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Antidepressants

Starting to take an antidepressant for the first time

Experiences with antidepressants vary. It usually takes several weeks before people begin to feel any benefit. Many we interviewed began to experience some benefits after about 4 -6 weeks; some felt they worked much sooner, some said it took up to 8 weeks to feel any benefit, and others felt no benefits or had to try several before they found one that worked. During the first few weeks' people commonly experience some side effects or feel worse before they begin to feel better. Although the newer Selective serotonin reuptake inhibitors (SSRIs) usually have fewer or less severe side effects than tricyclic antidepressants, various side effects can occur with them all. The doctor will typically prescribe a low dose at the start and this can help to reduce the risk or intensity of side effects. It may take a while to find the right dose. Some people may need to try several different antidepressants before they find one that suits them.
 
It’s important to have realistic expectations in the first few weeks. Andrew’s doctor had pre-warned him that ‘you may just find that you’re fine but it may make you feel a little bit odd at first’ so he had an idea about what to expect. Talking to the doctor helped Stephen to keep in mind that it could take a while to notice any improvements in mood ‘I knew that if I took a tablet that day I wasn’t going to feel better tomorrow... it would take several weeks before it started to have any effect’.
 

Stephen’s doctor explained that...

Stephen’s doctor explained that...

Age at interview: 48
Sex: Male
Age at diagnosis: 44
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I was actually more relieved from the talk rather than having the tablets because she was just such a good doctor that she made me feel that it might be a long powerful road to get better but it would happen and I knew that if I took a tablet that day I wasn’t going to feel better tomorrow it would take several weeks before it started to have any effect.
 
Is that what she told you?
 
Yes.
 
Or did you already have knowledge of that?
 
She basically well she basically said it was at least two weeks before they’re into your system before you start feeling any effect and it still might not be enough but I was on a very low dose, what the dose is I can’t remember after six weeks or eight weeks the dose was upped to a slightly higher level and we basically monitored it for, well she monitored it not me, but for like three or four months before we got to the level that felt just right. Because they can make you feel tired or I felt other side effects you’ve got to be very careful with that.
 
And did you get side effects when you first started taking them?
 
Every time the dose changed it would take me a couple of weeks to adjust and my sleep patterns were totally thrown out. I had none of the problems like upset stomach or anything like that but the one thing it did to me was really change my body clock.
Some people say they notice an immediate benefit or improvement in their mood, and experience few, if any, side effects when they start to take an antidepressant for the first time. Being proactive and starting to ‘tackle the problem’ can be enough to help people feel more positive so it’s not always clear how much of the effect they are feeling can be attributed to the medicine itself. Victoria said maybe it was the ‘placebo effect’ but whatever it was, she definitely felt different almost as soon as she began taking the antidepressant.
 

When John started taking fluoxetine he felt he the benefits...

When John started taking fluoxetine he felt he the benefits...

Age at interview: 84
Sex: Male
Age at diagnosis: 37
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I was taking something else, I don’t know what it was but it didn’t seem to do anything. I mentioned it to him one day and he says there’s a new one out, they called it something.
 
Prozac?
 
Prozac.
 
Yes.
 
That’s right, wow. He says try that, well…
 
Oh right, tell me about how that made you feel.
 
Lovely.
 
Did it?
 
Yes. It felt normal.
 
Ah right.
 
It took about three weeks to get into the system but after that it was a pleasure to take.
 
Really? So how different does it make you feel?
 
All your problems can be managed, I wouldn’t say they go away because they don’t, not when you’re 85 they don't go away but, you know, you look back and you think well it’s not so bad, but it is at the time.
 
Does it feel like it gives you a bit of perspective on things?
 
Yes, yes. The first thing that it did was lift the black cloud and I felt that go I was sitting there one day, my wife was there and we were talking, I said ‘whoops’, she said now what, I said ‘the black clouds going, I could feel it lift, travelled up from my feet through me up’.
 
Really?
 
Crazy isn’t it?
 
Well no it sounds quite a powerful feeling.
 
Yes it was good yes.
 

Victoria started to feel calmer and happier almost immediately...

Victoria started to feel calmer and happier almost immediately...

Age at interview: 25
Sex: Female
Age at diagnosis: 20
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Well I noticed an improvement immediately and people have said that’s probably the placebo effect because they take a couple of months to kick in but as I say as far as I was concerned I instantly felt much more calm, much more happy, much more able to view things kind of clearly. My mum kept going round the house going ‘Oh it’s amazing she’s a different person its lovely we’ve got our lovely little girl back,’ and all sorts of things like that so I don’t quite know why that was but certainly that’s kind of how I felt.
 
And did you have any side effects at all from it?
 
No not the first time round not that I remember everything seemed fine.
Catherine has taken several different antidepressants having experienced recurrent depressive episodes, and says they usually take between four and six weeks to start to work. Melanie experienced minor side effects when she started taking an antidepressant for the first time, but after a few weeks started to feel calmer and less anxious. She said it could feel disappointing at the start because ideally you’d like to notice improvements straight away but when she went back to see the GP for the second prescription and told him how she was feeling she was advised to give it more time.
 
Several people noticed a gradual ‘lifting’ of their mood which could be ‘hard to pinpoint’ but they slowly began to feel some benefits. Gerry said that two or three weeks after starting the treatment ‘I could feel the heaviness lift and I felt more relaxed’ and although he still felt rather depressed he said it felt as though the antidepressant was ‘levelling things off’. Around two months after Sharon started taking an antidepressant for the first time her husband noticed a big difference, he said ‘This is you, you’re back to your old self’. Roisin had tried a number of antidepressants that seemed to make no difference, but when she began taking one that did suit her she began to feel ‘almost normal’ after just a few weeks.
 

Ideally people would like a ‘quick fix’ when they start taking...

Ideally people would like a ‘quick fix’ when they start taking...

Age at interview: 44
Sex: Female
Age at diagnosis: 43
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I was worried about the fact that I knew the tablets would take some time to have an effect.
 
So you were worried that, you wanted some immediate relief and it wasn’t going to happen that quickly?
 
Yeah I kind of thought that and to be honest the counselling, even though it was only an hour a week, was medication to be honest. And that did give me a little bit of relief before the tablets started working because it just confirmed that it was, it was alright to be the way I was.
 
It is unfortunate that the antidepressants take a little while to work because you do get that box and you do sit down and think I’m going to be alright tomorrow and you’re not.
 
It’s not that simple.
 
And in fact, I suppose it’s like antibiotics they always say you get worse before you get better, I wouldn’t necessarily say I got worse by taking the antidepressants but obviously I had to suffer some of the little side effects but then now I can think well it was worth persevering because obviously my body’s accepted them now and they’re doing what they should be doing instead of; I suppose when you take something like that and they say you’re going to feel sick it could be your body saying ‘whoa hang on I don’t want this medication inside of me, let’s make you sick’.
 
So your body has to get used to having it inside.
 
Your body gets used to it and then it starts doing what it should be doing.
 
So you’ve now realised that’s it’s a much more gradual process than what you first thought?
 
Yeah but you do want, you do want that quick fix.
Lou’s depression subsided after a few weeks of taking a new antidepressant, but overall she said the medicine made her feel numb and distant. Some people said although they noticed some benefits after a short time, the medicine had also left them feeling detached or unemotional.
 
Initial side effects of antidepressants 
It’s important to remember that whilst antidepressants can cause a wide range of side effects, this does not mean that everybody taking a particular antidepressant will experience them.
 
The people we spoke to initially experienced insomnia, feeling lethargic and sleepy, dizziness, headaches, vivid dreams, dry mouth or bad taste in the mouth, sickness or nausea, hallucinations, loss of appetite, sweating, memory problems. They ranged from mild to severe and people responded differently to them. What one person will tolerate, another might not.
 
As well as physical side effects or symptoms, people also struggled with psychological effects initially, such as feeling ‘detached’, ‘numb’, ‘being in a dream- like state’, ‘feeling controlled’, ‘like a zombie’ all of which could make life hard to cope with and make them question whether they wanted to continue with the treatment. Greg said the first three weeks were ‘emotional as hell’. Some people also struggled with the idea of taking an antidepressant in the first weeks. Thomas it felt he had ‘surrendered’ because to him it signified that he was officially ‘mentally ill’.
 
Adjusting to antidepressants
It can take a while for people to adjust to a new antidepressant and sometimes side effects can disrupt everyday life. Getting up to go to work each day can feel impossible. Several people we interviewed had sleep problems in the first few weeks and found it difficult to think or concentrate. Thomas said he could barely function when he started taking an antidepressant because of its sedative effect on him. ‘I felt completely flattened, like I’d been hit by a truck’. Lucy X took Prozac (fluoxetine) as a teenager during her GCSE year, and said she struggled to go to school because it left her feeling sick, dizzy and gave her bad headaches. Even when the side effects wore off she still felt distant and numb.
 

Sleep problems had been one symptom of Lucy...

Sleep problems had been one symptom of Lucy...

Age at interview: 23
Sex: Female
Age at diagnosis: 18
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So autumn of 2009 it had been sort of building up all summer and I was feeling terrible again so I went to see the same GP and this time he prescribed mirtazapine and I’d been having terrible trouble sleeping and so I took it in the evenings and it was just incredible, it was, had quite a strong sedative effect and that was just very, very useful a time where I couldn’t sleep and that kind of, you know, knocked me out for a few weeks and allowed me to kind of sleep off the worst of it and you know, sort of slowly getting back there but I felt after maybe taking it for three or four months just like a completely new person. It had cleared up a lot of stuff that I hadn’t even, that I thought, you know, was my personality that I hadn’t even realised was related to the depression, stuff that I just thought was an intrinsic part of how I was and when I found that stuff kind of lifting and just feeling much more optimistic than I’d ever felt before I was like wow this is, this is pretty good stuff. So I continued taking that more or less straight for three years which have been the three happiest and most productive years of my life.
 
When you started taking that one did you get any different effects?
 
I felt like a zombie for the first 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.
 

Emily stayed with her parents for the first few weeks and said she...

Emily stayed with her parents for the first few weeks and said she...

Age at interview: 28
Sex: Female
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Can you remember roughly how long it did take to start to have any effect on you at all?
 
It’s, I find it very hard to judge thinking about it, I mean at the time because of the insomnia, obviously I had no clue what was going on, I was a complete mess, I mean I remember at one point I was at my parents’ house two or three weeks after I went on medication and I was lying downstairs on the sofa trying to sleep because I’d tried upstairs and I was just lying on the sofa and I just remember seeing a wall of spiders and I thought oh no I’m hallucinating. And so I find it very hard to judge and pin point when I would say the medication and it was starting to, I suppose make me feel… maybe more detached... because I think that was what I was looking for, I wasn’t expecting it to magically fix everything I was just looking for a bit of detachment so I could sort it out myself.
 
You could escape from the thoughts?
 
Yes and that I think the, it was, the insomnia was, was pretty awful. But I was talking to my mum about doing this interview and she said she goes ‘I think it’s very good that you’re doing that because I remember you on, when you first went on medication and what a horrific experience it was,’ I think I’d kind of a little bit blocked out just how bad that first month was, it was probably round about a month.
Some people had taken time off from work to help them cope with their initial reaction to an antidepressant. People typically said they found it difficult to work productively. Andrew said being able to control his own diary helped to an extent, but said ‘I winged it a bit and some days I’d come home a bit early or take a little longer for lunch’. Emily’s doctor signed her off work for a week when he prescribed citalopram for her, but in hindsight she felt it wasn’t long enough because she was having trouble sleeping and just couldn’t work properly. (See ‘Antidepressants and work') Staying with a friend or relative for a few weeks can help. Other help may also be available, for instance some employers can arrange workplace counselling, or reduce work hours for a few weeks. Some people were surprised at the help and support they received at work, but some preferred not to tell people at work that they were taking an antidepressant.
 
If side effects feel intolerable it’s important to talk to the GP, who may be able to offer practical solutions, advice or reassurance. Emily’s doctor prescribed sleeping tablets for insomnia in the short term.
 

Emily found it hard to concentrate at work when she started...

Emily found it hard to concentrate at work when she started...

Age at interview: 28
Sex: Female
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I had a week to adjust and then I went back to work and in hindsight that was a big mistake going back to work after a week because, firstly because I was, I don’t know I was still very embarrassed about my behaviour at work, I hadn’t seen anyone since, I’d spoken to my manager who’d been very supportive but that was it, I was very embarrassed about going back to work and the side effects from the from citalopram were really, really quite bad at that point in that well effectively I had insomnia I was getting sort of fifteen twenty minutes sleep here and there and that was it.
 
And that had been going on for about a week before I went back to work so I, for a week I tried to go into work, I never did a full day and I was sitting there and realising an hour had gone by where I had just been staring and done nothing and don’t, didn’t really know what had happened in that hour. And so I went back to the doctor at the end of that week and that’s when I sort of explained it and he said to me you know, this is one of the side effects one of a potential massive list of side effects it is one of them what we need to do is break the cycle, get you sleeping again, so that’s when he diagnosed sleeping pills. He said ‘Try these for two weeks try and break the cycle and then come back again,’ and he also signed me off for another two weeks which was what I needed because I actually went back to my home town where my parents were and I moved in with them for a week and, I mean the sleeping pills they didn’t really.
 
I wouldn’t say they really worked straight away but by the end of those two weeks that I had off I was, I was sleeping better and I was feeling a little bit more positive.
 

Andrew felt guilty that he wasn’t working productively...

Andrew felt guilty that he wasn’t working productively...

Age at interview: 50
Sex: Male
Age at diagnosis: 49
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That first month or so when you were starting to take the citalopram, how easy or difficult was it to continue working normally?
 
It was so I could get up and get to work, it was actually, it coincided with downtime at work, because I work in a University and the Christmas period is very quiet, people go away for weeks, it’s not just like taking the odd day.... I took a fortnight off or maybe even three weeks off over the Christmas period. So I could get myself into work, you know, maybe I wasn’t shaving as much as I used to and I was leaving here a lot later.
 
I was quite lucky that I could do that, you know, controlling my own diary. but it could have been, it would have been a lot worse if I’d had, I don’t see my boss on a day to day basis, I’m left to get on with it and I think I was just able to wing it a bit. That would have been picked up at some point but so I could come and go as I pleased I’d also come home a bit early or take a little longer lunch break.
 
Would you see that as a weakness or as being able to be kind to yourself?
 
Well I think that was a weakness then but in hindsight I just think, you know, we all owe it to ourselves to take things quietly when we can because we all give more than we ought to when it’s busy, you know, and we always forget when we’re really busy and how many hours we put in then and then carry on working and so I said to myself now ‘be kind to yourself, think about the hours you put in, think about’...
 
So work/life balance is a completely other thing but it’s a massively important one and I think what I’ve learned is that you need time to think about your mental health and you need time to take your tablets and deal with treatments as they come along, it’s no good rushing it.
Several people had found that varying the time of day when they took the antidepressant could help iron out sleep problems, or make other side effects such as nausea more bearable, for instance by timing them so that the worst of the effects happened when they were asleep.
 

Olivia Y found that changing the time...

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Olivia Y found that changing the time...

Age at interview: 33
Sex: Female
Age at diagnosis: 16
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I’d taken 10 milligrams of citalopram that time before and I hadn’t felt any side effects, the citalopram this time around… I was taking 20 milligrams every morning as instructed and I just wasn’t sleeping, I can’t remember if it was trouble getting to sleep or if it was waking up early, I can’t remember which but my sleep cycle was messed up. So without asking my doctor I switched to taking it at bedtime, that fixed it, just simply moving it from morning to night, I don’t know how these things work, I’m not a, I’m not well I’m not a medic, I’m not into kind of stuff but I don’t know when I moved it to 12 hours later I slept better. it took about six weeks I have to say for that to get into my system that was not an easy experience getting it into my system, I don’t know maybe if it would have levelled it anyway maybe if I’d continued taking it in the morning maybe that would have just have, maybe it was just levelling out anyway or I don’t know if making the switch was what levelled it.
Although initial side effects should wear off after a few weeks, some people found that they continued, or the antidepressant seemed to have no beneficial effect even after several weeks or months. It’s important to review your progress with the GP after a few weeks. He or she may alter the dose, or switch to a different antidepressant. (See ‘Stopping taking antidepressants’, ‘Changing antidepressants’, ‘Reviewing antidepressant use’, and ‘Coping with antidepressant side effects’).

Last reviewed June 2016.
 
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