MANAGING DEPRESSION WITH ANTIDEPRESSANTS
As a private GP clinic, our doctors regularly see patients suffering from mental health conditions such as depression and anxiety. In fact, it's thought that up to 10% of people in the UK will experience depression at some point in their lifetime.
Depression can be managed using a range of tools, including therapies (such as cognitive behavioural therapy, CBT) and lifestyle changes (including reducing stress, getting more exercise and better sleep). Some people are able to effectively manage their depression using a combination of these tips, whereas others may find their depression resistant to such management techniques. This is where antidepressants come in, which we will discuss in more detail this article.
The first antidepressants were developed in the 1950s and have been used regularly since. They can also be used to treat chronic pain. Antidepressants work by increasing the power of the neurotransmitters that control your mood and can be divided into the following different classes:
- SSRIs (selective serotonin reuptake inhibitors)
- SNRIs (serotonin noradrenaline reuptake inhibitors)
- Tricyclic antidepressants
- MAOIs (Monoamine oxidase inhibitors)
- Other medications
Antidepressants & Chronic Pain
Increasing the levels of neurotransmitters such as serotonin and noradrenaline can also disrupt the pain signals sent by nerves to help with chronic pain.
How Are Antidepressants Taken?
Antidepressants are normally taken in a tablet form and need to be taken for up to four weeks before any benefit is felt. Some side effects may be felt during the first few weeks but these usually wear off.
A normal course of treatment is 6 months, although some doctors will recommend taking antidepressants for at least 6 months after the last period of low mood to try and prevent the low moods from developing again.
Your doctor should start you on the lowest possible dose and slowly increase, to try and work out the dose most effective for you.
Monitoring Progress on Antidepressants
When starting treatment, stay in touch with your doctor as they will monitor your mood and if you experience any side effects; they then may recommend changing the dose or drug you are taking. You will need to take the medication every day.
Antidepressant Side Effects
- While taking antidepressants, you may feel sleepy if you also drink alcohol. You can drink alcohol, but this should be in moderation.
- Some antidepressants can make you feel drowsy which can affect your ability to drive or operate heavy machinery, and this is something you should consider.
- Antidepressants may also affect your sex life, by causing tiredness and affecting your hormones so that you have a lower sex drive, difficulty getting an erection or difficulty having an orgasm.
Some antidepressants can make you feel sleepy or drowsy
Can I Take Antidepressants If I Am Pregnant?
Some antidepressants may be better than others during pregnancy and so this is something that should be discussed with your doctor.
The side effects of some antidepressants during pregnancy can include:
- Low birth weight of your baby
- Heart disease
- Being bad tempered
- Increased blood pressure in the vessels between your lungs and heart.
Small amounts of antidepressants can also be passed into breast milk and so this should be discussed with your doctor or midwife.
The Different Types of Antidepressant
There are many different medications used to treat depression, with most of which falling into the following categories:
SSRIs are primarily prescribed for low mood and depression and are believed by NICE (National Institute for Clinical Excellence) to cause less side effects than other forms of antidepressants. They are the most widely prescribed type of antidepressants. They can also be prescribed for other mental health issues such as anxiety, bulimia, panic disorders and obsessive compulsive disorder.
How Do SSRI's Work?
SSRIs work by blocking the re-uptake of serotonin into the nerve cell, prolonging its action in the brain. SSRI’s include medications such as:
- Citalopram* (Cipramil**)
- Escitalopram (Cipralex)
- Fluoxetine (Prozac)
- Fluvoxamine (Faverin)
- Paroxetine (Seroxat)
- Sertraline (Lustral)
(*Active ingredient; ** brand names given by the manufacturer)
What Are The Side Effects of SSRIs?
SSRIs can cause a range of side effects depending on the person who is taking them. These include nausea and vomiting, insomnia, sexual dysfunction. There is some evidence that SSRIs increase suicidal thoughts in young people and for this reason only fluoxetine is licensed for use in under 18s.
SNRIs are used to treat depression and chronic pain. They include medications such as:
- Duloxetine (Cymbalta/ Yentreve)
- Venlafaxine (Efexor)
- Reboxetine (Edronax).
A side effect of these is high blood pressure.
3. Tricyclic antidepressants
Tricyclic antidepressants can be used to treat a variety of conditions including chronic pain, depression, migraine, panic disorders and obsessive compulsive disorder (OCD).
These medications can take two to four weeks to start having an effect and generally have more side effects than other antidepressants; they are prescribed less frequently as overdoses can be more dangerous.
How Do Tricyclic Antidepressants Work?
They work by prolonging the action of noradrenaline and serotonin in the brain.
Side Effects of Tricyclic Antidepressants
Tricyclic antidepressants often have more side effects than other antidepressants and these include dry mouth, blurred vision, drowsiness, weight gain and constipation.
4. Monoamine oxidase inhibitors
Monoamine oxidase inhibitors are an older class of medication that aren’t prescribed as regularly now; they include the following:
How Do MAOI's work?
They stop monoamine oxidase from breaking down serotonin and noradrenaline, causing them to stay active for longer and boost mood.
Side Effects of MAOI's?
These have similar side effects to tricyclic antidepressants in that they can cause dizziness, drowsiness, dry mouth and constipation.
When taking MAOIs, you should be careful not to eat foods containing tyramine, as this is a protein that can build up in your body when on this medication. This includes foods such as:
- Salted meats or fish
- Pickled meats
- Overripe fruit and vegetables
- Oxo/ Marmite /Bovril
- Certain wines or beers
If you are taking MAOI's, you should be careful not to eat foods containing tyramine (including cheese), since the protein can build up in your body.
Other Antidepressant Medications
Mirtazapine can also be prescribed as an antidepressant; it is a noradrenaline and specific serotonergic antidepressant (NASSAs) believed to be effective in those that cannot take SSRIs. It may cause drowsiness at first but is believed to cause fewer sexual issues.
Stopping Taking Antidepressants
Antidepressants should not be stopped suddenly and your GP will advise you on how to slowly reduce the dose to minimise the chance of developing withdrawal symptoms. People can react very differently to coming of antidepressants; some may experience a lot of side effects whereas others will experience none at all.
Antidepressant Withdrawal Symptoms
Common side effects of stopping SSRIs include irritability, vivid dreams, difficulty sleeping, flu-like symptoms, feeling tearful or dizzy and shock-like feelings. Occasionally people can develop memory and concentration problems or problems with their movement.
SNRI withdrawal can cause tiredness, dizziness, headache, difficulty sleeping, nightmares, dry mouth, loss of appetite, nausea, diarrhoea, nervousness, agitation, confusion or tingling. Rarely people may experience electric shock sensations, weakness, sweating, seizures or flu-like symptoms.
Stopping tricyclics suddenly can cause difficulty sleeping, flu-like symptoms and excessive dreaming. Rarely they can also cause movement problems, heart rhythm issues or euphoria.
MAOI withdrawal can cause drowsiness, anxiety, irritability, disturbed sleeping patterns, slowed speech and lack of muscle coordination. They can occasionally cause hallucinations or delusions.
If you are living with depression, or think you might be depressed, we would strongly recommend booking in an appointment at your GP surgery, to discuss your options. It's important to note that antidepressants are not prescribed by any doctor without significant consideration, and in the majority of cases, other therapies and lifestyle changes are recommended either beforehand or concurrently.
By Katie Hodgkinson