A-Z

Antidepressants

Taking an antidepressant with medicines for other illnesses

Doctors need to be aware of all the medicines a person is taking so that he or she can check that they can be taken together without any adverse (bad) effects. The pharmacist may also review how people take the medicines they are prescribed, particularly if they take several different types, and offer advice and support. Screening for depression is a routine part of managing long-term conditions such as diabetes, so many people take other medicines as well as an antidepressant.
 
We talked to people who were also taking medicines for arthritis, high blood pressure, high cholesterol, a neurological disorder, stomach problems, heart problems, fibromyalgia, thyroid problems, acute asthma, and Crohn’s disease.
 
People who have to take several different medicines each day find it helps to get into a routine so that they remember to take everything. Some count out each day’s medicines in advance, or use a pill organiser with the days of the week marked on it. Stephen takes several tablets each day ‘I had this little pill box with Monday to Friday because I’m also on tablets for blood pressure ... and there’s a statin which I take in the evenings as well.’ When people have become accustomed to taking several different medicines it often becomes routine to take them each day. Victoria was diagnosed with Crohn’s disease a few years ago and is now used to taking a number of tablets every day. Jenny has acute asthma and takes nineteen different tablets each day. Without them she would become very unwell so she knows it’s in her interest to remember them all. (See ‘Reviewing antidepressant use’, ‘Managing antidepressants’ and ‘The Pharmacist’). 
 

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.
Sometimes people who have been diagnosed with depression may also be prescribed sleeping tablets to help with insomnia, or they may be prescribed a particular antidepressant that has a sedative effect. Rachel takes Montelukast to help with urticaria (allergies) which she takes at night time as it can cause drowsiness, so may help with her sleep problems. Sharon was prescribed a medicine for acne which on rare occasions heightens depressive feelings, so her doctor increased the dose of her antidepressant when he prescribed it. ‘I had to start on Roaccutane, for acne ….so the fluoxetine was upped in anticipation of a dip and it worked, it worked quite well - we managed to sort of keep it on an even keel’. Peter has to take several different medicines each day to cope with ulcerative colitis, a condition that causes bowel and digestive problems. He now takes several tablets each day including his antidepressant and says he feels resentful about having to take so many pills.
 
It can be frustrating to have to take a medicine to help counteract the side effects from another one. Janet has osteoporosis and a problem with her parathyroid gland (possibly caused by taking lithium) so has to take other medicines to help regulate the levels of calcium in her body. 
 

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 feels different about the medicines she takes for her physical health...

Janet feels different about the medicines she takes for her physical health...

Age at interview: 71
Sex: Female
Age at diagnosis: 28
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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.
 
So do they make, is it different, do you feel differently taking the ones for the bones as opposed to the psychiatric ones, do they make you feel do you have different feelings about taking them?
 
I do actually yes I think I feel that the olanzapine and the lithium and the lofepramine are more important but in fact they’re not more important but they're more important because they’re meant to enhance me which they never do, they going to make life better whereas the calcet and the Vitamin A and D are just as important but I never really feel they are.
Antidepressants are sometimes prescribed to help someone cope with the difficulties posed by physical health problems. Catherine takes what she describes as ‘a cocktail of medication’ for her fibromyalgia (chronic pain). Similarly, Jenny, who has acute asthma and a number of other serious health conditions, feels that taking an antidepressant helps her cope with being so unwell. Dina has Crohn’s disease and was originally prescribed steroids, but since she started taking antidepressants the steroids have had to be replaced by other medicines. ‘Because steroids can sort of exacerbate psychotic sort of tendencies or whatever you want to call that I wasn’t able to take steroids’.
 

Catherine takes medicines to cope with her chronic pain...

Catherine takes medicines to cope with her chronic pain...

Age at interview: 41
Sex: Female
Age at diagnosis: 14
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Fibromyalgia chronic pain, it’s actually a really, it’s what they class as a set of symptoms, it’s, it’s not a specific illness as such, it’s a set of symptoms where there’s chronic pain, widespread pain in the muscles and with it sleep disturbance, chronic fatigue is quite common, I experience chronic fatigue with that. I also experience Sjogren’s syndrome which is the dry mouth, dry eyes, dry skin and that’s quite common again to be with, to go with fibromyalgia. One thing maybe not quite so common is lymphedema in my left arm, swelling, they don’t really know if that’s really, if that’s related but they basically fibromyalgia chronic pain condition.
 
So would you say that part of the reason for carrying on with the Prozac now is to kind of alleviate the feelings that you have about that condition?
 
Yes, yes I would yes because the other thing is about that is I have attended the chronic pain services and ironically part of the process of, the services you use is psychological therapies which is CBT as well as physiotherapy and also I think many people who I’ve spoken to about fibromyalgia are also on antidepressants because they still think that the serotonin can be useful in fibromyalgia. Whether it, whether, I mean again it’s, it’s a, a difficulty whether you could say that having a long history of depression would ever have triggered off fibromyalgia because again there’s a thing about whether fibromyalgia, is it a psychological condition, is it a physical condition, is it both? There’s an ongoing.
 
And some of the symptoms are pretty similar too it sounds like from what you’ve just told me.
 
Yeah, yeah, so that, that can be, yeah that can be a bit of a difficulty but certainly my fear would be I would have a, I mean actually before I developed fibromyalgia I was already looking to coming off Prozac, so it wasn’t really as if there was a fear there at the time, I think the fear has come around from the fact that I have a physical condition to deal with while I’m working fulltime still, which is very, you know, it’s hard in itself a fulltime job and, you know. A lot of people with fibromyalgia aren’t fortunate enough to work at all, I am, so and I’m also now on a cocktail of pain medications so, you know I think the fear is valid I would say and kind of the Prozac thing and whether there’s a placebo thing or whatever I don’t know but, you know, for me it’s, it’s, I really don’t want to take that risk at the moment because I’m, I am working, I don’t want to disrupt that, what I have is still good and it would be a bit daft really to, to think about that just now.
 

Jenny has an acute form of asthma and takes numerous...

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Jenny has an acute form of asthma and takes numerous...

Age at interview: 36
Sex: Female
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I wish I could take less medication. I sit at the breakfast table and look at the 14 tablets I call my second breakfast, and I wish that for just one day I could not take any pills. Many years ago, before I was as ill as I am now, I did decide that I wasn’t asthmatic anymore. I lasted 32 hours before I ended up in hospital. Now if I tried that I wouldn’t last 12 hours without help, and would probably be dead in under 24 hours. My medication literally keeps me alive. Thinking about this now, maybe this realisation is one very good reason to keep taking the anti-depressants. It’s a depressing thought that without pills I would be dead. If I had been born even 25 years earlier than I was, i.e. in the1950’s, I wouldn’t have survived to be 36, as I am now, and my body would have given up before this age.
 
After years of experience of anti-depressants I can now see changes in myself which might indicate a need for a dose or medication review. But I have also learnt how to identify when my low mood is related to my chronic health problems and when it is the underlying depression rearing its ugly head again. It has taken me quite a while to accept that when I have been unwell or in hospital I might be “down” for a few weeks. “Normal” people have this psychological response to ill health and/or hospitalisation. I used to think that because I was on my anti-depressants I shouldn’t be feeling like that. I now know that they don’t stop me feeling down when it is natural to feel down; rather they prevent me from getting stuck down there. They allow my not to pile one thing on top of another and get bogged down by life.
 
I think it is obvious from what I have already said, that I am a real advocate for anti-depressants if they work for you. For me personally they maintain me on a level plane from which I can then deal with whatever else life throws at me. Trying to cope with a serious chronic physical illness whilst your emotions are yo-yoing up and down would not be fun. I’m not sure that I would have coped this long if I hadn’t been on the anti-depressants. I have so many medications in the house that, taken in big enough quantities could kill me, that I think had I been as low as I was before the anti-depressants, temptation for the easy way out would have been too much. My asthma is not curable, the side-effects caused by some of the medications, have given me several other serious non-curable conditions, and some of the medications themselves are depressives. On top of all this I don’t know from one day to the next, how my lungs are going to be, and I’m in and out of hospital on a depressingly regular basis. Is it any wonder that I keep taking the tablets! I challenge anyone to live my life, with my history, without taking anti-depressants.
The doctor and pharmacist should ensure that the antidepressant you are taking does not interact adversely (badley) with other medicines prescribed. Reviewing medicines on a regular basis is good practice. Sometimes though, people said this had been overlooked, especially when the antidepressant had been prescribed on a long term basis with regular repeat prescriptions. Jenny, who took numerous medicines, preferred to keep her own record and check drug interactions in her own copy of the BNF (British National Formulary).
 
When people were admitted to hospital some people said they would take in their own supplies of the antidepressant they were taking although other medicines were started on the ward. Some felt satisfied that the specialists they saw about their physical health conditions worked together with their GP and that there had been good communication between the two. Emma has a neurological condition and sees both a consultant at the hospital as well as her GP about different aspects of her health and is confident that they each know what the other is doing. ‘They know that I take the (oral contraceptive) pill... the medication that I take for my neurological disorder reacts with certain types of pill so my GP makes sure that that works out and then some of the antidepressants react with my brain drugs so they have to make sure they don’t interfere so there’s a lot of communication, I have to say I’ve got a really good medical team there’. Others felt that there was a lack of ‘joined up care’ and that it would be helpful if health practitioners were to take a more holistic approach. Victoria said that although the specialists she sees about Crohn’s disease know she takes an antidepressant, it would be helpful if they asked her more about how it was affecting her emotionally. ‘I think because it’s all ‘me’ so all my problems kind of link into one, because obviously they’re going on in the same body it might be nice if they kind of spoke to each other and kind of cross referenced things.’ Thomas commented that ‘you can find that the prescribing for your psychiatric medications can be very different to the prescribing for your physical conditions’ and that doctors can have different attitudes to prescribing medicines to deal with these distinctly different types of conditions. 
 

Jenny takes numerous medicines for other health conditions...

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Jenny takes numerous medicines for other health conditions...

Age at interview: 36
Sex: Female
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The main thing I have noticed in terms of the anti-depressants is that when you have been on them a long time, had them on “repeat prescription”, GP’s tend to forget about them when prescribing other acute medications. There can be some interactions with other medications. But these are usually picked up by the pharmacist dispensing the drugs, if the doctor has missed it.
 
For me the only real issue I’ve had was when I started my current anti-depressant, it upset my Warfarin levels, blood thinning medication, but after a few weeks, and a few extra blood tests we got things levelled out again.
 
I have to admit to being different from most people. Due to the large number of drugs I take, I have my own copy of the BNF publication that doctors use, so that I can check up on any interactions etc that might occur when I have to start a new medication. I get a new BNF annually from my GP.


Last reviewed June 2016.
​Last updated June 2016.
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