Medical treatments

What are the side effects?

Like taking any other medication, some people may experience some side effects. Depending on which medication you’re prescribed, common side effects can include nausea, headaches, sweating, dizziness, agitation, weight gain, dry mouth and sexual difficulties (e.g. difficulty becoming/staying aroused). The likelihood of a particular side effect happening varies between individuals and medications. Many of these symptoms can be short-lived and settle after a few weeks, but let your doctor know if you experience any of these symptoms – there may be ways of minimising them.

There is also some concern that antidepressants, such as SSRIs, can increase the risk of suicidal thoughts and behaviour among a minority of adolescents and young adults, and less commonly among other adults. Given the risk of side effects, it is important that a decision to use antidepressant medications is based on a thorough discussion with your doctor about the relative benefits and harms. 

How long will I need to take antidepressants for?

It’s important to be aware that it may take a few weeks for an antidepressant to have its full effect. If there is no significant improvement after this time, your doctor may suggest switching you to a different antidepressant medication as some people find that one type may work better than another, or cause fewer side effects. It can take a couple of tries to get the right medication, but it’s important to persevere.

Like any medication, the length of time someone needs to take antidepressants depends on the severity of their condition and how they respond to treatment. It is generally recommended that people stay on an antidepressant for six to 12 months following an initial episode of depression to prevent a relapse. If a person has repeated bouts of depression, their doctor may recommend that they continue to take medication over a longer period to prevent further relapses.

Once you’ve settled on a medication you shouldn’t stop taking it suddenly or without consulting with your GP or psychiatrist, even if you start feeling better. When stopping medication it is important to do so gradually to avoid side effects that can occur if you suddenly stop antidepressants and to make sure that your condition does not worsen. Your GP or psychiatrist will need to assess you regularly as you’re coming off the medication.

• Download the Antidepressant medication: Advice for adults fact sheet

Can I take medication if I’m pregnant or breastfeeding?

Research has shown that certain antidepressants – selective serotonin reuptake inhibitors (SSRIs) (except paroxetine) and tricyclic antidepressants – can be safely used during pregnancy and carry very low risk of harm to the foetus. They can also be used if you’re breastfeeding as they pass into the milk at very low levels.

Antidepressants are not recommended for people with mild depression but may be considered in the treatment of people with moderate-severe depression. While medication can be beneficial in treating moderate-severe depression, research has also found that it is most useful to combine this with psychological therapy or ‘talking therapies’. Use of antidepressants should therefore only happen as part of a complete treatment plan that combines medication with general lifestyle advice, social support and psychological therapy.

The decision to take medication while pregnant or breastfeeding is an individual one. It should be made in consultation with your doctor after considering the risks and benefits to both mother and baby of the proposed medication.

If a doctor suggests antidepressant medication they will talk with you about these issues in detail before prescribing any medication. They should also review you regularly to monitor for any side effects. It's important that you don't miss these appointments, particularly in the first few weeks. It can take a few weeks before you may begin to feel better.

Further information on the use of antidepressant medications during pregnancy and while breastfeeding:

• Managing mental health conditions in pregnancy and early parenthood: A guide for women and their families
  
• Perinatal Clinical Practice Guidelines

Are antidepressants safe for young people?

Research shows that certain antidepressants, such as fluoxetine, are effective in the treatment of depression and anxiety conditions among young people. Antidepressants are not recommended for young people with mild depression but may be considered in the treatment of young people with moderate or severe depression.

While medication can be beneficial in treating moderate to severe depression, research has also found that it is most useful to combine this with psychological therapy or ‘talking therapies’. Use of antidepressants in young people should therefore only happen as part of a complete treatment plan that combines medication with general lifestyle advice, social support and psychological therapy. Psychological therapies can help a young person to better understand their condition, improve their coping skills and work through any issues or stresses that might be contributing to the symptoms of anxiety or depression.

The decision to take medication for depression or anxiety is an individual one. It should be made in consultation with your doctor after very carefully weighing up the likely benefits and harm. If a doctor suggests a young person begins on medication they will talk about these issues in detail before prescribing any medication.

They should also review the young person regularly to monitor for any side effects or changes in the young person’s risk of suicide. It's really important that the young person doesn't miss these appointments, particularly in the first few weeks. It can take a few weeks before the young person may begin to feel better. Ideally, a parent or responsible adult should supervise the use of antidepressants by adolescents.

What are the different types of antidepressants?

There are many different types of antidepressant medication. Your doctor may need to find the medication and dose which is most effective for you. Keep in mind antidepressants take time before they start to help (at least two weeks).

There are differences in effects and side-effects of the antidepressants listed below, which can be discussed with your prescribing health professional.

There is a wide range of antidepressant medication available. Below is a description of the different classes of antidepressants used in Australia.

Selective Serotonin Reuptake Inhibitors (SSRIs)

This class includes sertraline; citalopram; escitalopram; paroxetine; fluoxetine; fluvoxamine.

SSRIs are:

• the most commonly prescribed antidepressants in Australia
• ·often a doctor's first choice for most types of depression
• generally well tolerated by most people
• generally non-sedating.

Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs)

This class includes venlafaxine; desvenlafaxine; duloxetine.

SNRIs:

• have fewer side effects compared to the older antidepressants
• are often prescribed for severe depression
• are safer if a person overdoses.

Reversible Inhibitors of MonoAmine oxidase (RIMAs)

The class includes moclobemide.

RIMAs:

• have fewer side effects
• are non-sedating
• may be less effective in treating more severe forms of depression than other antidepressants
• are helpful for people who are experiencing anxiety or sleeping difficulties.

TriCyclic Antidepressants (TCAs)

The class includes nortriptyline; clomipramine; dothiepin; imipramine; amitriptyline.

TCAs are:

• effective, but have more harmful side effects than newer drugs (i.e. SSRIs)
• more likely to cause low blood pressure – so this should be monitored by a doctor.

Noradrenaline-Serotonin Specific Antidepressants (NaSSAs)

This class includes mirtazapine.

NaSSAs are:

• relatively new antidepressants
• helpful when there are problems with anxiety or sleeping
• generally low in sexual side effects, but may cause weight gain.

Noradrenalin Reuptake Inhibitors (NARIs)

This class includes reboxetine.

NARIs are:

• designed to act selectively on one type of brain chemical – noradrenalin
• less likely to cause sleepiness or drowsiness than some other antidepressants
• more likely to:

• make it difficult for people to sleep
• cause increased sweating after the initial doses
• cause sexual difficulties after the initial doses
• cause difficulty urinating after the initial doses
• cause increased heart rate after the initial doses.

Monoamine Oxidase Inhibitors (MAOIs)

This class includes tranylcypromine. MAOIs are prescribed only under exceptional circumstances as they require a special diet and have adverse effects.