beyondblue factsheet 11 antidepressant medication - Man Therapy

Antidepressant medicationAdvice for adultsfact sheet 11There is a great deal of misinformation aboutantidepressant medication and there is no simpleexplanation of how antidepressants work.Medication can be important in the treatmentof moderate to severe depression and in someanxiety and related disorders. This fact sheetlooks at what antidepressants do, how they workand where to get more information and help.HOW DO ANTIDEPRESSANTS WORK?Research shows that more severe forms of depression areassociated with specific changes in the brain, including changes tosome hormones and chemical message systems. In these forms ofdepression, there are alterations in the activity of the brain in areasunder the influence of neurotransmitters serotonin and noradrenalinewhich may cause a major depressive episode. This is associated withthe symptoms and disability seen with depression. Antidepressantmedication is thought to increase the levels of serotonin andnoradrenaline in some areas of the brain. However, depressionis not simply a deficiency of these chemicals. Different types ofantidepressants work in slightly different ways, but they all have aninfluence on parts of the brain related to emotions and motivation.WHEN IS ANTIDEPRESSANT MEDICATIONUSED?Antidepressant medication is often prescribed, alongsidepsychological treatments, when a person experiences a moderateto severe episode of depression and/or anxiety. Sometimes theyare also prescribed when other treatments have not been helpful.WHICH ANTIDEPRESSANTS ARE THEMOST USEFUL?Making a decision about which antidepressant is best for a personcan be complex. This decision should be made in consultation witha doctor after careful assessment and consideration. People canhelp the doctor’s assessment by providing as much information aspossible about themselves and their medical history. The followingshould be considered and discussed with the doctor beforestarting antidepressants.AgeDepression is common and can affect people of all ages, however,generally medication is not recommended as the first choice for thetreatment of depression in children and young people.The Therapeutic Goods Administration (Australia’s regulatory agencyfor medical drugs) and manufacturers of antidepressants do notrecommend antidepressant use for depression in young peopleunder the age of 18.There are, however, no government (i.e. Pharmaceutical BenefitsScheme) restrictions placed on the prescription of antidepressantsand doctors are not prevented from prescribing them if they feelthey are needed.There is concern that a small percentage of young people up tothe age of 24 years taking SSRIs for the treatment of depressionmay experience an increase in suicidal thoughts and behaviour.Research shows the risk to be roughly 4 per cent compared to2 per cent for those taking a placebo (dummy pill). No deaths fromsuicide have been reported in any clinical trials. However, a youngperson will require close medical supervision and monitoring in theearly stages of treatment if an antidepressant is prescribed.For more information see Youthbeyondblue Fact Sheet 5 –Antidepressants For The Treatment of Depression in Adolescentsand Young Adults.Chronic illnessLike any medication, antidepressants can produce side-effects.In some cases, taking antidepressants can affect existing symptomsor treatments for other illnesses. It is important for people to letdoctors know about any illness they may have and any medicationthey are taking.Pregnancy and breastfeedingThe decision to take medication while pregnant or breastfeedingis an individual one. It should be made in consultation with a doctorafter considering the risks and benefits to both the mother and baby.If a woman is breastfeeding, generally specific types of medicationsare preferred. While a number of factors will influence the choiceof antidepressant, a group of antidepressants called tricyclics, aswell as sertraline, citalopram and fluvoxamine are most commonlyprescribed for breastfeeding women.Studies show that paroxetine is generally not recommended atthis time. 1SymptomsWhen deciding on the most appropriate antidepressant medication,it’s important to consider what symptoms they treat. Some classesof antidepressant medication are more effective in treating specificdepression-related symptoms, while other types can be helpful inmanaging anxiety disorders.1Buist, 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 medicationAdvice for adultsfact sheet 11People who have bipolar disorder and experience an episode ofdepression will often be given a mood stabiliser alone. It can taketime for mood stabilisers to work. Sometimes antidepressants areused along with mood stabilisers to help ease the symptoms.Antidepressant medication is generally not recommended for use byitself in people with bipolar disorder as it can trigger mania.Types of antidepressantsThere are many different types of antidepressant medication. Yourdoctor may need to find the medication and dose which is mosteffective for you. Keep in mind antidepressants take time beforethey start to help (at least two weeks). Below is a description ofthe different classes of antidepressants. Please note, this list onlyincludes the generic medication names and not the pharmaceuticalbrand names. Please look on your medication packaging to findthe name of the medication you are taking (this is usually written inlowercase).There are differences in effects and side-effects of theantidepressants listed below, which can be discussed withyour prescribing health professional.Selective Serotonin Reuptake Inhibitors (SSRIs)SSRIs are the most commonly prescribed antidepressants inAustralia and are often a doctor’s first choice for most types ofdepression. Generally, SSRIs are well-tolerated by most people andgenerally, are non-sedating.This class includes:• sertraline• citalopram• escitalopram• paroxetine• fluoxetine• fluvoxamine.Serotonin and Noradrenaline Reuptake Inhibitors(SNRIs)SNRIs have fewer side-effects compared to the older antidepressants(such as TriCyclic Antidepressants), are often prescribed for severedepression and are safer if a person were to overdose.This class includes:• venlafaxine• desvenlaxafine• duloxetine.Reversible Inhibitors of Monoamine Oxidase –A (RIMAs)RIMAs have few side-effects and are non-sedating. They may beless effective for more severe forms of depression than some otherantidepressants, but are helpful for people who are experiencingproblems with anxiety or are having difficulty sleeping.This class includes:• moclobemide.Monoamine Oxidase Inhibitors (MAO-Is)MAO-Is are seldom prescribed in Australia as people are requiredto keep to a special diet, otherwise serious side-effects can beexperienced.This class includes:• tranylcipramine• phenlzine.TriCyclic Antidepressants (TCAs)TCAs are effective, but have more harmful side-effects than newerdrugs such as SSRIs. They are more likely to cause low bloodpressure – so this should be monitored by a doctor. They are morerisky if a person were to overdose.This class includes:• nortriptyline• clomipramine• dothiepin• doxepin• imipramine• amitriptyline.Noradrenaline-Serotonin SpecificAntidepressants (NaSSAs)NaSSAs may be helpful when there is difficulty sleeping and poorappetite. Generally, they are low in sexual side-effects, but maycause weight-gain.This class includes:• mirtazapine.Noradrenaline Reuptake Inhibitors (NARIs)NARIs are designed to act selectively on one type ofneurotransmitter (noradrenaline). They are less likely to causesleepiness or drowsiness than some other antidepressants, but aremore likely to make it difficult for people to sleep.This class includes:• reboxetine.2 of 4 Visit www.beyondblue.org.au Call 1300 22 4636 Email infoline@beyondblue.org.au

Antidepressant medicationAdvice for adultsfact sheet 11Some have particular areas of speciality. If you would like aconsultation with a psychiatrist, you will need a referral from your GP.Mental health nurses are specially trained to care for people withmental health problems such a depression, anxiety and relateddisorders. They work with psychiatrists and General Practitionersto review a person’s mental health, monitor medication and provideinformation about mental health problems and treatment. Somehave training in psychological therapies. If you would like a referral toa mental health nurse who works in a general practice, ask your GP.Social workers in mental health are specially trained to work withpeople who are experiencing difficulties in life. Social workers cansupport people with depression, anxiety and related disorders byhelping them find ways to manage more effectively some of thesituations that trigger these disorders such as family issues, financialproblems, work stress and living arrangements. Mental health socialworkers can also provide focused psychological self-help strategies.Occupational therapists in mental health help people whohave difficulties functioning because of a mental health problem(such as anxiety or depression) to participate in normal, everydayactivities. Mental health occupational therapists can also providefocused psychological self-help strategies.For a list of psychologists, psychiatrists, social workers andoccupational therapists with expertise in treating mental healthproblems, visit www.beyondblue.org.au and click Find aDoctor or other Mental Health Practitioner or contact thebeyondblue info line on 1300 22 4636 (local call cost froma landline) or infoline@beyondblue.org.au.MORE INFORMATIONbeyondbluewww.beyondblue.org.auInfo line 1300 22 4636 or infoline@beyondblue.org.auInformation on depression, anxiety and related disorders, availabletreatments and where to get helpYouthbeyondbluewww.youthbeyondblue.combeyondblue’s website for young people – information on depression,anxiety and how to help a friendLearn more about self-help techniquesbeyondblue online Fact sheet 6 – Reducing stressbeyondblue online Fact sheet 7 – Sleeping wellbeyondblue online Fact sheet 8 – Keeping activebeyondblue Fact sheet 9 – Reducing alcohol and other drugsbeyondblue online Fact sheet 10 – Changing your thinkingbeyondblue A Guide to What Works for Depression –a comprehensive review of all known treatments for depression,including medical, psychological, complementary and lifestyleinterventions.Lifeline13 11 1424-hour counselling, information and referral (local call)Black Dog Institutewww.blackdoginstitute.org.auInformation on depression and bipolar disorder – including causes,treatments, symptoms, getting help and current research findingsMensLine Australia1300 78 99 78www.menslineaus.org.auCounselling for men with family and relationship problems especiallyaround family breakdown or separation – this service providesanonymous telephone support, information and referral (local call)Suicide Call Back Service1300 659 467Telephone support for those at risk of suicide, their carers andthose bereaved by suicideCRUfADwww.crufad.orgInformation and internet-based education and treatment programsfor people with depression or anxietyMulticultural Mental Health Australiawww.mmha.org.au02 9840 3333Provides mental health support for people from culturally andlinguistically diverse backgroundsTherapeutic Goods Administrationwww.tga.gov.auInformation relating to all registered therapeutic goods, includingprescription medicines, available in AustraliaTHINGS TO REMEMBER• Medication can be important in the treatment of moderateto severe depression and in some anxiety-related disorders.• Stopping medication should only be done gradually,on a doctor’s recommendation and under supervision.beyondblue has developed Clinical Practice Guidelines for:• Depression in adolescents and young adults• Depression and related disorders in the perinatal period.The guidelines were approved by NHMRC in February 2011 – visitwww.beyondblue.org.au/guidelines for more information.beyondblueInfo line 1300 22 4636 or infoline@beyondblue.org.auwww.beyondblue.org.au© Beyond Blue LtdBL/0125 10/114 of 4 Visit www.beyondblue.org.au Call 1300 22 4636 Email infoline@beyondblue.org.au