Antidepressants are medications that are prescribed to treat certain types of mental illness, including depression, anxiety and OCD.
- Treat various forms of mental illness.
- Available in numerous forms.
- Occasionally used to treat certain types of pain.
If you are concerned about mental illness, you can speak to one of our GMC-registered clinicians via our online video consultation service. They are available from 9.30am to 4.30pm, Monday to Friday.
What are antidepressants?
Antidepressants are a group of medications that treat various forms of mental illness, including depression, generalised anxiety disorder, post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). There are different types of antidepressants, ranging from the older monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) to the newer selective serotonin reuptake inhibitors (SSRIs) serotonin noradrenaline reuptake inhibitors (SNRIs) and noradrenaline and specific serotonergic antidepressants (NaSSAs).
Because people react differently to these medications, finding the right dosage and specific treatment for you can involve some trial and error.
What is depression?
Clinical depression is when you experience low mood for a prolonged period of time. Depression is not the experience of general ‘ups and downs’, which everyone feels at some point. Instead, the low mood associated with depression is profound and sometimes dangerous, and may persist for many months at a time without treatment.
What symptoms does depression cause?
Symptoms of depression can be quite varied, but the most common include sadness, hopelessness, tearfulness, low self-esteem, misplaced guilt, irritability, a lack of motivation, indecisiveness, anxiety, suicidal thoughts and a compulsion to self-harm. You may also experience some physical symptoms, including constipation, weight changes, fatigue, loss of libido, menstrual changes, insomnia, over sleeping and general aches and pains. One of the major symptoms of depression is difficulties socialising, which can in turn exacerbate the condition. This may manifest as avoiding contact with your loved ones, no longer engaging in things that you used to enjoy and strain on your personal relationships.
Causes of depression may vary significantly from one person to the next. For some people, it can be triggered by the loss of a loved one or job, while for others it may be caused by a traumatic event. In many cases however, it isn’t always clear why it develops.
How is depression treated?
Treatment depends on what’s triggering the depression in the first place, and its severity. Milder forms of the condition can be managed by making lifestyle changes, such as taking exercise, and seeing if the depression resolves itself. In more severe cases, a mixture of medication and talking therapies, known as combination therapy, may be required. This can include cognitive behavioural therapy (CBT), which helps someone to manage negative thought patterns and reverse their effects. Self-help groups may also offer support by providing a space in which to interact with others who have the condition.
What is generalised anxiety disorder?
Generalised anxiety disorder can often be a symptom of depression, but may present independently as a condition in its own right, and it can cause significant distress for people who experience it. Anxiety is characterised by a feeling of unease, which can range from a general sense of discomfort to severe panic disorders (such as chronic panic attacks). We all experience anxiety from time to time, but in some cases, it can become difficult to manage, and interfere with someone’s daily life.
What symptoms does generalised anxiety disorder cause?
Symptoms include a sense of dread, restlessness, irritability and poor concentration, which may lead someone to avoid social situations and contact with friends and family in severe cases. Physical symptoms may also manifest, with fatigue, dizziness, palpitations, a dry mouth, shaking, aches and pains, sweating, difficulty breathing, stomach aches, nausea, headaches, insomnia and pins and needles commonly reported.
What causes generalised anxiety disorder?
Causes of anxiety differ from person to person. Most cases are triggered by something specific, such as climbing a ladder with a phobia of heights. Generalised anxiety disorder however causes anxiety that persists beyond the perceived threat, and functions in the background day-to-day, sometimes without any clear cause.
Because generalised anxiety disorder is a long-term condition, it often requires a mixture of talking therapies and medication. CBT has proven to be as effective a treatment for anxiety as it is for depression, and meditation may help to manage symptoms without the need for medication. If your anxiety does not improve with these practices however, medication may be offered. Antidepressants or anti-anxiety drugs can be effective, although anti-anxiety drugs are only suitable on a short-term basis. Finding the right dosage and treatment for you may require some trial and error, with how effective particular treatments might be for you specifically and side effects of medications taken into account.
Many symptoms of anxiety can also be managed with lifestyle changes, such as exercise and avoiding alcohol, stopping smoking and reducing your caffeine intake.
What is post-traumatic stress disorder?
Post-traumatic stress disorder, or PTSD, can develop having experienced a distressing or traumatic event. It may stem from being the victim of a violent act, emotional distress or experiencing a life-threatening illness. Symptoms of PTSD can have a major impact on someone’s life, and sometimes manifest years after the traumatic event has occurred. They can include re-experiencing the event in flashbacks and nightmares, and include physical symptoms such as sweating, nausea and even pain.
People with PTSD often feel inclined to avoid certain triggers, such as specific people or places, making day to day life and personal relationships difficult. Other symptoms may include angry outbursts, insomnia, poor concentration, depression, anxiety, drug abuse (including alcohol), headaches, chest and stomach pains, as well as seemingly unrelated phobias.
How is post traumatic stress disorder treated?
Confronting PTSD can be difficult for someone who has the condition, but there are many treatment options available. These include psychological therapies alongside medication, CBT and group therapy, which can also prevent the isolation associated with PTSD from becoming overwhelming. A new treatment called eye movement desensitisation and reprocessing (EMDR) has shown to be very effective for some people. It entails side to side eye movements (tracking of your therapist’s finger) while re-living the event that triggered the condition in the first instance. It is not fully understood how this helps, but it can cause a significant reduction in the severity of PTSD.
What is obsessive compulsive disorder?
Obsessive compulsive disorder, or OCD, is a common complaint in the UK that can affect men, women and children, and may develop at any age. It involves obsessive behaviour that is hard to control. For example, you may find it difficult to leave the house because you can’t resolve yourself with having not left the oven on. In other instances, the condition may present as an impulse to touch certain objects in a specific order, a specific number of times. Other forms of OCD may cause you to have obsessive thoughts about a subject that you find difficult to stop, causing a great deal of anxiety, or an obsession with germs, for example, resulting in obsessive cleaning of surfaces, objects or your hands. One of the most common presentations of the disorder is hoarding, where someone finds it difficult to part with objects, resulting in large accumulations of objects. It can be distressing for people who experience it and impact on their daily lives considerably, but treatment can help to bring symptoms under control.
What treatments are there for obsessive compulsive disorder?
Treatment for OCD will largely depend on the degree to which it is affecting your life. There are two types of treatment which are available: psychological and medicinal. Psychological treatments include CBT and exposure and response prevention (ERP). These work by unpacking symptoms into their separate parts and dealing with them one by one, for example your thoughts, actions and feelings. By encouraging someone to face your fears, it can make the condition more manageable, and provide them with tools to deal with its symptoms when they occur.
Should CBT and ERP not prove effective, medication may be suggested, with SSRI antidepressants the most commonly prescribed treatment. You should notice a difference within around 12 weeks, as well as a reduction in side effects.
If you would like to discuss symptoms of mental illness with a doctor, you can make an appointment to speak to one of our GPhC-registered clinicians via our online video consultation service, from 9.30am-4.30pm, five days a week. They can also issue fit notes and referral to specialists for treatment, where suitable.
What side effects do antidepressants have?
There are many types of antidepressants available, and the side effects listed below may not apply to the medication you have been prescribed. If you have any concerns about side effects, you should speak to your prescribing clinician and read the patient information leaflet that comes with your medication.
The following side effects relate to the most commonly prescribed type of antidepressant, selective serotonin reuptake inhibitors. These include:
Very common (may affect more than 1 in 10 people): nausea, dry mouth, headache, increased sweating, sleepiness and difficulty sleeping.
Common (may affect up to 1 in 10 people): tremors, dizziness, loss of appetite and weight, anxiety, feeling ‘on edge’, confusion, a reduced sex drive, numbness of the skin, difficulties concentrating, ringing in the ears, loose stools, being sick, problems defecating, indigestion, stomach pain, wind, excessive saliva, muscle and joint pain, itching, fatigue, tiredness, difficulties achieving orgasm amongst women, menstrual discomfort, impotence, difficulties ejaculating and nightmares.
Uncommon (may affect up to 1 in 100 people): altered heartbeat, increased appetite and weight gain, aggression, feeling detached, hallucinations, mania, euphoria, increased sex drive, fainting, dilated pupils, hives, rash, hair loss, redness or red spots on the skin, photosensitivity, urinary retention, heavy menstrual period and oedema.
Rare (may affect up to 1 in 1,000 people): Abnormal bleeding, fits, involuntary movements, taste abnormalities, liver inflammation, fever and low blood sodium.
The following side effects have been reported but there is not enough data to reflect their frequency: arrhythmias, allergies, syndrome of inappropriate antidiuretic hormone secretion (SIADH), low potassium levels, panic attacks, teeth grinding, restlessness, serotonin syndrome, movement disorder, visual disturbances, QT-prolongation, dizziness having stood up quickly, nosebleeds, blood in the stools, abnormal liver function test results, bruising, milk secretion from the breasts in men, painful prolonged erection, irregular menstrual bleeding and an increased risk of bone fractures.
Warnings and precautions for antidepressants
If you experience any of the following symptoms during treatment you should seek immediate medical assistance: Restlessness, confusion, trembling, euphoria, fever, shivering, hallucinations, muscle cramps, rapid heartbeat may signify a condition called serotonin syndrome. Restlessness may mean you are suffering from a side effect called akathisia. You should also seek medical attention if you are having suicidal thoughts or those of self-harm.
Is it safe to take antidepressants alongside other treatments?
You should inform your doctor of any other medication you are currently taking or have recently taken. You should avoid using Citalopram if you are also taking: MAOI antidepressants, Linezolid, class IA and III antiarrhythmics, antipsychotics, tricyclic antidepressants, sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, halofantrine, astemizole and mizolastine.
Your doctor should also be informed if you are taking any of the following: sumatriptan or other triptans, oxitryptan or tryptophan, tricyclic antidepressants, other serotonin re-uptake inhibitors, lithium, tramadol, St. John’s Wort, desipramine, blood-thinning medicines, oral anticoagulants (including aspirin), NSAIDs, dipyridamol and ticlopidine, cimetidine, medicines to treat stomach ulcers, fluvoxamine, neuroleptics, metoprolol, heart rhythm medicines, medicines that reduce blood levels of potassium or magnesium, antipsychotic medicines.
Are antidepressants safe to take while you are pregnant?
It depends on the treatment you are taking. You should speak with your prescribing clinician if you are pregnant, thinking of becoming pregnant or are breastfeeding.
Can I consume alcohol whilst taking antidepressants?
Consuming alcohol whilst taking antidepressants is generally not recommended, as it can make depression worse. It can also increase the risks of side effects in some cases.
Some antidepressants, such as SSRIs, don’t usually interact adversely with alcohol, but the interaction may lead to drowsiness. If you are unsure, consult your prescribing clinician.
Will my ability to drive be affected whilst taking antidepressants?
Antidepressants are likely to affect your ability to drive at the beginning of treatment. These symptoms, such as slow reactions, tend to subside after a few weeks. You should therefore avoid operating any heavy machinery until you are sure how these medications affect you.
Can antidepressants cause allergic reactions?
Allergies to antidepressants do occur, but they are rare. You should read the patient information leaflet that comes with your treatment if you have a specific allergy that you think may be relevant, and speak with your prescribing doctor if you have any concerns.
Can I buy antidepressants over the counter?
Almost all antidepressants require a prescription in order for you to receive treatment, with the exception of the herbal remedy St John’s Wort. You must not mix St John’s Wort with these treatments, however, and you should inform your doctor if you are currently taking it, or have recently used it.
How can I buy antidepressants online?
You can speak to one of our GMC-registered clinicians about antidepressants using our online video consultation service. They are available for appointments between 9.30am and 4.30pm, Monday to Friday. They can also issue referral to specialists for treatment and fit notes, where appropriate.