How long should I take antidepressants?
When you start a new antidepressant, the first step is to decide whether you can tolerate the side-effects; this should become clear within a few weeks. The next step is to decide whether the drug helps with your depression or anxiety; for this, you will need to take it at full dose for at least six weeks.
If the medication does work for you, your doctor will advise you to continue taking it for at least six months after you start to feel its beneficial effects. People who stop taking antidepressants too soon risk having the symptoms of their depression or anxiety problem return. Most people who take antidepressants need to take them for at least a year. People who experience depression that keeps coming back may need to take them for a longer term.
Are antidepressants addictive?
Drugs that are addictive produce a feeling of euphoria, a strong desire to continue using the drug, and a need to increase the amount used to achieve the same effect. Antidepressants do not have these effects.
Antidepressants do, however, have one thing in common with some addictive drugs—they can cause withdrawal effects when you stop taking them. When you take antidepressants for months or years, your body adjusts to the presence of the drug. If you then stop using it, especially if you stop suddenly, you may experience withdrawal effects such as muscle aches, electric-shock-like sensations, dizziness, headache, nausea, chills and diarrhea. These effects are most commonly reported with paroxetine (Paxil) and venlafaxine (Effexor); however, they can occur with any antidepressant. Some people find these effects distressing and have difficulty withdrawing from these drugs.
How do I cut down or stop taking antidepressants?
Whether you want to cut down your dose or stop taking a medication, the same rule applies: go slowly. Sudden changes in your dose can greatly increase your risk of having another mood episode.
The first step is to ask yourself if this is the right time. Are you feeling well? Is the level of stress in your life manageable? Do you feel supported by your family and friends?
If you think you’re ready, talk to your doctor. If your doctor doesn’t agree, find out why. If you are not satisfied with his or her reasons, you may want to see another doctor for a second opinion.
If your doctor does agree, he or she will advise you not to skip doses but to reduce your dose gradually—usually by about 10 per cent at a time—with at least two to three weeks between each reduction. This process of cutting back will take several months. Using a pill cutter can help you to cut your dose down in small amounts.
If you want to stop taking more than one medication, your doctor will usually suggest that you lower the dose of one drug at a time.
As you cut down, if you start to feel unwell, let your doctor know. He or she can help you determine whether you are experiencing withdrawal effects or signs that symptoms are returning. Don’t be afraid to go back up with your dose. Find the dose that works best for you.
Will antidepressants interact with other medications?
Antidepressants may interact with some other types of medication, even over-the-counter medications, such as cold or allergy tablets or cough syrups, and some herbal remedies, such as St. John’s wort. Always ask your doctor, dentist or pharmacist about potential drug interactions with the medication you are taking before you take other medications.
What if I drink alcohol or coffee while taking antidepressants?
Drinking alcohol can worsen symptoms of depression or anxiety. Alcohol can also worsen some side-effects of antidepressants, making you more sleepy, dizzy and lightheaded. However, if you have been taking antidepressants for more than a few weeks, and you are feeling well, having a drink or two on occasion should be okay—but remember that one drink could have the effect of two or even three drinks.
The caffeine in coffee and other beverages can cause problems if you struggle with depression or anxiety. Depression disrupts sleep and caffeine, a stimulant, can make the problem worse. It is better to drink decaffeinated coffee and beverages or to decrease the amount you drink.
What if I use street drugs while taking antidepressants?
If you’re taking antidepressants, chances are you’re trying to get relief from symptoms of depression or anxiety. You want to feel well. While street drugs such as marijuana or cocaine may have some effects that seem to make you feel better for a while, mixing the effects of these drugs with your symptoms may make your situation worse. Street drugs may also interact with your medication, for example, by interfering with its effectiveness or by worsening side-effects.
Will antidepressants affect my ability to drive safely?
Depression itself can lead to fatigue and concentration problems, affecting your ability to drive. Antidepressant medications may also cause drowsiness, especially in the early stages of treatment, before your body has adjusted to the medication. If you feel drowsy, do not drive a car or operate machinery. Alcohol, sedatives and antihistamines (cold and hay fever medication) will worsen the problem. It’s never wise to drive after drinking alcohol, and it’s even more important to follow this rule when taking antidepressants.
Will antidepressants affect my sex drive and function?
Both depression and the drugs used to treat it can decrease people’s desire for sex. Antidepressants, especially those that increase serotonin activity, can also negatively affect sexual function. Sexual side-effects of antidepressants can include delayed ejaculation and the inability to experience an orgasm.
Many factors affect your sexuality. When antidepressants bring relief from the distress of depression or anxiety, this may help you to focus more on your partner and to feel more desire. If you think your medication affects your sexual function, your doctor may be able to help by changing your dose, switching medication or adding other medications.
Is it safe to take antidepressants while pregnant or breastfeeding?
Each woman’s situation is unique and should be discussed with her doctor. For any pregnant woman with a history of depression, the question of whether to take antidepressants during pregnancy usually comes down to a risk-benefit analysis. Depression can affect prenatal care and a mother’s ability to parent her newborn child. When treatment with an antidepressant helps to avoid a relapse or to reduce distress, the benefits of continuing the medication may outweigh the risks.
Antidepressants are relatively safe to use during pregnancy. When they are used close to delivery, newborns may be restless and irritable, and may have sleeping, feeding and breathing difficulties. These problems resolve within three days to two weeks. Antidepressants do not increase risk for birth defects.
The amount of antidepressant passed through breast milk is very small and is not considered to be a risk to the baby, especially when weighed against the benefits of breastfeeding.
If you decide to stop taking medications during pregnancy or while breastfeeding, it is a good idea to see your doctor more often, to help you monitor for a return of symptoms.
Is age an issue when taking antidepressants?
The effectiveness and risks of an antidepressant can vary depending on the age of the person taking it.
Children, teens and antidepressants
Most antidepressants are not officially approved for use by children and teens. The first line of treatment with this age group should always focus on resolving issues in the young person’s life and on counselling. However, when distress is so severe that non-drug approaches are not possible, or when they do not work, antidepressants may be considered. Studies of children and youth who take antidepressants suggest an increased risk of suicidal thoughts and behaviour, but not death by suicide.
Older adults and antidepressants
Antidepressants are an effective treatment for depression in adults over 65 and are known to decrease the risk of suicide in this population. However, due to the increased sensitivity of the older body, older adults are more vulnerable to side-effects. As older adults often take multiple medications, they are also more vulnerable to drug interactions.
Copyright @2009, 2012 Centre for Addiction and Mental Health