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Antidepressants

Being prescribed an antidepressant

The four main groups of antidepressant medicines are

These days an SSRI is most often prescribed first, but which antidepressant is prescribed varies. It can take a while to find one that works as antidepressants affect people differently.

People told us about their first and later prescriptions of an antidepressant, either by their GP, or by a psychiatrist.

 

Steve saw his GP and told her how he’d been feeling. She...

Steve saw his GP and told her how he’d been feeling. She...

Age at interview: 31
Sex: Male
Age at diagnosis: 30
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So I went to see the doctor and I told her, the next day I went to see the doctor and I told her that I was struggling, well I just told her what had happened even though it was drink related that actually my depressions are getting worse and worse and that my thoughts are darker and I’m unable to enjoy things like reading which I love and even started to get to the point where I didn’t want to watch movies anymore, I didn’t want to do anything, you know, you just get to the point where everything that used to be fun and exciting and interesting for you just kind of seems dull and.....So really because I’ve got this kind of lust for life as well and I do quite like life when it’s working nicely I just wanted to get back to that place again where I could think straight about what I was even thinking about if that makes sense, so that’s when I don’t know I got put on, put on citalopram which was about not so long ago, possibly two months ago. 
Being offered a prescription for an antidepressant tells people that their symptoms are recognised as an illness. It can be a relief to know that it might help the person feel better and give them hope for the future. Sometimes just being given a prescription can help people feel more positive knowing that they are being proactive, acknowledging they are depressed, and beginning to ‘tackle the problem’. But some people feel differently about being prescribed medicines ‘for the mind’ rather than for physical symptoms.
 

Clare’s GP described how an antidepressant works...

Clare’s GP described how an antidepressant works...

Age at interview: 59
Sex: Female
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He was very gentle and he was very he actively listened to me and I thought that was, I now know that that was really important because I felt, I felt as though somebody was giving some credence to the way I was feeling at the time. And so it was he that described the serotonin and the need for it to be replenished and he described to me the way in which the physiology of the brain if you like, the anatomy of the brain, the ‘how it all works’. What it was that I needed to have in order to feel better and he relayed me the story about the plaster cast that all those years before that the GP had mentioned so I was very open to when he said ‘Look we will prescribe for you some SSRI’s,’ I can’t remember what it was he prescribed, it wasn’t what I’m currently taking.
 

Thomas hadn’t really known about depression until the counsellor...

Thomas hadn’t really known about depression until the counsellor...

Age at interview: 34
Sex: Male
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So she continued to see me and then she was a group therapist by background and they ran groups, cost effective, a group in that so called… And I started going to group therapy but it seemed to be making me worse and worse and worse, and then in the year 2000 my GP prescribed me for the first time an antidepressant called amitriptyline and I had a big, I was very hesitant about whether to take amitriptyline because I thought well you know, that’s it, I’m official. I’m depressed. I’ve been given medication for depression. You’re depressed.
 

Andrew was relieved by the diagnosis of depression. Feeling valued and cared for made him more confident about taking the antidepressant he was prescribed.

Andrew was relieved by the diagnosis of depression. Feeling valued and cared for made him more confident about taking the antidepressant he was prescribed.

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I’d only gone in for this quick consultation and I was in for quite some time. But it was a massive relief to come out having actually had this discussion where someone said ‘Yes what it is you’re telling me are symptoms of an illness and we can probably sort that out.’ because for a lot of the time they’re kind of odd symptoms which kind of come together sometimes and then they don’t and you feel like it’s just, you know.

Like a little jigsaw type of thing?

Yes it is, it is just like a jigsaw yes and also I felt that nobody could understand how I felt, not even my wife and so it was pointless talking to anybody about it because no one could possibly know how awful I was feeling and what thoughts I was having. and I was frightened if I did say them that I might be really, really ill and, you know, there may be some really horrible thing happening in my head that would, you know, could pull our family apart or something, you know, so I was worried about there being an over-diagnosis or that I was really very, very depressed and I might, you know, I never wanted to kill myself but I did often think about dying and others around me dying all the time. And that thought really worried me because I thought someone might intervene and think that I was a danger to myself and a danger to my family. So I was really concerned, you know, and that really worried me. And of course depression made that worse because that’s the kind of thing that depression does, yes so admitting and talking to the doctor about it and him saying, ‘You know what, just what you’re telling me is - you’re depressed, you know, and a lot of these thoughts you’re having are just because you’re depressed.’ Fantastic, that was a good conversation and the Cognitive Behaviour Therapy and the citalopram that I’m on have been fantastic.

So how did you feel about taking medication for that?

I was relieved that someone could tell me that there might be something that could help. the doctor said, so the second, the doctor who put me on the medication said ‘Obviously it’s up to you, you don’t have to do this but I think you ought to think about it,’ and he was aware that I was doing the cognitive stuff too but he said ‘You might want to try that you know first and then come back to me if you think that you’d benefit from something else.’ Because I had a good experience with the doctors; I think that they levelled with me. They... being told I was depressed, you know, clearly being told that was the case and all these other things that were going through my mind were a symptom and not a cause felt good to me. I think the doctors spent time with me I never felt rushed at all and we talked about me and my emotions and how I felt and I really valued that. I really valued feeling cared for and someone took an interest in me more than anything else. And I think I may not have taken the tablets if I’d come out of there thinking ‘Oh it’s just another patient to be given drugs to shut up,’ or whatever.

Talking to the doctor and asking questions is a good way to find out about how antidepressants might help and what to expect (see also ‘Expectations about taking antidepressants’). Feeling involved in the process can give people more confidence about what they are being prescribed, especially as they can worry about how it might affect them. Like Andrew (above) people value being listened to, and having time to discuss available options and any concerns.

It’s important for the doctor to know how a person feels about different types of treatment and that where possible decisions are made together about whether an antidepressant is the right thing. Booking a longer appointment than usual can allow enough time to talk things through. Sometimes appointment times are limited and some people we spoke to said they felt their doctor had prescribed an antidepressant too readily without much discussion, (see ‘Antidepressants: finding information’ and ‘Reviewing medicine use’).
 

Greg felt his doctor handed out a prescription for Prozac...

Greg felt his doctor handed out a prescription for Prozac...

Age at interview: 34
Sex: Male
Age at diagnosis: 34
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I guess I must have been 23, around about that and I think it’s always linked, with me, with the end of relationships. I noticed that I always get very low, very down. I think I was in an intense relationship when I was 23 with a lady who actually had mental health issues and got sectioned. And I remember that was a really difficult thing for me to deal with and it really kind of shook me up and so I went to the doctor and it was really, it was really strange, I went to the doctor and had a, literally had a minute chat with him going ‘I feel a bit down’ and without even thinking or chatting to me he just signed me off these pills. I got home and I looked down on the sheet and it was like fluoxetine and I was like ‘what’s that?’ Anyway, so when I was 23 that must have been 19…, when was that? 199…, 23 so yeah about 2000 and Prozac was a massive kind of thing around that time, a bit before. And then I sort of looked on the internet and was like ‘oh he’s prescribed me Prozac’ and I was like ‘really, am I mental?’ and I left them on my top shelf for ages and I just didn’t want to take them because I was a bit confused as why I; he’s prescribed me that after like a really short chat, just me saying I was down and maybe at the time they were handing them out left right and centre, I don’t know.
 
When I was 29 I again, another relationship as these always seem to be, I split up with a girl that I really loved and was having a real tough time so I thought I’m going to try these again. My doctor was a very big believer, he didn’t prescribe them after like a mini chat, I spoke to him for about an hour and a half, really lovely doctor.
 

Emily’s doctor suggested she might want to try [talking] therapy first...

Emily’s doctor suggested she might want to try [talking] therapy first...

Age at interview: 28
Sex: Female
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I just felt like I needed to come out of there with something that would do something straight away. I literally felt like I can’t go home and have another night, just one more night of feeling like this. I just needed to do something then and there.
 
So do you know that they don’t take effect straight away?
 
No.
 
But do you think it was the very fact of having it in your hand and starting to take it do you think that kind of helped you?
 
Absolutely, absolutely.
 
You felt like you’d done something.
 
It was the biggest relief, it was relief that firstly you know, there was a justification that, you know, for me feeling like that, certainly that a healthcare professional agreed with me and, you know, and was effectively saying ‘there is something wrong with you this isn’t just you for the rest of your life, you know, this isn’t just how you’re going to have to live.’

I mean he was fantastic I have to say, absolutely fantastic just very calm sort of very relaxed vibe and he just sort of said to me ‘What’s wrong?’ and again I said ‘I don’t know nothing should be wrong, my life’s great I’ve got nothing to complain about,’ I think that was my biggest problem I really felt like I was complaining about nothing but I was just, I just said I was just tired and sad all the time and I’m exhausted and just fed up with it and exhausted, all I want to do is sleep.’ And he actually said to me ‘What do you think is wrong?’ and I said ‘I think its depression.’ and so it was sort of, you know, I don’t remember intricate, because it was five years ago this happened and so the real ins and outs of this conversation I don’t remember too well. But it ended up with him sort of saying that he agreed with that and, it was very, there were lots of questions from him, I remember that and he was very much sort of ‘What do you think we should do about it?’ and so I said ‘What are the options?’ so he went through a sort of, we discussed medication he said sort of ‘we can put you in for therapy sort of put you on the list for therapy and see how that goes and then go onto medication or we can try medication straight away’. And I was like, I said to him ‘no I would like him to try medication straight away because I feel like I can’t, I actually can’t carry on without something straight away ‘and he said to me he didn’t know how long it would take before I could see someone professional about it and so I went onto citalopram that day and he signed me off of work for a week.

Many people valued being offered talking therapy as well as an antidepressant and saw it as a way to tackle the causes as well as the symptoms of depression. Unfortunately services were often limited with long waiting lists. This left some people feeling let down and unsupported. Some felt that a prescription for an antidepressant was all their doctor could offer them. Taking an antidepressant was sometimes seen as a first step to help improve mood so that they could engage with a talking therapy (see Feelings about using an antidepressant and ‘Talking therapies and antidepressants’).
 

Tim’s doctor explained the options were therapy or drugs..

Tim’s doctor explained the options were therapy or drugs..

Age at interview: 29
Sex: Male
Age at diagnosis: 27
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I was diagnosed with depression by my GP, in Spring 2010 I think it had been triggered by the fact that I was having a very difficult time at work and I had actually walked out of the workplace just one day I couldn’t function and I couldn’t think I didn’t know what was going on I felt I just had an overwhelming urge to leave which I did and my girlfriend at the time and my mum were both like you need to see the doctor which, you know, I had that natural reluctance that lots of people do to go to see the doctor. and so I went the next day and pretty much straight away she said, you know, you exhibit all the signs of depression and I’m going to sign you off work for two weeks and so I was immediately signed off work with depression or stress I think it was put down as depression. and in a way that was quite a relief that she was just so definite about it and she was also quite frank and said now what we do with people that have depression is we either offer them therapy or drugs and you know this is a fairly new world to me so I mean in a personal sense I’d never seen a doctor before for a mental health issue although I’d had family experience of it and I remember thinking quite clearly I wasn’t, I’d rather not try the drugs so if you’re offering me these two things I’d try the therapy first please. So that was that and I, over the period of twelve months embarked on a something like a guided self-help course and then a slightly more intensive form of CBT.
 
So anyway I did that and I sort of, I didn’t really, I was kind of, you know, functioning but not functioning particularly well and feeling quite concerned that I didn’t have I had a kind of sense of well this isn’t really working that much but I remember the offer therapy or drugs so I went to the GP’s again and I this was about 12 or 14 months on from the original diagnosis so probably Autumn 2011 and I said, you know, I’ve tried the therapy that I’ve been offered and it's been okay but I don’t fundamentally feel any different so, you know, I’d like to try the drugs now please because those are my options. And I was quite, remember feeling quite kind of hopeful and the GP was sort of like okay fine and she prescribed me sertraline at 50 milligrams and I’m sure explained all the things that are normally explained to people taking antidepressants.
 

Victoria tried counselling first but returned to ask the GP for...

Victoria tried counselling first but returned to ask the GP for...

Age at interview: 25
Sex: Female
Age at diagnosis: 20
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I tried some counselling sessions and they were helpful but I found that I’d get everything straight in my head in the session and then come out and a few hours later be all angry and all over the place again and I just thought I need something stronger to sort me out, I want to give this a go. And then again I mean it was quite a lengthy discussion with the doctors and I went back several times before anyone said, you know, we are going to put you on pills.
 
So what was talked about before they actually decided on them?
 
I think just whether it was serious or not, enough to put me on the, I mean they have the questionnaires that you have to fill in, you know, how many times have you felt like this week and stuff like that. And it was obviously getting quite sort of solid that I really wasn’t coping very well with things.
It can feel frustrating to be given a prescription without the offer of other help. As Stuart reflected, ‘I think the biggest problem with going to a GP when you’re depressed is you come out and you feel bereft, you feel that okay he talked to me for, or she, she’s talked to me for ten minutes, they’ve given me some drugs but that’s it - what now if the drugs, the drugs might work they might not.’
 
However, not everyone feels able or willing to talk openly to the GP and some people believe an antidepressant could provide ‘a quick fix’. The experience of depression itself often makes it hard for people to think or talk about how they are feeling, although those who have had positive experiences with taking an antidepressant sometimes said they found it helped their recovery to talk about depression, symptoms and treatment.
 

Sharon has had several episodes of depression and sometimes...

Sharon has had several episodes of depression and sometimes...

Age at interview: 37
Sex: Female
Age at diagnosis: 22
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Sometimes to be fair, sometimes I wasn't bothered. It was like, "Oh just give me the tablets and that will do," and I didn't want to talk to them but that's not necessarily the right approach. I think maybe they should have probed a bit more, asked a bit more because that's what helped. It's, it's the talking about it, discussing it and talking about different approaches and different things and different ways of looking at things that has helped ultimately and if that had been done ten/fifteen years ago.
 
Mm
 
It could have made such a difference.
People who have already taken one or several different antidepressants before may already know what works for them and ask for a specific prescription. Others may have had difficult experiences with antidepressants and feel anxious or reluctant when their doctor suggests a particular drug. Greg had taken Prozac (fluoxetine) when he was younger and hadn’t felt it had been effective. He also had side effects so when he had a second episode of depression he asked his GP to prescribe something different. Sonia has tried a number of different antidepressant medicines over the years and says she knows what works for her and what doesn’t. If the doctor knows how the person feels and why, it can make it easier to prescribe the right antidepressant.
 

Lou knew from past experience that sertraline worked best...

Lou knew from past experience that sertraline worked best...

Age at interview: 39
Sex: Female
Age at diagnosis: 22
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So after that life changed dramatically I had a fantastic career, great relationships, got married and recently had a baby and that was all great but then got hit with some post natal depression which I was kind of expecting really and the great thing about it was that because I’d had such a positive experience, before it got bad at all I merrily trotted down to the GP’s and said “I’d like some sertraline please” got a prescription ...and within a few days was back to my normal self again and that was great because it meant that, you know, my daughter particularly didn’t suffer for too long. I mean I think as the post natal depression had built up I had become a little bit distant and I noticed it quite quickly and because I wasn’t scared of the medication I just ran straight and sorted it out so she didn’t have the kind of distant depressed mum for more than, more than was necessary because I wasn’t intimidated or afraid to ask for help I knew that it would sort it out straight away and it did and I feel great now.
It’s important to talk openly with the doctor about the medicines he or she has prescribed, and to go back at regular intervals to review how things are going, (see also ‘Reviewing antidepressants use’).
 

Lucy X thinks it’s important that people talk to their doctor...

Lucy X thinks it’s important that people talk to their doctor...

Age at interview: 21
Sex: Female
Age at diagnosis: 15
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I haven’t had this situation but I’ve heard it from other people that sometimes there’s a feeling that you go to the doctors and they just say ‘here’s some antidepressants and off you go’. I mean they’re you know, anti-depressants aren’t right for everyone some people need other things that, like CBT for me was fantastic and you know, it was the combination that’s really got me where I am now and so, you know, if you feel anti-depressants aren’t the right thing not to be scared to go back and say ‘what else can I have, what else can we do?’ you know, and there’s a lot of help out there, I mean but also to be patient because these things don’t always come through that quickly.
People can find it difficult to challenge or disagree with what a doctor recommends but need to remember that it’s a personal and individual choice. Some people worry about what other people will think, or fear being labelled and judged. People also worry that antidepressants may be addictive or that they will become reliant on them. Melanie felt unsure about being prescribed an antidepressant – ‘they’ve got a kind of stigma and I didn’t want anything I could get addicted to’.
 

Catherine feels that doctors should realise that a patient may...

Catherine feels that doctors should realise that a patient may...

Age at interview: 41
Sex: Female
Age at diagnosis: 14
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There is a fear I think from doctors where somebody is going to say no because a doctor is offering you something, you politely, because there is a well of people who have already made that decision, I’ve spoken to people myself who are adamant they don’t ever want to take antidepressants and I think they’ve got to be prepared for that, they’ve got to be prepared for all responses, not just the yes I will and just hand out a prescription or yes I will can I have more information but no I’d rather not and I think it’s about, you know you must spend that extra five or ten minutes giving, you know, saying to the person are there any questions you’d like to ask me about this medication I’m about to prescribe to you, this is what it’s about.
People may also be prescribed other medicines in addition to an antidepressant to cope with symptoms of depression such as anxiety or not being able to sleep (see also ‘Taking other medicines with antidepressants’).

Last reviewed June 2016.

 

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