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Antidepressant medication
Advice for adults
There is a great deal of misinformation about The Therapeutic Goods Administration (Australia’s regulatory agency antidepressant medication and there is no simple for medical drugs) and manufacturers of antidepressants do not recommend antidepressant use for depression in young people explanation of how antidepressants work.
Medication can be important in the treatment There are, however, no government (i.e. Pharmaceutical Benefits Scheme) restrictions placed on the prescription of antidepressants of moderate to severe depression and in some and doctors are not prevented from prescribing them if they feel anxiety and related disorders. This fact sheet looks at what antidepressants do, how they work There is concern that a small percentage of young people up to and where to get more information and help.
the age of 24 years taking SSRIs for the treatment of depression may experience an increase in suicidal thoughts and behaviour. Research shows the risk to be roughly 4 per cent compared to 2 per cent for those taking a placebo (dummy pill). No deaths from Research shows that more severe forms of depression are suicide have been reported in any clinical trials. However, a young associated with specific changes in the brain, including changes to person will require close medical supervision and monitoring in the some hormones and chemical message systems. In these forms of early stages of treatment if an antidepressant is prescribed.
depression, there are alterations in the activity of the brain in areas For more information see Youthbeyondblue under the influence of neurotransmitters serotonin and noradrenaline which may cause a major depressive episode. This is associated with antidepressants for the treatment of Depression in adolescents the symptoms and disability seen with depression. Antidepressant medication is thought to increase the levels of serotonin and Chronic illness
noradrenaline in some areas of the brain. However, depression is not simply a deficiency of these chemicals. Different types of Like any medication, antidepressants can produce side-effects. antidepressants work in slightly different ways, but they all have an In some cases, taking antidepressants can affect existing symptoms influence on parts of the brain related to emotions and motivation.
or treatments for other illnesses. It is important for people to let doctors know about any illness they may have and any medication Pregnancy and breastfeeding
Antidepressant medication is often prescribed, alongside The decision to take medication while pregnant or breastfeeding psychological treatments, when a person experiences a moderate is an individual one. It should be made in consultation with a doctor to severe episode of depression and/or anxiety. Sometimes they after considering the risks and benefits to both the mother and baby.
are also prescribed when other treatments have not been helpful.
If a woman is breastfeeding, generally specific types of medications are preferred. While a number of factors will influence the choice of antidepressant, a group of antidepressants called tricyclics, as well as sertraline, citalopram and fluvoxamine are most commonly Making a decision about which antidepressant is best for a person can be complex. This decision should be made in consultation with Studies show that paroxetine is generally not recommended at a doctor after careful assessment and consideration. People can help the doctor’s assessment by providing as much information as possible about themselves and their medical history. The following Symptoms
should be considered and discussed with the doctor before When deciding on the most appropriate antidepressant medication, it’s important to consider what symptoms they treat. Some classes of antidepressant medication are more effective in treating specific depression-related symptoms, while other types can be helpful in Depression is common and can affect people of all ages, however, generally medication is not recommended as the first choice for the treatment of depression in children and young people.
1 Buist, A. ‘Guidelines for the Use of SSRIs in Pregnant Women’, Obstetrics and Gynecology, Vol. 7, No. 4, Summer 2005, pp.18-20. Visit www.beyondblue.org.au Call 1300 22 4636 Email infoline@beyondblue.org.au 1 of 4
Antidepressant medication
Advice for adults
People who have bipolar disorder and experience an episode of Reversible Inhibitors of Monoamine Oxidase –
depression will often be given a mood stabiliser alone. It can take A (RIMAs)
time for mood stabilisers to work. Sometimes antidepressants are used along with mood stabilisers to help ease the symptoms. RIMAs have few side-effects and are non-sedating. They may be less effective for more severe forms of depression than some other Antidepressant medication is generally not recommended for use by antidepressants, but are helpful for people who are experiencing itself in people with bipolar disorder as it can trigger mania.
problems with anxiety or are having difficulty sleeping.
This class includes: • moclobemide.
There are many different types of antidepressant medication. Your doctor may need to find the medication and dose which is most Monoamine Oxidase Inhibitors (MAO-Is)
effective for you. Keep in mind antidepressants take time before MAO-Is are seldom prescribed in Australia as people are required they start to help (at least two weeks). Below is a description of to keep to a special diet, otherwise serious side-effects can be the different classes of antidepressants. Please note, this list only includes the generic medication names and not the pharmaceutical brand names. Please look on your medication packaging to find the name of the medication you are taking (this is usually written in There are differences in effects and side-effects of the
TriCyclic Antidepressants (TCAs)
antidepressants listed below, which can be discussed with
your prescribing health professional.
TCAs are effective, but have more harmful side-effects than newer drugs such as SSRIs. They are more likely to cause low blood Selective Serotonin Reuptake Inhibitors (SSRIs)
pressure – so this should be monitored by a doctor. They are more SSRIs are the most commonly prescribed antidepressants in Australia and are often a doctor’s first choice for most types of depression. Generally, SSRIs are well-tolerated by most people and Noradrenaline-Serotonin Specific
Antidepressants (NaSSAs)
NaSSAs may be helpful when there is difficulty sleeping and poor Serotonin and Noradrenaline Reuptake Inhibitors
appetite. Generally, they are low in sexual side-effects, but may SNRIs have fewer side-effects compared to the older antidepressants (such as TriCyclic Antidepressants), are often prescribed for severe depression and are safer if a person were to overdose.
Noradrenaline Reuptake Inhibitors (NARIs)
NARIs are designed to act selectively on one type of neurotransmitter (noradrenaline). They are less likely to cause sleepiness or drowsiness than some other antidepressants, but are more likely to make it difficult for people to sleep.
This class includes: • reboxetine.
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Please note:
• When the symptoms are directly due to depression, they Like any medication, the length of time a person takes antidepressants are likely to begin to improve following four to six weeks of depends on the severity of the illness and how the person responds effective therapy. For example, although SSRIs commonly to treatment. For some people, antidepressants are needed only for a make sleep disturbance/insomnia worse initially, they are short time (generally six to 12 months) with psychological treatments associated with improved sleep four to six weeks later. and self-help techniques being sufficient. For others, antidepressants • TCAs are commonly prescribed for their wide range of are needed on an ongoing basis – in the same way that someone general benefits, but are also the most toxic antidepressants with asthma would use respiratory medication. People often want to stop taking antidepressants quickly because • SSRIs or clomipramine (a TCA) would be the first choice if they are concerned they are addictive. This may be because they obsessive compulsive symptoms are prominent.
confuse them with sedatives, a group of medications that are used • All of these drugs have been shown to be effective to help a person feel relaxed and, in some cases, fall/stay asleep. antidepressants, but their effectiveness differs from person Stopping some antidepressants quickly (e.g. some SSRIs and SNRIs) can lead to a discontinuation syndrome, which consists of flu-like symptoms. Generally this lasts for several days and can be avoided if the medications likely to do this are stopped gradually, on a doctor’s recommendation and under supervision. Sometimes discontinuation symptoms are severe, including irritability, agitation, Antidepressants can make people feel better, but antidepressants Unlike antidepressants, sedatives are designed to be used only will not change their personality or make them feel happy all the time. for a short time. If used for long periods of time, sedatives may be Like any other medication, some people who take antidepressants craved and needed in higher doses in order for them to have the also experience some side-effects. Common side-effects include: same effect. This is not the case with antidepressants. Stopping medication should only be done gradually, on
a doctor’s recommendation and under supervision.
• sexual difficulties (e.g. difficulty becoming/staying aroused).
A General Practitioner (GP) is a good person with whom to
Some of these symptoms are short-lived. However, people taking discuss your concerns in the first instance. Your GP will be able to antidepressants who experience any of these symptoms should tell conduct or arrange any necessary medical tests, provide treatment their doctor, as there are ways of minimising these or other side- or refer you to a mental health professional. It is recommended effects. The likelihood of a particular side-effect happening varies that you go to your regular GP or another GP in the same clinic as they will have access to your medical file. If you don’t have a Adverse side-effects may occur in a minority of people when taking regular GP or clinic, a list of GPs with expertise in treating common very low doses of antidepressants. This is because their bodies mental health problems is available at www.beyondblue.org.au – break down the medication more slowly than the majority of people. click Find a Doctor or other Mental Health Practitioner or contact There is a blood test doctors can order to predict if you’re likely the beyondblue info line on 1300 22 4636 (local call cost from a to react this way – and if necessary, they can adjust the dose of landline) or infoline@beyondblue.org.au.
Psychologists can assist people who are having difficulty controlling
It is not uncommon for people with depression to have suicidal their emotions, thinking and behaviour. Clinical psychologists are thoughts. Treating the depression effectively will reduce the likelihood specialists in the assessment, diagnosis and treatment of mental of a person hurting him/herself. In the period of time between illness such as depression, anxiety and related disorders.
the person starting antidepressant medication and responding to Psychiatrists are doctors who have undergone specialist
treatment – which can be more than two weeks – the person should training to treat all mental disorders. They can make medical and still be monitored by the doctor and his/her progress reviewed, as psychological assessments, conduct medical tests and prescribe the risk of suicidal behaviour may even be slightly increased.
medication. Depending on their expertise and type of practice, they can also provide psychological treatments such as Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT). Visit www.beyondblue.org.au Call 1300 22 4636 Email infoline@beyondblue.org.au
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Antidepressant medication
Advice for adults
Some have particular areas of speciality. If you would like a Lifeline
consultation with a psychiatrist, you will need a referral from your GP.
Mental health nurses are specially trained to care for people with
24-hour counselling, information and referral (local call) mental health problems such a depression, anxiety and related Black Dog Institute
disorders. They work with psychiatrists and General Practitioners www.blackdoginstitute.org.au
to review a person’s mental health, monitor medication and provide Information on depression and bipolar disorder – including causes, information about mental health problems and treatment. Some treatments, symptoms, getting help and current research findings have training in psychological therapies. If you would like a referral to a mental health nurse who works in a general practice, ask your GP.
MensLine Australia
Social workers in mental health are specially trained to work with
1300 78 99 78
people who are experiencing difficulties in life. Social workers can www.menslineaus.org.au
support people with depression, anxiety and related disorders by Counselling for men with family and relationship problems especially helping them find ways to manage more effectively some of the around family breakdown or separation – this service provides situations that trigger these disorders such as family issues, financial anonymous telephone support, information and referral (local call) problems, work stress and living arrangements. Mental health social Suicide Call Back Service
workers can also provide focused psychological self-help strategies. 1300 659 467
Occupational therapists in mental health help people who
Telephone support for those at risk of suicide, their carers and have difficulties functioning because of a mental health problem (such as anxiety or depression) to participate in normal, everyday activities. Mental health occupational therapists can also provide www.crufad.org
focused psychological self-help strategies.
Information and internet-based education and treatment programs for people with depression or anxiety For a list of psychologists, psychiatrists, social workers and occupational therapists with expertise in treating mental health Multicultural Mental Health Australia
problems, visit www.beyondblue.org.au and click Find a www.mmha.org.au
Doctor or other Mental Health Practitioner or contact the 02 9840 3333
beyondblue info line on 1300 22 4636 (local call cost from Provides mental health support for people from culturally and a landline) or infoline@beyondblue.org.au.
Therapeutic Goods Administration
www.tga.gov.au
Information relating to all registered therapeutic goods, including prescription medicines, available in Australia www.beyondblue.org.au
Info line 1300 22 4636 or infoline@beyondblue.org.au
Information on depression, anxiety and related disorders, available
• Medication can be important in the treatment of moderate Youthbeyondblue
to severe depression and in some anxiety-related disorders.
www.youthbeyondblue.com
• Stopping medication should only be done gradually, beyondblue’s website for young people – information on depression, on a doctor’s recommendation and under supervision.
Learn more about self-help techniques
beyondblue online fact sheet 6 – Reducing stress
beyondblue has developed Clinical Practice Guidelines for:•  Depression in adolescents and young adults beyondblue online fact sheet 7 – sleeping well •  Depression and related disorders in the perinatal period. beyondblue online fact sheet 8 – Keeping active The guidelines were approved by NHMRC in February 2011 – visit www.beyondblue.org.au/guidelines for more information. beyondblue fact sheet 9 – Reducing alcohol and other drugs beyondblue online fact sheet 10 – changing your thinking beyondblue a Guide to What Works for Depression – a comprehensive review of all known treatments for depression, Info line 1300 22 4636 or infoline@beyondblue.org.au including medical, psychological, complementary and lifestyle Visit www.beyondblue.org.au Call 1300 22 4636 Email infoline@beyondblue.org.au

Source: http://www.mantherapy.org.au/Docs/Fact-Sheet-Antidepressant-Medication.pdf