The main medical treatment for depression is antidepressant medication. There is a lot of misinformation about antidepressant medication and while there is no simple explanation as to how it works, it can be very useful in the treatment of moderate to severe depression (and some anxiety disorders).
People with more severe forms of depression (bipolar disorder and psychosis) do generally need to be treated with medication. This may include one or a combination of mood stabilisers, anti-psychotic drugs and antidepressants.
Which antidepressant should be used?
Making a decision about which antidepressant is best for a person can be complex. The decision is 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. Important factors include the person's age, symptoms, other medications and, if female, whether they are pregnant or breastfeeding.There are many different types of antidepressant medication which have been shown to work, but their effectiveness differs from person to person. Antidepressants take at least two weeks before they start to help, and it may also take some time for the doctor to find the most suitable medication and dosage.
What are the side effects?
Antidepressants can make people feel better, but they won't change their personality or make them feel happy all the time. Like taking any other medication, some people will experience some side effects. Common side effects, depending on which medication is taken, include nausea, headaches, anxiety, sweating, dizziness, agitation, weight gain, dry mouth and sexual difficulties (e.g. difficulty becoming/staying aroused).Some of these symptoms can be short-lived, but people who experience any of these symptoms should tell their doctor, as there are ways of minimising them. The likelihood of a particular side effect happening varies between individuals and medications.
Types of antidepressants
There is a wide range of antidepressant medication available. Below is a description of the different classes of antidepressants used in Australia.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 moclobemide. RIMAs:- have fewer side effects
- are non-sedating
- may be less effective in treating more severe forms of depression than other antidepressants
- are helpful for people who are experiencing anxiety or sleeping difficulties.
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 mirtazapine. NaSSAs are:- relatively new antidepressants
- helpful when there are problems with anxiety or sleeping
- generally low in sexual side effects, but may cause weight gain.
Noradrenalin Reuptake Inhibitors (NARIs)
This class includes reboxetine. 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 doses
- cause sexual difficulties after the initial doses
- cause difficulty urinating after the initial doses
- cause increased heart rate after the initial doses.
Monoamine Oxidase Inhibitors (MAOIs)
This class includes tranylcypromine. MAOIs are prescribed only under exceptional circumstances as they require a special diet and have adverse effects.Things to note
- All of these drugs have been shown to be effective as antidepressants.
- When symptoms are directly due to depression, the person is likely to begin to improve after 4-6 weeks of effective therapy. For example, although SSRIs commonly make sleep difficulties or insomnia worse initially, they are associated with improved sleep 4–6 weeks later.
- SSRIs or clomipramie (TCA) would be the first choice if Obsessive Compulsive Disorder symptoms were prominent.
How long are antidepressants usually needed?
Like any medication, the length of time a person needs to take antidepressants for depends on how severe the illness is and how they respond to treatment. Some people only need to take them for a short time (usually 6–12 months), while others may need to take them over the long term, just like someone with diabetes might use insulin or someone with asthma would use ventolin. Stopping antidepressant medication should only be done gradually, on a doctor's recommendation and under supervision.Everyone needs to find the treatment that's right for them. Just because a treatment has been shown to work scientifically, doesn't mean it will work equally well for every individual. Some people will have complications, side effects or find that the treatment does not fit in with their lifestyle. It can take time, strength and patience to find a treatment that works.
After seeking appropriate advice, the best approach is to try a treatment you're comfortable with and one that works for most people. If you do not recover quickly enough, or experience problems with the treatment, discuss this with your health professional and consider trying another.
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