Antidepressants

Doctors need to be aware of all the medicines a person is taking so that he or she can check that they can be taken together without any adverse (bad) effects. The pharmacist may also review how people take the medicines they are prescribed, particularly if they take several different types, and offer advice and support. Screening for depression is a routine part of managing long-term conditions such as diabetes, so many people take other medicines as well as an antidepressant.
 
We talked to people who were also taking medicines for arthritis, high blood pressure, high cholesterol, a neurological disorder, stomach problems, heart problems, fibromyalgia, thyroid problems, acute asthma, and Crohn’s disease.
 
People who have to take several different medicines each day find it helps to get into a routine so that they remember to take everything. Some count out each day’s medicines in advance, or use a pill organiser with the days of the week marked on it. Stephen takes several tablets each day ‘I had this little pill box with Monday to Friday because I’m also on tablets for blood pressure ... and there’s a statin which I take in the evenings as well.’ When people have become accustomed to taking several different medicines it often becomes routine to take them each day. Victoria was diagnosed with Crohn’s disease a few years ago and is now used to taking a number of tablets every day. Jenny has acute asthma and takes nineteen different tablets each day. Without them she would become very unwell so she knows it’s in her interest to remember them all. (See ‘Reviewing antidepressant use’, ‘Managing the use of antidepressants’ and ‘The Pharmacist’). 

Sometimes people who have been diagnosed with depression may also be prescribed sleeping tablets to help with insomnia, or they may be prescribed a particular antidepressant that has a sedative effect. Rachel takes Montelukast to help with urticaria (allergies) which she takes at night time as it can cause drowsiness, so may help with her sleep problems. Sharon was prescribed a medicine for acne which on rare occasions heightens depressive feelings, so her doctor increased the dose of her antidepressant when he prescribed it. ‘I had to start on Roaccutane, for acne ….so the fluoxetine was upped in anticipation of a dip and it worked, it worked quite well - we managed to sort of keep it on an even keel’. Peter has to take several different medicines each day to cope with ulcerative colitis, a condition that causes bowel and digestive problems. He now takes several tablets each day including his antidepressant and says he feels resentful about having to take so many pills.
 
It can be frustrating to have to take a medicine to help counteract the side effects from another one. Janet has osteoporosis and a problem with her parathyroid gland (possibly caused by taking lithium) so has to take other medicines to help regulate the levels of calcium in her body. 
Antidepressants are sometimes prescribed to help someone cope with the difficulties posed by physical health problems. Catherine takes what she describes as ‘a cocktail of medication’ for her fibromyalgia (chronic pain). Similarly, Jenny, who has acute asthma and a number of other serious health conditions, feels that taking an antidepressant helps her cope with being so unwell. Dina has Crohn’s disease and was originally prescribed steroids, but since she started taking antidepressants the steroids have had to be replaced by other medicines. ‘Because steroids can sort of exacerbate psychotic sort of tendencies or whatever you want to call that I wasn’t able to take steroids’.
The doctor and pharmacist should ensure that the antidepressant you are taking does not interact adversely (badley) with other medicines prescribed. Reviewing medicines on a regular basis is good practice. Sometimes though, people said this had been overlooked, especially when the antidepressant had been prescribed on a long term basis with regular repeat prescriptions. Jenny, who took numerous medicines, preferred to keep her own record and check drug interactions in her own copy of the BNF (British National Formulary).
 
When people were admitted to hospital some people said they would take in their own supplies of the antidepressant they were taking although other medicines were started on the ward. Some felt satisfied that the specialists they saw about their physical health conditions worked together with their GP and that there had been good communication between the two. Emma has a neurological condition and sees both a consultant at the hospital as well as her GP about different aspects of her health and is confident that they each know what the other is doing. ‘They know that I take the (oral contraceptive) pill... the medication that I take for my neurological disorder reacts with certain types of pill so my GP makes sure that that works out and then some of the antidepressants react with my brain drugs so they have to make sure they don’t interfere so there’s a lot of communication, I have to say I’ve got a really good medical team there’. Others felt that there was a lack of ‘joined up care’ and that it would be helpful if health practitioners were to take a more holistic approach. Victoria said that although the specialists she sees about Crohn’s disease know she takes an antidepressant, it would be helpful if they asked her more about how it was affecting her emotionally. ‘I think because it’s all ‘me’ so all my problems kind of link into one, because obviously they’re going on in the same body it might be nice if they kind of spoke to each other and kind of cross referenced things.’ Thomas commented that ‘you can find that the prescribing for your psychiatric medications can be very different to the prescribing for your physical conditions’ and that doctors can have different attitudes to prescribing medicines to deal with these distinctly different types of conditions. 


Last reviewed June 2016.
​Last updated June 2016.