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Antidepressants

Expectations about taking antidepressants

Because everyone reacts differently to an antidepressant, there are no certainties and the extent to which people expect or hope the medicine will ‘work’ varies widely. Emma felt optimistic when she started taking an antidepressant ‘ it just takes a lot of weight lifted off your shoulders that you’re starting medication and that you’re starting on the road to get better’.
 
As Stuart pointed out, ‘You can’t tell until you’ve started taking the drugs what they’re going to do for you.’ Many of the people we interviewed were uncertain about how long it might take to begin to take effect, how far it might help, and about what to expect in the first few weeks. They were concerned that it could make them feel worse rather than better, and how long they would need to take an antidepressant for. For some people, finding out more about antidepressants helped ease their concerns but hearing about bad experiences with anti-depressants could be alarming and off-putting.
 
Where people felt they hadn’t been told enough about what to expect, the uncertainty could be unsettling. Some were frustrated that there were no hard and fast rules, or that the evidence about the effectiveness of antidepressants was vague or ambiguous. Negative thinking and feelings of hopelessness can stop people from believing that they will ever recover, or that anything will help.
 

Thomas wanted to know more about what to expect from an antidepressant

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Age at interview: 34
Sex: Male
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One thing I’ve learned with antidepressant medication is they always say, “Look it takes a while for the levels to build up in your system to the point where they are efficacious.” They work. But they gave me no particular information about how long that might be. They said, “Well it could be another few months, it could take up to a year, and perhaps even longer for someone.” 
Clare’s doctor told her it could take up to six weeks before she might feel positive benefits from the antidepressant he prescribed. After that time, she thought she noticed an effect, but wasn’t sure whether it was the medicine itself, or a ‘self-fulfilling prophecy… you kind of look at the calendar and you go right... so it’s going to be 1st October, smashing... but I did feel better and more able to cope with life’s ups and downs’. Greg felt it was important that once you started taking an antidepressant, you should have some belief or expectation that it could be of benefit.
 
‘Getting better’ means different things to different people, and people aim for different levels of recovery. People often say that taking an antidepressant gives them a feeling of hope that it will ‘work’ and that they could begin to ‘feel better’ but it can be difficult to predict and is different for each person.

Jenny had high hopes initially ‘I sort of expected to feel ‘happy’ because the media were dubbing antidepressants as ‘happy pills’. In hindsight she says they don’t stop her from feeling ‘down’ but they prevent her from ‘getting stuck down there’.

For Stuart ‘they gave a bit of hope.... taking the drugs was part of the relief, the hope that I could now feel better because the drugs might work’ but he saw them more as a ‘straw to clutch at’ and had no clear expectations ‘they might work, they might not’. An antidepressant had worked well for Stephen’s father helping him to recover from his depression, so when Stephen was first prescribed one he saw it as a way of ‘fixing things… I thought at the time she’ll give me some tablets for a few months, six months or whatever... and I’ll get better and stop taking the tablets’.

Sharon hoped an antidepressant would ‘get me out of the dip and pick me up a little bit’. Emily ‘wanted to come out of there [the GP surgery] with ‘something that would do something straight away, I literally felt I can’t go home and have another night of feeling like this’. Melanie’s doctor told her ‘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’.
 
Whilst it can be tempting to hope for a ‘quick fix’, and people expected an antidepressant to improve the way they were feeling, they also stressed that it was important to see it as just one aspect of the ‘road to recovery’ rather than a solution in itself. They emphasised the importance of dealing with problems, learning to understand yourself better and finding other ways to cope, for example through therapy or other lifestyle changes. As Greg pointed out ‘I was thinking ‘oh I’ll just take these pills and I’ll be better, but that doesn’t obviously solve deep rooted issues that I may have...’ Some were frustrated by long waiting lists for therapy or counselling and felt that an antidepressant was the only thing their GP could offer in the short term. (See ‘Talking therapies and antidepressants’, ‘Antidepressants: the GP’ and ‘Being prescribed an antidepressant’). 
 

Steve hoped that an antidepressant might help him to think more...

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Age at interview: 31
Sex: Male
Age at diagnosis: 30
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I couldn’t see how it was going to hurt, I mean because, rather than, I didn’t expect it to help me deal with the wider things that I’ve just kind of spoken about, I didn’t expect it to help me deal with my issues about me being bullied still or the way other people think about me. I wasn’t expecting any of that to happen from the pills but I did see how it could, well I did hope as well that it could kind of just bring back some more positive ways of looking at things if that makes sense because when you do think negatively and you see things negatively you can’t, you can’t see the wood for the trees, you can’t get yourself out of your own head and if you can’t get yourself out of your own head you can’t help yourself to even know where you need help from and that’s. So what it, to me it was hopefully going to give me that kind of boost of, not boost, boost is the wrong word, I suppose to just.
 
Shift your mood a bit?
 
Yes just to help you turn things so I could actually think straight, so if I could think straight then I could work out what it is I need and then do something about it hopefully.
 

Catherine feels it’s unrealistic to think an antidepressant...

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Age at interview: 41
Sex: Female
Age at diagnosis: 14
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It’s not just about the medication; it has to be about other things that you’re doing in your life as well, not just medication. Medication is very much a kind of crutch, it’s an additional kind of thing to other things I don’t think you can solely rely that medication is going to cure all the problems in my life, it’s not, it’s great isn’t it, it’s great as a tool really, in a toolbox with lots of things that can be used.
 
So do you think it’s kind of helped you to get to the place along the way where you’ve had different bouts of therapy and you’ve been within, it’s helped you in the headspace to be able to deal with some of those things?
 
Yes, yes, I think it gets you to a, when you have such significant depression that, that you’re not wanting to live, you know you’re suicidal, you’re not wanting to live anymore. I think the difficulty with, with trying to say well we’ll just start to talk about things you’re not even in that place you can do that at that point. Whereas the medication takes that edge off the, the thoughts of suicide and the wanting to harm yourself to the point where actually, okay you’re still low, you’re in a low mood, you’re still struggling, you know to get through the day but you’re able to then start to do things about it in other ways and I think that’s where the benefits come in. Where it’s just that kind of lifting you 20/30% up and the rest, the 70%, the rest is down to you, you know, you’ve got to do the right, people around you and see what services you have around you. 
 
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Gerry thinks people have too...

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Age at interview: 31
Sex: Male
Age at diagnosis: 29
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I do believe this like depression is, is one of those illnesses where you can, it’s like you can live with it for years and almost become a victim of it, you know, and maybe that’s where antidepressants don’t help as well, you know you can I don’t know you can almost see it as an easy way out, you know, ‘things aren’t going well for me I, you know I’m suffering from depression I’ll just take some antidepressants and I’ll feel better.’ I definitely think that you as an individual need to take ownership of it as a condition and seek, and seek help and never ever look to blame depression for what, do you know what I mean, that is quite important to realise you’ve got it to realise it’s an illness and realise you can get better rather than keep going on ‘oh I’m really prone to depression and the reason I’m doing or I’m feeling like this or I’m not doing well and not getting a job is because I’m depressed’ because then it becomes sort of self-reinforcing.
 
Yes I see what you mean, so it’s no good just taking tablets and then expecting them to do all the work for you and kind of address your life in some way.
 
Yes, yes exactly. You’ve got to really take ownership of it. Otherwise it’s just, you know, like I say the analogy of it’s just like getting a heart operation but not doing anything about changing your lifestyle, you know, what’s, what’s the point.
 

Stuart stresses the importance of having realistic expectations...

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Age at interview: 52
Sex: Male
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Don’t rely, think of it as a bit like taking an aspirin, you know, it’s something that if you’re lucky will give you some relief from the symptoms, will help you feel better but particularly if it’s someone who has, you can tell has maybe got deeper issues that are contributing to that then I’d say look at, you look at therapy as well look at CBT. The people who are not in a position to afford long courses of therapy then there’s some, you know, there’s things on the internet sort of online CBT an online website … help to help. So often I find for a lot of people it's about, you know, as it was for me it’s about education, you know, when it first hits you, you don’t know what’s, you know, what’s involved and so yes I definitely I think drugs are always, always worth trying and from my experiences they work very differently for different people and you can’t tell until you’ve started taking the drugs what they’re going to do for you, you can’t tell what the therapeutic effect is going to be, you can’t say what side effects you’re going to get if any. 
It is thought that antidepressants work by increasing the activity of certain chemicals (Serotonin and Noradrenaline) in the brain called neurotransmitters which pass signals from one brain cell to another. People’s underlying beliefs about the causes of depression can influence their expectations about the extent to which taking an antidepressant might help them. Some found the explanation that an antidepressant replaces missing chemicals in the brain convincing, and were inclined to expected that it should alleviate their symptoms. When Sharon was first prescribed an antidepressant she believed that it would help because her doctor had explained that depression can be caused by a chemical imbalance. ‘`Initially I thought, 'Oh it's chemical imbalance, it's not my fault, the pills will help, I'll get better and then I'll be OK’. But many people said that whilst that may be true it was also important to recognise depression as a complex condition and that although an antidepressant could help, it was unhelpful to place all your expectations on it. Gerry likened it to ‘getting a heart operation but not doing anything about changing your lifestyle, what’s the point?’
 

Steve’s understanding is that an antidepressant increases...

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Age at interview: 31
Sex: Male
Age at diagnosis: 30
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I think if you look at it in its simplest form, serotonin probably gets depleted over a period of time when it’s not naturally refilling itself because you’re not having a really good time and so I, this is as far as I understand it so I, I could imagine that over a period of time when you’re not enjoying yourself or you’re kind of really, you’re serotonin does get depleted and so obviously antidepressants are going to help build that back up again, that’s as simple as I understand it, I don’t know if I am right or wrong with that because I’ve never really looked into it that’s just kind of what I know. and I know that serotonin is something that’s kind of necessary for you to be able to enjoy things or for you to be able to see the light around you if that makes sense. So I think in that way it helps.
 

Greg believes that depression is a mixture of a chemical...

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Age at interview: 34
Sex: Male
Age at diagnosis: 34
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I think it’s a mixture of, I think it’s a mixture of both isn’t it, it’s repeated patterns in your life that you can, that underlie and that underlie the situation and you don’t know how to cope with them or your brain doesn’t produce enough serotonin is one way of looking at it, I don’t really have an opinion on depression of how, why it’s there, is it something that’s always going to happen to you as a person because you’re built that way and your brain doesn’t produce enough serotonin so you need these helping hands or is because you put yourself in situations that, that make you depressed. I think it’s probably for me it’s always a mixture of both.
 

Roisin believes ‘there are a group of people and I think I’m one...

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Age at interview: 45
Sex: Female
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There was no point in me having any counselling because there was nothing wrong with my life... what was wrong was the chemicals in my brain that’s what was wrong.
 
So you subscribe to that theory about the cause of depression, do you think it’s a, sometimes a combination?
 
Sometimes I think it’s, everybody’s different some people it will be, you know their circumstances, you know it will be a reaction to something in their circumstances but other people... I think there are a group of people and I think I’m one of them who just have effectively... a chemical imbalance and because I’ve had this my whole life.
Where people have taken an antidepressant in the past, or tried several different types, their expectations are influenced by their previous experiences. They may feel more optimistic if a particular antidepressant has helped them in the past. However, people who had taken antidepressants before and not experienced benefits, or had a difficult experience with them, sometimes said they had few or even no expectations that anything would ‘work’. Those who had experienced several bouts of depression could feel that going back on to antidepressants felt like a setback, especially if they had expected to be ‘cured’ by the previous treatment. Peter said it felt hard to go back to the doctor for an antidepressant. ‘You sort of feel as if it should be ‘sorted’ and as if you’re taking this antidepressant and it should be fine... and I wasn’t and it took me a long time to admit that things weren’t going ok. Going back felt like a bit of a failure it felt like a setback’.  
 

Lucy Y had few expectations that an antidepressant would be...

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Age at interview: 23
Sex: Female
Age at diagnosis: 18
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I’ve had friends who’ve tried one drug and it hasn’t worked for them and that’s put them off the whole experience. I mean for me the big things was, and yeah, there were, there were times when I thought this isn’t, you know the day my doctor prescribed mirtazapine first of all, I went back to him and just, was not expecting him to be able to suggest anything that would help I was, you know, kind of, in despair about the chances of anything working or even you know prescribing a different drug or doing it, or being able to do anything that would usefully make me feel better and then when he, he suggested something I hadn’t heard of and I thought that could be interesting and gave it a try and just, you know, within a couple of months felt incredibly good.
 
I suppose it’s quite easy to, to kind of fall in that belief that when you’re trying something and it hasn’t worked so nothing else will, they could all be pretty similar really.
 
It plays into the mentality of depression as well, the kind of hopelessness of it all.
Whilst some people saw taking an antidepressant as a temporary measure that they would feel well enough to stop taking it at some point, others resigned themselves to the possibility that they may need to take antidepressants on an on-going basis as a means of keeping their mood more stable, or as a preventive measure.
 
(See also ‘Reviewing antidepressant use’, Feelings about using an antidepressant’ and ‘Managing antidepressants’).

Last reviewed June 2016.
​Last updated June 2016.
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