What are antidepressants?
Antidepressants are drugs prescribed by doctors to treat depression, anxiety, post-traumatic stress disorder and/or obsessive compulsive disorder. Antidepressants appear to work by increasing the amounts of certain chemicals (neurotransmitters) such as serotonin and noradrenaline in the brain. These chemicals are thought to be responsible for regulating mood.
The jury is still out on how well antidepressants work. The Royal College of Psychiatrists suggest that around 50-65% of people taking antidepressants see some benefit, compared to 25-30% who took a placebo. They seem to be most effective at helping more severe types of depression.
There are several types:
SSRIs (Serotonin Re-uptake Inhibitors) work by blocking the re-absorption of serotonin in the brain. SSRIs include Sertraline (Lustral) as well as Fluoxetine (Prozac) which is the most widely prescribed antidepressant in the world. These are thought to be the safest type of antidepressant.
SNRIs (Serotonin and Norepinephrine Re-uptake Inhibitors) work by affecting serotonin and norephinephrine levels in the brain. SNRIs include Venlafaxine/Effexor Some people respond better to SNRIs than SSRIs and vice versa.
NASSAs (Noradrenaline and specific serotonergic antidepressants)
NASSAs may be effective for some people who are unable to take SSRIs.
MAOIs (monoamine oxidase inhibitors) act by inhibiting the activity of monoamine oxidase, thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability. This in turn increases the levels of ‘feel-good’ neurotransmitters such as serotonin, norepinephrine and dopamine, by preventing their breakdown in the brain. They are not prescribed very much any more.
Tricyclic antidepressants (TCAs) are an older type of antidepressant. They are no longer usually recommended as a first-line treatment for depression because they can be more dangerous in overdose. TCAs include amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil) and trimipramine (Surmontil)
Most antidepressants take a few weeks to start working.
There has been alarm over the large number of prescriptions being written for antidepressants. Recent prescription figures from the Health and Social Care Information Centre showed that over 57m prescriptions for antidepressants were issued in England in 2014, enough for one for every man, woman and child. This represents a 7.5% increase since 2013, and over 500% since 1992.
Antidepressants are not generally used as street drugs however there has been some evidence of Prozac use in combination with drugs such as an LSD, ecstasy or cannabis.
People do not develop a tolerance to antidepressants in the same way as they do to alcohol or opiates, which require increasing dosages to maintain their effect. However, studies have revealed that people may become psychologically dependent and that about one third of patients experience withdrawal symptoms when they stop taking these drugs.
Withdrawal symptoms include increased anxiety, dizziness, flu like symptoms, stomach aches and nightmares. It is best to talk to your doctor about coming off antidepressants and to do so gradually.
Interactions with other drugs
Antidepressants may interact with street drugs in ways that can cause problems.
Cannabis has been found to interact with certain types of antidepressants, such as tricyclic antidepressants (TCAs), which share similar side effects.
It is best to avoid alcohol while taking antidepressants because alcohol can make depression worse. It can also increase the side effects of some antidepressants, such as drowsiness, dizziness and co-ordination problems.
Always read the information leaflet that comes with your drugs and/or talk to your doctor.
Antidepressants are Prescription Only drugs. They are controlled under the Medicines Act but not under the Misuse of Drugs Act. It is not an offence to be in possession of antidepressants without a prescription but it is an offence to supply it (including giving it away free) to other people.
Prescribed medicines review: report, 2019
Report of the review of the evidence for dependence on, and withdrawal from, prescribed medicines | PHE, UK