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Antidepressants

Deciding to take an antidepressant

A wide range of feelings and beliefs influenced people we interviewed when deciding whether to begin taking an antidepressant. Some believed and trusted their doctor and preferred to be guided by him or her. Some saw the decision to take the antidepressant as relatively straightforward, but others took a while to decide.
 
 

Caroline’s doctor recommended an antidepressant and she was...

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Caroline’s doctor recommended an antidepressant and she was...

Age at interview: 60
Sex: Female
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It sounds as though you didn’t have any qualms about being offered the medication and accepting that offer?
 
No why would, why would I have?
 
Did you get any information given to you by the GP at that time to help you sort of decide if you wanted to take medication, how was that decision taken?
 
No, but well no. the GP just said ‘Well I think I’m going to prescribe you antidepressant medication and I’ll prescribe this kind, and if you take it at night then that should immediately help you to sleep better and then after a few weeks you should start feeling better during the day,’ so I just said ‘great.’
 
An antidepressant can offer the potential to alleviate symptoms and people deciding whether to take a course often say it gives them a sense of relief and hope for the future. Deciding to take an antidepressant can feel like a positive step. For some, there is an overwhelming motivation to start ‘tackling the problem’ and to do something that could help lift their mood. The first time Collette was prescribed an antidepressant she said she was willing to try anything that could help with her symptoms and that she wasn’t well enough to think about it too much ‘I didn’t want to feel like I was feeling… so... yes why not give it a go and I really couldn’t be bothered either way, it was just easier to take the pills’. People talked about ‘just wanting to feel normal’ again’, ‘feeling like I couldn’t carry on’ ‘needing help straight away’ or feeling ‘desperate’ for something that might help.
 
Others we spoke to took time deciding whether or not to go ahead and said they ‘wavered’, or ‘dithered’ about it for a while. Some people had always felt they should be able to deal with depression without medical intervention ‘it’s a crutch... willpower’ and felt that deciding to use an antidepressant was betraying themselves, or giving up (see Feelings about using an antidepressant’). People described balancing ‘pros and cons’ when deciding whether to go ahead, for example weighing up perceived benefits against fears about side effects, feelings about stigma, or whether they might become ‘hooked’.
 
 

Lucy X had taken Prozac (fluoxetine) before and wasn’t keen...

Lucy X had taken Prozac (fluoxetine) before and wasn’t keen...

Age at interview: 21
Sex: Female
Age at diagnosis: 15
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Did the doctor give you some information about it?
 
Yes she gave me some information but I also did personally did like some of my own.
 
And how did you go about doing that?
 
It was like Google searched it. I mean there is lots of stuff, I mean it’s a bit like, like hit and miss you know there’s lots of stuff online about people talking about anti-depressants and some of its a bit like, you know, I mean as most people I don’t go on the internet and trust everything that I read you know... the NHS website has the information and that’s where I got a lot of it from. But also there were bits where people were talking about their own personal experiences and when I researched Prozac there seemed to be a lot of people who had the same feelings as me. And there was the citalopram, there were people who had sickness and stuff but there was no, there didn’t seem to be so much of this feeling that it was something terrible and awful.
 
Was that what you were most interested to find out when you, when you were thinking about taking the citalopram, about how other people reacted to it?
 
Yes before, for like for me with the citalopram if I’d had the two weeks sickness or just the beginning period of sickness again like I would have, I would have been fine with that. The main thing for me was I didn’t want the numbness and that, the sort of like you feel like it kind of creeps up on you and then it’s there and then it takes a bit of time to go I just so didn’t want that and so it wasn’t, it was important to me to sort of hear what other people felt like.
 
And see how you could function on a daily basis?
 
Yes and there just didn’t seem to be that same like consensus that it was a problem so. you know there are always going to be people who react badly to something and, you know, that’s part of it but yes it seemed, people seemed to be much more positive about it.
 

Gerry tried Cognitive Behaviour therapy...

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Gerry tried Cognitive Behaviour therapy...

Age at interview: 31
Sex: Male
Age at diagnosis: 29
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I really wanted to concentrate on the talk therapy which my GP was happy for me to do, he said go and discuss it with the specialist. so I went to see the specialist and he referred me for Cognitive Behavioural Therapy but at the same time because I gave him my story and told him how long I’d been struggling with depression he was of the view that I should try antidepressants as well. And I resisted for the first three weeks, so you know like I kind of spoke about it, accepted that I had this condition and but went and spoke to the specialist too and I said well no I’ll just try the CBT first and so yes I think I had a follow up, I went to see him, got CBT, got referred for CBT and then I went back to see him about three, two or three weeks later and, you know, he looked at me and said, I don’t think I actually started CBT but he said ‘Look I think you would really benefit from, from medication as well’ and just talked me through, you know, how it alters your brain chemistry etc.
 
So yes I decided at that point to start on antidepressants.
 
Sometimes even when people had collected their medicines from the pharmacy they did not begin taking the tablets immediately. Reading the list of side effects in the patient information leaflet made some worry that taking an antidepressant might make things worse. Hannah read the leaflet and was unsure about whether to go ahead because "it says it can cause suicidal feelings.... if you weren’t already feeling suicidal is it worth the risk?" (See also ‘The Patient Information leaflet’).
 
Melanie read the leaflet in the packet "front and back… to make sure I knew exactly what could happen to me in the course of taking them". Greg wondered whether his doctor should have spent more time talking to him before handing him a prescription and after he collected the tablets he kept looking at the box wondering whether or not to start taking them. They talked about a range of considerations including uncertainties about how the medicine might make them feel, how long it might take to work, how long they might need to take it, fears about potential side effects, about becoming reliant on medication, or wanting the opportunity to try therapy first.
 
Even after deciding to go ahead, actually swallowing the tablet for the first time could feel like a big decision. Greg said once you’d decided you had to have some faith and ‘believe in it’.
 
 

Melanie collected the prescription but took time to read...

Melanie collected the prescription but took time to read...

Age at interview: 44
Sex: Female
Age at diagnosis: 43
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And whose suggestion was it to have the antidepressants, was it the doctor who suggested it to you?
 
Yeah.
 
Yeah.
 
Yeah it was the doctor.
 
And how did she explain to you what they, how they might help?
 
She just sort of said that, you know, they would calm me down, they would just make me feel a little bit more in control of things, they would reduce my anxiety and my stress levels and to be honest at that point I was just ready for anything that would do that. I couldn’t think of anything else to do I mean I certainly didn’t want to go down the drinking avenue because I’m sensible enough to know that that doesn’t cure things. but at the same time I did still have a worry that I’m taking medication and what’s going to happen when I have to stop taking it.
 
Were you worried about how they would make you feel, how did, what did you think about that?
 
I was a little bit worried because you know obviously I am fiercely independent and, you know, I have heard people have said when they’ve taken antidepressants that they go all fluffy and they don’t really know what they’re saying and what they’re doing and I didn’t really want to be like that and obviously with being on my own I didn’t want to put myself into any situations where, you know, I wasn’t in control of myself or I could fall over or I could injure myself because of the medication. So to be honest when I did get my first prescription I read the leaflet inside, front and back, to make sure I knew exactly what could happen to me in the course of taking them.
 

Greg felt scared about taking the tablet for the first time...

Greg felt scared about taking the tablet for the first time...

Age at interview: 34
Sex: Male
Age at diagnosis: 34
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For me you know taking the pill kind of was basically saying ‘I’m not going to cut myself’ and it was a decision and I was being proactive, I was picking up the pill and I cried before I did it, this time I cried a lot because I didn’t want, I was scared of it and. But you know that, taking that was basically going right I am being proactive, I’m doing something to help myself and I had to have that confidence knowing that you know if I’m going to take this pill it’s going to help me or have belief it’s going to help me.
 
So when you’ve got that sort of moment trepidation taking the pill.
 
Yeah.
 
Is that a feeling of failure or something like that?
 
Yeah, yeah and like, yes like sort of saying to yourself over and over again ‘what am I doing to myself, why do I need to do this, what’s wrong with me’, in all honesty you feel quite low about yourself I think, like ‘oh I need this, do I need this, do I need this?’. You know ‘am I mental, am I?’, you know all those connotations of all those stigmas I think of mental illness and, you know, and I think it takes a braver person to actually do it and go ‘okay I’m going to commit to doing this’ than not.
 
So yeah, yeah but it’s not a nice thing to do the first time you take it. For me I got emotional about it because it’s like okay this is a journey I’m going to have to go on and I’m going to have to try and see it through as much as I can to help myself.
 
Finding out more about the medicines that have been prescribed, and talking it through with the GP can help people to decide (see also ‘Finding out more information about antidepressant medicines’ and ‘Being prescribed an antidepressant’).
 
 

Andrew was relieved when his doctor diagnosed depression...

Andrew was relieved when his doctor diagnosed depression...

Age at interview: 50
Sex: Male
Age at diagnosis: 49
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I was enormously encouraged that he didn’t just say here’s some tablets go away and take them, think about it. And he gave me a couple of websites to look at to just looking at possible side effects and how it might work and that sort of thing. so that gave me enormous encouragement with him as a doctor I have to say that he was actually thinking about me and what was best for me. and then I came home and talked to my wife about it and it was about November, October or November and I remember thinking the doctor said the first month on this treatment can be pretty grim or not, you know it can highlight some of the worst aspects of, of the depression, it can be a problem. and I remember thinking Christmas was coming up and I was feeling awful and I didn’t want to mess up Christmas and so I thought if I start now with the tablets, if I’m lucky I’ll get the month or six weeks in of not feeling so good and they might actually start to kick in the benefit for Christmas. And I just thought with the children around I came to the conclusion I didn’t want to waste any time and I’d spent enough time feeling, you know, unwell and if they could provide, if there was a treatment that could help then I would go on it.
 

Hannah spent a week wondering whether to take the...

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Hannah spent a week wondering whether to take the...

Age at interview: 28
Sex: Female
Age at diagnosis: 23
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She suggested that I start taking citalopram and I think I was in, I think I was in two minds about taking it, I think I would have rather have gone to see a counsellor first and tried that really but at the same time I really wanted to do something to feel better and to make sure… I didn’t miss any more days from work.
 
So I remember so she wrote me a prescription and I think I spent a week worrying about it and wondering whether to go ahead and take it and especially I think because the first thing I did was Google the antidepressant and find out more about it which was probably the worst thing you can do sometimes I think to be honest because there’s so much information out there and it’s not always the most reliable sort of information. But there was, I came, I remember I came across an article and that was, it was it raised concerns about that particular antidepressant where I think someone had taken it and they had suicidal ideas like they hadn’t previously had them and it was, it was kind of even though these... I think it was quite a biased article and it was implying that that was why this person felt more began to feel suicidal which but we don't know if that was necessarily the case. So but reading that was kind of put me off taking them completely and I remember I, because I still wasn’t feeling well I spoke to a friend who, and told her I’d been to see my GP and tried and got her thoughts and she very helpfully suggested ‘why don’t you tell your GP your worries and that you’ve come across this article and see what she says.’
 
So I went back and to see my GP and it was just helpful sort of talking to her about it again and I just I don’t remember exactly what she said but I remember feeling more sort of prepared to try, to give it a go at least.
 
Past experiences of using a particular antidepressant can influence people’s decisions about taking it again. Lou had taken Prozac (fluoxetine) when she was younger: it had increased her anxiety levels and made her feel worse, so when she returned to the GP some years later she told him she was reluctant to take it again. Her doctor explained that she could try others that that would not have the same effect.
 
 

Lou had the prescription for a while and wasn’t sure she...

Lou had the prescription for a while and wasn’t sure she...

Age at interview: 39
Sex: Female
Age at diagnosis: 22
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I think I just thought, you know, something’s got to change and I can’t change, I can’t even begin to take a step when I’m kind of stuck like this really depressed, really low. and so I kind of thought - ‘I know I’ll go and speak to my GP about it’ and I was really reluctant to take antidepressants, you know, I said about the previous experience because this was a different GP at this time and they persuaded me that things had really moved on patient wise and that they would give me an antidepressant that definitely wouldn’t make me feel more anxious because that was the thing I was so, so anxious and having so many anxiety attacks that the thought of having something that would increase the likelihood of me having an anxiety attack was absolutely unpalatable and they assured me that this particular antidepressant wouldn’t do that and that people didn’t have problems coming off it as well because that was the other thing it was like I didn’t want to be stuck on this for the rest of my life. And I trusted my GP was we had a long talk about it and I think he had said, was it she, no he, he had said that actually the one I was on before was known to be rubbish now and that they didn’t prescribe it anymore. So I thought okay fine, fine so I took it reluctantly and I think I had the prescription for a while and was sort of dithering about taking it and eventually I thought no, do it.
 
People can also feel unsure about what to expect, and it can be difficult to make decisions and think things through when you’re experiencing depression (see also ‘Getting to the doctor -seeking help for depression’ and ‘Being prescribed an antidepressant’).
 
While appointments with GPs increasingly involve ‘shared decisions’ we talked to both younger and older people who told us that this hadn’t been the case for them. Olivia Y, for example, said she hadn’t felt she had an opportunity to make a decision as a teenager ‘you don’t question it, when a person in front of you is called a doctor you just do it, especially when you’re a child’. Now though she says she wants to know more about medicines before deciding whether to take them. Some older people said they had always believed that the ‘doctor knows best’. Michael has taken an antidepressant most of his adult life on the advice of his doctors and had been too overwhelmed by his depressive symptoms to be able to make decisions ‘I was very accepting, it was just an overall battle to keep going each day, a struggle’.
 
People who are in hospital with severe depressive symptoms may feel so unwell that they don’t know what medicines they are getting and it can feel as though there is little choice. Olivia X did not agree with her doctor’s diagnosis and refused to take the medicine that he said she needed. Her refusal to comply resulted in a chain of events leading to a hospital admission under a ‘section’ of the Mental Health Act (1983). She felt that decisions about her treatment were effectively removed from her control. Thomas worried that if he didn’t take the medicines he had been prescribed, that his doctors might commit him to hospital, so while he collected the prescriptions from the chemist he decided not to take them. ‘I thought if I can be seen to be compliant to treatment it would make me less likely to be sectioned’. (See also ‘Treatment in hospital’).
 
Making decisions about using antidepressant medicines is an on-going process and people’s views about taking a particular medicine may change over time (see also ‘Managing antidepressants’, ‘Stopping taking antidepressants’, ‘Changing antidepressants’ and ‘Reviewing antidepressant use’).
 

Thomas wrote down the positives and negatives...

Thomas wrote down the positives and negatives...

Age at interview: 34
Sex: Male
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I weighed things up in my mind. So I would write down on a sheet of paper what were the positives and what the negatives were and for the Cipramil it was almost all negatives but that was coupled, with they became to be more reticent about prescribing Cipramil at the time, because I’d taken an overdose and so on. But I clearly saw there were many more negatives and almost no positives. I mean I couldn’t think that it had improved my mood. It hadn’t done anything for me. It had made me more sedated which wasn’t a good thing, I wanted to be active and doing things. And, and so I just wrote it on a piece of paper and took it from there really.


Last reviewed June 2016.
Last updated June 2016.
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