Other medical treatments for depression
The older antidepressants medication: Tricyclic antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) are effective against certain kinds of depression, and are still sometimes prescribed if other antidepressants like SSRI’s are not effective.
- TCAs -Tricyclic antidepressants and tricyclic-related drugs include amitriptyline (Tryptizol),clomipramine (Anafranil), imipramine (Tofranil), lofepramine (Gamanil),nortriptyline (Allegron) and trazodone (Molipaxin).
- MAOIs - Monoamine oxidase inhibitors include drugs such as moclobemide (Manerix) and phenelzine (Nardil).
Those we interviewed had mainly used TCA’s and MAOIs before the 1990s, or if recommended by their doctor for their particular circumstances. People we spoke to seemed more concerned about the side effects of these drugs, compared to those describing the newer anti-depressants (see 'Newer Anti-depressant medication: SSRI’s and SNRIs'). With tricyclics (TCA’s), people talked about side effects such as constipation, drowsiness, dry mouth, blurred vision, tremor, and weight gain. MAOIs could make people feel sluggish and drowsy, gain weight, and there was a risk of fainting when standing up due to low blood pressure. Because of the risk of a sudden increase in blood pressure called "hypertensive crisis", people on MAOIs had to follow a strict tyramine-free diet, excluding such diverse foods as broad bean pods, cheese and marmite. Thus, MAOI’s are prescribed by psychiatrists and people have to be supervised when they start to take them.
For more information see our antidepressants section.
Episodes of depression can occur alone ('unipolar depression') or with episodes of related mood swings ('bipolar disorder'). This is an important distinction to make, as it may affect whether or not antidepressants are suitable, and whether other medication might be better. Antidepressants are usually used to treat unipolar depression, but, in bipolar disorder different medications may be used, such as mood stabilisers (e.g. lithium or valproate) and/or other medicines such as quetiapine and mirtazapine.
Lithium is used routinely in bipolar disorder as it has a therapeutic effect on both depression and manic episodes, and is also used as an “add-on” medication in treating depression alone. A number of people took lithium, a drug which was first used to control bipoplar disorder (previously known as manic depression). People with bipolar are thought to have a chemical disturbance in the brain which causes alternate periods of very high and very low mood, over periods of weeks or months. Sometimes these mood swings go in only one direction - either high or low - and this is called "unipolar disorder". Lithium can help some people who experience serious downward swings into depression, whether or not these lows are followed by highs.
Many people said that lithium helped them to steady their moods, and avoid extreme highs and lows. However, people on lithium had to have their blood monitored regularly to avoid toxic blood levels or under treatment. There were also side effects with lithium that people did not like. Common side effects included increased urination, increased thirst, metallic taste in the mouth, mild nausea, weight change, hair loss and trembling hands.
One man felt that lithium took away some of the enjoyment of life, as well as his creativity and 'about 10 IQ points.' He wanted to be in control of his treatment, and so he negotiated with his doctor to come off lithium. Unfortunately, some found that reducing their lithium led to depression again. Some people who needed lithium were tempted to come off it when they felt well, not realising how it was preventing mania and depression. A few were angry that their doctors were not aware of less common problems with lithium such as hair loss (due to low thyroid function). Although friends of hers did well on lithium, one woman was adamant that lithium made her more paranoid, and also suicidal and violent. After much effort, she persuaded her doctor to change to another medication, and she then improved substantially.
Was well informed about lithium side effects, and was willing to take lithium to avoid depression...
I've reacted fine, I haven't... apart from a slight tremor of my hands at the beginning, which is to be expected, you know, you, you're given a sheet which tells you what to expect, and I looked it up on the internet as well. I'm very against taking medicine for a long time, but after my experience with the depression I decided I would be prepared to take it to the.... for the rest of my life if I don't get it again, the depression again, if it stops that.
And, and also I'm not, I'm not over the top with the manic aspect but it has made me make choices I wouldn't otherwise have made. It's made me make choices which haven't been good choices, and so I've I hope, I mean all my friends are watching out now, you know, that I'm calm and not getting hyperactive as I did before.
Says he did not like taking lithium because it stopped him doing things he enjoyed, and so he...
But I'. I didn't enjoy taking lithium because it stopped me doing things which I did enjoy, the few things that actually did give me pleasure in life, such as writing music. The lithium robbed me of that pleasure. So I started dropping my dose and found that I could halve my dose and feel OK. So I did that for a few weeks and then stopped taking it altogether and felt OK. And then sort of reported back to the doctor and said '. to my GP and said, 'Well look, this is what I am doing. If I start feeling depressed again I shall take it again. This is my disease, it's part of me, and I want to control it and I want to be in control of the pills I'm taking. If I am feeling that the pills aren't helping me then I want to have the power to stop. If I get depressed again, well I will realise that, you'll realise that. I'll take my pills again.' So I stopped the lithium and was actually OK slightly depressed but not, you know nothing, nothing drastic and stayed with that for a while.
He tends to become depressed when he tries to come off lithium, although his last depression wasn...
Once a day?
Once a day, and though I've had periods when I've stopped taking it in the past, it usually ended by my getting depressed again. So I've tended to just stick to it. But I know that it's very powerful stuff, and I don't believe that I can really get better while taking something like Lithium. But on the other hand, I've found it has had very uncomfortable consequences for me, even when I've reduced it gradually the last time, I mean since 93 I have had one or two periods when I went several months reducing the Lithium.
The last time that happened was about four years ago I reduced it to the point where it was really having hardly any effect on me at all. And then I went' I found myself going into a depression, so I got back on the Lithium but of course it's' but there was a period of about a month before it really fully takes effect.
And in that time I was suffering from moderate depression which was so much better than the previous times when I'd been in hospital, that although I wouldn't say it was exactly pleasant it was still' it gave me a feeling that I've got some control now of this thing. And I was having some experiences like increased sensitivity to things like noise and colours and feelings.
He lost his faith in psychiatrists when his hair fell out. His psychiatrist initially said it was...
So I tried, I'd try anything to get out of it so I went onto the lithium salts, and one day I was washing my hair over a sink and when I opened my eyes the sink was lined with masses of hair. So I pulled my hands through my hair and I could pull it out and over the next 2 or 3 weeks I guess it all fell out.
So I had no hair at all and I saw this psychiatrist and he said, 'Oh, don't worry about it, I'll send you to a skin specialist, its come out because you've had a great deal of stress.' So I went to see the skin specialist and by a piece of good luck he said, 'I get depressed as well.' And he said, 'And I know what lithium salts do.'
And by examining my scalp he said, 'I can assure you it will grow again.' Which it did, so that was a relief [pause]' And to continue that story I was expected to become depressed when my wife died. The bereavement was thought'.[to perhaps trigger depression].
But I didn't really feel that ill at that time. And I saw this same psychiatrist. This was about another 10 years after the first visit to him when he had prescribed lithium. And when I walked in he said, 'Oh, I remember you, you had an overdose of lithium!' And I said, 'You told me it was stress.' And he said that he could have made a mistake. So all my faith in psychiatrists went zooming out the window with one man.
Though her friends did well on lithium, she became suicidal and very paranoid before she stopped...
It could work for one and not work for another. But my friends who are on lithium who are manic depressives, it worked for them. They believed..... but it changed my whole personality terrible. And I've got a lot, a lot of friends and I don't know how I've still got them because it was terrible.
The trouble I caused and the paranoia was really, really bad. And I used to think that I was a thief, that I was shoplifting. I used to think the benefit agency... were following me everywhere, and I have never, never, never cheated or lied or anything. And this has been going on and on. And I still get it like this paranoia.
The suicidal thoughts they are away completely. I don't get... you know, but it was horrendous for a year. And I've been down to the underground to try and throw myself on the track.
For more information on lithium see MIND’s booklet – Making sense of lithium and other mood stabilisers.
Electroconvulsive Therapy (ECT)
People who had electroconvulsive therapy (ECT) were so severely depressed they were often in hospital at the time (although people do, for example, attend as outpatients for ‘maintenance’ treatments from time to time). Being severely depressed, it was difficult for people to decide whether or not ECT was the right treatment. One man said, 'I didn't know what ECT meant' when he had begun a series of 20 sessions of ECT. Our website on ECT includes many more experiences of and information on ECT.
One woman insisted that ECT had resulted in her extraordinary recovery. Others had more mixed experiences, felt only slight improvements, or were unsure if there was any benefit. Because many were also taking medication for depression, some found it difficult to know if ECT had helped them. The main problems reported were memory loss (temporary and more permanent), severe headaches, tearfulness, and feeling confused and frightened by the whole experience, including anaesthetic and waking up disorientated. Several people reported memory loss after ECT, e.g. they forgot names of things, forgot whole holidays they had been on. A few people had a particular dislike of ECT, and some were traumatised by the whole experience. Some people associated the look and smell of the ECT theatre with their negative and frightening experiences. One woman avoided further ECT treatment by pretending she was better. Another woman tried to find the humour in a frightening experience.
While she was unable to give consent to ECT (Electroconvulsive Therapy) in hospital, her recovery...
So I wasn't given that without their consent, so the change in me though after the ECT was almost miraculous' it all sounds very scary, but you really don't... you don't see anything because you are anaesthetised, so you are asleep. And you wake up, and I... you have a slight headache, but apart from that, I had no side-effects.
And, I'm not too sure how it works, but I... my mood improved instantly, and I was talking and laughing... and to the point where the nursing staff were saying, you know, "What's the story you're meant to be depressed?" [laughing] And the doctor was quite surprised by my recovery and he said though that for many people that happens. You the ECT I had, I think I had five lots of ECT, and with each successive lot I got slightly better, but, I, with the first lot I was pretty well better, and then I was in hospital for three, three weeks, and they put me on some medication.
He 'swallowed his tongue' during ECT (Electroconvulsive Therapy) and had to try to alert the...
And so I was strapped onto a trolley, and up round my feet and waist and chest and my arms at the side. And then I was in that state, with two anaesthetists who stood by me talking about something I don't remember what. And I swallowed my tongue and I couldn't move or shout, so I thought 'I'm going to die if these two don't soon notice what's happening'.
So I moved my body as much as I could and hit the one of them with the trolley, and they were terribly apologetic and asked me if I wanted to go on with it. And I did, but ever since then I've had quite a lot of surgery. And I always ask the anaesthetist to be careful not to let that happen again.
So that period then I was taking quite a lot of anti-depressants drugs as well and I was off work for about 6 weeks'. 6 months, I mean 6 months. When I went back to work I had no recollection of what had happened while I was away. And I knew the job well enough to go on doing it, but my memory was bad so'
While I was off, we went on holiday. And to this day I have no recollection of where we went or what happened or anything. So that was a bit frightening. And then I was determined to go back and do the job so my memory was affected by this time so I got into the habit of carrying a note book and putting everything down that I'd to do. And so to all intents and purposes, I was back to normal, or I felt I was.
Did not like ECT (Electroconvulsive Therapy), felt frightened and confused, and when she tried to...
What was that like?
Horrid. I just remember being so frightened going into a room with a bed laid out and they'd get you to lie down on the bed, and give you an anaesthetic in your hand, which would basically make you go unconscious. But just that 2 minutes when you might have gone into the room and been waiting, I was just so frightened. And then they give you ECT and you wake up after a while and, again, that is quite a confusing experience. I did find that it affected my memory a fair bit.
What do you mean by that?
I remember talking to one of the women in hospital, bearing in mind I was in a mother and baby unit, and we discovered we lived quite close. And we agreed, she was leaving, so we agreed we'd swap telephone numbers, and I couldn't remember my telephone number... so to not be able to recognise my own telephone number' And she couldn't remember her address. And you think, well....
Had she had an ECT as well?
She'd had ECT as well, it's laughable because you can't remember some of the most basic things about yourself. You know, "How old am I? When, what's my birthday?" And that's... that's frightening when you actually feel as though, you know, you're completely losing your mind because you can't remember anything. I mean you can remember things, you can remember where the kitchen is to go and make a cup of tea, it's, it's odd things that you can't remember. And they come back but'.
Some felt that they side effects of ECT were more substantial than they were initially led to believe. Some reported the loss of long term memories, and doctors were not open about the possibility of memory loss.
After ECT (Electroconvulsive Therapy), she has no memory of specific time periods, and her...
I've absolutely no recollection of it whatsoever. I could, and I've searched my brain'. You know, and I said, 'Well, what did we used to do there?' 'Oh we used to go round the shops, and we used to go to that disco all night' and blah de blah and you know. I can't find any memory of it whatsoever...
I get angry with the professionals that this wasn't explained that this could happen. ' I've tried to talk about it with the doctors at the hospital and they say, 'Give me an example' and I give them an example and they say, 'Oh that's normal, that's just normal, that's not the ECT (Electroconvulsive Therapy), that's normal'.
I mean when they hear it, they don't want to hear, you know. They don't want to know, but if you look on the Internet most American psychologists or psychotherapists, psychiatrists believe that ECT causes long-term memory problems' it can damage the brain. In fact even if they do give ECT, they only give it very rarely over there, and if they do they give it to one side of the brain.
They don't zap both sides at the same time and things like this. And [cough] I think well, "How come this treatment has been given to me? And they are not aware of these things? Why aren't they aware of it? They are working in this field? Why, why aren't they aware of this?"
People said that their ECT experience was better if staff were friendly and helped to put them at ease throughout the procedure. For more information on electroconvulsive therapy see our website on ‘Electroconvulsive thereapy’ or the MIND’s website.
For more information on advance directives and the Mental Capacity Act see Mind’s website.
Anti-anxiety and sleeping tablets
Anxiety and panic were very common among the people we talked to. Two common treatments for anxiety were benzodiazepines (e.g. diazepam, lorazepam, chlordiazepoxide), and beta-blockers (e.g. Inderal (propanolol)). Some benzodiazepines (e.g. temazepam) were also used to help people sleep. These drugs helped many people to cope with anxiety and sleep better. But few people had become addicted to benzodiazepines and had trouble withdrawing, and such people need support from their GPs to withdraw very gradually.
For more information see MIND’s website - sleeping pills and minor tranquillisers.
A number of other medications are now being used to treat depression or unipolar depression and some are still classed as antidepressants but some were developed for other conditions. We have not yet interviewed people about most of these medications.
Agomelatine (Valdoxan) is a type of antidepressant that works by helping to restore the balance of circadian rhythms (the ‘body clock’ which tells us when to sleep and regulates many other physical, mental and behavioural processes). It is licensed in the UK but has not yet been approved by NICE.
Quetiapine (Seroquel) is and antipsychotic medication that has been approved as add on treatment for those with major depression. It is also use to ease symptoms of schizophrenia, bipolar disorder and other mental health problems. Quetiapine works on the balance of chemical substances in the brain and is used to help keep moods within normal limits.
Mirtazapine (Zispin SolTab) is a presynaptic alpha 2 adrenoreceptor antagonist unrelated to SSRIs or SNRIs. It is thought that this medicine acts on receptors in the brain, increasing the amounts of the chemical messengers noradrenaline and serotonin and can improve mood. It often causes sedation during initial treatment. It is more usually prescribed to people with serious depressive symptoms but is sometimes given to help with insomnia. The following experiences of this medication are from our website on 'Experiences of antidepressants'.
Lucy Y was ‘functioning’ on fluoxetine but mirtazapine made...
When you started taking that one did you get any different effects?
I felt like a zombie for the first few weeks, I felt like almost stoned, it was the sort of cognitive effects were really powerful, I remember thinking it’s great that I can sleep for twelve hours but, you know, if this stuff doesn’t clear up then I’m not going to be able to function long term on this.
So when you were waking up after your long sleep you were still feeling groggy?
Yeah, for about three or four hours, yeah which, which again was useful it was a kind of cushion from all the horrible feelings which, you know, it sort of gave me a couple of weeks to sort of sleep off the worst of it and. But yeah luckily after, I kind of acclimatised to the levels or whatever it, the cognitive stuff got a lot better. I had a bit of, sort of strange short term memory stuff going on as well, the first maybe month that I took it but all that cleared up really quickly.
And so you said that you felt really good on that one.
And how different was the feeling from fluoxetine then?
Yeah it felt like, it felt like I was finally, you know, my true self and living my own life and able to do the things that I wanted to do, you know, for, for the first time in years since I, since childhood almost I felt like this was how normal was supposed to feel and this was, you know, how to be happy, it was yeah, which I never quite got on fluoxetine, I kind of felt, you know.
Yes functioning but not really good whereas on the mirtazapine I felt incredibly high achieving.
Sonia was prescribed mirtazapine to help her sleep, because...
So I was prescribed 20 milligrams when I started them last year and I stayed on that for about two months and then she upped it to 40 milligrams and that seemed to work for quite a while until about May time this year when again I started to get very depressed again, so she’s now increased that to 60 milligrams and also added on mirtazapine. One of the side effects of fluoxetine, which I was never told that I read about on the patient leaflet is, insomnia. And as she increased the dose of the fluoxetine the insomnia got worse which is why she had to add the mirtazapine because the mirtazapine is a sedative. So that helps me sleep, so I’m taking an antidepressant to deal with the effects of an antidepressant which I don’t really like doing but you kind of get to the point where you have to trust them and trust that they know what they’re doing. So that’s what I currently take alongside something else, quetiapine, which again is an antipsychotic which she uses to minimise my impulsive behaviour in terms of self-harm and to keep me calm, and that’s kind of where we are now.
Thomas took mirtazapine but the sedative effects disrupted his...
Collette changed from mirtazapine to duloxetine, which...
Can you describe them?
Well my head would spin one way my stomach was spinning another it was a bit of vertigo you end up with a bit of an odd twitch because my head would spin kind of jerk out a bit just even though we were still weaning down very slowly at first even then it was still too fast and I just basically ended up curled in a heap on the sofa because I couldn’t move, to try and move would make my head spin.
Quite alarming actually
It was, it wasn’t nice it took me, as I say, it took me months to come off of it, absolutely months to come off of it because actually it was so, so slowly in the end the last little bit was the worse.
Oxford University's Department of Psychiatry has carried out some research in the use of ketamine for severe depression. It has shown that for people with severe depression (including those with depression as part of bipolar disorder) that have not responded to other treatments the use of ketamine may be beneficial. This type of depression only affects a small number of people with the condition, and the research into using ketamine is still at a very early stage.
Last reviewed September 2017.
Last updated September 2017.