Antidepressants The Royal College of Psychiatrists Antidepressants relieve the symptoms of depression. They were first developed in the 1950s and have been used regularly since then, with almost thirty available today.

Antidepressants can be used for a number of conditions, including:

• Moderate to severe depressive illness (not mild depression)
• Severe anxiety and panic attacks
• Obsessive compulsive disorders
• Chronic pain
• Eating disorders
• Post-traumatic stress disorder

Research suggests that after three months of treatment, around 50-65 per cent of people with moderately severe depression will be much improved.

There are four main types available:

• SSRIs (Selective serotonin reuptake inhibitors)
• SNRIs (serotonin and noradrenaline reuptake inhibitors)
• Tricyclics and MAOIs (monoamine oxidase inhibitors) which are less commonly used

Side-effects

Common side effects for the first couple of weeks include:

• Nausea
• Anxiety
• Indigestion, particularly when taken without food or water
• Problems with your sexual drive and function
• Lethargy and slurred reactions
• Increased blood pressure (which should be monitored by your doctor)

Most people only get mild side-effects which usually wear off after a couple of weeks.

Antidepressant drugs don’t cause the addictions that you get with tranquilisers, alcohol or nicotine. They don’t act quickly, you don’t need to keep increasing the dose to continue getting the same effect and you don’t find yourself craving them.

Some people who stop SSRIs and SNRIs do get withdrawal symptoms, including:

• Stomach upsets
• Flu like symptoms
• Anxiety
• Dizziness
• Vivid dreams
• Sensations similar to electric shocks

In most people these withdrawal effects are mild, but in a small number they can be severe, so it’s usually recommended to gradually reduce the dosage rather than stopping suddenly.

There is evidence of increased suicidal thoughts (although not actual suicidal acts) and other side effects in younger people taking SSRIs. So, apart from fluoxetine, SSRIs are not licensed in the UK for use in people under 18.

There is no clear evidence of an increased risk of self-harm and suicidal thoughts in adults – but individuals mature at different rates. Young adults are more likely to commit suicide than older adults, so need close monitoring if they take an antidepressant.

Without any treatment, most depressions will improve after about eight months. If you’ve had two or more attacks of depression then treatment should be continued for at least two years.

If you stop medication before your depression has fully improved, it’s much more likely to return. It’s recommended that you continue taking them for at least six months after you start to feel better. Some people have to take antidepressants for several years to control severe depression, and other drugs such as lithium may be recommended.

Antidepressants don't necessarily treat the cause of the depression, or take it away completely, so it’s worth thinking about what the causes may be through counselling and psychotherapy.

Recent studies have suggested that over a period of a year, many talking treatments are as effective as antidepressants, particularly in mild to moderate depression, although it’s generally accepted that antidepressants work faster. Some studies suggest it’s best to combine antidepressants and psychotherapy.

This article was first published in April 2009.