Antidepressants

Because everyone reacts differently to an antidepressant, there are no certainties and the extent to which people expect or hope the medicine will ‘work’ varies widely. Emma felt optimistic when she started taking an antidepressant ‘ it just takes a lot of weight lifted off your shoulders that you’re starting medication and that you’re starting on the road to get better’.
 
As Stuart pointed out, ‘You can’t tell until you’ve started taking the drugs what they’re going to do for you.’ Many of the people we interviewed were uncertain about how long it might take to begin to take effect, how far it might help, and about what to expect in the first few weeks. They were concerned that it could make them feel worse rather than better, and how long they would need to take an antidepressant for. For some people, finding out more about antidepressants helped ease their concerns but hearing about bad experiences with anti-depressants could be alarming and off-putting.
 
Where people felt they hadn’t been told enough about what to expect, the uncertainty could be unsettling. Some were frustrated that there were no hard and fast rules, or that the evidence about the effectiveness of antidepressants was vague or ambiguous. Negative thinking and feelings of hopelessness can stop people from believing that they will ever recover, or that anything will help.

Clare’s doctor told her it could take up to six weeks before she might feel positive benefits from the antidepressant he prescribed. After that time, she thought she noticed an effect, but wasn’t sure whether it was the medicine itself, or a ‘self-fulfilling prophecy… you kind of look at the calendar and you go right... so it’s going to be 1^st October, smashing... but I did feel better and more able to cope with life’s ups and downs’. Greg felt it was important that once you started taking an antidepressant, you should have some belief or expectation that it could be of benefit.
 
‘Getting better’ means different things to different people, and people aim for different levels of recovery. People often say that taking an antidepressant gives them a feeling of hope that it will ‘work’ and that they could begin to ‘feel better’ but it can be difficult to predict and is different for each person.

Jenny had high hopes initially ‘I sort of expected to feel ‘happy’ because the media were dubbing antidepressants as ‘happy pills’. In hindsight she says they don’t stop her from feeling ‘down’ but they prevent her from ‘getting stuck down there’.

For Stuart ‘they gave a bit of hope.... taking the drugs was part of the relief, the hope that I could now feel better because the drugs might work’ but he saw them more as a ‘straw to clutch at’ and had no clear expectations ‘they might work, they might not’. An antidepressant had worked well for Stephen’s father helping him to recover from his depression, so when Stephen was first prescribed one he saw it as a way of ‘fixing things… I thought at the time she’ll give me some tablets for a few months, six months or whatever... and I’ll get better and stop taking the tablets’.

Sharon hoped an antidepressant would ‘get me out of the dip and pick me up a little bit’. Emily ‘wanted to come out of there [the GP surgery] with ‘something that would do something straight away, I literally felt I can’t go home and have another night of feeling like this’. Melanie’s doctor told her ‘they would calm me down, they would just make me feel a little bit more in control of things… they would reduce my anxiety and my stress levels’.
 
Whilst it can be tempting to hope for a ‘quick fix’, and people expected an antidepressant to improve the way they were feeling, they also stressed that it was important to see it as just one aspect of the ‘road to recovery’ rather than a solution in itself. They emphasised the importance of dealing with problems, learning to understand yourself better and finding other ways to cope, for example through therapy or other lifestyle changes. As Greg pointed out ‘I was thinking ‘oh I’ll just take these pills and I’ll be better, but that doesn’t obviously solve deep rooted issues that I may have...’ Some were frustrated by long waiting lists for therapy or counselling and felt that an antidepressant was the only thing their GP could offer in the short term. (See ‘Talking therapies and antidepressants’, ‘Antidepressants: the GP’ and ‘Being prescribed an antidepressant’). 
It is thought that antidepressants work by increasing the activity of certain chemicals (Serotonin and Noradrenaline) in the brain called neurotransmitters which pass signals from one brain cell to another. People’s underlying beliefs about the causes of depression can influence their expectations about the extent to which taking an antidepressant might help them. Some found the explanation that an antidepressant replaces missing chemicals in the brain convincing, and were inclined to expected that it should alleviate their symptoms. When Sharon was first prescribed an antidepressant she believed that it would help because her doctor had explained that depression can be caused by a chemical imbalance. ‘`Initially I thought, 'Oh it's chemical imbalance, it's not my fault, the pills will help, I'll get better and then I'll be OK’. But many people said that whilst that may be true it was also important to recognise depression as a complex condition and that although an antidepressant could help, it was unhelpful to place all your expectations on it. Gerry likened it to ‘getting a heart operation but not doing anything about changing your lifestyle, what’s the point?’
Where people have taken an antidepressant in the past, or tried several different types, their expectations are influenced by their previous experiences. They may feel more optimistic if a particular antidepressant has helped them in the past. However, people who had taken antidepressants before and not experienced benefits, or had a difficult experience with them, sometimes said they had few or even no expectations that anything would ‘work’. Those who had experienced several bouts of depression could feel that going back on to antidepressants felt like a setback, especially if they had expected to be ‘cured’ by the previous treatment. Peter said it felt hard to go back to the doctor for an antidepressant. ‘You sort of feel as if it should be ‘sorted’ and as if you’re taking this antidepressant and it should be fine... and I wasn’t and it took me a long time to admit that things weren’t going ok. Going back felt like a bit of a failure it felt like a setback’.  
Whilst some people saw taking an antidepressant as a temporary measure that they would feel well enough to stop taking it at some point, others resigned themselves to the possibility that they may need to take antidepressants on an on-going basis as a means of keeping their mood more stable, or as a preventive measure.
 
(See also ‘Reviewing antidepressant use’, ‘Feelings about using medication for depression’ and ‘Managing the use of antidepressants’).

Last reviewed June 2016.
​Last updated June 2016.