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.
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.
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.
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.
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.
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.
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.
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.
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’).
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’.
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.