed to be a more effective antidepressant than SSRIs. However, the evidence that SNRIs are more effective in treating depression is uncertain. It seems that some people respond better to SSRIs, while others respond better to SNRIs. Examples of SNRIs include duloxetine and venlafaxine.
Noradrenaline and specific serotonergic antidepressants (NASSAs)
NASSAs may be effective for some people who are unable to take SSRIs. The side effects of NASSAs are similar to those of SSRIs, but they're thought to cause fewer sexual problems. However, they may also cause more drowsiness at first. The main NASSA prescribed in the UK is mirtazapine.
Tricyclic antidepressants (TCAs)
TCAs are an older type of antidepressant. They're no longer usually recommended as the first treatment for depression because they can be more dangerous if an overdose is taken. They also cause more unpleasant side effects than SSRIs and SNRIs. Exceptions are sometimes made for people with severe depression that fail to respond to other treatments. TCAs may also be recommended for other mental health conditions, such as OCD and bipolar disorder. Examples of TCAs include amitriptyline, clomipramine, imipramine, lofepramine and nortriptyline. Some types of TCAs, such as amitriptyline, can also be used to treat chronic nerve pain.
Monoamine oxidase inhibitors (MAOIs)
MAOIs are an older type of antidepressant that are rarely used nowadays. They can cause potentially serious side effects so should only be prescribed by a specialist doctor. You often cannot eat certain foods if you take these. Examples of MAOIs include tranylcypromine, phenelzine and isocarboxazid.
Different antidepressants will have different side effects. The newer antidepressants should have fewer side effects than the older ones however people can have different reactions to medication so it is important to bear this in mind and keep in regular contact with your GP to review anything prescribed. If you have been taking antidepressants for a few weeks you should also not stop taking them suddenly. Antidepressants are not addictive but the body can become used to them. If you stop taking them suddenly you may experience withdrawal symptoms so discuss stopping medication with your GP. They will probably suggest a plan to slowly reduce you off them, which can help reduce any withdrawal effects.
It is also important to bear in mind that while antidepressants can treat the systems of depression, they don’t always address its causes. This is why they should be used in combination with therapy.
There is unfortunately still a stigma around depression and anti-depressant medication. At some deep level, Newspaper reports and well-meaning advice seem to want people to be wrong for choosing to take antidepressants. Every now and then columnists circle like vultures over each new story about how doctors hand out antidepressants “like sweeties”, or that side-effects might turn you into a monster, or that the drugs don’t in fact work at all.
Despite the scaremongering in the media we need to remember the benefit these medications have on people on a daily basis. We need to remember that taking antidepressants do not make you weak – they make you stronger and anyone who has taken antidepressants and found they feel less depressed will tell you, it can be the difference between life and a kind of living death. Don’t put off doing something about depression – go and see your doctor straight away and follow their recommendations. They know what they are talking about!