Being prescribed antidepressants
Adam Murphy chats to GP Sarah Smith about her experiences prescribing antidepressants. First up, Adam asked, how might someone actually be feeling when they come to see a GP?
Sarah - So an average patient would perhaps come in saying that they're feeling lower in mood, sometimes they're sad and emotional and might be crying more. They can often feel tired and some people don't sleep very well. They can have increased or decreased appetite. And then with that, either some weight gain or some weight loss. And often just feel that they're not enjoying things as much, less motivated to get things done, sometimes feeling more hopeless with reduced self esteem.
Adam - How would you decide whether or not that person would need, say medication for the problem?
Sarah - Guidelines suggest that in most cases of mild to moderate depression, we can manage that with some sort of counselling or talking therapy. One problem is that we often don't have enough counsellors or psychologists at our fingertips to for someone to be seen within the next two or three weeks. And sometimes you can be on waiting lists for some therapies for several months. So for some people, they might need a depression medicine to just help prop them up while we're waiting for those other therapies to happen. And then we see some of the more severe depressions where it's appropriate to prescribe an antidepressant straight away.
Adam - And then what kind of antidepressants are there that you could prescribe?
Sarah - Nowadays we tend to use selective serotonin reuptake inhibitors, SSRI antidepressants, and they're quite nice because they have less side effects than the older-fashioned tricyclic antidepressants that we use historically. We pick and choose SSRI antidepressants depending on what the person's coming to see us with. So we might pick a certain one if they're more depressed and anxious or if they've got depression alone, obsessive compulsive disorder, or post traumatic stress disorder, we might pick a different one. And then we have others that we might use in cases of anorexia with depression, or in people that are depressed and can't sleep. So we've got several that we can choose from.
Adam - Do we know much about how these different antidepressants work?
Sarah - Yeah, so the more modern SSRI antidepressants help to lift our serotonin levels in our brains up. It's a neurotransmitter chemical in the brain, which sends messages from one nerve to another nerve. Because what happens normally is the serotonin is absorbed back into the cells. And what it does is it stops that process from happening. So there's more serotonin washing around and sending messages to the right nerve cells in our brain. If we have more serotonin washing around, we tend to feel more cheerful and upbeat, helps our mood, helps our emotions and helps our sleep.
Adam - And what kind of side effects do people have? And can you like make a path through antidepressants if one isn't working?
Sarah - Yes. So we warn people at the very beginning of taking them that they might feel a bit of nausea for the first week or 10 days. They might feel a little bit spaced out and not to worry if those simple things happen because it will pass. We always warn people to come and tell us if they're getting any major side effect problems or if they get an increase or sudden onset of any suicidal thoughts. And then we talk those through and then decide whether we need to change their antidepressant. If we've perhaps tried two or three different things and we're still not winning, we might ask the psychiatrist for their opinion, and then we can move forward that way.
Adam - How long would a course tend to be?
Sarah -If we go onto an antidepressant, it's sensible to keep taking it for six months. Studies have shown that if you stop it sooner than six months, you're more likely to have a relapse of your depressed mood. So we tend to advise people that when we're starting them on them as well. And ask people to come back to talk to us if they want to stop them or come off them so that we can plan it carefully.
Adam - Speaking of that, what is the procedure then when someone wants to, or is ready to come off an antidepressant?
Sarah -People come and have a chat with us and we tend to try and plan a phased reduction of their medication. So if they were taking, for instance, two tablets of a certain antidepressant, we might then suggest they take one for three or four weeks and then perhaps one every other day for a couple more weeks. Gradually wean them off because that's much better to do it that way with less withdrawal symptoms if they do it sensibly.
Adam - When we're talking about withdrawal, what kind of symptoms could people be looking at if they went into withdrawal like that? From an antidepressant?
Sarah -People get a variety of symptoms. They can feel dizzy, tired, they can get blurred vision, sometimes feeling more irritable or anxious. Some people struggle with their sleep and get insomnia, vivid dreams, um, nausea and sometimes tummy symptoms with diarrhoea or tummy aches. So it's sensible to come and have a chat with your GP or your psychiatrist and just plan to come off them very carefully over a four to six week period. And then you shouldn't have any problems, because the risk if you do stop them suddenly, you do generally get some withdrawal symptoms within the first five days. And if you've been on higher doses of antidepressant medicine that can go on for six weeks, so much better to come off them gently and gradually.