Pros & cons of medication

Avoid a knee-jerk response either for or against medication. Find out the facts and make an informed decision.
Where to go next:
One of many options

Medication (or taking tablets) is simply one of the many options available to help combat depression. It has both benefits and drawbacks. People often feel apprehensive about going to a doctor becaquse they feel they will just be prescribed unhelpful medication – but it’s important to understand the myths around medication, not just so that you can have an open mind about it, but also so that you can make an informed decision if you are given the choice to take some.

Some of the myths and concerns about taking medication include:

“What’s the point of getting ‘false happiness’ which will disappear when I stop taking the pills?”

Antidepressants do not make you ‘happy’ as such – they help to adjust abnormally low levels of brain chemicals to lift mood to more normal levels.

They are most effective when part of a multi-faceted strategy for reversing the depression habit spiral by providing motivation to tackle other unhelpful habits, like depressed thinking, reduced activity levels or disturbed sleep patterns. When continued for 6 months after remission from depression, antidepressants have been shown to significantly reduce the chance of relapse*.

“Pills are a crutch and taking them means I am weak”

So if you break your leg it would be ‘weak’ to have it in plaster for a while to help it repair itself, rather than leaving it to mend on its own? Basing a decision about medication on harsh, self-judgmental standards like this is a sign of depressed thinking.

“I don’t want to feel like I ‘need’ pills to make me happy”

Again, this is unnecessarily perfectionist. Would you make the same judgement about using contact lenses to see better? The brain’s mood chemicals are just another part of our bodies which may not always operate optimally, but which can be corrected with medication (which is usually used temporarily, unlike glasses!).

“So, if I just take some pills it will make it all go away…?”

Actually, NHS guidelines suggest that antidepressants should not be offered in the first instance for mild depression as other strategies may be more effective with fewer side effects. Medication can reverse some of the effects of depression, such as low mood and lack of motivation, and can provide the energy for re-engagement with life, socialising etc which helps combat other depressive effects. Medication is most useful when forming part of a combined strategy to tackle the various effects of the depression habit spiral.

“What about these side effects then?”

Newer antidepressants do have fewer side effects, but none of them are side effect free and some side-effects, though rare, can be quite serious. Some side effects can be useful eg. aiding sleep. The side effects tend to be worst in the first couple of weeks and then many taper off. Make sure you discuss the potential side effects with your doctor, as each type of medication has a slightly different side effect profile. You may need to try a few different types of antidepressant before you find one that suits you.

“I don’t want to become addicted”

Antidepressant medication is not addictive. It does not cause craving, and you don’t need to take more and more in order to get the same effect. However, it is important that when you stop taking the medication you do so gradually to prevent the unpleasant symptoms of sudden withdrawal.

“I suppose I could get some and just take them when I’m feeling particularly low…”

No, they don’t work that way. The medication usually takes several weeks to build up enough in your system to have a beneficial effect (though you may feel some of the side effects straight away). Stopping suddenly or missing doses can cause unpleasant symptoms such as dizziness, nausea, pins and needles, anxiety and headaches.

“I’ve heard some antidepressants can make you feel suicidal”

Research has shown an increased risk of suicidal thinking on first starting on some antidepressants for people under the age of 18, but no evidence of an increased risk above that age*. However, because people mature at different rates and young adults tend to have a higher background risk of suicide, doctors are advised to carefully monitor young adults taking anti-depressant medication. This means you should be asked to book a follow up appointment when you first get prescribed antidepressants. It is very important to attend this and keep in touch with your doctor.

It is also important to be aware, if you have been having suicidal thoughts, that when you first take antidepressants your energy and motivation improve before your mood – you can remain suicidal but now have the energy to do it. It is important to look out for increased negativity and hopelessness or sudden changes in mood, as well as suicidal thoughts, and to have regular check ups with your doctor and good support systems in place. Only you can decide whether this initial risk is worth the potential longer-term benefits.

“Is it worth it? They don’t seem to have made much difference for some people I know who’ve taken them…”

The most recent NHS guidance* cites research showing antidepressants are indeed not as beneficial for mild depression as for moderate and severe depression, so should not be prescribed initially in this case. If antidepressants are indicated, it may be necessary to try several varieties before finding the most appropriate pill and dose. Once these factors are taken into account, research shows that 80% of people taking antidepressants experience benefits*.

Finding the right medication

There are a range of medications that doctors can prescribe to address depression and anxiety, with different pros and cons.

It may be a slow process to find the right medication and the right dosage for you. Antidepressant medications often need to be taken for several weeks before they take effect, although the side effects are noticeable sooner than this. It is important to be patient and give things a proper chance to work, but at the same time to communicate regularly with your doctor if you are not getting the expected benefit. Always consult the doctor if you want to stop taking the medication and do not withdraw abruptly.

Medication vocabulary

SSRIs (selective serotonin reuptake inhibitors)
The newer antidepressants which are recommended for use in routine care of depression*. Generic names include fluoxetine, paroxetine, sertraline and fluvoxamine. Available under a variety of trade names, but the best known is Prozac (fluoxetine).

MAOIs (monoamine oxidase inhibitors)
Slightly older antidepressants which are sometimes used when the depression comes with a lot of anxiety. Certain foods have to be avoided to prevent severe reactions. Generic names include isocarboxazid, phenelyzine and tranylcypromine.

Older antidepressants which may have stronger side effects. Generic names include amitriptyline, clomipramine, dothiepine, imipramine and lofepramine.

Used to stabilise mood when the person has swings in mood between depression and mania, or sometimes given in addition to other antidepressants when other types of medication have not helped.

ECT (electroconvulsive therapy)
Electric shock administered under general anaesthetic. Only advised for rapid, short-term improvement for severe and life-threatening depression where other treatment options have not been effective.

St John’s wort
A natural remedy available without prescription which may be of benefit in mild or moderate depression. However, NHS guidelines are that it should not be prescribed nor its use advised because there is uncertainty about appropriate doses and it has potentially serious interactions with other drugs (including oral contraceptives, anticoagulants and anticonvulsants).

Beta blockers
Sometimes prescribed for anxiety.