Depression: Antidepressant medical treatment
Antidepressants are drugs that are used to treat depression and can be prescribed only by a doctor.
There is a great deal of misinformation about antidepressant medication and there is no simple explanation of how antidepressants work.
Medication can be important in the treatment of moderate to severe depression and in some anxiety and related disorders. The following information provides detail about what antidepressants do, how they work and where to get more information and help.
How does antidepressant medication work?
Research shows that more severe forms of depression are associated with specific changes in the brain, including changes to some hormones and chemical message systems. In these forms of depression, there are alterations in the activity of the brain in areas under the influence of the brain chemicals serotonin and noradrenaline.
Different types of antidepressants work in slightly different ways, but they all act on chemicals in the brain related to emotions and motivation.
When is an antidepressant medication used?
Antidepressant medication is often prescribed, alongside psychological treatments, when a person experiences a moderate to severe episode of depression and/or anxiety. They are also prescribed when other treatments have not been helpful or psychological treatments are not possible due to the severity of the illness or the lack of access to treatment.
Which antidepressants are best?
Making a decision about which antidepressant is best can be complex. The decision should be made in consultation with a doctor after careful assessment and consideration. People can help the doctor's assessment by providing as much information as possible about themselves and their medical history.
The following are some factors that should be discussed with a doctor before starting antidepressants:
- Age - Depression is a common condition that affects people of all ages. These medications are not generally recommended for treatment of depression in children and young people, but they may be prescribed in certain circumstances. Psychological therapies such as Cognitive Behavioural Therapy and Interpersonal Therapy are the recommended first option the treatment of depression children and young people.
- Chronic illness - Like any medication, antidepressants can affect existing symptoms or treatments for other illnesses.
- Pregnancy and breastfeeding - The decision to take medication whilst pregnant or breastfeeding is an individual one. This decision should be made in consultation with a doctor who can provide information about the risks and benefits to both the mother and baby.
What effects do antidepressants have on the person taking them?
Antidepressants can make people feel better, but it does not change their personality or make them feel endlessly or artificially happy. Like with any medication, some people who take antidepressants also experience side-effects. Many of these side-effects are short-lived and well tolerated; however, people who take antidepressants and experience any of these side-effects should tell their doctor during their reviews. If severe, the medication may be inappropriate. If mild, the symptoms may well quickly resolve.
Common side-effects can include:
- nausea
- headaches
- anxiety
- sweating
- dizziness
- agitation
- weight gain
- dry mouth
- difficulties sleeping
- loss of appetite
- sexual difficulties (e.g. difficulty becoming/staying aroused).
Types of antidepressants
There are many different types of antidepressant medication. Below is a description of the different classes of antidepressants.
Selective Serotonin Reuptake Inhibitors (SSRIs)
This class includes:
- sertraline
- citalopram
- escitalopram
- paroxetine
- fluoxetine
- fluvoxamine.
SSRIs are:
- the most commonly prescribed antidepressants in Australia
- often a doctors' first choice for most types of depression
- generally well tolerated by most people
- generally non-sedating.
Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs)
This class includes:
- venlafaxine
- desvenlafaxine
- duloxetine.
SNRIs:
- have fewer side-effects compared to the older antidepressants
- are often prescribed for severe depression
- are safer if a person overdoses.
Reversible Inhibitors of MonoAmine oxidase (RIMAs)
The class includes:
RIMAs:
- have fewer side-effects
- are non-sedating
- may be less effective in more severe forms of depression than some other antidepressants
- are helpful for people who are experiencing problems with anxiety or difficultly sleeping.
TriCyclic Antidepressants (TCAs)
The class includes:
- nortriptyline
- clomipramine
- dothiepin
- imipramine
- amitriptyline.
TCAs are:
- effective, but have more harmful side-effects than newer drugs (i.e. SSRIs)
- more likely to cause low blood pressure - so this should be monitored by a doctor.
Noradrenaline-Serotonin Specific Antidepressants (NaSSAs)
This class includes:
NaSSAs are:
- relatively new antidepressants
- helpful when there are problems with anxiety or difficulty sleeping
- generally low in sexual side-effects, but may cause weight gain.
Noradrenalin Reuptake Inhibitors (NARIs)
This class includes:
NARIs are:
- designed to act selectively on one type of brain chemical - noradrenalin
- less likely to cause sleepiness or drowsiness than some other antidepressants
- more likely to:
- make it difficult for people to sleep
- cause increased sweating after the initial dose
- cause sexual difficulties after the initial doses
- cause difficulty urinating after the initial doses
- cause increased heart rate after the initial doses.
Please note:
- When the symptoms are directly due to depression, then they are likely to begin to improve following four to six weeks of effective therapy. For example, although SSRIs commonly make sleep disturbance/ insomnia worse initially, they are associated with improved sleep four to six weeks later.
- All of these drugs have been shown to have effect as antidepressants.
- SSRIs or clomipramie (TCA) would be the first choice if Obsessive Compulsive Disorder symptoms were prominent.
How long do people need to take antidepressants?
Like any medication, the length of time a person takes antidepressants depends on the severity of the illness and how the person responds to treatment. For some people, antidepressants are only needed for a short time (generally six to 12 months) with psychological treatments and self-help techniques being sufficient to prevent relapse. For others, antidepressants are needed on an ongoing basis - in the same way that someone with asthma would use respiratory medication.
Are antidepressants addictive?
Antidepressants are not addictive. They are sometimes confused with sedatives (for example diazepam). This group of medications is used to help a person feel relaxed and, in some cases, fall/stay asleep. Unlike antidepressants, sedatives are designed to be used for a short time. If used for long periods of time, sedatives may be needed in higher doses in order for them have the same effect. When people are addicted to sedatives and they stop taking them, they crave the effects of the sedatives. This is not the case with antidepressants.
When medication starts working and people feel better, they can often be tempted to stop taking it. Abrupt cessation can lead to unpleasant symptoms ('rebound symptoms' such as anxiety, headaches and a 'flu-like' feeling). Stopping medication should be done gradually, on a doctor's recommendation and under supervision.
Where to get help
When would someone need to see a General Practitioner?
Visiting a doctor who is a General Practitioner (GP) is a good first step in getting help for a mental or physical health problem. Some GPs may manage your mental health themselves, while others may refer you to a specialist such as a psychologist or a psychiatrist. Referral to a psychiatrist may occur if the illness is particularly severe, complicated or where there is uncertainty as to the best approach. Referral to a psychologist is usually done when specific psychological therapies are thought to be appropriate. Continuing to see the same doctor is important. Changing doctors can make it hard for them to get a good sense of a person's medical history. If however, you are not happy with your current doctor, don't be afraid to seek a second opinion.
You can find a GP or other health professional in your area who has had extra training in mental health by looking at the beyondblue Find a Doctor or other mental health practitioner list at www.beyondblue.org.au.
When would a person with depression need to go to hospital?
These days, most people can live at home while they receive treatment for their illness.
Occasionally though, people will need to go to hospital, usually under the care of a psychiatrist for treatment if they:
- have severe symptoms
- have complicated medical problems
- are in danger of hurting themselves or others
- need more intensive treatments and monitoring.
Major general public hospitals have psychiatric inpatient units attached to them. To find your nearest local hospital, contact your local council or refer to the White Pages. Most major centres have private psychiatric hospitals which also provide these treatments.
When should a crisis team be contacted?
These services generally operate 24 hours a day and should be contacted when a person needs urgent, short-term help while living in the community. Crisis services provide intensive treatment and support, usually in the person's own home. They can be contacted in an emergency as a way of helping the person to stay out of hospital.
Crisis Teams are attached to the psychiatric inpatient units and specialty community mental health services. To find the nearest local Crisis Team, call the local public hospital or Community Mental Health Service or refer to the White Pages.
A person may qualify for Medicare rebates for treatment of a mental health disorder. Download beyondblue Fact Sheet 24 - Help for depression, anxiety and related disorders under Medicare.
For more information about treatments for depression, anxiety and related disorders, download the following beyondblue fact sheets and resources.
