A B C D E F G H I J K L M N O P R S T U V W

ANTIDEPRESSANTS

What are the types of Antidepressant?

Tricyclics include amitriptyline, clomipramine, dothiepin, imipramine, lofepramine. Maprotiline, mianserin, trazodone and viloxazine belong to a similar group. Serotonin re-uptake inhibitors (SSRIs) include citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline. Monoamine oxidase inhibitors (MAOIs) include phenelzine, tranylcypromine and moclobemide. Other antidepressants include flupentixol, mirtazepine, nefazodone, reboxetine and venlafaxine.

What are Antidepressants for ?

The problem of depression is dealt with separately. Some people who are depressed also get quite anxious: some antidepressants are particularly good for this combination, and your doctor will be prescribing one for you, if appropriate. Some antidepressants are used for other mental health conditions such as obsessive-compulsive disorder (OCD) and panic disorder. They are also sometimes used in pain relief treatments.

How do Antidepressants work ?

Normally your brain produces chemicals that in turn stimulate certain brain cells which control mood. Although the causes of depression are complicated, it may be due to a change in the amount of certain chemicals in the brain. Antidepressants work by changing the balance between these chemicals, and so « boost » mood. The drugs vary in the way in which they achieve this aim.

How should Antidepressants be used ?

Most antidepressants come as tablets or capsules, but liquids are sometimes used. You need to take your antidepressant regularly and keep taking it for as long as your doctor tells you to. Make sure you know how many to take, and how often to take them. For some antidepressants the time of day you take them is important, because some can make you drowsy, while others can stop you from sleeping. If you're not sure, ask your doctor or pharmacist, but check the label first. It will probably tell you what to do. A counsellor, psychologist or psychiatrist may be recommended to provide additional help.

During Treatment

You might need to take your antidepressant for 2 to 4 weeks before you start to feel any better. You might need them for several months before your depression gets better completely. When you feel better your doctor might tell you to take a lower dose for some months to stop your depression coming back. Your doctor might need to see you more often when you first start your antidepressant, to see how you are getting on. If you are taking tricyclics or related antidepressants you might feel drowsy, or have a dry mouth, blurred vision, constipation, sweating or flushing. Often these problems get better as you keep taking your tablets. Occasionally your doctor might change your dose. If you are elderly, you are more likely to get dizzy and faint. If you get a rash, palpitations or (yellow) jaundice, or have difficulty passing urine, stop taking your tablets, and call a doctor immediately.

If you are taking SSRIs or related antidepressants you might get diarrhoea, nausea and vomiting, headaches, restlessness, weight loss, anxiety, tremor, sexual difficulty or be unable to sleep. If you get a rash, contact your doctor immediately. If you are taking an MAOI , certain foods must be avoided, and for at least 2 weeks after you have finished taking them. Cheese, pickled herring, broad bean pods, meat and yeast extracts, fermented soya extract and alcoholic drinks are the ones to watch. Ask your pharmacist for a special card that has a full list of problem foods to carry with you so you don't forget. Feeling dizzy, faint, restless or vague may be symptoms of food reacting with these drugs. Unlike other MAOIs, with meclobamide problems are only likely to occur if large amounts of these foods are eaten. If you get a rash or (yellow) jaundice, stop taking your tablets, and see your doctor promptly. If you are taking any antidepressant , feeling very drowsy, confused or generally unwell is good reason to see your doctor as soon as possible. Top

Drug Interference

Alcohol with many antidepressants causes drowsiness. With MAOIs all alcohol drinks should be avoided. Taking more than one type of antidepressant may cause problems. If you change from one antidepressant to another, your doctor may suggest a gap between the two. Follow his or her advice carefully. Antihistamines (eg chlorpheniramine and astemizole) can give you a dry mouth, constipation, blurred vision and difficulty in passing urine. Ideally they should be avoided. Blood thinners (anticoagulants) may have their effect increased by SSRIs. The dose of anticoagulants may need to be reduced. Epilepsy medication may be affected by anti-depressants. Doses of the anti-epilepsy medication may need to be increased or decreased. Painkillers may interact with antidepressants: get your doctor's or pharmacist’s advice on choosing them. Sedatives will make you even more drowsy. MAOIs have a number of important interactions. Therefore be sure that doctors and pharmacists are aware that you are taking them when any new drugs are being prescribed. This is not a full list. You must tell your doctor or pharmacist if you are taking ANY other medications , even cough or cold remedies.

What if Antidepressants are not taken ?

If you have been taking your antidepressant regularly for a number of weeks and you stop them suddenly you may get withdrawal symptoms: nausea, vomiting, headache, giddiness, chills and insomnia. You could feel agitated, panicky, anxious and restless. Your depression can also come back. Your doctor will advise you how to stop them gradually. If you miss a dose take it as soon as you remember.

General advice on the use of Antidepressants

Do not drive if you feel at all drowsy. Pregnancy and breast-feeding will affect the choice of antidepressant. If you have either glaucoma or prostate gland problems, some antidepressants may worsen these conditions.