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A Patient
This guide aims to outline why antidepressants(or other treatments) may be recommended by yourdoctor and also provides information about how theyshould be used.
What is depression?
Feeling unhappy and depressed is part of the range of normal and
understandable human emotions, often as a result of difficult
circumstances and happenings in our lives. Everyone knows how it feels
to feel sad and low. Some people find that their low mood becomes so
severe that it affects their usual ability to function, for example look after
themselves, in their home or at work. Normally pleasurable activities feel
difficult and are not enjoyed. Sleep may be disturbed and appetite often
reduced. Similarly the ability to concentrate on simple tasks like reading
or watching the television can be difficult. Everyday thoughts are often
bleak and thoughts of hopelessness and even suicide may be present.
If such symptoms last for over a couple of weeks it is quite likely that
the person is suffering from depression.
Depression can sometimes occur ‘out-of-the-blue', without beingconnected to any recent stressful event. Very often, however, people canidentify a trigger, or series of events that preceded their feelings of lowmood. Ongoing stress may also be preventing them from feeling better.
A Guide to Depression & Antidepressants Regular and/or excessive use of alcohol is also a well known cause forfeeling low and depressed. Although alcohol is commonly used as a meansof coping with stress, it can actually make depression worse and preventmood from lifting. Any person feeling depressed is therefore advised toreduce and minimise their alcohol intake as much as possible.
It is very important that you seek help urgently if your symptoms aresevere, particularly if you feel so depressed that you are considering someform of escape, including suicide. In such circumstances please contactyour GP or NHS 24. Local helplines will also be able to offer support andadvice (contact details at the back of this leaflet).
Why has my doctor recommended an antidepressant?
If your symptoms of depression are relatively mild, your mood may
well lift by itself, without the need for any particular help. However,
some form of help, treatment and support is usually recommended if
your mood stays particularly low for a period of over two weeks.
Antidepressant medication has been shown to treat and relieve the
more severe types of depression. Your doctor will have recommended
antidepressants as he/she believes they are an appropriate option given
your current and past circumstances.
How effective are they?
Antidepressants are not recommended for the initial treatment of mild
depression. They can however be particularly helpful in the treatment of
moderate or more severe cases. Your doctor will be in the best position to
help with a diagnosis. You will usually start to notice an improvement after
taking treatment regularly for about two weeks. In general, most
antidepressants are as effective as each other. If your mood does not
improve after taking treatment for 4 to 6 weeks, your doctor may well
recommend either a change in dose, a different preparation or offer an
alternative form of treatment, for example cognitive behavioural therapy
(CBT). It is therefore important for you to continue to consult with your
health professional, particularly if your treatment doesn't seem to be
working. It is strongly advised that you do not stop taking antidepressant
medication without discussing first with your doctor.
Are there additional treatments available?
Although there are many different techniques that can help, the most
well researched and beneficial appear to be those utilising cognitive
behavioural therapy (CBT) or inter-personal therapy (IPT). A CBT self-
help guide to depression is available as a companion leaflet. Many people
have found that undertaking regular exercise and maintaining social
activities is also helpful for lifting mood. Further details on the various
‘talking' and other non-medication treatments can be found in a further
companion leaflet ‘Self help and Talking Therapies'.
A Guide to Depression & Antidepressants Medication and talking treatments together seems to provide additionalbenefit. Other interventions can also sometimes be helpful, for examplealternative medical approaches. Many have not been properly researchedand therefore may not be recommended by your doctor. Your doctor willrespect your decision regarding your preferred treatment choice.
What other conditions are antidepressants helpful for?
Antidepressants have also been found to be helpful treatments for a
number of different conditions including anxiety, obsessive-compulsive
disorder (OCD), post traumatic stress disorder and eating disorders.
Some antidepressants also have pain relieving properties.
Antidepressants and suicidal thoughts
Over recent years there have been some concerns raised about
antidepressants being the cause of suicidal ideas, particular early on in
treatment. Successful treatment of depression does, however, reduce
the risk of suicide substantially. If you do experience the onset of suicidal
ideas it is very important that you seek professional advice as a matter
of urgency.
What should I do if side effects are troublesome?
It is relatively common to experience mild side effects for a few days,
particularly in the first week of treatment. This may take the form of
mild nausea, tummy upset or increased anxiety. These symptoms usually
disappear after a few days. If side effects are more severe, you should
seek the advice of your doctor. Changing the dose of medication may
be all that is required.
How long should I take them for?
It is generally advised to continue taking antidepressant treatment for
6 months after your depression has lifted. If treatment is stopped before
this time there is a high chance that your symptoms will return. If you
have experienced two or three episodes of depression your doctor may
recommend continuous treatment for two or more years. For more
recurrent and severe episodes you may choose to continue
antidepressant treatment indefinitely.
Are antidepressants addictive?
Antidepressants are not addictive. Some people do experience some
symptoms after stopping certain treatments, particularly if this is done
suddenly. A more gradual reduction in dose is usually all that is required.
What if they don't work?
Depression is a treatable illness. However, initial treatments may not
always be successful. Your doctor may therefore recommend changing
to a different type of antidepressant or recommend another form of
treatment .Your doctor may also refer you for more specialist advice.
A Guide to Depression & Antidepressants Some Frequently Prescribed Antidepressants
USUAL DOSE
20-60 milligrams/day 20-50 milligrams/day 50-200 milligrams/day 20-60 milligrams/day 75-375 milligrams/day 60 milligrams/day 30-45 milligrams/day 75-200 milligrams/day 75-200 milligrams/day 75-250 milligrams/day Note: dose ranges listed are the usual recommended doses for adults.
On occasions doses may be prescribed outwith these ranges.
OTHER USEFUL RESOURCES
Websites providing information on antidepressants
The following websites provide detailed factual information regarding
medicines commonly prescribed for mental health conditions, including
depression .
www.nmhct.nhs.uk/pharmacy – A website maintained by an NHS mentalhealth trust in Norfolk offering comprehensive information on medicines.
http://emc.medicines.org.uk – Summaries of Drugs and PatientInformation Leaflets Information on thousands of licensed medicinesavailable in the UK. Continuously updated.
Websites providing information and further help for depression
www.dascot.org – Information about symptoms and treatment
of depression.
www.edspace.org.uk – An information source providing a directoryof local services in Edinburgh.
www.livinglifetothefull.com – Self help for depression and anxietyand related mental health issues.
www.eastlothian.gov.uk/documents/contentmanage/directory– A very useful directory of national and local East Lothian services.
A Guide to Depression & Antidepressants www.moodgym.anu.edu.au/ – Interactive self help site for cognitivebehavioural therapy for depression.
www.cci.health.wa.gov.au/about/index.cfm – Free workbooks andresources for varied mental health issues.
Further Reading
Some useful books which you may like to buy or borrow from your library.
In some areas your GP can prescribe one or more of these books for you
to get from your local library.
Burns, D. (2000). Feeling Good, The New Mood Therapy (2 rev Ed).
Avon Books. New York. ISBN 0380810336.
Gilbert, P. (2000). Overcoming Depression (2rev. Ed).
Constable and Robinson Publishing. ISBN 1841191256.
Greensberger, D and Padesky, C A (1995). Mind Over Mood:
Change How You Feel by Changing the Way You Think.
Guilford Publications. ISBN 0898621283.
Naime, K and Smith, G (2001. Dealing With Depression (2 Rev.Ed).
Women's Press Ltd. ISBN 0704344432
Rowe, D (2003). Depression: The Way Out of Your Prison (3rd Ed).
Brunner-Routledge. ISBN 158391286X.
Williams, C. (2006). Overcoming Depression: A Five Areas Approach
(2nd Ed). Hodder Arnold. ISBN 0340905867.
The following organisations and help lines may also be useful:
NHS24 (www.nhs24.com) Tel: 08454 242424
– Provides comprehensive up-to-date health information and self care
advice for people in Scotland.
Edinburgh Crisis Centre (www.edinburghcrisiscentre.org.uk)Freephone: 0808 801 0414 – Support for persons in Edinburghexperiencing an emotional crisis.
Association for Post Natal Illness – For women who are experiencingdepression following the birth of their baby.
Address: 145 Dawes Road, London, SW6 7EB.
Tel: 0207 3860868.
Crossreach Post Natal Depression Project – Counselling for familiessuffering from post natal depression.
Address: Wallace House, 3 Boswall Road, Edinburgh EH5 3RJ.
Tel: 0131 538 7288.
CRUSE Bereavement Line – Help line for bereaved people and thosecaring for bereaved people.
Tel: 08700 1671677.
National Debt Line – Help for anyone in debt or concerned they mayfall into debt.
Tel: 0808 8084000.
Couple Counselling Lothian. Tel: 0131 556 1527 A Guide to Depression & Antidepressants West Lothian: Mood – Support and advice for people over sixty years oldwho have, or are at risk of, developing depression or mental healthproblems. Tel: 01506 651 067.
Midlothian: Early Intervention Crisis Response Service– Tel: 0131 663 5533 (Mon – Fri 4pm–10pm; Sat & Sun 10am–4pm).
Community based support for people in Midlothian who are experiencingmental health difficulties, and their carers, when they are facing a crisis.
Midlothian: Orchard Centre Service – Health in Mind.
Tel: 0131 663 1616 (Mon - Fri 9.30am–5pm, except Tues 12.30pm–5pm). Offers a wide range of information, support and activities for peoplewith mental health problems.
East Lothian: CHANGES Community Health Project.
108 Market Street, Musselburgh EH21 6QA. Tel: 0131 653 3977 or3813. Promotes positive wellbeing, providing a resource base andinformation about support for people experiencing stress, depression,panic attacks, phobias and anxiety.
NHS Lothian: v2 June 2009
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Source: http://edspace.org.uk/upload/DepressionAntiDepstnts.pdf