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A group of medications with a wide range of helpful actions to assist with many nervous and physical conditions, not just depressive illness.

There is a lot of misinformation about antidepressants. They are a safe group of medications with many uses and limitations.

Most antidepressants are also very effective with anxiety.

What do Antidepressants Do?

They return you to your pre-depressed level, including mood, energy, bodily functions, thinking processes, confidence, motivation, interests, behaviours and relating.

Antidepressants Can Assist With:

Low Dose – Pain(s), nausea, insomnia, premature ejaculation, sleep, digestion, bladder/bowel, and other body functions.

Higher Dose – Anxiety, panic, phobia, obsessions, compulsions, depression(s), mood stabilising.

Existing Illness – Recurrent or chronic illnesses can have more relapses or severity when a patient is depressed and less when they are not depressed, eg asthma, irritable bowel syndrome, pre-menstrual syndrome.

Which Antidepressant for Me?

In New Zealand we have over 17 antidepressants. These can be placed into 7-9 groups, some of which may not suit or work for you!
The problem of selection is threefold:
· What will suit you?
· What is the right dosage?
· What will work for you?
We learn by trial what is right for you. Most antidepressants work for 50% to 70% of patients. Initially, if one does not suit you, knowing your side effects can help in the quest to find one that does suit you.

How Much Do I Need?

You will probably start with a low dose, increasing over a few days/weeks until we find the dose you need. Blood tests for some antidepressants can establish whether the medication has achieved a therapeutic level in your body. We do not have biological tests to tell us what will suit you, or the correct dose for you.

What if it Fails to Work?

If the antidepressant has not worked after 4-6 weeks we need to find one in a different group which you may respond to (and maybe consider other treatments).

How Long Do I Take Them?

You will probably need to take this medication for a few months after you recover from this depression, which may return if the medication is stopped too soon.

My usual advice is to encourage patients to continue the antidepressants until they are not just out of illness, but into wellness, then a decision can be made about tailing-off medication.

A small proportion of patients need to continue antidepressants or a mood stabilizer (eg Lithium, Sodium Valproate, Olanzapine, Quetiapine, Gabapentin, Lamotrigine, Carbamazepine) to prevent relapse, for the rest of their lives.

How Long Do They Take to Work?

· Some symptoms relieve within a day or two and others take up to 12 weeks – be patient.
· Calming effects with less anxiety/panic; better sleep usually starting in 2-7 days.
· Physical symptoms, eg nausea, abdominal problems, pain, decrease within 1-10 days.
· Mood, irritability, energy, can take 7-35 days.
· Memory and concentration take 14-35 days.
· Confidence, motivation, social behaviours usually improve within 21-56 days.
· Premenstrual and menstrual symptoms improve within two cycles.
· Sexual problems, obsessions, compulsions, phobias, hypochondriacal beliefs, fatigue, social phobias, alcohol and drug problems can be the slowest to respond and may need other therapy.

Treatments Which May Work for You

If you are aware of medicines or treatment that has worked for someone you know – and could work for you – talk this over with me.

CAUTION – Some effects and interactions

· Cars and machinery – Your reactions may be slower in the first few days on medication.
· Alcohol and medication – In the first week or two you may feel more sleepy, dizzy, light-headed, intoxicated, hung over.
· Sleep debt – Initially on antidepressants you may sleep longer. This makes up for the past sleep loss.
· Other Medications – These can be additive and make you drowsy or dizzy, including pills for pain, colds, hayfever, blood pressure, travel sickness, diet etc.

What About Side Effects?

· You may feel worse before you start to feel better.
· All drugs can have side effects.
· Most side effects are not serious!
· Most stop within a few days.

Side Effects – Report Today

· Rash or itchy skin
· “Flu” (aches, pains and fever)
· Muscle spasms, restlessness, tremor, rigidity
· Problems with urinating
· Over-activity, elation, excessive spending

Side Effects – Report Next Visit

Drowsiness, dizziness, feeling faint or light-headed, dry mouth, shaking/trembling, constipation, diarrhoea, sweating, weight-gain, weight-loss, blurred vision, appetite changes, sexual problems.

Please advise of changes of medication and treatment from your other doctors
When you see other doctors always tell them you are on antidepressant medication and which one!
Keep your GP in the treatment loop and get blood pressure checked after changes in medication.

Safety with Contraception and Pregnancy

Missing a period, possibly pregnant or planning a pregnancy, or breast-feeding – talk to me, your GP or your midwife.

Depression and Your Sex Life

This is a complicated situation.

· Some patients have pre-existing sexual problems and anxieties.
· Depression is often associated with a lowered sexual appetite (libido), especially in women.
· Antidepressants can correct sexual problems associated with anxiety and depressions, and can sometimes help existing problems, eg assisting orgasm and solving premature ejaculation.
· Some antidepressants are associated with sexual problems, eg Prozac can have negative sexual effects on about one-third of patients (but with others if can help a full return of your previous sexual function).

It is important to indicate sexual issues at your consultations.

Which Antidepressants for –

· Anxiety Disorders – Citalopram, Doxepin
· Social Phobia – Moclobemide
· Agoraphobia – Clomipramine
· Panic Attacks – Dothiepin
· Obsessive Compulsive Disorder – Clomipramine Fluoxetine

Are Antidepressants Addictive?

Most are not.

The following five antidepressants are infrequently addictive:
Paroxetine (Aropax) for approximately 1 person in 20
Venlafaxine (Efexor) for approximately 1 person in 20
Clomipramine (Clopress) for approximately 1 person in 30
Tranylcypromine (Parnate) for approximately 1 person in 40
Phenelzine (Nardil) for approximately 1 person in 50

Dr Harvey Williams
M.B., Ch.B, DPM (Lond), F.R.A.N.Z.C.P

Medical Specialist (Psychiatrist)

Medical Director and Founder
of Caledonian Clinic (1986)

Caledonian Clinic
304 Papanui Road, Christchurch

Ph: 03 355 0336
Fax: 03 355 0337
Cell phone: 0274 58 78 28

E-mail: harvey@caledonianclinic.co.nz

Treatment Costs – approximately $360 (inc GST) for Assessment and a Treatment Management Plan. A course of treatment costs approximately $1,000 (inc GST) for approximately five consultations.

Contact us for Treatment Advice
We would like to be of service.

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