SSRIs - Selective serotonin reuptake inhibitors These are the most prescribed type antidepressant, have less side effects than others and are less risky in case of an overdose. Side effects – nausea, sickness, problems with sexual functioning can be side effects in the first few weeks.
SNRIs – Serotonin and noreadrenaline reuptake inhibitors These offer a different mode of action to SSRI’s in treating depression and anxiety and can be an effective alternative to SSRI’s if they are not effective. Side effects – nausea, sickness, headaches, fluctuations in blood pressure, sweating and problems with sexual functioning can be side effects in the first few weeks.
NaSSAs – Noreadrenaline and specific serotoninergic antidepressants These work by antagonising the parts of the brain that are noradrenaline and serotonin receptors, enhancing the way that these chemicals work. Side effects – there are often fewer side effects with NASSA’s but they can act as a sedative and cause weight gain.
Tricyclics This type of antidepressant is not prescribed as much as SSRI’s / SNRI’s because it can have worse side effects and there are more risks if an overdose is taken. They can have potentially life threatening cardiac effects in overdoses. However it can be very effective for treating severe depression that has not responded to other treatments and can also be used to treat obsessive compulsive disorder or bipolar affective disorder. Side effects – dry mouth, constipation, tremors, sleepiness, increased appetite, issues with sexual functioning
MAOI’s – Monoamine oxidase inhibitors These antidepressants are rarely prescribed because there are severe dietary restrictions imposed. Consuming cheese, red wine, yeast, marmite and some meat can all result in dangerous increases in blood pressures.
I started antidepressants and felt a bit sick and woozy to start with. My husband tells me I was quite disconnected for the first few weeks as well, but things shifted about then. I am a year into taking them and can’t see why I would stop. Having battled with self harm, depression and anxiety for most of my adult life, just feeling stable and able to cope with life’s challenges is a complete blessing. I can still ‘feel’ emotions but I don’t hit the complete lows any more.
Patient on Citalopram
What to expect when starting antidepressants
Reading the side effects above you might feel a little nervous and worried about starting antidepressants – many people will experience some side effects in the first few weeks as the brain gets used to the new levels of chemicals. However, for most, these side effects do disappear within a few weeks.
Start low - your doctor will normally start you on a low dose of antidepressants and then advise that you can increase the dose over time.
Check-ups - it’s common to need to revisit your GP or Psychiatrist at around 6 months to see if your symptoms are improving.
It can take time to see the effects - research has suggested that one role antidepressants can play in helping depression is by building new neurons, which explains why they take some to come into full effect. This being the case, you may need to wait a few weeks before knowing if you should increase your dose.
It’s normal to worry that your personality might change - some people worry that by taking antidepressants they might turn into ‘zombies’ or feel ‘dead behind the eyes’, or perhaps even feel like they might become a different person. There is no way of knowing what you will feel like until you have tried them, but working with a Psychiatrist you should be able to find the right treatment option for you.
Patients are sometimes reluctant to start antidepressant medication for fear of becoming addicted to them. Antidepressants can be discontinued at any time without any long term effects. As long as they are tapered off slowly, withdrawal symptoms can be minimised or avoided all together.
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.
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