Anti-depressants
are not addictive, although see news stories on Venlafaxine.
Results
will not be seen straight away. Everyone is different
but it may take some weeks before you feel the full effect,
others may only partially respond.
In
cases where there is a partial response, your doctor
may increase the dose as there is a range for all anti-depressants
and you will rarely start on the highest dose.
Usually,
anti-depressants are initially prescribed by general
doctors. In some cases, whether non-response or the severity
of the depression, it may be necessary to refer you to
a psychiatrist, who has more specialised knowledge. This
is NOT because you are 'mad', this is because he has
expert knowledge of depression and the medications that
can help you. (*Treatment or assessments by a consultant
psychiatrist is sometimes needed when bringing a legal
case or if you think ill-health retirement may be an
option for you. This will be covered elsewhere in jfo)
You
may think that as soon as you feel better you can stop
taking the medication. Anti-depressants may need to be
taken for a period, usually six months, AFTER recovery
due to the higher risk of relapse on stopping your medication.
You should not rush to 'dump the drugs' or see this as
a negative thing - a relapse of depression is a real
risk once you have had it.
When
it is time to stop the medication, make sure that you
follow your doctors guidelines, which may include a period
of reducing the dose until you stop completely. Sudden
cessation can cause severe problems in some cases and
withdrawal may be an issue if not managed effectively.
Drugs
are not the only answer - but in some cases it is vital.
Psychological interventions can be effective and may
be the only treatment needed but in cases where you are
too low to function normally, medication is usually needed.
Choosing
a specific drug to help someone is a very inexact science
(at the moment!). The first medicine to try is often
decided on the grounds of its other effects rather than
its antidepressant properties. Each doctor has their
own preferences, through experience or knowledge so there
is no set method of prescribing anti-depressants. If
you do not respond or partially respond, other options
will be considered. The area of treatment resistant depression
will deal with this.
Is
it important to give drugs a fair chance. Taking them
intermittently or stopping taking them after a week if
you haven't seen any improvement will not give you the
full effect. Some drugs will show an effect after 2 weeks,
others longer. Some may need their dosage increasing,
others may need to continue as they are. It would be
fair to say that after 4 weeks of NO effect, your doctor
may consider changing your medication. After 4 weeks
of a partial effect, your doctor may consider changing
drugs, increasing the dose of the present one or combination
therapy. This is covered under treatment resistant depression.
All
drugs carry risks of side effects. Side effects can be
minimised by starting on lower doses and this is particularly
important in those patients with a known low tolerance,
such as some with CFS or older patients. Some anti-depressants
will be taken without any side effect being felt, others
may be mild and disappear after a couple of weeks.
If
a side effect is particularly severe, the choices are
to decrease the current dose, change to a different drug
or stop the medication. Any change or stopping of medication
should be managed properly so that there are no withdrawal
symptoms or interactions (eg changing from or to an MAOI).
Sometimes the impact of a side effect has to be weighed
against the benefit of the anti-depressant where there
is little alternative or the risk to life great.
