The main types of antidepressant medications used used to treat depression today are:
- SSRIs – Selective serotonin reuptake inhibitors. Examples of commonly used SSRI antidepressants are Cipramil (citalopram), Prozac (fluoxetine), Seroxat (paroxetine) and sertraline (Lustral)
- SNRIs – Serotonin-noradrenaline reuptake inhibitors, such as Efexor (venlafaxine), Cymbalta or Yentreve (duloxetine) and desvenlafaxine (Pristiq)
- And older antidepressants, either TCAs -Tricyclic antidepressants and tricyclic-related drugs, or MAOIs – Monoamine oxidase inhibitors (see ‘Other medical treatments used for depression: TCAs, MAOIs, Lithium, ECT and other drugs’ for more information).
It is thought that antidepressants relieve depression by altering the way that chemicals (called neurotransmitters) work in our brains to transmit signals between cells. These days an SSRI is most often prescribed in the first instance, but which specific antidepressant is actually prescribed varies greatly. It is difficult to know how each individual will respond to any particular antidepressant, and it takes a number of weeks to know whether it will work. Some people need to try several before they find one that suits them. Some may find that an SSRI does not work for them, and so may be prescribed a different type of antidepressant.
Newer antidepressants are used to treat moderate to severe depressive illnesses as well as severe anxiety, panic attacks, chronic pain, obsessional thoughts, eating disorders and post-traumatic stress disorder.
Episodes of depression can occur alone (‘unipolar depression’) or with episodes of related mood swings (‘bipolar disorder’). This is an important distinction to make, as it may affect whether or not antidepressants are suitable, and whether other medication might be better. Antidepressants are usually used to treat unipolar depression, but, in bipolar disorder different medications may be used, such as mood stabilisers (e.g. lithium or valproate) and/or other medicines such as quetiapine and mirtazapine (see ‘Other medical treatments used for depression: TCAs, MAOIs, Lithium, ECT and other drugs’).
Compared with older antidepressants (e.g. TCAs) that were developed from the 1950s, newer drugs (SSRIs and SNRIs) tend to have fewer side effects and cause less harm in overdoses.
Benefits of SSRIs and SNRIs
The benefits of taking the newer antidepressants were rated from negligible to highly effective by the people we spoke to. While it usually took weeks for the effects of medication to work, some people were surprised that after feeling so bad that they could feel better even sooner. People were divided between those who felt antidepressants numbed, dulled or even made them into ‘functional zombies’, and those who felt medication made them feel normal, happy and ‘authentic’.
Said it took 7 weeks from starting fluoxetine (Prozac) to the time that her depression lifted in…
While improvements were long lasting for many, some people only had short-term improvement before the effects tailed off. Unfortunately, some people seemed unable to benefit from the medication altogether. Through trial and error though, it was clear that many who had not done so well on certain medications in the past could hit upon a drug or drug combination that really worked well. Psychiatrists were considered by some to have the best knowledge of antidepressants to assist in getting medication right. Some people had doctors who explained in detail the kinds of drugs available and their side effects, inviting the person to share in the decision-making about which drug to take. Those who had less than satisfactory experiences on the newer antidepressants sometimes complained to their doctors, and argued they needed to be tried on something different. One woman said she ‘refused to be on something that makes me feel indifferent,’ and kept demanding different drugs until she was put on Efexor (venlafaxine), which worked for her.
Says that Efexor was the best drug she had ever taken, with better effects and fewer side effects.
However, Efexor (venlafaxine) does not work well for everybody and is associated with a greater risk of suicide than other antidepressants, together with small rises in blood pressure. For this reason it needs close monitoring, and can only be initiated by consultant psychiatrists in many parts of the NHS.
Side effects of SSRIs and SNRIs
The side effects from taking the newer antidepressant drugs ranged from very minor to severe. People reported that side effects could be more severe at the start of taking medication, but reduce and even disappear over time. People were inclined to forgive the side effects (e.g. inability to ejaculate, nausea, muscle ache) if the benefits outweighed the costs. Some people felt they were not adequately warned of potential side effects, such as one young woman who was sure her suicide attempt was triggered by Seroxat (paroxetine).
While the initial side effects of Efexor (venlafaxine) seemed severe, they settled down, and even…
Found he could not ejaculate or have an orgasm on Seroxat (paroxetine), but the side effect was…
Believes Seroxat contributed to her suicide attempt. With counselling and new medication…
Managing antidepressant use
For some people, the unpleasant effects of changing doses or discontinuing some of the newer antidepressants can be severe. Whilst antidepressants are not thought to be physically addictive, stopping medication abruptly (e.g. Seroxat (paroxetine), Efexor (venlafaxine) can result in disconcerting and even frightening and bizarre symptoms (e.g. volatile moods, electric shock sensations, nausea, lurching sensations in the head, intense stinging ant sensations under the skin). People who forgot to take their medication did not always immediately link such events to discontinuation symptoms, but then found that remembering and taking their medication made them feel better again. In order to avoid missing doses and unpleasant effects, people found ways to try and remember. One woman carried around a pill dose box to remind her when to take her medication. She also left some pills in her drawer at work in case she ran out of pills at work. Those who suffered withdrawal symptoms, and who wanted to reduce or stop their medication, learned they should withdraw from their medication very gradually. People also tried to reduce or stop their medication with the support of their doctor.
Stopping her Efexor resulted in a lurching sensation in her head, electric shock sensations in…
Stopping Efexor resulted in nausea, depression and panic. (Played by an actor)
Felt numbed by Lustral (sertraline) and stopped taking her tablets, but suffered strange…
She had to experience not taking her Prozac to understand that it works for her, and she now…
Tried stopping venlafaxine (Efexor) and suffered unpleasant withdrawal symptoms, and so slowly…
For more information on antidepressants see our antidepressants section.