There's a lot of conflicting evidence out there about antidepressants. There‘s no doubt that they have helped and saved countless lives over the decades. They should be prescribed appropriately for moderate to severe depression, and for anxiety disorders such as OCD and PTSD especially when severe. This is supported by the UK National Institute for Health and Care Excellence (NICE) clinical guidelines.
Antidepressants are a popular treatment choice for GPs, psychiatrists, as well as patients. NHS statistics have shown that in 2022/23, 86 million antidepressants were prescribed to an estimated 8.6 million identified patients.
There are many different types of antidepressants available with different mechanisms of action and effects. There's plenty of clinical evidence of how effective and tolerable antidepressants are. Professor Cipriani et al (2018) performed a systematic review of the efficacy and acceptability of 21 antidepressants. They found that Agomelatine, Amitriptyline, Escitalopram, Mirtazapine, Paroxetine, Venlafaxine, and Vortioxetine were more effective than other antidepressants. For patient acceptability, Agomelatine, Citalopram, Escitalopram, Fluoxetine, Sertraline, and Vortioxetine were more tolerable than other antidepressants.
Of course, antidepressants and medications don't work for everyone. For some, side effects such as anxiety, headache, nausea, vomiting, and diarrhoea are intolerable. These can typically last for the first 1-2 weeks as your serotonin levels start rising. Short term use of anti-anxiety medication such as Diazepam for the first week may help with some of the initial side effects. Sometimes, increased suicidal thoughts may also occur so beware. It’s best to see your GP or psychiatrist urgently to change the medication if you feel suicidal or have intolerable side effects. Sexual side effects can also occur with the selective serotonin reuptake inhibitors (SSRIs) such as Citalopram, Escitalopram, Paroxetine, Fluoxetine and Sertraline.
If you can get through the first few weeks of medication titration and potential side effects, many patients start to feel the benefits of increased serotonin with SSRIs such as Sertraline, Citalopram, Escitalopram and Fluoxetine, and increased serotonin and noradrenaline with Amitriptyline, Mirtazapine and Venlafaxine. The full therapeutic effects of antidepressants may take up to 3 months. If there‘s no improvement it’s worth considering a change to an alternative antidepressant that may suit you better. It would be best to discuss this with your GP or psychiatrist.
Once antidepressants start to work it’s important to continue them for at least 6 months to prevent a relapse. You should never stop antidepressants suddenly and always seek medical advice from your GP or psychiatrist first. There is a risk of experiencing withdrawal symptoms and relapse of depressive and anxiety symptoms. The dose should ideally be reduced slowly over weeks to months depending on how high the dose is and how long you have been taking the antidepressant for.
Whilst antidepressants can be a safe and effective treatment option for many patients, psychosocial interventions need to be considered first before starting an antidepressant. These may be effective in treating mild to moderate depression or anxiety and preventing further deterioration. Effective interventions include 7:11 diaphragmatic breathing and relaxation, meditation, mindfulness practise, exercise, a balanced diet with plenty of water and protein, increased daily physical activity, hobbies and activity scheduling. Talking therapies such as Cognitive behavioral therapy (CBT) and Human Givens therapy (HGT)
can also be effective in treating depression and anxiety disorders. Clinical evidence suggests that the combination of psychosocial interventions with medication produces the best outcomes in terms of recovery and relapse prevention.
Book a private mental health assessment with Dr Iqbal Mohiuddin to discuss your mental health problems, medication and a personalised treatment plan for your recovery. Email IamPsychiatryEnquiries@gmail.com or call 0800 779 7800.