Please note that all advice here is unprofessional and DEFINITELY should not replace advice from your doctor or pharmacist.
Depression is a very common feeling which will affect virtually all of us in our lifetime. Depression is treatable, and in this thread there will be information on 'talking treatments' and certain common anti-depressant drugs. Don’t worry if your prescription isn’t on the list. As you can appreciate it there is so much information to write down. If something is missed or if the is some information on a treatment excluded, feel free to add it in.
Antidepressant medication is usually prescribed for moderate to severe cases of depression, or milder depression in adults if it is their treatment of choice. Some antidepressants are also commonly prescribed for other disorders, such as anxiety disorders, PMDD, eating disorders and also non-psychiatric complaints. [1]
For more information on depression, see the Depression article.What is depression?
Read on for information on medication.
It is important to realise that depression is often caused by social conditions. That is, if you feel depressed, there are likely certain conditions in your life that are leading you to be depressed. Therefore, the most effective cure for depression is to change those conditions which led you to become depressed in the first place. Nevertheless, in some instances, depression has no outward cause however in both situations medication may be prescribed. Such medication may be effective, but this will vary according to the type of medication prescribed. Sometimes one medication may not work but this does not mean that another will not. Doctors will sometimes try you on one anti-depressant at first and change it if it is not working. However before attempting medication, it is advisable to seek other help methods such as counselling Anti depressants should only be taken if you are aware of the risks.
SSRIs
SSRI stands for Selective Serotonin Re-uptake Inhibitors. Serotonin is a chemical in the brain, and decreased levels of it are believed to cause depression in some people. They have fewer side effects than some other classes of anti-depressant medication. They are the most common first line of treatment for depression, particularly in young people. It is likely that your GP or psychiatrist will prescribe them for you before trying other kinds of anti-depressant.
As the SSRIs all have a very similar mechanism of action, the side effects tend to be quite similar. You shouldn't worry if you have a lot of side effects in the first few weeks of taking one of these medications, as they will tend to get better as you continue to take the drug. Common side effects include: indigestion or nausea (which can normally be helped by taking the tablet with food), loss of appetite, loss of libido, dry mouth.
Types of SSRI:
Citalopram (Celexa, Cipramil)
Doses tend to be about 20mg a day but can be higher (up to 40mg) for severe cases. It can also be used for anxiety and body dysmorphia. It does have side effects, but these are quite rare - sweating, hallucinations, sleep disturbance, nausea etc. It does cause some dizziness when taken but this is fairly mild and generally accompanies the natural mood boost created by the increase of free seratonin levels to stimulate nerve cells. Its one of the more commonly prescribed medications when dealing with depression.
Recent guidance to GP's states that the dose should not be upped above 40mg.
Fluoxetine (Prozac)
Fluoxetine has the active ingredient fluoxetine hydrochloride. This is often prescribed to under 18's as a first choice, it will usually start at low doses e.g 10/15 mg then be built up if the patient feels it has effect. For mental health issues such as bulimia it will be given at 60mg usually but is very case dependent and will generally start at a low dosage. The maximum dosage is 80mg per day. Generally it takes a few days- weeks to take efffect and this is also the case for when you stop taking the medication. Occasionally symptoms of depression will increase until the medication has started to take effect, other reported side effects include anxiety and nervousness, drowsiness, insomnia, dizziness, fatigue, weight loss, tremor and increased sweating. All reported side effects are listed with the medication.
Escitalopram (Lexapro, Cipralex)
This is a relatively new SSRI and so is not usually prescribed for those deemed to be in development, such as the majority of under-18s. It's quite a popular SSRI because of its minimal associated weight gain and because it doesn't cause too much fatigue. In most cases it's deemed as pretty effective, and is also one of the main choices when depression is present alongside personality disorders such as Social Anxiety Disorder. In most cases 5mg is the advised dose for the first two weeks, and then doubled to 10mg thereafter. 20MG is generally considered the maximum dose
Fluvoxamine (Faverin)
Paroxetine (Seroxat, Paxil)
Used for depression but also good for anxiety problems (OCD, SAD, Panic) in higher dosages . Doses generally range from 10 to 60mg once a day. Paroxetine has a short half-life which means it clears out of the body very quickly, leading to potentially severe and unpleasant withdrawal effects in some people, because of this your Dr may recommend switching you to another anti depressant medication to help you withdraw from Paroxetine. Not recommended for use in children or young adults due to links with self harm and suicide.
Sertraline (Lustral, Zoloft)
This is one of the more potent and stimulating SSRI medications that is often useful for people with anxiety spectrum disorders, such as OCD, social anxiety, panic, although ironically it can make patients more anxious during the first few weeks of treatment. It is generally well tolerated and usually started at 50mg a day with dosages up to 200mg possible.
SNRIs
SNRI stands for Serotonin and Noradrenaline Reuptake Inhibitor. These drugs work like SSRIs but slow the re-uptake of both 5-HT (serotonin) and noradrenaline, another neurotransmitter. Most Tri-Cyclic Antidepressants (TCAs; see below) function by the same pharmacological method, but SNRIs do so without some of the side-effects of TCAs, notably being less sedative (and lacking the anti-muscarinic component that affects the heart).
Common side effects of these medications include headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation.
Types of SNRIs:
Venlafaxine (Efexor)
Venlafaxine is licensed to treat major depression and generalised anxiety disorder and has some advantages over the older TCAs in so far as it is not sedative and it doesn't have an anti-muscarinic component. It is, however, associated with withdrawal symptoms upon conclusion of treatment.
Duloxetine (Cymbalta)
An SNRI used for major depression and generalised anxiety disorder (and also to treat complications of diabetes and stress urinary incontinence, to satiate curiosity). Whether it is as effective or more effective than TCAs has yet to be established, however it has the advantage of not being sedative or anti-muscarinic.
TCAs
TCA stands for Tricyclic antidepressant. The tricyclics are an older class of antidepressant that date back to the 1950s. They can be very helpful in treating depression in some people but are rarely prescribed as a first line of treatment these days because they are more likely to cause unwanted side effects than more modern medications. They are usually prescribed when other classes of medication (SSRI, SNRI, Mirtazapine) have failed or when an antidepressant with sedating qualities is required.
Common side effects from these drugs are: a dry mouth, a slight tremor, fast heartbeat, constipation, sleepiness, and weight gain.
The drowsiness often caused as a side effect with TCAs is exacerbated by consuming alcohol and as such Alcohol should be taken with extreme caution. Please discuss with your doctor or pharmacist.
Types of TCA:
Amitriptyline (Triptafen, Elavil)
A TCA that is rarely prescribed for depression due to its low therapeutic index (meaning a very small amount above the prescribed dose is dangerous) and high mortality associated with overdose, similar to Dosulepin. Common side effects are dry mouth, blurry vision, constipation and drowsiness and patients with high blood pressure or heart problems will need to be monitored carefully. Amitriptyline is often prescribed at low doses (<75mg) as a sleep aid and as a pain killer in conditions involving chronic pain, such as low back pain, TMJ and Fibromyalgia. The therapeutic dose for depression is 75 - 200mg usually taken at night time due to heavily sedating properties.
Clomipramine (Anafranil)
A standard TCA used for the treatment of depression, Clomipramine is not as dangerous in overdose like some of its counterparts, but still has a low therapeutic index and often causes drowsiness.
Dosulepin/dothiepin (Prothiaden, Prepadine, Dothapax)
TCA that is started at a low dose, and increased if that has no effect. Comes in 25mg capsules and 75mg tablets. Causes drowsness, which is usually incoporated as part of your treatment. (My personal experience [username hidden] with Dosulepin is LOTS of sleep (16hours) for a few nights when the dose is initially increased, but this wears off soonish).
Dosulepin is rarely used due to the high mortality associated with overdose. The theraputic index is low (meaning the theraputic dose is close to the fatal dose). A study reported 95% of deaths from antidepressants in England and Wales between 1993 and 1997 were associated with tricyclic antidepressants, particularly dothiepin (this drug) and amitriptyline (Elavil, Tryptizol, Laroxyl).
Because of the risks associated with Dosulepin treatment is normally only initiated by a specialist (BNF.org, 2013).
Doxepin (Sinequan)
Imipramine (Tofranil)
Lofepramine (Gamanil, Lomont)
One of the newer TCA medications having been introduced in the 1980s (older TCAs date back to the 1950 & 60s). Preferred by doctors and patients as it is the least associated with mortality in overdose and is less likely than many others to cause drowsiness, constipation and other unpleasant side effects. Usually prescribed as a second line of treatment when SSRI/SNRI medications have failed. Side effects may include vivid dreaming, constipation and dry mouth. Daily doses range from 70mg once a day to 70mg three times a day (210mg max daily). It is not recommended in children.
Nortriptyline (Allegron)
Trimipramine (Surmontil)
Noradrenergic and Specific Serotonergic Antidepressant (NaSSA)
Mirtazapine (Remeron, Zispin SolTab)
Mirtazapine is a NaSSA medication. Mirtazapine is usually prescribed to patients who do not respond to the main anti depressants such as Fluoxetine, or in patients who require a sleep aid. It is a strong medication which should be taken at night due to its heavily sedating properties. Common side effects include increased appetite and weight gain, vivid dreams and dizziness.
Patients on this drug predominantly start at a low dosage and like other anti depressants this is increased should it not work. There are rumours that its success rate changes with condition; (for example being low for sufferers of post traumatic stress, however increased results for depression).
MAOIS
MAOIS stands for Monoamine Oxidase Inhibitors. This class of anti-depressant is very rarely used these days, as you have to avoid a number of foods* if you are taking one.
Moclobemide (Manerix)
Moclobemide is a reversible monoamine oxidase inhibitor (MAOI) that is sometimes prescribed when other classes of anti depressants, such as SSRI, SNRI, and TCA, have failed. Unlike other MAOIs it does not require any dietary restrictions and is a relatively safe medication. It is effective in both depression and anxiety disorders and is noted for its very low side effect profile. Should not be confused with other irreversible MAOI medications that require strict dietary restrictions.
Other drugs used to treat depression
A number of other drugs are also used to treat depression. These include flupentixol (an anti-psychotic medication), lithium (for depression associated with bipolar disorder), and a number of other drugs.
Where can I find more information?
A number of organisations produce helpful leaflets about anti depressants. These include:
The MIND guide to making sense of anti-depressants
The Royal College of Psychiatrists Information Sheet: Antidepressants
You should ask your doctor or pharmacist if you have any questions relating to the medication you've been prescribed, and always read the Patient Information sheet!
TSR Users Experiences
Please note that different people have different experiences on the same drug and just because someone had a specific experience that does not mean you would have the same.
Antidepressants
Amitriptyline (Elavil, Endep)
Hellish withdrawal symptoms after 2 months taking it; shivering, headaches, couldn't eat, couldn't sleep. No sufficiently bad effects whilst taking it.
Very helpful as a sleep aid and anti anxiety medication. Weight gain due to increase appetite and daytime drowsiness. I strongly suggest you build up the dose slowly or else it will make you feel zombified. Some withdrawal effects but not as bad as the SSRI medications, again tape off slowly over a few weeks to be safe.
Lithium
Made me feel a little zombified and indifferent to everything. Didn't help my mood apart from making me not care about not caring.
Citalopram (Celexa, Cipramil)
Nausea, headaches, slight dizziness wore off after about 10 days. No other effects.
Trembling and nausea for the first two days of taking it, but after that there were no other issues.
Started at 10mg for a few days, then up to 20mg. 40mg after a couple of weeks. Nausea, dizziness for the first few days. No side-effects for a bit, then after a while it made me nocturnal. A while longer and it started giving me crippling headaches, nausea, generally quite unwell until I backed off the dosage from 40mg and eventually stopped it. Unpleasant withdrawal. Never hugely helped me aside from maybe making me marginally less suicidal.
Headaches, nausea, no real effect either.
Didn't really get many noticeable side effects other than a weird metallic taste and very vivid dreams. That said it didn't really help at all even after 6 months of use. Withdrawal wasn't very pleasant as citalopram can cause brain zap headaches.
Worsened my insomnia, gave me headaches and nausea (which, coupled with simply forgetting to eat, led to extreme weight loss and so I was taken off it). Might also have contributed to my increased suicidal thoughts and worsening self-harming. No positive effect on mood, but since I was only on it for six weeks at a fairly low dosage it wasn't really a fair trial.
Started on 10mg and worked up to 20mg. I felt absolutely physically exhausted on this medication and often slept for hours during the day. I also felt very agitated and like I was 'going crazy'. No positive effects on mood either. I really disliked this medication and I renamed it sh*talopram.
Ruined my A-Levels. Nausea headaches. The worst side effect was feeling like everything around me was moving in slow motion and I was sped up. My vision was cloudy. Withdrawal included tiny brain zaps.
Duloxetine (Cymbalta)
One of the less bad ones in terms of side effects, nausea, slight dizziness and headache which all wore off relatively quickly.
Started straight at 60mg. Nausea, dizziness, horrible stomach cramps for a couple of days. No side-effects for a while other than maybe feeling a bit more tired. After about a month made me feel almost normal again for a couple of weeks, then pooped out, made me nocturnal. Again got headaches/nausea/fever/generally badness after I'd tried stepping up to 90mg for a while. Also fairly horrible withdrawal, although maybe not as bad as Citalopram.
No initial side effects. No real effect for me. Withdrawl was horrific though. Like having a terrible case of the flu, and the dreaded "brain zaps". Totally wiped me for about two weeks. If you are going to come off, do at least work on a way to ease yourself off with your doctor.
Fluoxetine (Prozac, Sarafem, Symbyax)
Like the worst flu of my life. Aching muscles all over, coldness, headache, dizziness, nausea, seriously seriously horrible experience, I stopped it after 4 days no idea if it would have lasted. Also destroyed any feelings I had, I felt utterly dead inside.
Started on this when I was 14 so used the oral solution to start with (tastes horrible!) No major side effects but I found this did make me rather emotionless.
Wasn't on this for very long at all. I was prescribed this by the second GP I went to about all of this, she prescribed me it to see me through until my appointment with the psychiatrist that she referred me to. It always seemed to give me heartburn when I took it. More seriously though, it aggravated my moods, causing me to get more manic, more often.*
I've been on this for around 8 months now, started off with symptoms of flu, feeling of being too hot despite being winter & wanting to throw up. this went after a week or so and i was soon raised to 40mg a day as it didn't seem to be working. Made me feel pretty empty and still rather depressed now and also makes you a huge lightweight if you decide to drink on them
Started this 3 months ago at 20mg and it has helped somewhat. In the first week I felt a bit sick, but that went away really quickly. The main side effect I've had is tiredness and lack of energy. I wouldn't say I feel 'happy', and maybe 'emotionless' would be a way to describe it, but I've continued taking it because it's still a massive improvement from how I was prior. I've also found it controlled my overeating (which tends to happen a lot when I'm depressed) and have lost some of the weight I gained while really depressed. I am slightly more productive and able to function in daily life now.
Mirtazapine (Remeron, Avanza, Zispin)
Very sedating on low doses, not so much on higher doses. Also has a tendency to make people very very hungry and hence put on weight. Unlike quetiapine, I found the weight I gained on mirtazapine was from eating stupid amounts rather than it messing my metabolism up or anything like that. Worked well as an antidepressant for a few weeks for me, then quit working entirely.
Makes you very sleepy but this does wear off over time. Also made me very hungry (fun fact - used as an appetite stimulant and anti depressant in cats (my dad is a vet)). Currently on 30mg and no effect yet.
Despite also being an anti-depressant, this worked an awful lot better for me. It caused me to miss about a two months of my 3rd year of college due to the sedation. I also got the constant hunger- as a friend put it 'on this drug, I'd eat that door if there wasn't anything else available!' Over time, both those side effects wore off, but in the end, I stopped taking it because of the nasty overly vivid dreams. Drinking whilst taking Mirtazapine = very cheap nights out
First couple of days on 15mg I felt kinda sedated, didn't get any real oversleeping because of the Reboxetine at the time. No side-effects at all aside from that really. Maybe slight appetite increase, but I've been relatively bored/depressed in general which tends to make me eat more anyway. Quick acting, although positive effects generally tapered down a lot after the first few days (still better than without). Made me sleep a lot (which, what with my insomnia, I welcomed) and gave me vivid dreams. No positive effect on my mood.
Reboxetine (Edronax)
Massive ear pain in one ear, extreme coldness (was wearing so many layers and still freezing cold), dizziness, severe insomnia. The dizziness and ear pain wore off after a little while on it the coldness and insomnia did not.
Sertraline (Zoloft)
Nausea and insomnia, both of which wore off after about 10 days.
Caused significant nausea and killed my appetite causing me to lose a lot of weight, I dropped from 10 stone to 7 and a half stone. Didn't help with depression at all, and probably caused my insomnia to worsen. gave me awful hangover/flu-like symptoms and tachycardia, so I stopped taking it after several days. No effect on mood.
Some improvement in social anxiety and confidence initially but effects quickly wore off and required increased dosage. Suppresses appetite, seems to make anxiety worse at times. Unpleasant withdrawal symptoms.
Trazodone (Desyrel)
Very sedating, no other reportable effects.
Venlafaxine (Effexor)
Messed up my sleep a lot - can't remember if it was too much sleep or insomnia though. Didn't have any trouble coming off it despite taking it for several months.
flu-like symptoms, including dizziness and weakness, meaning I could barely get out of bed. Also mental confusion, similar to having a really bad hangover or being extremely sleep-deprived. After a week I saw my GP, who gave me a check up, found my pulse was over 170 bpm and so sent me into hospital overnight (I had a pretty severe and atypical reaction though, and my symptoms all disappeared as soon as I stopped taking the pills). No effect on mood.
Quite helpful for severe depression and social anxiety when I took it combined with CBT therapy. Had to come off it in the end due to side effects on the heart - strange pulse rate and increased blood pressure. This medication is widely known for its HORRIBLE withdrawal syndrome.
Agomelatine(Valdoxan)
Very itchy, was probably allergic to it so discontinued after a few days. Probably helped my sleep a little.
No side-effects whatsoever, gave me a slight lift in mood.
Lofepramine
Started at 70mg. Very dry mouth for the first few days, not so bad after that. Hot flushes kinda when starting up too. After a few days started giving me fairly bad tachycardia, tried cutting down to 35mg but it still gave me issues. Discontinued, no withdrawal syndrome (was only on it for a couple of weeks total).
Started on 70mg three times a day. Caused dry mouth and eyes, bad constipation, poor sleep/vivid dreams, weak orgasm and painful ejaculation. Gave up after a few weeks due to no benefits.
Reboxetine
Insomnia, weird kinda prickly heat feeling on my back occasionally for the first few days. Insomnia turned into waking up at 4 or 5am which got pretty annoying. Added Mirtazapine to try to sleep better, eventually discontinued Reboxetine as it was only minorly helping. As a solo med it kept me pretty stable and helped concentration a bit anyway. No discontinuation issues.
Lexapro/Escitalopram
Much better than citalopram, no side effects and actually had a decent effect (unfortunately, it stopped working for me after about 6 weeks so I changed)
Depakote (or Sodium Valproate)
When starting felt like a bit of an old man : heartburn, headaches, aches and pains etc. But does wear off. Has definitely reduced my highs.
Carbamazapine (tegretol)
I started this whilst on Mirtazapine. I've not really noticed any major side effects, other than it's a bloody pain when it comes to taking any other drug (most noticably: BC). You're also not meant to drink on it at all, which sucks.
