Tim Talks: Doc, What Are Antidepressants?

A note from Tine: Welcome to another edition of Tim Talks! For those who are new to Beautyholics Anonymous, Tim Talks is a new series on the blog where my husband, Tim, will be sharing his knowledge to help raise mental health awareness. Tim is a psychiatrist who works in metro Melbourne. His area of interest is child, adolescent and youth psychiatry.

Today, he answers some frequently asked questions about antidepressants. I hope this sheds some light to any questions you may have about antidepressant medications.

Tim Talks: Doc, What Are Antidepressants?

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In an earlier blog post, I touched on some of the principles of psychological treatment for depression, I thought it would be useful to explore and shed more light on the role of antidepressant medications. There is a plethora of information available on Dr Google about antidepressants, but I tread very cautiously around the source of information, not discounting the views and experiences of some who have had a less desirable or adverse response to these treatments. As with any medications, there are common and not so common side-effects which I will discuss.

The information provided here does not constitute medical advice; it is strongly suggested to have a detailed discussion with your treating GP or psychiatrist before commencing any form of antidepressant treatment.

How do antidepressants work?

A common class of antidepressants is termed SSRIs, which stands for selective serotonin reuptake inhibitors. Not to sound too technical, essentially it works to allow more availability of a neurotransmitter called serotonin, which we know to be linked closely to mood disorders such as depression. Another class of antidepressants is termed SNRI, where it also acts on increasing the availability of noradrenaline in addition to serotonin.

Do antidepressants make me feel more depressed?

This is quite a common concern from people weighing up whether to consider going on a course of antidepressant medications. The issue with a lot of the antidepressants that are available is that its onset of action, i.e. the time to the medication providing clinical benefit, is usually in the timeframe of 1 to 2 weeks. The full benefit of the medication usually can only begin to be realized by the 4-6 week mark. People will experience the common side-effects first, usually quite immediately, which can contribute to a worsening of how they are feeling, such as increased difficulties initiating sleep, vivid dreams, nausea and vomiting, flushes, headaches.

As time progresses, a lot of these physical symptoms will slowly subside or abate, but in some people they can persist. If there is a trending of worsening physical symptoms it would be appropriate to discuss with your treating doctor to consider trialling a different medication. Sometimes people can trial 3 or 4 antidepressants before finding the one where there are more tolerable side-effects. Usually, about 70% of people treated on antidepressants will find that they will respond to an antidepressant.

Do I need some tests before I start antidepressant treatments?

It is strongly recommended that some blood investigations focusing on your liver and thyroid function are done before commencing treatment. Most of the antidepressant medications are metabolized by the liver, so if there are indications of liver dysfunction, the dosage might have to be adjusted very cautiously. Some people may have abnormal thyroid function that directly impacts on their mood states, and this will require further follow-up with an endocrinologist as there may be a treatable cause to the depression. Most commonly people with hypothyroidism i.e. under-active thyroid will tend to present with depressive symptoms.

Can I have too much serotonin?

There are rare occasions where a combination of medications that increase serotonin availability can lead to a significant medical condition called serotonin syndrome. Usually, the onset of symptoms arise very soon after starting an antidepressant, up to 72 hours and includes confusion, dizziness, muscle rigidity or stiffness, fever and in serious cases convulsions. If these symptoms arise, urgent medical attention is required. Some over-the-counter medications or herbs such as St John’s Wort and Tramadol have to be avoided in combinations, and so it is really important to discuss with your treating doctor what other medications and over-the-counter preparations you are taking before commencing antidepressant treatment.

Is it safe during pregnancy?

There are some antidepressants that have been studied more robustly in pregnancy than others, and the general view is that most antidepressants have good safety profiles during this period, aside from one – paroxetine. Again, it will be very important to discuss with your treating doctor the lowest dose of medication to be maintained on during pregnancy, as it is equally vital to ensure that depression is adequately managed during this crucial point in time.

Can I get addicted to antidepressants?

There can be discontinuation symptoms which can manifest as significant dizziness, headaches, physical sensations such as pins and needle sensations when someone comes off their antidepressant medications, but there has not been any indication that one gets addicted to antidepressants that they are put on. Generally antidepressant medications are maintained for a timeframe of about 12 months if someone has had one depressive episode, but sometimes there may be justification to maintain this for a longer period of time.

I hope this has given you a better understanding of the antidepressant medications available. If you have any questions, please feel free to ask them in the comments below and I’ll try my best to answer them.

As always, I wish all you readers good mental health.

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4 comments… add one
  1. Robert C.

    I find that those living in asian countries such as Malaysia or even Korea have a lack of understanding of mental health issues. For some reason, people here seem to just shrug it off and consider it your own problem. For example, teachers in school would instantly categorize the child with adhd/depression/anxiety/etc as the “problem child” and not helping them. I hope lots more people will be aware of these issues.
    Robert C. recently posted..Product Empties #1My Profile

    1. Tine

      Tim: Hi Robert, you have touched on an important issue, which is how culture plays a role in our understanding of mental health. Depression in younger age groups can present more agitated rather than looking sad necessarily, and sometimes the changes in sleep or appetite can be frustrating for families to cope with. Also, to challenge this notion that people just ‘pick themselves up’, I counter with the argument that if someone had a fracture, you don’t approach that person and say ‘just pick yourself up, you will get better’ without any supports. I think schools are slowly responding better to some of these difficulties you have highlighted, but equally parents have to be more attuned to the emotional needs of their child.

  2. Felicity

    Thanks so much for this. I think this is such important information to get out there. It feels like a really comfortable safe space to have this information for people who may not seek it out consciously.
    I’ve been diagnosed with depression for about 10 years now (but looking back was suffering from it probably forever). I’ve been on a number of antidepressants during that time and think I’ve found one that works really well for me. I’ve also tried coming off them a number of times and just end up going back to being a sad crying mess, so I’m probably one of those people who will need to be on them long term.
    So many people are really dismissive of antidepressants, and while I realise they aren’t for everyone they’ve changed my life and I can’t imagine the type of person I’d be today without them. Probably I would be curled up in bed 90% of the time with no job and no friends. I also underwent CBT and regular sessions with a counsellor, and still ocassionally book in to have a chat when I’m feeling a bit down.
    I can attest that you really do need to give antidepressants time to work. It isn’t like taking a panadol for a headache and you feel better immediately. I’ve seen friends and people I work with try them for a couple of days and go off them straight away because they haven’t helped, which is a real shame.
    So thanks again for putting this information out there. Hopefully some people will read it and it may help change their opinions.

    1. Tine

      Tim: Hi Felicity, thanks for sharing your own personal experience with depression. With antidepressant treatment, what you strive to aim towards is the optimal and lowest dose that will keep you well, which can obviously change when there are more stressors or transitions in life that are challenging. I am glad that you are finding it useful to have psychological support from time to time; in my view, the working relationship with the therapist is the most important element in the effectiveness of such treatments.

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