Antidepressant medication

Quick facts

• Antidepressant medication can help ease symptoms of depression, anxiety, and other mental health conditions
• They affect brain chemicals called neurotransmitters.
• There are different types of antidepressants, and types such as SSRIs and SNRIs are commonly prescribed.
• Antidepressants don’t work for everyone, but for some people they are very helpful
• It is important to talk to a doctor about different options, side effects, and how to use medication effectively.

• About antidepressants

  Antidepressant medication refers to a few types of medication that can help relieve symptoms of low mood and anxiety. These medications balance your brain chemistry – by affecting neurotransmitters that influence mood and emotions.

  Antidepressant medication is often used to treat depression in combination with psychological therapies, but can also be used as part of treatment for other mental health conditions.

• When are antidepressants used?

  Antidepressants are often used to reduce the symptoms of depression, such as:

  • feeling extremely sad for no clear reason,
  • loss of interest or pleasure in things you usually enjoy;
  • sleeping too much or too little
  • feelings of worthlessness, guilt or worry, and
  • difficulty in thinking, making decisions or concentrating.

  Antidepressants may also be helpful in the treatment of other mental health issues, such as generalised anxiety disorder and eating disorders, obsessive-compulsive disorder, social phobia, chronic pain, and post-traumatic stress disorder.

  They may be prescribed when:

  • you have tried psychological treatments and not found them helpful so far
  • symptoms are severe, distressing, or impacting a lot on daily life
  • you cannot access psychological treatments currently.

  You might use antidepressants on their own (that is, as your only form of treatment). Or medications can also be used while trying other options, like self-help, psychological therapies or support in the community, and lifestyle changes like improving sleep and exercise. For example, people with moderate to severe symptoms of depression are usually recommended a combination of medication and psychological therapies¹.

  Antidepressants are not for everyone, but for some people, they can be life-changing. There is nothing wrong with wanting to try medication, or needing medication, to improve your mental health.

• Types of antidepressant medication

   There are several types of antidepressant medication available such as:

  • an older group, known as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs)
  • newer groups, known as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), which affect the amount of certain neurotransmitters in the brain.
  • Atypical antidepressants, which operate in a different way to most other antidepressants.

  Newer groups of antidepressants tend to have fewer side-effects and are safer when a wrong dose is taken. They are prescribed more often than the older types.

• Are antidepressants effective?

  They are effective – but not for everyone.

  A large study reviewed and summarised hundreds of studies of antidepressants compared to placebos. The researchers found that overall, compared to placebos, antidepressants reduce symptoms of depression². Another study found that antidepressants can also improve quality of life³.

  However, not everyone will respond to antidepressants in the same way. This means that it can be difficult to predict how well they might work for you. Some people find them very helpful, whereas for other people, they might not help or only have a small effect. Some people respond well to some types of antidepressants but not others⁴. Researchers estimate an average 30% of people who take antidepressants experience symptom reduction, and up to 50% for some types of antidepressants⁵.

  Antidepressants are generally most effective for people who experience more moderate to severe symptoms of depression. Some researchers report that 40-60% of people who experience moderate to severe depressive symptoms will experience some improvement after using antidepressants⁶.

• What treatment with antidepressant medication involves

  Initial consultation and prescription

  Antidepressant medication may be prescribed by a doctor (a GP or a psychiatrist). A doctor can discuss options with you, and prescribe you a type of medication and dosage that they think would be appropriate for you.

  It is okay to ask questions about things you are not sure about, and to express any concerns you have. There are some things you and your doctor can talk over to help decide what is right for you:

  • How severe your symptoms are and how they impact you
  • What different types of medication are available
  • What they recommend, and why
  • Any side-effects and how to manage these
  • What to do if you wish to stop taking the medication
  • Any allergies or physical health problems you may have
  • If you are pregnant or planning to become pregnant
  • Any other medications you are taking, or have taken previously
  • How and when to take the medication
  • How to store medication safely
  • Other factors, such as foods which may need to be avoided.

  Taking the medication

  People who take medication as recommended by their doctor are more likely to feel better than those who take too little or too much. So make sure that you follow the directions on the pack to get the best benefit from your medication. Finding the right medication for you may involve trying one or more types of medication, or adjusting the dose.

  It can take several weeks, or even a few months, after the first dose of medication before it has an effect¹. It is a good idea to check in with your doctor over time to discuss how you are feeling, and if you have any concerns.

  Coming off the medication

  Sometimes, people want to stop taking medication. You might find that the medication isn’t working for you, or the side effects are unpleasant.

  Sometimes the medication does work, and you feel better. In that case, it can be tempting to stop taking it. Like people with diabetes or high blood-pressure, some people with depression and anxiety-related disorders need to take medication on an ongoing basis to ensure the depression or anxiety doesn’t return. However, others find that with ongoing psychological support or having learned new ways of coping with situations, they no longer need to take antidepressants regularly.
  
  Before stopping or reducing any medication it is important to discuss your reasons with your doctor. They can advise on the best ways to reduce the dose safely. Stopping antidepressant medication suddenly can cause you to feel withdrawal symptoms, like feeling dizzy, agitated and uncomfortable, electric shock sensations, or low or anxious moods¹. So this needs to be done step-by-step with your doctor.

• Risks and side effects of antidepressant medication

  As with any type of medication, some people may experience side effects. Many of these settle down after a few weeks, when your body has adapted to the medication, while others may persist. Make sure you discuss any side-effects with your doctor.

  Some examples of side effects are:

  • Diarrhoea or constipation
  • Nausea
  • Headaches
  • Sleep disturbance
  • Lower sexual responsiveness
  • Dizziness or blurred vision
  • Weight changes
  • Dry mouth

  Some people unfortunately experience an increase in depression symptoms after starting an antidepressant medication. If you start to experience suicidal thoughts, or a worsening of mood and anxiety, it is important to take to your doctor as soon as possible.

  A doctor can suggest changes to minimise side-effects, such as changing your dosage, the time of day you take it, or the type of medication itself.

• Finding out more

  To learn more, a GP or psychiatrist can provide a personalised discussion about whether antidepressants are the right option for you.

• Resources

  • 1300 MEDICINE (1300 633 424) – Medicines Line
  • Depression (SANE Fact Sheet)
  • Antidepressant medications explained - NPS Medicine Wise
  • Forums Community chats depression – SANE Forums

• References

  1. NICE. NICE Guideline for depression in adults: treatment and management [Internet]. 2022 [cited 2023 Mar 30]. Available from: https://www.nice.org.uk/guidance/ng222/chapter/recommendations

  2. Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Focus (Madison). 2018;16(4):420–9.

  3. Wiesinger T, Kremer S, Bschor T, Baethge C. Antidepressants and Quality of Life in Patients with Major Depressive Disorder–Systematic Review and Meta‐analysis of Double‐blind, Placebo‐controlled RCTs. Acta Psychiatr Scand. 2023;

  4. Maslej MM, Furukawa TA, Cipriani A, Andrews PW, Mulsant BH. Individual differences in response to antidepressants: A meta-analysis of placebo-controlled randomized clinical trials. JAMA Psychiatry [Internet]. 2020 Jun 1;77(6):607–17. Available from: https://doi.org/10.1001/jamapsychiatry.2019.4815

  5. Alemi F, Min H, Yousefi M, Becker LK, Hane CA, Nori VS, et al. Effectiveness of common antidepressants: a post market release study. EClinicalMedicine. 2021;41:101171.

  6. Institute for Quality and Efficiency in Health Care. Depression: How effective are antidepressants. In 2015 [cited 2023 Mar 30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361016/