It can feel like a big move to start antidepressants, and it’s a very personal decision. Only you can know how your symptoms are affecting you and what your particular set of circumstances are, and your doctor is on hand to discuss this in detail. Antidepressants are usually reserved for moderate or severe depression rather than mild cases, and can also help with obsessive compulsive disorder, post-traumatic stress syndrome, generalised anxiety disorder and certain pain syndromes.
As a doctor, my patients come armed with questions and expectations, and they’ve often heard rumours that they want to be clarified. Let’s go through what's most likely on your mind and what you can expect.
It’s likely you’ll be offered one of the newer style antidepressants – the SSRIs (selective serotonin reuptake inhibitors). Their function is to increase a hormone in the brain that makes you feel better, called serotonin. They all help reduce feelings of sadness and anxiety, and so improve related symptoms, such as sleep disturbance, appetite, concentration and motivation.
Some may help slightly more with one aspect than others, but they all work similarly. Three in particular have been chosen for how well they work, minimal side effects and their safety profile. Citalopram may be better for the elderly or if anxiety plays a large part, sertraline is the safest if suicidal thoughts predominate or if you are taking medications for other conditions, and fluoxetine is the choice for children and adolescents.
Non-SSRIs are considered if SSRIs haven’t worked. Mirtazapine can help if sleep disruption or sexual dysfunction is significant, venlafaxine is used in severe depression. Psychiatrists occasionally start amitriptyline, an older type of antidepressant, but it can leave you feeling pretty groggy.
No medication comes without the risk of side effects. These differ from person to person, and are usually mild with antidepressants, but there are some common complaints. Emotional blunting is common – people complain of feeling "numb" or "spaced out" a few months after starting. This is because the antidepressant has sought to dampen the negative thoughts and feelings, and there aren’t really many positive feelings in depression to take their place. So you’re left with a sort of plateau of feeling – nothing is awful but nothing is amazing.
This may indicate some progress, and be an opportunity to implement coping strategies, such as seeing friends or getting to the gym, so that external cues can help you release endorphins and other feel-good hormones to give you positivity.
A change to your sexual function is another very common side effect – perhaps affecting more than half of those taking antidepressants – but one that many find difficult to talk about. Problems vary in severity, but can include loss of your sex drive, difficulty getting an erection and difficulty reaching orgasm, and this is true for both men and women. It’s tricky to know which is to blame, as these also feature in depression. If this isn’t improving a few months into a course of antidepressants, discuss this with your doctor.
It takes up to four weeks to see a mood-lifting effect. It’s very common to feel worse for the first couple of weeks after starting, as the antidepressants set about rebalancing your brain’s neurochemicals. After that, emotions should start to even out.
It can be hard to keep track of your own progress, so it's a good idea to keep a diary of your day-to-day feelings and thoughts, perhaps what you’ve accomplished in a day and what you’d like to get done. Look back at this every few weeks, and you’ll be surprised how far you’ve come. Your doctor can also be a good gauge on how well you're doing – keep in contact with them every few weeks until you're on track to feeling better.
I often have patients coming back a few months after starting antidepressants to tell me they’re feeling a lot better, so they don’t need antidepressants any more. I encourage them to consider whether the antidepressants can take some credit for this, and whether it’s best to keep the status quo for just a few more weeks or months. Doctors usually recommend to continue for about 6 months after you're feeling better. But as always, it’s your choice whether to stay on antidepressants or not.
If you do want to stop, don’t stop suddenly, you can experience a relapse. Discuss it with your doctor and come up with a plan to gradually reduce your dose to eventually stopping.
Book an appointment with your doctor. They will listen to your symptoms and how this is affecting your day-to-day functioning. They might want one or two meetings to get to know you before you both decide if antidepressants are right for you, or other options may be more appropriate.
If you are starting antidepressants, consider a good time as you are likely to feel a little worse for the first couple of weeks. For example, if Christmas is a challenging or emotive time for you, perhaps put it off until the new year.
Consider what else will help on your road to recovery, such as keeping in touch with friends and family (or indeed avoiding them, if some relationships are a source of tension). Introduce exercise, it releases feel-good endorphins and reduces stress, and make sure you’re avoiding alcohol as this can add to sadness and disrupt sleep. Similarly, cannabis and other street or party drugs can exacerbate depression.
Psychological input is often helpful, either on its own or in tandem with antidepressants. Your doctor can advise on local services, and they can assess you for which approach works best for you.
Keep in mind that there’s no magic bullet that will make you feel better right away. This takes time, patience, and a bit of effort from you. Once you’re feeling a little better, work on building those coping strategies, and the day will feel a little lighter. Disrupted sleep can be one of the most bothersome symptoms and one of the last things to recover. Be kind to yourself, try not to focus too much on this, and with time, you can regain your usual sleep rhythm.
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