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Antidepressants

Managing the use of antidepressants

People we interviewed described how they managed their medicines on a daily basis. They often had mixed, or conflicting feelings about taking an antidepressant, but even when they felt unsure whether it helped, were troubled by side effects or were uncertain, generally people said they took it regularly for a period of time after starting it. Some had missed or forgotten a dose now and again. People told us that establishing a routine helped them remember to take it each day, for example taking it a certain time such as first thing in the morning or at bedtime. Rosin described herself as ‘terribly organised... I wanted them to work so it was in my self-interest to take them, I was always really good at doing that’. Sharon kept hers by the kettle and took it each morning when she made breakfast, or if she has a tablet to take at night keeps it on the bedside table. It’s a regular part of Sonia’s daily routine. ‘I get up, shower, drink, tablet and that’s that done’. Caroline takes hers ‘every morning after I’ve brushed my teeth’. Emily took it ‘religiously… same time every single night’. Andrew said he never forgets ‘it’s like if you wear contact lenses… You never forget to take them out at night and it’s the same with this tablet… I think because it’s been so valuable in helping me feel better’. (See also ‘Feelings about using an antidepressant’, ‘Expectations about taking antidepressants’ and ’Starting to take an antidepressant’).
 

Lou has a reminder on her phone so she won’t forget to take her...

Lou has a reminder on her phone so she won’t forget to take her...

Age at interview: 39
Sex: Female
Age at diagnosis: 22
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Have you always been quite good at always remembering to take your tablets or, how do you remember?
 
Well previously like clockwork... but since I’ve had a baby it’s not as good, I‘ve got a reminder on my phone but I, the first packet of tablets, because now they’re all generics, you know, like not branded, the first time I took it was branded and it all had nice days of the week of packaging... This time I got some there was no days of the week and I was all over the place, sometimes I was taking two, sometimes I wasn’t taking any but at least now whichever chemist I got my last batch from it’s in days of the week and that really helped. because my alarm goes off, a reminder on my phone every day to take my tablet and I thought yes must do that but then, you know, something happens.
 
So if you had a time when you’ve forgotten or you haven’t taken one for a day, what would you do would you take one when you remember or would you wait until the next day?
 
I would probably take one when I remembered because I know I’m a, on a very low dose but then I guess if I remembered in the middle of the night I would wait until the next day. But I know on a couple of days I’ve missed them and I haven’t felt particularly unwell.
 
Right I was going, because I was going to ask if you’ve ever noticed a difference if you’ve missed?
 
No I think in maybe the first couple of weeks I noticed if I hadn’t taken one but not now.
 
What would be the difference?
 
Clenchy jaw.
 
That would return?
 
Yes clench jaw when you’re yawning would return.
 

Collette always takes her antidepressant in the morning when...

Collette always takes her antidepressant in the morning when...

Age at interview: 28
Sex: Female
Age at diagnosis: 19
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The ones I’ve been on have been stipulated as to what you do but I’ve always taken mine in the morning because I know that’s the, you know, I’m always up I’m always having food so it’s always a good time for me to eat and take the medication because in the evening, you know, I might not have an evening meal I might have it early or I might have it late so the morning works better for me.
Olivia Y said it helped if the days of the week were marked on the packet, but not all brands had this type of packaging. When people missed taking a tablet some said they noticed the effects straight away, others said they hadn’t noticed any difference. Tim worried about missing doses in case his mood dipped. Going on holiday or away for a few days can interrupt routines, and occasionally people had forgotten to pack their antidepressant. Stephen went to a pharmacy to ask for an emergency supply once when he was away. (Emergency pharmacists are allowed to supply a pack of a particular medicine and charge for it without a prescription).
 

When Simon was first prescribed an antidepressant he...

When Simon was first prescribed an antidepressant he...

Age at interview: 31
Sex: Male
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I reckon I took them for about three weeks regularly, I may have had prescriptions after that but I didn’t, I didn’t take them regularly.
 
So if you weren’t taking them regularly then do you know what the effect of that was on you, were you feeling different on days when you didn’t take it?
 
I’m trying to recall if the first time I took it I really took it, the first time I don’t think I took it regularly enough for it to really get into my system to the point of view of having withdrawal symptoms which I now know.
 
What the reason for not taking them regularly, were you, what were you, was it because of the side effects or what?
 
I think partly that, partly just being forgetful which has never changed since partly I was very ambivalent to taking them, until well until the last two or three years I’ve always been very ambivalent thinking, you know, is this the right things it’s been something that I’ve not wanted to do but have done begrudgingly so I think I was ambivalent about taking it.
 
And what’s, and what’s that ambivalence about?
 
Yes there’s not liking the side effects on medication which get a lot better but they didn’t completely go away especially with the first antidepressants I was on a reluctance to being on medication I, you know, I didn’t want to be on medication for a long period of time as I the more I understood about depression the feeling that I should be relying on psychological approaches to managing the depression as well and feeling like relying on the medication instead of these other things that I’d been doing was, was in some ways it felt lazy yes.
 
So are you saying that you didn’t see the medication as being the answer to solve whatever the problem was behind your depression?
 
No, no I certainly didn’t.
 
You said earlier that you weren’t really sort of good about taking things regularly at one point, are you more vigilant now about making sure you take it every day?
 
I’m still pretty hopeless.
 
Are you?
 
I’m still really hopeless.
 
A bit erratic?
 
Yes and quite often I will have two or three days and it’s only when the withdrawal symptoms are beginning to kick in that I then think ah I’ve not taken my medication and I feel awful and then I’m taking it.
 
So you do notice after a while?
 
Oh yes, yes.
 
What are the withdrawal symptoms?
 
Anxiety, tingling in my skin especially on my face sickness that sort of feeling like you’ve not eaten that kind of hypoglycaemic feeling.
 
A bit light headed?
 
Yes, yes they’re the main things.
 
So that would prompt you then to remember to take it. And then when you start again how does it?
 
Then I often get some of the increased kind of feeling sick again for a few more days and that gets better after I’ve remembered to take it for a little bit of time.
 

Caroline has a routine to ensure she remembers all her tablets...

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Caroline has a routine to ensure she remembers all her tablets...

Age at interview: 60
Sex: Female
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I just take it every morning after I’ve brushed my teeth.
 
Every morning?
 
Yes.
 
And are there times when you’ve forgotten to take them or forget or are you usually quite vigilant about it?
 
Well every Saturday morning I have to take several pills, I take pills for, I have hyper thyroidism and I have to take some pills for dermatitis so every Saturday, every Saturday I… cut out seven pills of citalopram, and seven pills of thyroid medicine and seven pills of the dermatitis medicine and then so it’s sort of like.
 
That’s very organised.
 
Well I, and then sometimes I come to the end of the week and I find I’ve got one left…
 
So do you know, would it be bad, detrimental if you didn’t, if you missed a few or… do you know?
 
I… the most I’ve not, I don’t think I’ve ever missed more than two in a row and very rarely not known if they’re detrimental but I mean all of the stuff on the blurb always says come off gradually. So I don’t have any personal experience of coming off too quickly and I’ve not noticed any ill effect from missing two days in a week- that’s the maximum. I’ve ever done.
 

Melanie made a mistake with her tablets and felt really unwell...

Melanie made a mistake with her tablets and felt really unwell...

Age at interview: 44
Sex: Female
Age at diagnosis: 43
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I have a routine on a morning where I take my antidepressants and I take my multi vitamin tablets and some other tablets had appeared in the same area and I must have run out of my anti-depressants and I just picked the blister pack up and I saw that half of the tablet was blue and I know my antidepressants are half of that colour as well. So I had taken those for about four or five days and I ended up in bed like really ill.
 
Where they tablets that you’d had previously for something else?
 
Yeah, yeah I’d had spasms in my stomach and they were like a relaxant and I had had an upset stomach and, you know, I was running to the toilet quite a lot and I thought oh well maybe I’ve eaten too much fruit or too much vegetables or something like that and I just this one morning I got up and I was only out of bed for about an hour and I just, I could hardly move, I could hardly motivate myself and I thought I’m going to have to get back into bed. And I just, I didn’t feel right at all and I went back to bed and I was asleep for six hours and that was after sleeping for the full night.
 
So they completely knocked you out.
 
And I had a really bad headache which, you know, I haven’t had a headache for a long, long time and then I woke up sort of mid to late afternoon and thought oh what happened then and I think I was due to go to the doctors that week for a review so I thought I’d better see where I’m up to with my prescription so I think that’s when I went back in to the drawer to find my tablets to see if I had any left and I looked and I thought ‘oh they’re not the right ones’.
 
And you put two and two together and realised what you’d been doing.
 
That’s when I realised what I’d done.
Some people had been told by the doctor to take the antidepressant at a certain time of day either morning or evening; for example antidepressants with a sedative effect may be best taken at night. Sometimes people said they had altered the time of day they took the antidepressant themselves for example, if it had made them sleepy in the daytime, they had switched to taking it at bedtime. Taking the tablet with food, or before eating, can help to avoid side effects like stomach upsets. The pharmacist can give information about how to manage prescribed medicines (see also ‘Coping with antidepressant side effects’ and ‘Taking other medicines with antidepressants’).
 

Lucy Y takes her antidepressant at night as it helps her to sleep

Lucy Y takes her antidepressant at night as it helps her to sleep

Age at interview: 23
Sex: Female
Age at diagnosis: 18
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It was very helpful to me in terms of sleeping the whole time I took it, not as powerful an effect as in the first couple of weeks but you know, I went from maybe having two or three nights a week when I couldn’t sleep very well to having I think only four nights when I couldn’t sleep in those three years on mirtazapine, so the only thing that it did do, it was very much, it did sort of feel like I was drugging myself to sleep a bit.
 
Did you pass out, not pass out but did you just fall into a very deep sleep?
 
Yeah about half an hour after taking it so, but it meant that I didn't really feel properly tired so, you know, I’d look at the clock and think oh it’s 10 ‘o’ clock, I’m not tired but if I want to go to sleep, at half ten I’d better take the pill now, job done. So I used to take it every night because if I didn’t I wouldn’t have slept.
 

Steve didn’t realise his stomach cramps may have been caused...

Steve didn’t realise his stomach cramps may have been caused...

Age at interview: 31
Sex: Male
Age at diagnosis: 30
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I didn’t really take notice of how I was meant to take them so I what I was doing I was waking up in the morning and taking one because it’s 20 milligrams that I take taking one and then eating about lunch time so for quite a while I was feeling really sick and I didn’t really understand why. I’m not clever enough at all to have worked out that my sickness was probably to do with the fact that I’d been taking antidepressants and that’s what was new, I just kind of was going through day by day going ‘Why does my stomach feel like this, it’s never like this,’ because I’m quite fit and healthy in general but it was actually my step mum that turned around to me and she said ‘Well when, haven’t you just started taking a new drug?’ I said ‘oh yes.’ So it wasn’t like forgetting about it I just hadn’t like, I hadn’t associated the side effects with what I was doing. Then when I told her the way I was taking it she said well ‘Did the doctor not tell you that you should take them when you’ve had something to eat?’ and I was like ‘Yes they did.’ So then I just realised that it was probably just the way I was taking them and I’ve not really had that many side effects since then.
Some people we spoke to had other health conditions in addition to depression, and so needed to remember to take a number of different medicines each day. Organisers or pill boxes with compartments with days of the week and times to take doses of medicines can help people to ensure they’ve taken all their medicines correctly. Victoria is used to taking medication each day because she has Crohn’s disease… ‘I’m so used to taking medication every morning anyway, it was just another pill I had to take so, you know, I never missed them or anything like that’. Jenny has an acute form of asthma and takes numerous tablets each day. When she’s prescribed new medicines she checks the British National Formulary (BNF), the publication doctors use to check information about medicines, to make sure there are no contraindications (reactions between medicines). When she goes in to hospital she takes a folder with all the details about her medicines to make sure health professionals know about everything. Some medicines are prescribed on the ward, but she takes her antidepressant in with her. (See also ‘‘Treatment in hospital’ and ‘Managing other illnesses’).
 
If you need more than 13 prescribed medicines each year, and are not entitled to a free prescription, it is cost effective to have a pre-payment certificate (PPC). You can also buy a three-month PPC, which will save you money if you need more than three prescribed medicines in three months. PPC are available by telephone, online or from some pharmacies.
 

Clare takes medicines to counteract the effects of other...

Clare takes medicines to counteract the effects of other...

Age at interview: 59
Sex: Female
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It’s interesting because apparently there’s something called I can’t remember what the phrase is but it’s that thing that were you’re on a medication you have to take another mediation to counteract the effects of medication you have to take and there’s, there’s a phrase for it it’s not over medication, something like that and one of things that I discovered was that these two medications both had constipation as, as a side effect.
 
Is that, so you take one for the arthritis?
 
Arthritis.
 
Then something else to counteract that?
 
I take the Naproxen twice a day (for arthritis) and I take my citalopram once a day so I have three tablets a day and they both have as a small side effect a sluggish bowel.
 
Is that the same for the citalopram?
 
Yes.
 
So it’s another side effect?
 
So I’m now I’m really good at drinking a lot of water, you know roughage but there are times when I have to take another medication to get the old body working properly.
 
So is that something you discussed with the doctor?
 
Actually it just.
 
As a side effect is it just from on the side of the leaflet?
 
No I just noticed it physically thinking oh God I’m really, you know, this is, this is not good. You know?
 
But you can usually manage it through diet though, roughage and so on?
 
I can yes I think at the time I was I wasn’t, my diet, I was on a diet trying to lose weight for the wedding so my diet wasn’t as good as it could be I think that was a factor as well so yes so again it was a kind of angst about oh God now I’m constipated three lots of prescriptions.
 

Janet takes seven different tablets each day. She sticks them...

Janet takes seven different tablets each day. She sticks them...

Age at interview: 71
Sex: Female
Age at diagnosis: 28
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Seven or eight.
 
Seven or eight. And is it all at different times of the day, do you have a routine?
 
No, no yes I do the lofepramine is three times a day so I take one of those in the middle of the day, in the morning I take a lofepramine and the vitamin D, the three... you have to take with food so I take those three first thing in the morning, lofepramine number two midday and… then the other two drugs the lofepramine, the olanzapine and the lithium at night. So actually I have them at the side of my bed the evening ones, they’re stuck up with Sellotape in the in the kitchen so that I don’t forget the morning ones and the lofepramine, I do occasionally forget to take that at midday.
 
Does it, do you notice it if you haven’t taken one?
 
No.
 
No. So although you’re a bit irregular sometimes, it’s not very often?
 
No, no.
 
How do you feel overall about the fact that you have to swallow all these tablets or have you just got used to it over the years?
 
I’ve just got used to it yes. I mean they’re for two different things I mean one is for psychiatric things and the others for bones.
 
Yes.
 
And so I can’t really muddle them up and say they’re all a nuisance because they’re for different, different things.
A few people recalled occasionally forgetting to renew their prescription when they were running out of tablets, or had encountered difficulties collecting their repeat prescription from the pharmacy or health centre.
 
If there are concerns about the risk of self-harm doctors may only prescribe a small supply of tablets at a time. Thomas had overdosed on citalopram because he ‘just wanted to be knocked out’ for a time but in his case the impact from the SSRI overdose was minimal. He believed the doctor used weekly renewal of the prescription as a lever to make him attend appointments. Hannah took an overdose of mirtazapine ‘It’s really appealing to sleep for a long time when you’re feeling suicidal’. Sharon recalled when she’d felt really unwell keeping a supply of ‘left overs’ from a previous time she’d used antidepressants ‘Just in case it got too much so I had them there’. Sonia was asked to sign a ‘self-harm contract’ and her doctor said treatment would be withdrawn if she did not comply with it. Victoria is prescribed medicines for Crohn’s disease on a three monthly basis, but citalopram is provided on a monthly prescription because she has taken an overdose in the past. Although she’s used to taking medication, this can catch her out ‘I can be a bit ‘scatty... I’m not allowed the citalopram for longer than a month at a time so I keep forgetting I don’t have another box up in the cupboard’.
 

Sonia’s doctor kept a close eye on her and only prescribed...

Sonia’s doctor kept a close eye on her and only prescribed...

Age at interview: 31
Sex: Female
Age at diagnosis: 17
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My GP then actually was brilliant in terms of, because I was only being given a weekly, I was on weekly prescriptions because my psychiatrist, because obviously she knew I was suicidal and because I’d tried to kill myself she didn’t trust me with, which is quite common they don’t often trust you with more than…
 
Had that being an overdose type of thing?
 
Yeah, they, they often don’t trust you with more than a week’s worth of medication and my GP was brilliant because she would leave out repeat prescriptions but she would never let a month go by without seeing me, so on the last one she would always leave a little note saying please make an appointment for your next prescription is due which was great because it was just someone to kind of keep in touch with and kind of someone saying ‘are you okay’, you know, ‘is everything going okay?’. Because obviously your psychiatrist is there but you don’t necessarily see them all that often. 
 

Thomas sometimes had problems getting a new prescription...

Thomas sometimes had problems getting a new prescription...

Age at interview: 34
Sex: Male
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I would sometimes miss doses. Prescribing was always a huge problem because the repeat prescriptions, they would always get mucked up by Boots. They would always get the timing wrong. They’d have to ring up the surgery. So it would be a few days when you wouldn’t get medication because the prescribing thing didn’t work out and also there was just access to doctors. I would, there were long, there was a long kind of waiting list for appointments at my GP’s surgery at the university so I’d have to go to a walk- in clinic. It would just be a huge palaver really to get a prescription. And even when they put you on a repeat prescription that didn’t work either. Boots would muck it up. They wouldn’t pick it up or say oh you have to tell us when to pick it up, and ring and so on, and then it wouldn’t come through and so on.
 
My GP would use it as a mechanism to get me to go back and see her, and see me in the surgery and that’s what they were doing recently with me, when I was coming off the sleeping pills. They would only prescribe me mirtazapine, the antidepressant that I was on and the sleeping pills one week at a time. They would force me to come back at one week intervals.
 
And what effect did that have on you? Did you kind of resent that or….?
 
I really resented it, because of work problems I was having. I was taking so much time off with these medical appointments and everyone else in the office was like, well they could see me coming in at 11 o’clock in the morning. It was like, it was because I’d been queuing since 8.30 to see my GP but it still looks bad. And trying to kind of explain to people, although I didn’t explain it at all at - It was a medical thing.
 
So that made it quite difficult kind of not being able to provide any kind of cogent explanation as to what…?
 
No and I would always have to give kind of, get into quite convoluted stories really, to try and explain why I was coming into the office late.
When a doctor first prescribes an antidepressant they usually start with a low dose and then if that is not effective increase it until they find what works for a particular person. The dose may change for a number of reasons, for example if the antidepressant isn’t working, or to help reduce side effects. Stuart now takes a ‘maintenance dose’ that keeps his mood relatively stable, but recalled ‘in the early days there was a lot of playing around with cutting tablets in half to get the right dose... taking that for six weeks and... see how you feel... and should we go up a bit, should we go down a bit’. When the dose is reduced sometimes the doctor will prescribe different strength tablets, or it may be possible to double up tablets if the dose has been increased. Where the dose had been reduced some people like Stuart had to cut up their tablets to get the dose they needed. Thomas described the difficulties he encountered doing this, and that it made him feel humiliated, ‘If you don’t have the right thing to cut up a pill you know, bits go flying or they crumble you start [thinking] oh I’ll have that half because it looks a bit bigger than the other half... or it will divide into sort of powder and you scoop up the powder and, I remember doing that once, and thinking this is like a scene off “Trainspotting”’.
 
Some people took their own decisions to alter their dose in an effort to manage their own symptoms, feeling that the lower the dose the better. Rachel had a ‘love hate relationship’ with antidepressants, knowing she needed them, but hating having to take them. ‘Last year I was only having 10 milligrams but my way of thinking was 10 milligrams psychologically I could cope with that’. Thomas tried to reduce the side effects he was getting ‘I would keep chopping and changing the doses myself, I wondered... if I changed the dose the side effect might be a bit different, but then they never seemed to be.’ Michael had sometimes taken extra tablets because he was desperate to feel better. ‘I’ve messed about with it a bit, taking extra, it was a cry of despair really let’s take something and see if it will do some good’.
 

Lucy X alters her dose according to how she’s feeling...

Lucy X alters her dose according to how she’s feeling...

Age at interview: 21
Sex: Female
Age at diagnosis: 15
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When you sometimes change the dose is that, do you always have a consultation to talk about that?
 
Yes I mean it’s, it’s kind of very much left up to me to make that decision now I always stick in the range between 10 and 30 and I will, I will always have a consultation, I mean sometimes it’s just over the phone because my GP knows me very well now and she sort of knows that because I’ve been taking it, I’ve been taking it since my first year so that’s just over two years now, that I’m quite aware of how these things affect me. She’s very happy for me to just, to let me take you know my sort of call with what I want to do.
 
Do you get a different prescription when you need a different dose or do you just take more tablets - how does that work?
 
It kind of depends because they only come in tens and twenties so if I take thirty I have to take two and then I take ten so, but normally because I get prescribed like them sort of intermittently on a different... normally I have enough to kind of be able to do it myself without having to be prescribed more. I mean so if they just cut the twenties but yes no so normally it’s not really a problem it’s normally just like, I’m more, I’m more – will phone her just to kind of have them just because like I do want to it feel like it’s a joint decision not just like I’m just going off an doing what I want on my own. I’d always want to her say that she felt that was okay but then I’m almost always certain that she will so when I was young I had a lot of sort of anxiety about sort of saying what I wanted to do just because it had been ignored. But very much now I can say ‘oh well this is what I’m thinking then.’
 
When you feel like you need to increase it for example what is it that you’re feeling that makes you want, need to do that?
 
So mainly for me it’s around the exams would be the normal one it’s just for me probably my trigger thing is just being a bit tearful and like just could be anything just like ridiculous stuff. And it’s not even, sometimes it’s not even that I feel like… sad I’m just like overly emotional and I notice it.
 
A drop in mood...
 
And then that for me that’s like oh okay that for me‘s not a good thing.


Last reviewed June 2016.
​Last updated June 2016.
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