Experiences of antidepressants

Managing the use of antidepressants

People we interviewed described how they managed their medicines on a daily basis. They often had mixed, or conflicting feelings about taking an antidepressant, but even when they felt unsure whether it helped, were troubled by side effects or were uncertain, generally people said they took it regularly for a period of time after starting it. Some had missed or forgotten a dose now and again. People told us that establishing a routine helped them remember to take it each day, for example taking it a certain time such as first thing in the morning or at bedtime. Rosin described herself as ‘terribly organised... I wanted them to work so it was in my self-interest to take them, I was always really good at doing that’. Sharon kept hers by the kettle and took it each morning when she made breakfast, or if she has a tablet to take at night keeps it on the bedside table. It’s a regular part of Sonia’s daily routine. ‘I get up, shower, drink, tablet and that’s that done’. Caroline takes hers ‘every morning after I’ve brushed my teeth’. Emily took it ‘religiously… same time every single night’. Andrew said he never forgets ‘it’s like if you wear contact lenses… You never forget to take them out at night and it’s the same with this tablet… I think because it’s been so valuable in helping me feel better’. (See also ‘Feelings about using an antidepressant’, ‘Expectations about taking antidepressants’ and ’Starting to take an antidepressant’).
Olivia Y said it helped if the days of the week were marked on the packet, but not all brands had this type of packaging. When people missed taking a tablet some said they noticed the effects straight away, others said they hadn’t noticed any difference. Tim worried about missing doses in case his mood dipped. Going on holiday or away for a few days can interrupt routines, and occasionally people had forgotten to pack their antidepressant. Stephen went to a pharmacy to ask for an emergency supply once when he was away. (Emergency pharmacists are allowed to supply a pack of a particular medicine and charge for it without a prescription).
Some people had been told by the doctor to take the antidepressant at a certain time of day either morning or evening; for example antidepressants with a sedative effect may be best taken at night. Sometimes people said they had altered the time of day they took the antidepressant themselves for example, if it had made them sleepy in the daytime, they had switched to taking it at bedtime. Taking the tablet with food, or before eating, can help to avoid side effects like stomach upsets. The pharmacist can give information about how to manage prescribed medicines (see also ‘Coping with antidepressant side effects’ and ‘Taking other medicines with antidepressants’).
Some people we spoke to had other health conditions in addition to depression, and so needed to remember to take a number of different medicines each day. Organisers or pill boxes with compartments with days of the week and times to take doses of medicines can help people to ensure they’ve taken all their medicines correctly. Victoria is used to taking medication each day because she has Crohn’s disease… ‘I’m so used to taking medication every morning anyway, it was just another pill I had to take so, you know, I never missed them or anything like that’. Jenny has an acute form of asthma and takes numerous tablets each day. When she’s prescribed new medicines she checks the British National Formulary (BNF), the publication doctors use to check information about medicines, to make sure there are no contraindications (reactions between medicines). When she goes in to hospital she takes a folder with all the details about her medicines to make sure health professionals know about everything. Some medicines are prescribed on the ward, but she takes her antidepressant in with her. (See also ‘‘Treatment in hospital’ and ‘Managing other illnesses’).
If you need more than 13 prescribed medicines each year, and are not entitled to a free prescription, it is cost effective to have a pre-payment certificate (PPC). You can also buy a three-month PPC, which will save you money if you need more than three prescribed medicines in three months. PPC are available by telephone, online or from some pharmacies.
A few people recalled occasionally forgetting to renew their prescription when they were running out of tablets, or had encountered difficulties collecting their repeat prescription from the pharmacy or health centre.
If there are concerns about the risk of self-harm doctors may only prescribe a small supply of tablets at a time. Thomas had overdosed on citalopram because he ‘just wanted to be knocked out’ for a time but in his case the impact from the SSRI overdose was minimal. He believed the doctor used weekly renewal of the prescription as a lever to make him attend appointments. Hannah took an overdose of mirtazapine ‘It’s really appealing to sleep for a long time when you’re feeling suicidal’. Sharon recalled when she’d felt really unwell keeping a supply of ‘left overs’ from a previous time she’d used antidepressants ‘Just in case it got too much so I had them there’. Sonia was asked to sign a ‘self-harm contract’ and her doctor said treatment would be withdrawn if she did not comply with it. Victoria is prescribed medicines for Crohn’s disease on a three monthly basis, but citalopram is provided on a monthly prescription because she has taken an overdose in the past. Although she’s used to taking medication, this can catch her out ‘I can be a bit ‘scatty... I’m not allowed the citalopram for longer than a month at a time so I keep forgetting I don’t have another box up in the cupboard’.
When a doctor first prescribes an antidepressant they usually start with a low dose and then if that is not effective increase it until they find what works for a particular person. The dose may change for a number of reasons, for example if the antidepressant isn’t working, or to help reduce side effects. Stuart now takes a ‘maintenance dose’ that keeps his mood relatively stable, but recalled ‘in the early days there was a lot of playing around with cutting tablets in half to get the right dose... taking that for six weeks and... see how you feel... and should we go up a bit, should we go down a bit’. When the dose is reduced sometimes the doctor will prescribe different strength tablets, or it may be possible to double up tablets if the dose has been increased. Where the dose had been reduced some people like Stuart had to cut up their tablets to get the dose they needed. Thomas described the difficulties he encountered doing this, and that it made him feel humiliated, ‘If you don’t have the right thing to cut up a pill you know, bits go flying or they crumble you start [thinking] oh I’ll have that half because it looks a bit bigger than the other half... or it will divide into sort of powder and you scoop up the powder and, I remember doing that once, and thinking this is like a scene off “Trainspotting”’.
Some people took their own decisions to alter their dose in an effort to manage their own symptoms, feeling that the lower the dose the better. Rachel had a ‘love hate relationship’ with antidepressants, knowing she needed them, but hating having to take them. ‘Last year I was only having 10 milligrams but my way of thinking was 10 milligrams psychologically I could cope with that’. Thomas tried to reduce the side effects he was getting ‘I would keep chopping and changing the doses myself, I wondered... if I changed the dose the side effect might be a bit different, but then they never seemed to be.’ Michael had sometimes taken extra tablets because he was desperate to feel better. ‘I’ve messed about with it a bit, taking extra, it was a cry of despair really let’s take something and see if it will do some good’.

Last reviewed June 2016.
​Last updated June 2016.


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