Depression treatment: medication

Antidepressants can be very effective at treating moderate to severe depression. Mild forms of depression usually respond to talking therapies alone, but antidepressants can also be used in conjunction or as sole treatment depending on the patient’s preference.

Depression treatment: medication options

Treatment for depression can be in the form of medication or talking therapies. Antidepressants are proven to help reduce the severity of the depression, hasten recovery and protect against a relapse.

Recent studies¹ have shown that antidepressants are an effective treatment for depression, although it may be necessary to trial a few different types of antidepressants before you find one that will work for you.

Life events such as deaths, births, getting married or divorce are a known cause of depressive episodes. The actual symptoms of depression are due to chemical imbalances in the brain, which is why antidepressants can be effective.

However, the actual life event that may have caused or exacerbated the depressive episode might require talking therapy to be resolved.

Talking therapies can be highly effective at helping someone overcome depression, with the added bonus that the effects can last a lifetime and teach the patient useful skills and coping mechanisms they can use at a later date.

¹ Cipriani, A. (2018)

Are antidepressants right for me?

Understanding the reasons for your depression is the first step to knowing whether antidepressants are right for you.

1. Not a magic pill - antidepressants are not a magic pill that can take your life problems away.
2. Talking therapies might be more effective - research has shown that in cases of mild to moderate depression, talking therapies may be more appropriate and give longer lasting effects than taking antidepressants.
3. Severity of symptoms - for those with severe disorders such as bipolar disorder or moderate to severe depression antidepressants can be very effective.
4. Combined approach - in many cases taking antidepressants along with a talking therapy such as counselling or psychotherapy is the most effective way of treating depression.

Prescribing antidepressants

Antidepressants need to be prescribed by a psychiatrist or GP.

During your initial assessment you will have a full medical history and will discuss your symptoms. There are several types of antidepressant you can take as not all antidepressants work for all people.

Your psychiatrist will work with you to ensure you are taking the right antidepressant and also to make sure you are taking the right dosage. It can take several weeks to see the effects, during which you may need to revisit the prescribing clinician to make any changes to the dose you are taking.

How do antidepressants work?

The brain consists of many nerve cells that relay messages back and forth, controlling our movements, emotions, thoughts and behaviours.

It is thought that one cause of depression could be due to changes in the levels of the chemicals (neurotransmitters) that relay these messages. Common antidepressants target two of these neurotransmitters, serotonin and noreadrenaline.

Antidepressants work by prohibiting the nerve cells from reabsorbing the neurotransmitters, once they have relayed their messages. Essentially this creates higher levels of these chemicals in the brain, which in turn decreases the feeling of depression.

Side effects of antidepressants

There is lots of information on the internet regarding the side effects of antidepressants, with many asking whether the side effects could actually be worse than the depression itself.

Side effects of antidepressants can unfortunately be quite common, particularly in the first few weeks.

The side effects will often subside or stop altogether after this time, once the individual has built up a tolerance to the drugs, however it’s not uncommon for people to stop taking their medication because they cannot tolerate the side effects.

Antidepressants can be hugely effective at making someone who is suffering with depression feel better and for those with severe depression or suicidal thoughts, they can be a lifeline.

Common side effects of antidepressants:

• Headaches
• Nausea
• Sickness
• Weight gain
• Trouble with sleeping – drowsiness in the day / trouble getting to sleep at night
• Sexual functioning problems – lack of libido, erectile dysfunction, difficulties achieving orgasm

It is very important that you discuss any changes to the way that you take your antidepressants with your prescribing consultant before you make changes as stopping them suddenly can lead to withdrawal or a rapid decline in mood.

Withdrawal symptoms for antidepressants

A study by the Royal College of Psychiatrists found that withdrawal symptoms from antidepressants were very common with 63% of people surveyed reporting some side effects.

The most common side effects were anxiety, dizziness, vivid dreams and ‘head zaps’. Other side effects include tremors, hallucinations, and sleep issues.

It is thought that the withdrawal symptoms could be caused by the impact that the reduced levels of neurotransmitters in the brain.

Abruptly stopping anti-depressant medication can greatly exacerbate withdrawal symptoms. All anti-depressants MUST be tapered off gradually – your doctor or Psychiatrist will be able to advise you on how to do this safely.
Dr Olukemi Akanle – Consultant Adult Psychiatrist and Clinical Partner: London

Some side effects may also be due to a relapse of the depression or a sign that the medication isn’t working so watching out for these signs is important.

The newer antidepressants (SSRIS, SNRIs and NaSSAs) are relatively safe to use. Venlafaxine can cause elevation of blood pressure, an ECG is usually recommended before commencing this antidepressant. TCAs and MAOIs are also effective but are less preferable due to their side effect profiles and the dietary restrictions necessary with MAOIs

Dr Olukemi Akanle

MBBS, MRCPsych

Consultant Psychiatrist

London

Dr Olukemi Akanle is a knowledgeable Consultant Psychiatrist currently working for Central and North West London NHS Foundation Trust. She has a Medical Degree and is a Member of the Royal College of Psychiatrists.