Medications can be used to treat certain mental health conditions, like depression and anxiety conditions. Any medication should be considered as part of a wider mental health treatment plan that includes lifestyle changes, social support and psychological therapy.
Hospital care might also be provided where someone is experiencing persistent thoughts of suicide and there are concerns about their safety. While in hospital they have access to a range of health programs and professionals to support their recovery.
There are a wide range of antidepressant medications, and while there is no simple explanation as to how these medications work, they can be very useful in the treatment of moderate to severe depression and anxiety disorders.
Antidepressants may be prescribed when other treatments have not been successful, when a person’s condition is severe, or where they express a preference for this sort of treatment.
People with more severe forms of depression (bipolar disorder and psychotic depression) generally need to be treated with medication, which may include one or a combination of antidepressants, mood stabilisers and anti-psychotic drugs.
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.
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:
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
If you’re experiencing severe anxiety symptoms and have been prescribed an antidepressant, you might also be prescribed benzodiazepines – a class of drug that includes minor tranquilisers and sleeping pills – until the antidepressant takes effect (up to three weeks).
Because they’re potentially addictive, benzodiazepines should not be taken beyond three to four weeks and are best avoided if possible. These medications vary in the amount of time it takes for the body to ‘eliminate’ or process them. Those that are eliminated more quickly – ‘short-acting’ benzodiazepines – can be used safely during pregnancy and breastfeeding if they are only used for a short time. The use of ‘long-acting’ benzodiazepines should be avoided. Your health professional can talk through the options with you.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) is a specialist treatment that is effective in treating major mental health conditions (e.g. severe depression and some forms of mania).
During pregnancy, ECT is only used when the risk of untreated symptoms (e.g. strong suicidal urges) may outweigh those of the treatment. The treatment can only be prescribed by a perinatal psychiatrist and is conducted with close monitoring of the woman and her unborn baby by a psychiatrist, obstetrician and specialist obstetric anaesthetist. The risks to the woman and baby from the treatment are low.
The use of alternative medicines, including herbal and homeopathic therapies, is becoming increasingly common in Australia. Some people may choose these to support wellbeing or because they are seen as 'safer' alternatives to medications. However, there is no scientific evidence about the benefits or safety of these therapies during pregnancy and breastfeeding. Some supplements may interact adversely with medications (e.g. St John's Wort should not be taken with some antidepressants) and may contain ingredients with unknown effects. You should always talk to a health professional about any alternative medicines you’re taking or planning to take.
Hospital care for young people
Hospital care might also be provided where a young person is experiencing persistent thoughts of suicide and there are concerns about their safety. While in hospital they have access to a range of health programs and professionals to support their recovery.
Many public mental health services have specific hospital units for young people. In general, hospital care is not provided over long periods; the aim is instead to stabilise a young person’s condition to enable them to return home with supports provided to them in the community.
Hospitals/Mother and baby units
Sometimes, health professionals will recommend that you go to hospital so that you’re in a safe place while they work out the best treatment for you. This is most likely if you:
- have severe symptoms
- have complicated medical problems
- are in danger of harming yourself or others
- ·need more intensive treatment and monitoring.
Time in hospital helps to stabilise symptoms and means you can start treatment in a safe place with ongoing monitoring. Whenever possible, mothers and babies are kept together, or contact is maintained.
Some states and territories have hospitals with special mother and baby units that provide a safe and supportive place for a mother and her baby to receive assistance and be monitored 24 hours a day. Mothers and babies are referred to these units by GPs, paediatricians, obstetricians or psychiatrists.