The effectiveness and adverse effects of antidepressants have been the subject of a great deal of research and competing claims, including about whether antidepressants address the underlying causes of depression.
Most people we talked with had some experience with antidepressants, usually in combination with other forms of treatment, and held diverse views about them. Many people had experiences with antidepressants; however people’s description of their experiences ranged from positive to negative. While some people described them as a 'saviour', others who had positive experiences still held ambivalent feelings about them. Several people described the fraught journey of trying to find a medication that would work for them, with side-effects they could tolerate. For others, the ‘right’ medication had eluded them completely.
Those who were opposed to antidepressants were concerned about becoming addicted or were reluctant to take medication in general. The majority of people were taking medication at the time of interview and this had been prescribed by GPs or psychiatrists. Most people described significant side effects; however, they chose to keep taking antidepressants as they claimed that, for them, benefits outweighed the side effects. A few people told us that they had experienced less significant side effects.
Finding the ‘right’ medication – benefits
The benefits described by people taking antidepressant ranged from insignificant to helpful. People talked about feeling ‘levelled right out’, ‘calm’, and ‘normal again’. Dani said that antidepressants ‘helped to clear my head and put me in a position where I [could] take care of myself and do the things I need to do’. The majority of people reported needing to keep taking antidepressants for an extended time to experience any benefits, while others described rapid positive change soon after starting on them. Often family members were said to be the first to notice a positive change in the person.
John is married with three children. He works part-time as an education officer. Ethnic background' Australian-Chinese.
I remember before I started on anti-depressants, it was the school holidays, I'd taken two weeks off work and I went away camping with my wife and another family, and I didn't talk to her for - I think we were camping for a whole week and I didn't talk to her for a whole week. I mean the hostilities were just so intense, the resentment was, just so intense, I just - I just didn’t want to talk to her. And aside from pass the salt, that was about all I said to her for a whole week.
And then I think for whatever reason I just thought, I've just got to try this, I've just got to take these - these anti-depressants and just give it a go and see if it helps. So I filled the script, the doctor said start for the first four or five days on half a dose, which I did and after two days - I think between 24 and 48 hours I felt so different that I rang the doctor and I said, look do I have to go up to a full dose, because this is amazing.
And he said, no not at all, just stay on what you're staying on, it's just that we normally ramp up.
And of course all the literature says, you know, six to eight weeks, or four to six weeks before you get an effect and I got an effect straight away and my wife basically said I became human again, and she said, I could talk to you again, because before that she couldn't talk to me because I'd just explode. And, the amazing - I guess for me medication meant that everything just levelled out.
I mean the downside of it is yeah, you go numb, so you neither feel good nor bad, and if something good happens it's like, wow, that's good, but you don't feel good about it, it's just logically you observe that that is a good thing.
So, I mean that's the downside, but the upside is that for me, I just levelled right out, I became, calm again, peaceful again, I didn't suffer from anxiety anymore and so, ah, I guess I advocate it for people whom it's prescribed for because it just gives you a chance to actually step, step back a little bit from just the frayed edges, the frayed nerves, the kind of - I mean you're on alert all the time, you're on high alert, it's just you're in this high state of alert, the adrenalin's pumping, um.
The importance of finding the ‘right’ antidepressant was frequently mentioned and most people tried a few before they found one that worked for them. Some believed they would be on antidepressants for life. The difference between a medication that did not work and one that did was described by one woman as the difference between feeling ‘very zombie-like and more depressed’ and feeling ‘just normal and just calm’.
Comments were made about ‘older style’ and ‘newer’ antidepressants and the different adverse effects of each. Being able to discuss medication and its effects, and making shared decisions with their treating doctor was always appreciated. Some suggested people should be closely monitored by health professionals while on antidepressants.
Gabrielle works as a registered nurse. She is married with one daughter. Ethnic background' Anglo-Australian.
I - the medication is something that is - should be looked at as a one on one type thing. It shouldn't be looked upon as a class of medicines that say okay, you've got this symptom; that will help it - because I think it - they react to people differently. And it really does clearly need to be, observed closely with your, health team.
So you had some not so good reactions with some medications?
Mm, yeah. I, I would have the reverse effect. Instead of it calming me down it would make me manic. And I'd be totally like, not with it. I tried lots of medication. I tried herbal remedies, but when I, I - I've been on two medications - two antidepressants - now for the last few years, with two other medications, and that's the best I've been. This is the best I've been.
They're old - it's an old style antidepressant. I take Anafranil (clomipramine) of a night time, and that helps me sleep. Also of a night time I take Seroquel (quetiapine) and one clonazepam, and that enables me to actually sleep. I wouldn't sleep otherwise. And then I'll take Prozac (fluoxetine) of a morning.
They're all, at the moment, being weaned down to lower doses for me. and that's a - I'm extremely lucky to have come across a very good, GP who is very with it and very, on the ball in regards to how you're feeling, how to judge it, what to do. And she is, keeping an eye on me while I'm weaning, and I, my psychiatrist, yes.
Age at interview:
Age at diagnosis:
Ivan is a retired speech pathologist who migrated to Australia from Croatia. He is divorced with two adult sons and lives with his current partner. He enjoys working part-time at a radio station, gardening and the arts, and is a Christian. Ethnic background' Croatian.
I certainly tried with medication, I mean my GP, he tried with two…huh, I couldn’t, I felt like I was not myself, like I was out of my body, horrible…I can’t remember what it was, I would be glad to give you the names of the medication but we can find it in my documents. We tried with two, but finally we found the third one which was Lovan (fluoxetine), 20mg and…my therapy was 4 capsules a day, two in the morning and two in the evening. That was a rather hard dose. I asked him, we discussed it as friends and he said' ‘Look, you will need about two weeks for it to become effective, to start building-up in your body’. And I said' ‘But how long will it take?’ He said' ‘The question is how long you have been ill?’ And then he explained to me a formula in defining depression as an illness. He told me something which made sense and sounded logical. He said' ‘Your recovery will take as much time as you were ill before it was discovered. For example, we diagnosed it in 2004 when you resigned from your job, which is not necessarily significant, so, it will take another four years to reach some kind of normality’…if…I was horrified. Then, in 2004 it sounded…what?! 2008 and I will still be on antidepressants!? Antidepressants, that was something which Hollywood stars used to take to poison themselves, take antidepressants to move to Xansa (alprazolam), they can’t live without Xanax, they live on Xanax…this was my feeling… of stereotypes, because you hear that from popular media, antidepressants have negative connotations, ‘Don’t give me antidepressants’, they are almost like anti-psychotics…aren’t they?
Anyway, I can say, here we are, it is April, 29th 2010 and I am proudly still on one capsule of Lovan (fluoxetine). It gives me confidence, it is like a security blanket and I think it is fine, I am not ready to terminate my therapy, not yet. I tried to stop it twice but after a couple of days I had a feeling that I felt better if I took it and so I returned to it. Well, how long will it take I don’t know. In any case from 2004 to 2006 I was on 4 capsules, from 2006 to 2007 on 3, from 2007 to 2008 on 2 and from 2008 on one. So, from 2008 I am taking one, one capsule of Lovan (fluoxetine), 20mg for the last two years.
A few people believed that their depression was caused by a chemical imbalance (see ‘Views about causes of depression’). Some holding this view said that they thought antidepressants were the most effective therapy for them and they tended to stay on antidepressants even after they felt better. In these instances, staying on antidepressants after an improvement in mental health was advised by their doctors.
Ruth has recently retired from a career as an executive assistant and is starting her own travel company. She is single and enjoys travel and sport. Ethnic background' Jewish.
So the medication doesn’t worry me. I'm more than happy to take it because when I'm on the medication it is who I am. It brings out – I- I've got - I guess they call it a chemical imbalance. And for me, the medication levels that; so medication has helped me.
I'm been very lucky that the medication that I've been on from day one hasn't given me any side effects; has just, just been great.
And when you're on the right medication, when you're on the right therapy, you're on the right track. And it makes such a difference to your life. When you're depressed you are not who you are; and that's what used to upset me because I am pretty outgoing, and when I'm depressed that's not who I am. Who I am is when I'm on my medication, when I'm properly treated, when I'm talking about it, when I'm not talking about, when I'm just getting on with life and...
Yeah. Look, I'd, I'd be happy to come off it, and I'd probably, you know, talk to my psychiatrist about coming off it. And, you know, she's always said to me you can, you can certainly level it back, you know, take smaller, a smaller dosage and then gradually come off it, if that's what you want to do. But we haven’t discussed it, probably, in the last six months. I think the last time I discussed it was about six months ago, and she, she wasn't keen for me to come off it. She just couldn't understand why. If it's working why do you want to, you know, - and like I said, that's probably a good thing because had I not been on it now, with what's been happening, I think I would have struggled.
Some men were reluctant to start taking antidepressants as they were concerned that antidepressants would ‘control’ them. One man changed his mind after he felt suicidal and was concerned that he might self-harm. A few people who tried to adjust their dosage without medical supervision described experiencing negative consequences. The importance of taking antidepressants for a sufficiently long period was emphasised by some people, who explained that it took time for the positive effects to outweigh the negative effects. A few said being ‘regular as clockwork’ in taking medication was very important.
Paul is a divorced former police officer with two sons, aged 10 and 14. His interests include spending time with his sons, friends and family, community involvement, his dog and keeping fit. Ethnic background' Australian.
But the problem is you’ve got to be on it for - unless you’re on it for four weeks or six weeks even. So you’ve got to go through all the side effects and all the reactions and most of them had something. You know it might be a headache, it might be a little bit of nausea, it might have been ah that you’d be very sleepy during the day and not sleepy at night. But whatever it was each one of them had something and that, you know and I was made aware of it. And you know I think at that stage I was seeing (psychiatrist’s name) on a weekly basis and I seen (psychiatrist’s name) predominantly.
Um so ah we continued with the medication for a while months I would say ah when it all first started. And then some would go all right for a little while and then it, the side effects would pick up, so just an absolute lottery. And then ah the - (psychiatrist’s name) prescribed Effexor (venlafaxine) and you know I - when people ask me I always use the term my life went from black and white to colour. Almost overnight you know. Whatever it was the lights went off, the whistles, everything said we’ve done it. And to this day ah I’m still on Effexor (venlafaxine) that I take every morning and now it’s just part of routine.
I’m very oh religious about medication now. I do not mess with it at all. And you know I know exactly what to do if I, for whatever reason, miss a day or whatever. I’ve, I’ve self-medicated in every direction. I’ve not taken them, I’ve taken more, I’ve tried all my own formulas but I figure (psychiatrist’s name) knows what to do, listen to her. Cause I felt every single time I’ve done it I’ve found the pitfall. But anyway I’m not necessarily one who knows best. But yeah so the - when, sometimes what - it’s almost like the, you know, I like, not like the term but the, the term the black dog you know.
Finding the ‘right’ medication - side effects and mixed effects of antidepressants
People's experiences with the severity of side effects also varied, from barely noticeable to severe. Side effects mentioned included' muscular pain; feeling ‘light in the head’; ‘spaced out’; short term memory loss; feeling ‘low’; ‘numb’; feeling indifferent to good things happening in peoples’ lives; losing interest in sex; not ‘feeling themselves’; feeling ‘in another world and another time’; difficulty concentrating; and dizziness. Emma said her thoughts were ‘a bit all over the shop’.
A few people were introduced to antidepressants following traumatic events in their lives. As a result of these events, some people experienced prolonged distress and resorted to taking antidepressants for a long time; others took them for a while then stopped.
Phil is divorced, lives alone, and works as a cleaner. He has three adult children and one grandchild. Ethnic background' Italian.
So he put he me on, Zoloft (sertraline).
And, yeah that was, sort of you know and sort of, take half of one every day and, sort of, here I go planet Zoloft, you know sort of, it did space me out.
But it helped me get through, and yeah, you know sort of saw me - saw me through til - til the end of the relationship.
Okay, I was on Zoloft (sertraline) I think for the - through two or three years. And then the problem with me being spaced out came up and then so I went onto another medication, XL - XR - XL…
Effexor (venlafaxine) - Effexor?
Yeah, I think that's it.
And I was on that for another year or so, and then, you know, I'd, I’d put on a lot of weight, and you know, I - I just felt like it was time for me to, you know - the - the marriage had - sort of had split up and stuff and if I wanted to, you know sort of, get off it so, so I did.
How did you do that?
I just pretty much just, cold turkey really.
Jules described progressing from starting antidepressants almost ‘by accident’ following a tragic life event, to using them long-term, despite not finding one that was effective.
Jules lives alone and is widowed with two adult daughters and five grandchildren. She is currently completing a PhD. Ethnic background' Anglo Australian.
They not only had adverse affects, that's why I asked you to go, remind me to go back to the day of (husband’s name) funeral. When I went to bed at two o'clock in the morning, the day after, the day, night, next to the bed was a box of Xanax (alprazolam) and a box of Zoloft (sertraline), and I had no knowledge
I have thought of suing the doctors because what I subsequently found out was that some, a doctor from a surgery which wasn't very far away from the location of the accident, had rung the house, someone had answered the phone, I don't know who, and been asked to come and pick up the script, take the script to the chemist, get it filled and put it by my bed.
Never was I consulted as to whether I either wanted it or assessed as to whether I needed either. And I am so angry about that because 16 years later I'm still on Xanax (alprazolam), 'cause when I went to bed and I saw these boxes, and even with my nursing background I didn't connect that Zoloft(sertraline) was an antidepressant, I just saw it as a, I'd take it every now and then.
And then when I was put, and I started dry retching and I would dry retch for years, and then when I was put on Zoloft (sertraline) as an antidepressant and the dry retching, the anger because it all clicked back, that for all that time that I'd been dry retching and going through it because scripts just kept being repeated. And why not? I was looking for an anaesthetic, something to ease, to stop the pain. Something to dull it.
So the antidepressants, the impact that they've had, obviously at the moment I'm pretty angry because after a year of being on Cymbalta (duloxetine), and gaining 13 kilograms in weight, and not having clothes that fit me, the agreement is that it has had such mild impact that it hasn't been worth it and that's been the case with every antidepressant that I've been on, and that's why I said you might as well go through MIMS to see what I've been on.
So I'm going back, I am currently in the process of being weaned over an eight week period, off the Cymbalta (duloxetine), and I'm going into the clinic on the day after Boxing Day, as last chance Parnate (tranylcypromine), a drug that was developed in the ‘50s and has, not used very often because of the seriousness of the relationship between food, certain foods and this drug. So when my younger daughter said well, what are the implications, I said well, stroke or death.
I would prefer not to be going on the Parnate (tranylcypromine), but as my external psychiatrist, who is very keen to see me finish my PhD, has said it would be a pity if it's the one thing that works. So let's just rule out whether it does or not. As he pointed out, there isn't an antidepressant in the world that will motivate me, give me the motivation to finish but it might get me feeling good enough about myself that I get to it, that it, that it is finished.
Shaz, who had a long history of depression persisted with taking different antidepressants over the years together with a range of other medications for her mental health including antipsychotic, anti-anxiety and mood stabilising medications, guided by her psychiatrist. She described experiencing side effects and no apparent positive outcomes.
Shaz has an adult son and two grandchildren, whom she sees regularly as well as her mother. She lives alone, and in her spare time enjoys crochet and tapestry, gardening and music. She is currently studying millinery. Ethnic background' Australian.
At the moment I’m on a anti-depressant called Cymbalta (duloxetine) which is - I don’t know that much about and I don’t really know whether it helps or not. But that’s a new sort of drug, yeah
I have. It was called - what was it called, started with an S. Serenace (haloperidol), I think and don’t know exactly what it was meant to do but it was prescribed by my psychiatrist, but it made me, it did, it made me really low. And I virtually just stayed at home in my pyjamas all day long. I didn’t do anything and I hate the television. I love my music but I wouldn’t even listen to my music. I’d just curl up on the couch like a veg-head and after much discussion and on it for about six months, he said, ‘Look we better get you off it, I don’t think it’s doing any good’. Then when I came off that, still took a while, I think once you’ve got these drugs in your body, it takes a while for them to get out. They’re, they’re not just going to disappear when you stop taking the medication.
But, and that was when he put me on the Cymbalta (duloxetine) instead.
Some people hid the fact they were on medication after being judged as ‘weak’ or not ‘in control’ for taking them. Jane talked about not disclosing that she was taking antidepressants, even though she thought they helped.
Jane is married with two children. She works as a consultant. Ethnic background' Anglo Australian.
I didn't go around telling - well, I mean, now, there – most people don't know that I've had postnatal depression, so I wasn't going around shouting from the roof tops, yee hee, look, I've got Zoloft (sertraline), wee hee!
I wasn't. But at the same time, if anyone had asked me directly I wasn't uncomfortable with saying I was on it. It did get in the way, I didn't feel like me, I felt like I lost a lot of my higher cognitive functions. I found thinking abstractly or highly abstractly very difficult. So if it was a concrete train of thought or if it was about sort of general sort of political issues or whatever, I could deal with it. If it was thinking about, you know, philosophy of – anything, I couldn't. So it was that next level of I just couldn't go there, my brain wouldn't do it, and I didn't like that.
So, yeah, and as I said before, I lived a long, lived a lot in my head and so it felt, it felt like part of my - I didn't have access to everything really. But it also, I mean, it did help. That's the other thing, it really, once I stabilised the dosage it got rid of most of the symptoms, if not all of them. Every so often I'd still get a bit of anxiety but I could manage that with breathing and visualisation. And also, – my stomach’s really rumbling here, this is going to be a very interesting soundtrack. It’s yeah it, yeah so got rid of most of it, you - the anxiety was manageable, and there wasn't really, I didn't get any physical side effects of it. Every so often I'd get a headache, that'd be about the most. Yeah. But it had to be done.
Reasons for not taking antidepressants and being ambivalent about them
Some people remained reluctant to take antidepressants even after they had tried them, regardless of the potential benefits that their doctors had explained to them. Reasons ranged from observing effects of medication on their relatives, wanting to feel ‘in control’ of themselves, or having good experiences with talking treatments (see 'Talking treatments').
Millaa is a full-time student. He lives at home with his parents and three siblings. He runs a weekly radio program looking at issues in relation to Queer-identifying youth. Ethnic background' Welsh, French, New Zealand and Australian.
But in, in the sense that - with medication for mental depression, for mental disorders, I don't - I think it's just a bandaid. Because I know that… it – you can't - they just, they work in that they stop all the demons coming out, or, or in, whatever, to your mind. So it's just, it’s - but once you stop the medication it's like the boom gate gets lifted [uses hands to demonstrate gate lifting and traffic passing through] and all of the cars start going again. It's, it’s not a cure. It's merely a, a preventative measure, and. It's a, it’s just a, it’s just a boom gate and… once the medication starts to wear down or once your body or mind, ah, gets used to the medication, perhaps they can smash through those boom gates, you know. And then you need something stronger and then something stronger and stronger. So I think you're just going to be perpetuating, I don’t know, a cycle that's just going to lead to drug addiction, in a sense. Because you'll know that you'll be dependent on these, these drugs.
And I know that I don't want to be like that. Because I know that my parents are very much like that. They’re - my mum especially is addicted painkillers and things like that. So I, I've seen it first-hand so perhaps that's also part of why I'm like that. But I prefer more of a natural approach to medicine when… when it's more appropriate. You know, like, if you cut yourself, put a bandaid on it, yeah. Just the most simplest way, you know, because your body is designed to heal and it's designed to recuperate and regenerate itself.
Age at interview:
Age at diagnosis:
Ron is a community mental health worker who lives alone with his cockatiel. He is divorced but is in another relationship, and has an adult son from his first marriage and a close circle of friends. Ethnic background' Scottish / Irish.
So medication has its place but it’s only really probably at the beginning of the recovery process. Some people may need to be on medications all their life, uh especially if they have a lot of fear about breaking down again, maybe that’s just another issue they can deal with, but I don’t have that fear. But I still have to trust the experts and maintain the medication for a reasonable amount of time after, just in case.
So you don’t take medication all the time?
No I haven’t, I haven’t continued to take it, in between these episodes I’ve got to the point of, [uses left hand to illustrate a gradual process] very slowly, gradually, with correct supervision, with my doctor, gradually coming off it. And uh this last episode I had, beginning of uh this year, and I’m now back on a medication, but I do, and I have discussed with the doctor, that in time I’ll probably have to stay a lot longer, this time because of the, the a - more short, severe, acute experience I had. But - we are talking about, already have reduced it a little bit. So there is - it’s a process we all have to go through, but I need to do other things besides medication. Exercise regularly, meditation, looking at problems in my life and trying to resolve them - the conflicts that we all have.
Age at interview:
Susan is a retired academic. She has a civil partnership with her same sex partner. Ethnic background' Anglo-Celtic.
Well I don't really like taking drugs at all, to tell you the truth. I don't really like taking drugs that interfere with the processes of the mind and the emotions, but sometimes you've just got to do it because not taking it is more dangerous than taking it. That's my view anyway, so - and I actually went along and saw my lovely GP here in (city name) and said, you know, I'm worried about this, I've been on these tablets for quite a long time now, you know. I'm worried about you know, damage...
…permanent damage, the way my mind works. And she said, well I'm worried about what might happen if you don't stay on them.
So that gave me a bit - oh. So that's - I've now been on them for, for about two, ooh… three years. On a very low dose, but it's there. Just there. But I'm finding just in the last six - three months or so ah, that the insulation layer has got thinner and thinner and the grief plug has got harder and harder and the basin is filling up and up and up, so that's why I've decided to double the dose.
Well for one thing - for one thing, I don't have a 100 per cent trust in drugs, particularly not drugs that mess about with your, with your mind and your emotions. It's a very delicate mechanism, the moods and the, and the mind and how you see the world, and how you deal with the ups and downs of life. It's a delicate mechanism and I don't really like interfering with it.
It's just that, as (doctor’s name) said, sometimes not doing it runs a greater risk than doing it, so as soon as I feel like I'm - that my zest is coming back and looks like it's there to stay, then I will leave the drugs alone. But then if things go pear shaped again I'll go back on them. I don't have any problem with it, if I need it.
Stopping taking antidepressants
There was a large variation in the length of time people kept taking antidepressants; from a short trial to being on them ‘for life’. Some people reported stopping abruptly which was sometimes associated with bad side effects. Others talked about the need to reduce the dose gradually. Safra was convinced she would be on medication for life and said stopping made her go back to a ‘deep depression’.
Safra migrated to Australia from Malaysia twenty-five years ago leaving behind a successful career in cookery. She is divorced with three adult children. Ethnic background' Malaysian.
My life is now very simple. I have my medicine in the morning which gives me a float and in the evening. I take it about 10 o’clock and I have a good sleep.
The effects I feel are when I take the pill I feel tired so I go to sleep. The next day I feel like light in my head, very light. And I also feel very oblivious of what’s happening if somebody in - I don’t get too emotional with things. It, it doesn’t stop. It just goes through so it makes me not so intense with emotions. So I can’t survive without my medication.
When I stopped taking it, my mind started over-telling me stories, too many stories in my head. I couldn’t stop my mind from telling me too many stories. You start putting, it’s like a different person in me say, see, see, see how they are living a life. Look at their life, all they had to do was shut up and they could have had that life. But look at you, you opened you mouth and look at you where you are now. So it made me very vindictive to myself. So the medicine stopped me from over thinking, give me a calmness.
Even when stopping was gradual and advised and supervised by a medical professional, some people experienced significant side effects which took them some time to get over.
Emma is an occupational therapist currently on maternity leave. She lives with her husband and two young children. Ethnic background' Anglo-Australian.
When going off, going off the Sertraline was horrendous. You get, I got brain zaps - I don't know if you've read about these brain zaps? They're horrible. They're sort of like a, it feels like you've touched an electric fence and you get a flash of light in front of your eyes. And it's, and you get a, one big enormous electric shock or shake out, as, out of your whole body. Quite a few of those. Got quite a lot of dizziness. This probably went on for two to three weeks while you're tapering down. Well you taper down for quite a few months but I had quite a bad period for two to three weeks there. And you get dry mouth.
Your thoughts again are a bit all over the shop. You, yer, I don't know how to describe it but I've always called it brain chatter and I was quite tangential in my thoughts. I'd, scattery, all over the shop when I was coming off the Sertraline, so, it was bizarre. But it, from my experience I wouldn't, I'd probably, wouldn't not have wanted to go on them.
Last reviewed January 2016.
Last updated January 2016.