Antidepressants

Warning

If you are taking antidepressants, make sure you have regular blood tests to check your potasium levels and kidney and liver function.

 You should inform a family member or someone close to you if you start taking antidepressants. This is advised by manufacturers and the Royal Colleges and Department of Health - Please read the editorial in the medical journal Prescriber: This was compiled by Millie Kieve of APRIL and Janet Krska, Professor of Pharmacy

November 2015 editorial in Prescriber journal by Millie Kieve and Professor Janet Krska

Concensus Statement for Suicide Prevention from Department of Health and Royal Colleges

 The article explains the need for a family member or friend to be informed when antidepressants are prescribed: entitled The role of relatives and friends in antidepressant treatment:  

 

If you are sad, not coping with work or other issues, or downright fed up, talking to someone who can help you plan how to resolve or work through your problems, can be the best way to cope.

If you are considering asking for a drug to help you, drugs alter your mind and not always for the better, though some people say they have helped, but make sure you make an informed choice.

About Depression

The World Health Organisation now ranks depression as the world's fourth greatest public health problem. Depressive states can range from feelings of sadness to severe illness. Accurate diagnosis is important. It is estimated that 30% - 50% of cases of depression in primary care and medical settings are not detected. It is important to provide more training for medical practitioners, reduce the stigma and create awareness in the general population, that help should be sought. It is important to talk to someone about how you feel and to try to unravel the cause of depression.

Depression may be a side effect of the  medicine you were prescribed before you became depressed, or following surgery (see anaesthetics information)

Many drugs' side effects may cause feelings of depression. This can range from feeling low, to feeling life is not worth living. Always check with your pharmacist or search the Internet to find if your changed mood may be due to medicines, even if life experiences may at first seem to be the cause. Drugs for indigestion, acne, cardiac problems, antibiotics, drugs for lowering cholesterol can all cause depressiion.

Tips that may help you if you feel depressed

 

Antidepressants

An antidepressant is a psychiatric medication often prescribed before the doctor has found out if the cause of the depression may be other medicines.

All psychoactive drugs change the state of our mind, is this what is required? A drug induced state may not be the best for everyone.Lack of emotions is one effect which can lead to inapproriate behaviour.

You should always inform someone close to you when you start taking antidepressants, as advised by the manufacturers. Your personality can suddenly change without you realising and you can find yourself in a dark place, even worse than when you went to the GP to deal with your problem in the first place.  See above for link to our article in Prescriber journal about this directive.

Looking at the cause of the depression is important and whatever the cause it has been found that cognitive behavioural therapy (cbt) is by far the best method of dealing with depression.

Following bereavement, specialised bereavement counselling is helpful. Drugs stiffle feelings and can subdue our emotions, only delaying the progress of the journey we all have to make to cope with loss.

Drugs can cause us to suffer worse problems than they were initially prescribed for.  They are often  unfortunately prescribed without warnings of the long term and short term adverse effects. Coming off these drugs is a problem for many people so one should only start taking them if the withdrawal problems have been assessed and the risk benefit really contemplated.

These medications are now amongst the drugs most commonly prescribed by psychiatrists and as well as other physicians, and their effectiveness and adverse effects are the subject of many studies and competing claims. 

Despite the name, antidepressants are often used in the treatment of other conditions, including anxiety disorders, bipolar disorder, obsessive compulsive disorder, eating disorders, bowel and bladder problems stopping smoking and for chronic pain. Some people may find them of benefit but no one should be unaware of the possible long term physical, neurological and psychological adverse side effects and possible withdrawal problems. Some people develop seizures and the link to the prescribed drug may not be recognised.

Physiotherapy, focus on relaxation, breathing, and excercise can be of value for many of the above disorders and should be tried before resorting to drugs.

Withdrawal or Discontinuation Syndrome

It is possible that some people may not be able to stop taking the drugs for reasons that the pharmaceutical companies have not yet investigated or disclosed. A person contemplating taking antidepressants should know the risks and weigh up the possible benefits before taking them. Low doses for short periods may not cause such difficulty as when the drugs are taken for many months or years at highter doses. Everyone is different and one should read as much as possible. Some people have severe reactions after only one or two doses. Missing even one dose can cause severe reactions too.

Link to video of Coming Off breakout sesson at APRIL's 2008 conference

The chief pharmacist at the Maudsley and Bethlem Hospital wrote about withdrawal from a personal as well as professional perspective:

The Critical Psychiatry group of UK psychiatrists comments about withdrawal:

Types of Antidepressant

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Noradrenergic and specific serotonergic antidepressants (NASSAs)
Norepinephrine (noradrenaline) reuptake inhibitors (NRIs)
Norepinephrine-dopamine reuptake inhibitors
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitor (MAOIs)

Psychiatric Adverse Side Effects

Insomnia, increased anxiety, suicidal thoughts, violent behavour, sedation, loss of libido, anxiety, agitation, loss of libido, failure to reach orgasm and erectile problems

The Food and Drug Administration has included Black Box warnings on all SSRIs stating how they double suicidality (from 2 in 1,000 to 4 in 1,000) in children and adolescents who are prescribed these drugs.

See Links to Support Groups

 

Reporting Adverse Drug Reactions (ADRs)
If you have suffered psychiatric adverse reactions please report them. There may be side effects not mentioned on the data sheets. You can request a list of drugs used pre surgery and during surgery. You should be given patient information for all drugs prescribed as you are discharged from hospital.

Please report Adverse Drug Reactions (ADRs) to:

UK Yellow Card Reporting for Patient and Health Professional reports of Adverse Drug Reactions

USA and worldwide to the Food and Drug Administration for Patients and Healthcare Professionals

Universal free, independent drug safety website - Rxisk

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