Why have I been prescribed antidepressants?

You have been prescribed antidepressants because you have been diagnosed with depression. Depression is much understood by the public, yet it affects many people of all ages. It is estimated that one in five people will experience depression at some point in their lives.

Depression has a wide range of physical and psychological symptoms, which sometimes make it hard to recognise and understand. Depression can affect anyone at any time. Depression can be treated with, among other things, antidepressants.

How do antidepressants work?

The symptoms of depression are thought to be caused by a drop in the levels of some natural brain chemicals. These brain chemicals are called noradrenaline and serontonin and it could be that one or both of them are causing your depression. All antidepressants work by increasing levels of these chemicals in the brain.

Are antidepressants effective?

Around 60-70 per cent of people will make a good recovery, so the medicines can be very effective. If one particular medicine does not work for you, often another one will. People also usually find that a combination of treatments, for example, medication, 'talking treatments' (therapy) and self-help work best.

Why have I been prescribed this particular drug?

There are several different groups of antidepressants available in the UK. The most commonly used ones are tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs).

• MAOIs are not used very much now, even though they are effective antidepressants, mainly because people takings MAOIs have to follow a special diet that excludes cheese and other foodstuffs. However, MAOIs are sometimes still used, particularly when a person has not improved with other forms of treatment.
• TCAs are often used when treating people with depression. Unfortunately, most TCAs have troublesome side-effects in some patients, causing problems such as sleepiness, dry mouth, blurred vision, constipation and weight gain. Most are also dangerous if taken in overdose.
• SSRIs are also effective as antidepressants. Many depressed patients find them easier to take than other antidepressants. However, the SSRIs can cause problems such as sexual difficulties or worsened anxiety, in a minority of patients.

There are a number of new antidepressants that do not belong to the three main classes - for example nefazodone, mirtrazapine, reboxetine and venlafaxine. All are effective antidepressant drugs, and somewhat better tolerated than older TCAs. Their side-effect profiles differ from each other, and from the other classes of drug.

Antidepressants need to be tailored to meet the needs of individual patients, so if you are not on commonly prescribed antidepressants, it is probably just because they do not suit you, while the less common one works for you.

How long will the antidepressants take to work?

Antidepressants need to reach a certain dose before they begin to work. The level of the dose varies for different antidepressants. They do not work quickly. For most people a response occurs within about two to three weeks of reaching the minimum dose. For some it may take a month and in older people even longer, perhaps as long as six or even eight weeks. It is important to persevere to give the treatment a full chance of working.

What will happen if I miss a dose?

Don't worry. Take it as soon as you remember, as long as it is only a few hours after the usual time. Otherwise wait until your next dose is due and take it as normal - do not try to catch up by doubling your dose.

When I feel better can I stop taking them?

No. You need to allow time for the brain chemicals to recover fully. This takes at least four to six months in most people, sometimes longer. How long you need to take them for is something you should discuss with your doctor or nurse. Do not stop taking your tablets without talking to a health professional first.

Why is it so important to keep taking them?

When taken regularly, antidepressants will contribute to the recovery of around 60-70 per cent of patients. Typically, you will feel significantly improved within a few months. It is important that you continue with the treatment, as prescribed by your doctor, even beyond the time you feel better: if you stop too early, there is a high risk of becoming depressed again, within the first six months of stopping treatment.

In those with more severe forms of depression, with recurring episodes, antidepressants can have a role in preventing new periods of depression along with talking treatments, self-management and self-help.

Are antidepressants addictive?

Current medical advice is that antidepressants are not addictive. People often confuse antidepressants with a type of tranquilliser called benzodiazepines. Tranquillisers are habit forming and people can find it difficult to stop taking them.

Do antidepressants have any unpleasant side-effects?

All medicines have side-effects - even the ones you can buy at the chemist without a prescription. The important thing to remember is that not everyone gets them. In fact, usually only a minority of people get side-effects that are so bad they cannot continue the treatment. It is important to balance unpleasant side-effects against the distress and pain caused by the depression. Even if you do get side-effects, you will get them for a limited period of time, while depression can last a lot longer if it is left untreated. Nevertheless, if they do persist, go back to see your doctor or nurse.

Do I really have to take them?

Depression should always be taken seriously, it is an illness that affects your quality of life and that of all your family. Antidepressants provide one effective form of treatment but they only work if they are taken properly. Persevere with taking them and make sure you discuss fully with your doctor or nurse any side-effects, or if you think they are not working. It is also worth remembering that there are many other treatment options available and many people find that combination of medication, talking treatments and self-help works best. It may take a little while before you find the right treatment(s) for you, but you should give each one enough time to work before giving up on it.

Remember that although you may find it difficult to look forward to the future with any optimism or hope for recovery, millions of other people have faced similar feelings and have been helped to recover by taking antidepressants.

© Nursing Standard (2002), August 7 2002, 16, 47

For further information contact:

• Depression Alliance,Depression Alliance Scotland Depression Alliance Cymru 35 Westminster Bridge Road,Telephone: 0131 467 3050 Telephone: 029 2069 2891 London, SE1 7JB Telephone: 020 7633 0557