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Antidepressants

Telling the difference between depression symptoms and antidepressant side effects

‘The trouble with the drugs is actually disentangling what is the effect of the drug and what’s the effect of the depression. It’s so difficult to tell’ – Stuart.
 
Stuart’s observation sums up a problem that a number of people we spoke to identified, about how difficult it can be to know whether a particular feeling or symptom is a side effect of the antidepressant, or a symptom of the illness itself. People we talked to described a variety of symptoms that they believed to be side effects of antidepressants, both physical and psychological. Headaches, stomach upsets, numbness, insomnia, wanting to sleep more, feeling detached from reality, loss of concentration or memory problems may be typical symptoms of depression, but were also identified as side effects of the medicines (see ‘Coping with antidepressant side effects’).
 
Hannah said she wasn’t always sure whether to go back to see her GP about side effects because ‘sometimes you don’t know if how you’re feeling is as a result of the depression or whether it is actually a side effect’. When Gerry first started taking an antidepressant he described feeling a heightened sense of anxiety and that ‘it didn’t feel that much different from having depression... in terms of... I still felt depressed but at the same time I felt like ‘spaced out’. Dina thought that antidepressants had affected her appetite but said ‘I don’t know, if it was the drug... I can’t tell whether it was actually a side effect or if it was just the suppression of appetite that I get when I’m depressed anyway, that’s hard to tell’.
 

Rachel explains how difficult it is to know how much the...

Rachel explains how difficult it is to know how much the...

Age at interview: 51
Sex: Female
Age at diagnosis: 11
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I think that is very, very misunderstood or we even just not knowing about how physical an illness depression can be, how physically ill you can feel, you know you do have aches and pains you do you know have nausea, you do have more headaches, you do have just, you know, shakes and stuff like that you do wake up with your, with your jaw stiff because you’ve been clenching, you wake up with your knuckles white and your hands aching so much because you’ve been so tense or whatever.
 
They’ve all given me side effects and in some places more or less of fairly similar ones. which are putting on weight, losing appetite and sleep disturbance terribly, I mean I do get insomnia anyway but I just can’t sleep and I can’t sort of, I can’t establish a pattern of sleeping and incredibly vivid dreams.
 
Is that side effect from your medication?
 
I think, well this is one of the big things which is very, very confusing and I was saying to my CPN yesterday that it’s very hard to separate what belongs in the fact that, you know, you’re suffering from or recovering from a severe episode of depression and what, what is the, what is the medication. but the things I’m saying are things that have happened and persist, persist in happening even when I might still be depressed but I’m over that real crisis period and, you know, they’ve had, they’ve had their two weeks or three weeks or whatever it is to work and there are some things which like putting on weight, loss of, loss of well not, not loss of interest in things like sex and you’re libido but a lack of being able to feel.
 
I mean three times I’ve set fire to the kitchen just I forgot, I forgot I was cooking. I mean and I don’t know how much of that is, is depression but some of it is definitely the medication. This sort of memory loss all this distraction, inability to stay on point.
Commonly people felt worried when they read the possible side effects listed in the patient information leaflet, which some people noted could be strikingly similar to the symptoms of depression. Melanie was unsure about taking an antidepressant when she read the leaflet and went back to see the GP for reassurance. ‘There were certain bits of it that I thought... you know a lot of the symptoms were things that... a lot of the side effects of the medication were things that I was already suffering with symptoms of the depression.’ Some people worried that taking an antidepressant could make them feel worse rather than better. People who were experiencing severe or serious depression had concerns about the increased risk of suicidal feelings that an antidepressant can potentially precipitate. Rachel observed ‘it seems to repeat the symptoms of what you’re suffering from already... you may feel suicidal’. Lou said she experienced heightened feelings of anxiety when she started on Seroxat (paroxetine). ‘I was feeling depressed before, and this was really bad, because of the medication’.
 

Hannah wondered if it was worth the risk of taking a drug that...

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Hannah wondered if it was worth the risk of taking a drug that...

Age at interview: 28
Sex: Female
Age at diagnosis: 23
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I think initially, I know when I first started taking, when I first started taking antidepressants and I took the citalopram that I did read all the information, actually I probably did read all the information leaflets on all of them but I think the first time I thought ‘oh my God’ because there was so many different things it was almost like some of them it was almost like it negated taking them in the first place because I’m sure like some of them where it says like, you know, can cause suicidal feelings that’s if you weren’t already feeling suicidal it’s just well is it worth that risk?
Some people we interviewed had other health conditions which could also cause similar symptoms. Sonia had suffered from migraines all her life and said it was difficult to tell whether the increased number of headaches she experienced could be linked with the antidepressant sertraline. Emma had a neurological problem which caused difficulties concentrating and with memory, so she couldn’t be certain what was a consequence of the neurological impairment, what might be a side effect of Cipramil, or a symptom of her depression. Dina put on weight with mirtazipine, but recognised that she also used to comfort eat as part of her depression and felt that ‘the weight gain isn’t just about the drugs’.
 

Sonia reflected ‘They’re giving you a drug to counteract suicidal...

Sonia reflected ‘They’re giving you a drug to counteract suicidal...

Age at interview: 31
Sex: Female
Age at diagnosis: 17
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I was told, it was something that I read because I always suffered from migraines always since I was a teenager, and I’ve noticed that once I started taking sertraline I was getting them very, very often. But no one had told me anything so I went and looked it up and realised and you know you read up oh okay actually migraines and headaches are a side effect of this drug. So I ended up taking another drug to counteract that side effect and so it’s a kind of, that was one of the side effects of sertraline. With fluoxetine again I mentioned earlier the insomnia which again I’m taking another drug to counteract that.
 
Also you also have to remember that antidepressants, certainly the SSRI’s, can cause suicidal feelings, so while they’re giving you a drug to counteract suicidal feelings that it can also cause them. And it’s, it is a side effect that does kind of go away with time so again it’s one of these things they kind of say to you ‘I know it’s awful I know it’s shit but please can you kind of just sit with it for a couple of weeks until the side effects go away’.
One example people gave of how difficult it is to tell a side effect from a symptom is in relation to sex. Some people experienced loss of libido, had difficulties climaxing, or were totally disinterested in sex when they were taking an antidepressant, but it wasn’t always clear whether this could be attributed to the antidepressant, as these problems can also be symptoms of depressive illness. Michael remembered that his wife had thought his lack of interest in sex was a side effect of taking antidepressants ‘She said it was the pills that were making me not interested in sex and the doctor said “No it isn’t, that’s his depression”’. Charlotte said her loss of libido had caused problems between her and her boyfriend, which she partly attributed to venlafaxine, but also said that the circumstances at the time, and feeling so depressed, had made her lose interest in sex.
 

Flora felt that ‘I couldn’t relate a lot of the time to any feelings...

Flora felt that ‘I couldn’t relate a lot of the time to any feelings...

Age at interview: 43
Sex: Female
Age at diagnosis: 21
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When you are depressed you’re just so absorbed in yourself, you don’t feel empathy or I certainly couldn’t feel empathy and I couldn’t relate a lot of the time to any feelings and again I’m not sure how much medication contributed to that but I know that after a long period on these medications I felt... often quite numb and unable to laugh but unable to cry just existing and feeling very abnormal because realising that I had lost, it felt like I’d lost my sense of humanity, you know. When I’d hear about something and think why can’t I feel sadness for this person or happiness for that person?
(See also ‘Coping with antidepressant side effects’,‘Starting to take an antidepressant’, ‘Reviewing antidepressant use’ and ‘The Patient Information leaflet’).

Last reviewed June 2016.
 
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