Treating depression: newer antidepressant medications

The main types of antidepressant medications used used to treat depression today are:

  • SSRIs – Selective serotonin reuptake inhibitors. Examples of commonly used SSRI antidepressants are Cipramil (citalopram), Prozac (fluoxetine), Seroxat (paroxetine) and sertraline (Lustral)
  • SNRIs – Serotonin-noradrenaline reuptake inhibitors, such as Efexor (venlafaxine), Cymbalta or Yentreve (duloxetine) and desvenlafaxine (Pristiq)
  • And older antidepressants, either TCAs -Tricyclic antidepressants and tricyclic-related drugs, or MAOIs – Monoamine oxidase inhibitors (see ‘Other medical treatments used for depression: TCAs, MAOIs, Lithium, ECT and other drugs’ for more information).

It is thought that antidepressants relieve depression by altering the way that chemicals (called neurotransmitters) work in our brains to transmit signals between cells. These days an SSRI is most often prescribed in the first instance, but which specific antidepressant is actually prescribed varies greatly. It is difficult to know how each individual will respond to any particular antidepressant, and it takes a number of weeks to know whether it will work. Some people need to try several before they find one that suits them. Some may find that an SSRI does not work for them, and so may be prescribed a different type of antidepressant.

Newer antidepressants are used to treat moderate to severe depressive illnesses as well as severe anxiety, panic attacks, chronic pain, obsessional thoughts, eating disorders and post-traumatic stress disorder.

Episodes of depression can occur alone (‘unipolar depression’) or with episodes of related mood swings (‘bipolar disorder’). This is an important distinction to make, as it may affect whether or not antidepressants are suitable, and whether other medication might be better. Antidepressants are usually used to treat unipolar depression, but, in bipolar disorder different medications may be used, such as mood stabilisers (e.g. lithium or valproate) and/or other medicines such as quetiapine and mirtazapine (see ‘Other medical treatments used for depression: TCAs, MAOIs, Lithium, ECT and other drugs’).

Compared with older antidepressants (e.g. TCAs) that were developed from the 1950s, newer drugs (SSRIs and SNRIs) tend to have fewer side effects and cause less harm in overdoses.

Benefits of SSRIs and SNRIs

The benefits of taking the newer antidepressants were rated from negligible to highly effective by the people we spoke to. While it usually took weeks for the effects of medication to work, some people were surprised that after feeling so bad that they could feel better even sooner. People were divided between those who felt antidepressants numbed, dulled or even made them into ‘functional zombies’, and those who felt medication made them feel normal, happy and ‘authentic’.

Said it took 7 weeks from starting fluoxetine (Prozac) to the time that her depression lifted in…

Age at interview 44

Gender Female

Age at diagnosis 41

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But I still… I was still waiting for this feeling of happiness I suppose to come in, and it didn’t. And then one morning, and it was exactly 7 weeks to the day that I took, you know, the first tablet. I woke up that morning and I just knew that inside myself that I felt different. I’m not, I don’t know that I could describe it, or have the language to describe it, I just know, I knew that morning when I woke up that I feel differently, things are different. And that was the turning point. So I think I’d started medication towards the end of May and this was into July.

It was this lifting again, this lifting of overall and just…. contentedness I think probably, this, it was, back there again, from I don’t now how long ago since I had felt that way. Whether it was a combination of that and the sleep that I just generally began to feel better. And, and physically more well. And happy again. You know, I think I began to laugh out loud again and, and that it was from inside, it wasn’t just a sort of superficial laugh, it was a sort of deep inside laughing.

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While improvements were long lasting for many, some people only had short-term improvement before the effects tailed off. Unfortunately, some people seemed unable to benefit from the medication altogether. Through trial and error though, it was clear that many who had not done so well on certain medications in the past could hit upon a drug or drug combination that really worked well. Psychiatrists were considered by some to have the best knowledge of antidepressants to assist in getting medication right. Some people had doctors who explained in detail the kinds of drugs available and their side effects, inviting the person to share in the decision-making about which drug to take. Those who had less than satisfactory experiences on the newer antidepressants sometimes complained to their doctors, and argued they needed to be tried on something different. One woman said she ‘refused to be on something that makes me feel indifferent,’ and kept demanding different drugs until she was put on Efexor (venlafaxine), which worked for her.

Says that Efexor was the best drug she had ever taken, with better effects and fewer side effects.

Age at interview 24

Gender Female

Age at diagnosis 14

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What’s it like, taking the Efexor?

What was it like, oh, it’s probably the best drug I’ve ever taken.

Why’s that?

Because I don’t feel like I’m out of control. I don’t feel like I’m not being myself. I feel, I.. [sighs] I suppose I feel a little bit more secure in myself. A little bit more in control of myself, more in’ I’m in more of a routine with it. So, you know my sleeping patterns are a lot better, than what they were.

I did get ill on it, I’ve never really been physically sick, but most anti-depressants I’ve taken have made me feel queasy for a couple of weeks. Efexor was a bit different, I felt sort of queasy, a lot less, I was given 75mg to start with. And when I moved to the hospital, they put me up to 150mg.

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However, Efexor (venlafaxine) does not work well for everybody and is associated with a greater risk of suicide than other antidepressants, together with small rises in blood pressure. For this reason it needs close monitoring, and can only be initiated by consultant psychiatrists in many parts of the NHS.

Side effects of SSRIs and SNRIs

The side effects from taking the newer antidepressant drugs ranged from very minor to severe. People reported that side effects could be more severe at the start of taking medication, but reduce and even disappear over time. People were inclined to forgive the side effects (e.g. inability to ejaculate, nausea, muscle ache) if the benefits outweighed the costs. Some people felt they were not adequately warned of potential side effects, such as one young woman who was sure her suicide attempt was triggered by Seroxat (paroxetine).

While the initial side effects of Efexor (venlafaxine) seemed severe, they settled down, and even…

Age at interview 27

Gender Female

Age at diagnosis 16

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When I first took them, it was really really horrible, and luckily I was temping, and doing a job that was quite easy, and I just had to sit there, and just sort of shuffle papers around. Because it was like being on’ on really strong drugs. You looked like you were on pills.

Because it made your pupils dilate. And I was shaking. And I would wake up in the middle of the night with a bolt of fright, and shaking and stuff. And I only persevered with it because I thought I’ve got to give this a go… And after about’I think you really had to make sure you ate a big meal too’Otherwise is messed up your stomach’ And after a few weeks it kind of calmed down’

I find that I probably do sweat more than I used to have done. And I also feel like I have put on weight that I can’t shift. And that does happen to people. But all things considered, I would rather put on weight than be depressed. I know that for some people, it doesn’t help them’And I feel that despite all the side-effects, and that I can’t get off them, that’s a scary thing.

But I would never regret taking them because taking them has totally changed my life…Taking them’I don’t feel that so much now’But when I first took them, I felt like I had been given my life back. I feel like I can now be a normal person.

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Found he could not ejaculate or have an orgasm on Seroxat (paroxetine), but the side effect was…

Age at interview 31

Gender Male

Age at diagnosis 17

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I’ve taken fluoxetine (Prozac), and Seroxat (paroxetine). With Seroxat the first thing I noticed was, [laughs] this is a bit embarrassing, but I couldn’t ejaculate It’s extraordinary, absolutely extraordinary, so you have no erection problems as such and you can have sex you know, but you just don’t come [laughs]. And it’s kind of a weird’

Is that a good or a bad thing?

Theres a question. You feel like a sort of porn star, you can go for hours you know [laughs]. On the whole I would say it was a bad thing, because you just think whoa, theres something fucked up in my body [laughs], this isn’t the way it was supposed to be. You actually get over it, that lasted about a month, about two or three months I think I can’t remember if you could, yeah because you’ you just can’t you just can’t ejaculate. I’m trying to remember if you can actually orgasm, I can’t remember, I’m not even sure you can actually, no you can’t’You know you can put up with not ejaculating in return for not wanting to die you know.

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Believes Seroxat contributed to her suicide attempt. With counselling and new medication…

Age at interview 20

Gender Female

Age at diagnosis 19

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Well, since I was very little I had occasionally had suicide fantasies. When I was little I used to imagine creeping out of the house at night up to the nearby railway tracks, and that was… that was in a way a comfort for me, because you know sometimes I would feel like my life was completely out of my control, and I didn’t have any options.

But then I would always think I did have another option, I could take my life into my own hands and you know sometimes, sometimes I would feel ignored or unloved, and then I could imagine how people would feel if I did kill myself, and you know, it would remind me that people did love me And for many years I hadn’t had any suicide thoughts at all, and I had certainly never thought of cutting myself, but while I was on Seroxat, I did start to get sudden images in my head of you know, cutting long gashes in myself, and just… just seeing the blood running everywhere and, you know, the feeling of compulsion to do it.

You know, feeling a need to see that, and I did used to get images coming in my head of lying in a blood- filled bath or jumping into a river or off a tall building. And those images would just sit in my head for a long time until they just melted away, and…sometimes they left me feeling a bit disturbed, but usually they didn’t cause any emotions in me.It was like… like my personality had been withdrawn and my rational mind had been overwhelmed, or insulated or cut off in some way and I was just purely running on immediate needs…

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Managing antidepressant use

For some people, the unpleasant effects of changing doses or discontinuing some of the newer antidepressants can be severe. Whilst antidepressants are not thought to be physically addictive, stopping medication abruptly (e.g. Seroxat (paroxetine), Efexor (venlafaxine) can result in disconcerting and even frightening and bizarre symptoms (e.g. volatile moods, electric shock sensations, nausea, lurching sensations in the head, intense stinging ant sensations under the skin). People who forgot to take their medication did not always immediately link such events to discontinuation symptoms, but then found that remembering and taking their medication made them feel better again. In order to avoid missing doses and unpleasant effects, people found ways to try and remember. One woman carried around a pill dose box to remind her when to take her medication. She also left some pills in her drawer at work in case she ran out of pills at work. Those who suffered withdrawal symptoms, and who wanted to reduce or stop their medication, learned they should withdraw from their medication very gradually. People also tried to reduce or stop their medication with the support of their doctor.

Stopping her Efexor resulted in a lurching sensation in her head, electric shock sensations in…

Age at interview 27

Gender Female

Age at diagnosis 16

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(Withdrawing from Efexor) basically, you start getting this really weird thing, like if you are feeling perhaps a bit sea sick. Like your motion has been a bit disturbed. So you sort of get this sickening lurch in your head. You can’t really describe it unless you have experienced it. It is horrible. It is not nice.

Well, the other one that I get is, it’s a kind of numb feeling, slightly like an electric shock as well. Sort of like a tingling sensation mainly in my hands but also sometimes on my nose as well. It sounds really funny, but sometimes the tip of nose goes really like, feels really funny.

I think after a while, like if that happens a bit, you know you can deal with it, but sometimes I’ve gone out, and I’ve forgotten my tablet or whatever, and it used to be that if I waited for the evening, I’d still be all right. But now, if I couldn’t have it [my tablet] until the evening, by that point I’d probably be like experiencing like severe motion sickness or whatever, just like proper lurches in my head. And after a while, like after a bit longer, you start feeling a bit kind of like crying and stuff, just really kind of emotional and like a bit teary basically.

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Stopping Efexor resulted in nausea, depression and panic. (Played by an actor)

Age at interview 39

Gender Female

Age at diagnosis 36

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Ooh dear, bad news. Being stupidly pig-headed, just stopped it (Efexor) at 300mg and stopped it and that was the, I thought I was going to go mad.

What happened?

I was just completely off my head with depression. I was down in a pit of despair and really quite unstable. And I thought, “What you are doing to yourself, [interviewee name]?” So I just, and I got back on it. And the reason why I know those feelings are really bad is because if I’ if I forgot to put my prescription in, and I would go about a day to 2 days without it, the symptoms would start. About 48 hours of. after stopping the tablet, if I missed a dose, and the and the symptoms were so acute it was very frightening. You feel sick, nausea, the nausea was awful. And just panic, really.

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Felt numbed by Lustral (sertraline) and stopped taking her tablets, but suffered strange…

Age at interview 40

Gender Female

Age at diagnosis 37

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You stopped taking your Lustral, you were angry?

[laughs] Yes, I was remarkably angry, distressed, frustrated. I was very angry with the therapist for being off sick, and I thought, no, I’m not feeling anything. I thought these tablets are stopping me feeling things, I’m just being passive, and I’m coping. So I thought, no, I’m going to stop taking them, and I stopped taking them for a week. And by the end of the week I realised it was a really, really bad idea. You get the fuzzy head. Yeah, I had a week of withdrawal.

And well when you experience those they’re the strangest things ever. When you make a movement, a muscle movement, you get this incredible, uh… it’s not a tingling, you get this incredible buzz in your head. Which is quite bizarre, and that’s the first time I’d really experienced them, so I wasn’t very happy with the physical side effects.

So after a week I thought, ‘That was a really silly idea, I’d better go back on them’, but of course, after even a week the damage is done, because then you’ve got to build back up to the level you were at. So it took me, that probably set me back about five or six months.

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She had to experience not taking her Prozac to understand that it works for her, and she now…

Age at interview 63

Gender Female

Age at diagnosis 30

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But they (Prozac) are working for me and I will keep going with them. She says I can’t get addicted to them and I don’t feel I’m addicted. I had to have the experience of not having them to know that I can’t be without them and that was, in a way, a good thing that we forgot to take them with us because it tells me don’t ever forget to take them again, which I don’t. The first thing I do in the morning is take my tablet.

So as I say, I think that is the one. It is the tablet for me. I feel better on these than I ever felt when I was on Librium, Valium, Amatryptiline. I’ve had so many different antidepressants over the years that this is definitely the one that makes me feel calm all day, and I don’t feel docile like I used to. I used to get zombified sometimes but I don’t on these.

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Tried stopping venlafaxine (Efexor) and suffered unpleasant withdrawal symptoms, and so slowly…

Age at interview 33

Gender Male

Age at diagnosis 24

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Oh well let’s try stopping the venlafaxine and see what happens, which actually turned out to be extremely, extremely difficult. Again the, the ants under the skin. Really terrible nausea and also sort of perceptual problems that – sort of feeling everything is too far away or it’s too close and feeling off balance.

So I had to go back onto 75mg and then try taking it one pill every other day and then one pill, leaving it as long as I could until the withdrawal symptoms became unbearable and taking another pill and they would go away. And eventually I could kind of get to about one pill every two and a half days.

Really terrible nausea and also motion sickness that I haven’t taken a pill the day before. I’m driving in the car really making me quite nauseous. And then eventually I started to take, you know, I’d take a pill and when the withdrawal symptoms got too bad, I broke it open and I would take half a pill and then again leave it for as long as possible and then take another half pill and eventually I weaned myself off That took a long time.

It took about eight weeks and it was very unpleasant and so there was part of that you know, I started looking on the internet for other people who had effects of withdrawal symptoms’ and actually a lot of people have had effects of withdrawal symptoms and a lot of people are quite pissed off with the makers for not really saying what the withdrawal is like. But you know I got through it.

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For more information on antidepressants see our antidepressants section.

Other medical treatments for depression

The older antidepressants medication tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are effective against certain kinds of depression, and are still sometimes prescribed if...