Taking antidepressants
How do antidepressants work?
Are antidepressants addictive?
The SNRIs
The SSRIs
Older antidepressants
Side effects

The first step in getting help for depression is recognising that you may have a problem and discussing your symptoms with your GP. This is not necessarily as easy as it sounds. Accepting the help of others can be a major hurdle to overcome.

As a start, if you find that you have five or more of the following symptoms, you should seek medical advice:
Feeling. Depressed, sad, anxious or bored.
Energy. Tiredness, fatigue, everything seems an effort, slowed movements.
Sleep. Waking during the night or too early in the morning. Oversleeping or trouble getting to sleep.
Thinking. Slow thinking, poor concentration, forgetful or indecisive.
Interest. Loss of interest in food, work, sex and life generally.
Value. Reduced sense of self-worth, low self-esteem or guilt.
Aches. Headaches, chest or other pains or palpitations without a physical basis.
Live. Not wanting to live, suicidal thoughts or thinking of death.

Taking antidepressants
The aim of antidepressant treatment is to remove the symptoms of depression, to help an individual function well in life and to prevent relapse. Ideally, antidepressant treatment should be combined with counselling.

There have been major improvements in antidepressant medicines over the past 20 years. There are many different groups or classes of antidepressants. These work on the brain in different ways. The newer classes of drugs are known as the SNRIs and the SSRIs. They are safer than the older classes of drugs.

An important consideration in antidepressant treatment is that medication is prescribed at an adequate dose and that it is taken for as long as the doctor recommends. Research has indicated that more than half the people prescribed with antidepressants don’t take their medication according to the instructions. This means that failure to improve and relapse is quite common.

The choice of medication is tailored to the individual. It is important to work closely with your doctor in devising a treatment plan and to have regular reviews to assess how effective the medication is proving, whether there have been any side effects and how severe these are. To make the best choice of medication, the doctor needs to know how depression is affecting an individual. For example, are there other disorders along with the depression, does the person feel anxious or tired, do they have panic attacks, will an antidepressant work well with another medicine the person might be taking? Until an antidepressant is tried out, it is difficult to know whether it will work.

Improvement may not be felt for two to four weeks after starting on an antidepressant. It is important to continue with treatment even when you feel better. Treatment usually lasts from six to nine months once results are seen from initial treatment. In addition, it is unwise to discontinue medication without discussing this with your doctor first.

How do antidepressants work?
It is believed that depression is linked to an imbalance of chemicals within the brain. Different antidepressants have been designed to deal with these imbalances but they do so in slightly different ways. Within in the brain there are a number of chemical messengers. There are called neurotransmitters. Key neurotransmitters are serotonin and noradrenaline. When these behave normally, mood is regulated. However, if these neurotransmitters are not moving freely as they should, depression occurs. In different ways, antidepressants act on the brain to keep these neurotransmitters working properly.

Are antidepressants addictive?
Antidepressants are not addictive. In some cases there can be withdrawal symptoms, but these can be avoided if the drug is gradually stopped. It is important to consult with your doctor if you are due to finish up a course of antidepressants and not to give up your medication without medical advice.

The SNRIs
The newest antidepressants are called serotonin and noradrenaline re-uptake inhibitors (SNRIs). These work on both serotonin and noradrenaline to achieve a better balance of chemicals in the brain to alleviate depression. There are two SNRIs available in Ireland Efexor/Efexor XL and Cymbalta.

The SSRIs
The most commonly used class of drug are the SSRIs. Selective serotonin re-uptake inhibitors work on the serotonin levels in the brain. Serotonin is a neurotransmitter which passes messages between nerve cells. SSRIs help the serotonin to function properly, thus alleviating depression. There are many SSRIs available in Ireland. Examples of commonly used ones are Lexapro, Seroxat and Prozac. There are several versions of Prozac available such as Prozamel and Prozatan.

Other antidepressants are noradrenergic and specific serotonergic antidepressants (NsSSAs), reversible inhibitors of monoamine oxidase type A (RIMAs) and noradrenaline re-uptake inhibitors (NARIs).

Older antidepressants
Tricyclic antidpressants have been around for a long time and are still used extensively in certain cases. TCAs also work on balancing serotonin and noradrenaline. They are used when newer drugs are not effective or not suitable for an individual.

Monoamine oxidase inhitors (MAOIs) are less frequently used because they can interact with food and cause other severe side effects. Moclobemide is a newer version which is safer and may be used as a second choice for major depression if other antidepressants do not work.

Lithium is an older but commonly used treatment for people who have major bouts of depression and elation. (See Lithium treatment).

Side effects
With all antidepressants, there can be side effects in the first few weeks of treatment. These should be reported to the doctor. Sometimes, you can feel more anxious at the beginning of treatment but this feeling usually settles down.

The emphasis should be take an antidepressant strictly as directed by your doctor, keep a note of mood and any possible side effects and if you feel that you may be experiencing something serious, visit your doctor.

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For more information and advice, contact the Aware Helpline at 1890 303 302