Antidepressants – your questions answered

It’s likely you’ll be offered one of the newer style antidepressants – the SSRIs (selective serotonin reuptake inhibitors). Their function is to increase a hormone in the brain that makes you feel better, called serotonin. They all help reduce feelings of sadness and anxiety, and so improve related symptoms, such as sleep disturbance, appetite, concentration and motivation.

Some may help slightly more with one aspect than others, but they all work similarly. Three in particular have been chosen for how well they work, minimal side effects and their safety profile. Citalopram may be better for the elderly or if anxiety plays a large part, sertraline is the safest if suicidal thoughts predominate or if you are taking medications for other conditions, and fluoxetine is the choice for children and adolescents.

Non-SSRIs are considered if SSRIs haven’t worked. Mirtazapine can help if sleep disruption or sexual dysfunction is significant, venlafaxine is used in severe depression. Psychiatrists occasionally start amitriptyline, an older type of antidepressant, but it can leave you feeling pretty groggy.

No medication comes without the risk of side effects. These differ from person to person, and are usually mild with antidepressants, but there are some common complaints. Emotional blunting is common – people complain of feeling "numb" or "spaced out" a few months after starting. This is because the antidepressant has sought to dampen the negative thoughts and feelings, and there aren’t really many positive feelings in depression to take their place. So you’re left with a sort of plateau of feeling – nothing is awful but nothing is amazing.

This may indicate some progress, and be an opportunity to implement coping strategies, such as seeing friends or getting to the gym, so that external cues can help you release endorphins and other feel-good hormones to give you positivity.

A change to your sexual function is another very common side effect – perhaps affecting more than half of those taking antidepressants – but one that many find difficult to talk about. Problems vary in severity, but can include loss of your sex drive, difficulty getting an erection and difficulty reaching orgasm, and this is true for both men and women. It’s tricky to know which is to blame, as these also feature in depression. If this isn’t improving a few months into a course of antidepressants, discuss this with your doctor.

It takes up to four weeks to see a mood-lifting effect. It’s very common to feel worse for the first couple of weeks after starting, as the antidepressants set about rebalancing your brain’s neurochemicals. After that, emotions should start to even out.

It can be hard to keep track of your own progress, so it's a good idea to keep a diary of your day-to-day feelings and thoughts, perhaps what you’ve accomplished in a day and what you’d like to get done. Look back at this every few weeks, and you’ll be surprised how far you’ve come. Your doctor can also be a good gauge on how well you're doing – keep in contact with them every few weeks until you're on track to feeling better.

I often have patients coming back a few months after starting antidepressants to tell me they’re feeling a lot better, so they don’t need antidepressants any more. I encourage them to consider whether the antidepressants can take some credit for this, and whether it’s best to keep the status quo for just a few more weeks or months. Doctors usually recommend to continue for about 6 months after you're feeling better. But as always, it’s your choice whether to stay on antidepressants or not.

If you do want to stop, don’t stop suddenly, you can experience a relapse. Discuss it with your doctor and come up with a plan to gradually reduce your dose to eventually stopping.