Experiences of antidepressants

Starting to take an antidepressant for the first time

Experiences with antidepressants vary. It usually takes several weeks before people begin to feel any benefit. Many we interviewed began to experience some benefits after about 4 -6 weeks; some felt they worked much sooner, some said it took up to 8 weeks to feel any benefit, and others felt no benefits or had to try several before they found one that worked. During the first few weeks' people commonly experience some side effects or feel worse before they begin to feel better. Although the newer Selective serotonin reuptake inhibitors (SSRIs) usually have fewer or less severe side effects than tricyclic antidepressants, various side effects can occur with them all. The doctor will typically prescribe a low dose at the start and this can help to reduce the risk or intensity of side effects. It may take a while to find the right dose. Some people may need to try several different antidepressants before they find one that suits them.
 
It’s important to have realistic expectations in the first few weeks. Andrew’s doctor had pre-warned him that ‘you may just find that you’re fine but it may make you feel a little bit odd at first’ so he had an idea about what to expect. Talking to the doctor helped Stephen to keep in mind that it could take a while to notice any improvements in mood ‘I knew that if I took a tablet that day I wasn’t going to feel better tomorrow... it would take several weeks before it started to have any effect’.
Some people say they notice an immediate benefit or improvement in their mood, and experience few, if any, side effects when they start to take an antidepressant for the first time. Being proactive and starting to ‘tackle the problem’ can be enough to help people feel more positive so it’s not always clear how much of the effect they are feeling can be attributed to the medicine itself. Victoria said maybe it was the ‘placebo effect’ but whatever it was, she definitely felt different almost as soon as she began taking the antidepressant.
Catherine has taken several different antidepressants having experienced recurrent depressive episodes, and says they usually take between four and six weeks to start to work. Melanie experienced minor side effects when she started taking an antidepressant for the first time, but after a few weeks started to feel calmer and less anxious. She said it could feel disappointing at the start because ideally you’d like to notice improvements straight away but when she went back to see the GP for the second prescription and told him how she was feeling she was advised to give it more time.
 
Several people noticed a gradual ‘lifting’ of their mood which could be ‘hard to pinpoint’ but they slowly began to feel some benefits. Gerry said that two or three weeks after starting the treatment ‘I could feel the heaviness lift and I felt more relaxed’ and although he still felt rather depressed he said it felt as though the antidepressant was ‘levelling things off’. Around two months after Sharon started taking an antidepressant for the first time her husband noticed a big difference, he said ‘This is you, you’re back to your old self’. Roisin had tried a number of antidepressants that seemed to make no difference, but when she began taking one that did suit her she began to feel ‘almost normal’ after just a few weeks.
Lou’s depression subsided after a few weeks of taking a new antidepressant, but overall she said the medicine made her feel numb and distant. Some people said although they noticed some benefits after a short time, the medicine had also left them feeling detached or unemotional.
 
Initial side effects of antidepressants 
It’s important to remember that whilst antidepressants can cause a wide range of side effects, this does not mean that everybody taking a particular antidepressant will experience them.
 
The people we spoke to initially experienced insomnia, feeling lethargic and sleepy, dizziness, headaches, vivid dreams, dry mouth or bad taste in the mouth, sickness or nausea, hallucinations, loss of appetite, sweating, memory problems. They ranged from mild to severe and people responded differently to them. What one person will tolerate, another might not.
 
As well as physical side effects or symptoms, people also struggled with psychological effects initially, such as feeling ‘detached’, ‘numb’, ‘being in a dream- like state’, ‘feeling controlled’, ‘like a zombie’ all of which could make life hard to cope with and make them question whether they wanted to continue with the treatment. Greg said the first three weeks were ‘emotional as hell’. Some people also struggled with the idea of taking an antidepressant in the first weeks. Thomas it felt he had ‘surrendered’ because to him it signified that he was officially ‘mentally ill’.
 
Adjusting to antidepressants
It can take a while for people to adjust to a new antidepressant and sometimes side effects can disrupt everyday life. Getting up to go to work each day can feel impossible. Several people we interviewed had sleep problems in the first few weeks and found it difficult to think or concentrate. Thomas said he could barely function when he started taking an antidepressant because of its sedative effect on him. ‘I felt completely flattened, like I’d been hit by a truck’. Lucy X took Prozac (fluoxetine) as a teenager during her GCSE year, and said she struggled to go to school because it left her feeling sick, dizzy and gave her bad headaches. Even when the side effects wore off she still felt distant and numb.
Some people had taken time off from work to help them cope with their initial reaction to an antidepressant. People typically said they found it difficult to work productively. Andrew said being able to control his own diary helped to an extent, but said ‘I winged it a bit and some days I’d come home a bit early or take a little longer for lunch’. Emily’s doctor signed her off work for a week when he prescribed citalopram for her, but in hindsight she felt it wasn’t long enough because she was having trouble sleeping and just couldn’t work properly. (See ‘Antidepressants and work') Staying with a friend or relative for a few weeks can help. Other help may also be available, for instance some employers can arrange workplace counselling, or reduce work hours for a few weeks. Some people were surprised at the help and support they received at work, but some preferred not to tell people at work that they were taking an antidepressant.
 
If side effects feel intolerable it’s important to talk to the GP, who may be able to offer practical solutions, advice or reassurance. Emily’s doctor prescribed sleeping tablets for insomnia in the short term.
Several people had found that varying the time of day when they took the antidepressant could help iron out sleep problems, or make other side effects such as nausea more bearable, for instance by timing them so that the worst of the effects happened when they were asleep.
Although initial side effects should wear off after a few weeks, some people found that they continued, or the antidepressant seemed to have no beneficial effect even after several weeks or months. It’s important to review your progress with the GP after a few weeks. He or she may alter the dose, or switch to a different antidepressant. (See ‘Stopping taking antidepressants’, ‘Changing antidepressants’, ‘Reviewing antidepressant use’, and ‘Coping with antidepressant side effects’).

Last reviewed June 2016.
 

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