When it comes to mental health conditions such as depression and anxiety, there are various methods to help treat them and lessen the symptoms. For many, making simple life changes can help improve mental wellbeing, however those with more severe mental health problems may choose psychological treatment such as cognitive therapy and counselling, whilst others choose medical treatment, this can include antidepressants.
Going down the antidepressant route can be rather intimidating for many. With the mind already feeling delicate and vulnerable, it can seem risky to add repeat prescription drugs to the mix. There are a lot of facts and figures online regarding the practicality and effectiveness of antidepressants, so it can be tricky to know what to believe. But don’t worry, in this article we’ve answered all of the common questions regarding antidepressants so that if you’re curious and maybe considering asking your GP or pharmacist about them, you’ll have a better understanding of what they’re all about.
What are antidepressants?
Antidepressants are primarily used to treat clinical depression – a mental instability where you feel persistently down for weeks or months. You can also feel constantly fatigued, numb, drained, and burnt out.
Antidepressants can also treat obsessive compulsive disorder (OCD), generalised anxiety disorder, and post-traumatic stress disorder (PTSD), they often come in tablet form, and you tend to start on the lowest dose necessary to help treat your symptoms.
According to PHE’s analysis, 17% of the adult population were prescribed antidepressants in 2017/18, a 15.8% increasing from 2015/16.
Types of antidepressants
What are SSRIs?
The most common and widely prescribed type of antidepressant is SSRI: Selective serotonin reuptake inhibitors. SSRI are preferred over other antidepressants as it tends to cause less side effects, and if an overdose were to occur, it would be less likely to be serious.
What are SNRIs?
Similarly to SSRIs, SNRIs (Serotonin–norepinephrine reuptake inhibitor), increases serotonin levels in the brain, however SNRIs also increase norepinephrine levels as they were originally designed to be more effective than SSNRs, however whether they’re more or less effective is debatable as people respond differently to each antidepressant.
What are TCAs?
An older type of antidepressant is TCAs. This rarely used medication can cause potentially serious side effects so should only be prescribed by a specialist doctor.
What do antidepressants do and how do they work?
If you don’t know how antidepressants work, then you’re not alone, in fact, no one knows exactly how they work. Although it is thought that they increase the levels of neurotransmitters in the brain, certain neurotransmitters, such as serotonin, are linked to your emotions, so by increasing the level of this chemical in your brain, your mood will change.
How do SSRIs work?
What SSRI stands for pretty much explains how this antidepressant works. To allow more serotonin to pass more messaging between nerve cells to increase the serotonin levels in your brain, SSRI blocks reuptake, thus changing your mood.
How do SNRIs work?
By increasing norepinephrine levels as well as serotonin levels. SNRI prevents you from rapidly absorbing these neurotransmitters. Norepinephrine affects your ‘fight-or-flight’ response, therefore reducing that feeling of anxiety that comes with an overstimulated fight-or-flight response.
How do TCAs work?
Like the other antidepressants, tricyclic antidepressants block the reuptake of serotonin and norepinephrine in presynaptic terminals, they also block the action of acetylcholine, another neurotransmitter like norepinephrine. All of this combined is believed to lessen depression.
Antidepressant side effects
One of the biggest worries that people have when antidepressants come up in conversation is the side effects that come with them, and if they’re worth experiencing for the result. Below, we’ve listed some of the most common, as well as some of the less common symptoms that you may experience.
It is worth noting that side effects of antidepressants are often worse to begin with but generally get easier over time as your body gets used to them.
Common side effects across all antidepressants are:
- Dizziness
- Drowsiness or difficulty sleeping
- Confusion
- Sweating
- Headaches
Other side effects that you may experience depends on the type of antidepressant you are taking.
SSRIs and SNRIs side effects
- Nausea and possible vomiting
- Feeling anxious and shaky
- Loss of appetite
- Low sex drive
TCAs side effects
- Dry mouth
- Constipation and difficulties urinating
- Heart rhythm problems such as arrhythmia or tachycardia
- Weight gain
It is important that you must continue taking your medication despite the side effects to ensure that the antidepressants work as intended. If the side effects are too much for you, make sure you speak to your GP, who may decide other treatment is necessary.
Switching antidepressants
In some cases, your GP may change your antidepressant if they believe one may be more effective than what you’re currently prescribed. Switching antidepressants requires careful consideration and monitoring as you may experience withdrawals from your old medication, and strong side effects from your new medication – not a nice combination.
There are four different ways in which your doctor will recommend you ease into your new antidepressant:
- Direct switch
Direct switch is when you stop taking your previous antidepressants and start taking your new medication the following day.
- Taper and immediate switch
This strategy is when you slowly take your old medication less and less until you stop altogether, then you begin your newly prescribed antidepressant. This is to decrease withdrawals.
- Taper, washout, and switch
With this method, after slowly decreasing the dosage of your previous medication, you wait up to six weeks for said medication to fully ‘washout’ of your system. Then you can switch to your new antidepressant.
- Cross taper
Cross taper involves gradually decreasing the dosage of your old medication whilst increasing the dosage of your new one.
Whichever method your GP recommends depends on various factors. Make sure your follow your doctor’s advice.
Antidepressant withdrawals and how to come off them safely
You should only come off antidepressants if your GP says that it is safe to do so. If you are stopping altogether, it is important to come off them slowly to reduce withdrawal symptoms.
Your doctor will discuss with you’re the best method for coming off antidepressants, it usually takes over 4 weeks or over to completely come off your prescribed medication.
Many of the withdrawal symptoms are similar to common symptoms when taking antidepressants, this can include:
- Trouble sleeping
- Sweating
- Anxiousness and confusion
Other possible symptoms are:
- Stomach problems
- The feeling of an electric shock in your head
Most people will experience withdrawal symptoms from their antidepressants after 5 days of stopping their medication and they tend to last couple of weeks. If you experience severe withdrawal symptoms for an extended period of time, make sure that you contact your GP.
Antidepressants and alcohol: Can you drink on antidepressants?
Like all prescribed medication, you should be careful when consuming alcohol. However, you should be particularly careful with antidepressants as alcohol itself is a depressant.
Drinking alcohol with common antidepressants, such as SSRIs and SNRIs, is less likely to cause unpleasant effects than TCAs, which may cause you to experience dizziness and drowsiness. It is recommended that you avoid alcohol as much as possible with any antidepressant.
So there you have, hopefully you learnt a thing or two about antidepressants in the article, and if you have been considering them as a method to help battle your demons, then we hope that you now have a better understanding of the medication, and the idea of being prescribed them by your GP is less scary and intimidating than before.
Remember that there is always help out there, one of the best treatments for depression is talking. Below we’ve listen some useful websites and helplines. No matter who you are or where you are, there is always someone out there who is a text or phone call away from giving you the opportunity to talk to them.
Samaritans - 116 123 (free from any phone)
Mind – 0300 123 3393
Anxiety UK - 08444 775 774
Nightline – for students
BEAT Eating Disorders - 0808 801 0677 (adult helpline), 0808 801 0711 (youth line)