Antidepressants

Some of the people we interviewed had been prescribed other medicines alongside an antidepressant, or in place of one. These included sleeping tablets, medicines to alleviate anxiety, antipsychotics, and mood stabilisers.
 
Sleeping tablets

It can be difficult to know sometimes whether difficulty sleeping is a side effect of antidepressant medicines, or a symptom of depression. Caroline’s depression is triggered ‘by not being able to sleep properly therefore not being able to cope very well’ while Sonia attributed her insomnia to the effects of fluoxetine.
 
Sleeping tablets (hypnotics) may sometimes be prescribed to help ease short-term insomnia. Doctors are cautious about prescribing sleeping tablets. They only help to initiate sleep and don't treat the cause of insomnia. People diagnosed with depression who are experiencing problems with sleep may be given an antidepressant which has drowsiness or sleepiness as a side effect but sometimes doctors may prescribe sleeping tablets for a short time to help establish a sleep routine. Doctors guidelines recommend prescribing the smallest effective dose possible for the shortest length of time necessary (for no longer than a week). In some cases, the GP may advise only taking the medicine two or three nights a week, rather than every night. Sleeping tablets can cause side effects such as feeling ‘hungover’ or drowsiness during the day (see 'Telling the difference between depression symptoms and antidepressant side effects').
 
There are two main groups of sleeping medicines, Benzodiazepines which include temazepam and loprazolam, and non- benzodiazepine hypnotics (also commonly known as Z drugs) which include zopliclone, zolpidem and zaleplon. However there is no firm evidence of differences in their effects and all three Z-drugs carry warnings about their potential to cause tolerance, dependence and withdrawal symptoms.
 
Some older people said they had been prescribed sleeping tablets over prolonged periods in the past. John who is now in his 80’s took a benzodiazepine medicine (Mogadon) for many years and he said they were prescribed freely when he was younger. Michael is in his 70’s and has taken antidepressants for a most of his adult life. Sometimes he has had trouble sleeping, but he avoids taking sleeping pills because he knows how addictive they can be. ‘I won’t take a sleeping tablet because next thing I’ll get hooked on them’.
 
When Dina first went to see a doctor some years ago complaining of insomnia her doctor prescribed sleeping tablets but looking back she thinks it was a symptom of depression. ‘I realised later on the, the sleep disturbance is part of [depression] it is interesting though, I don’t remember her going through and asking other questions to look at the whole picture’.
 
People who were prescribed sleeping tablets more recently had usually only taken them for short periods, or occasionally when needed. Hannah was prescribed zopiclone for a short while whilst she was in hospital but after a couple of weeks was put on an antidepressant that had a sedative effect instead. Olivia Y took temazapam for a few weeks when a relationship broke down and she couldn’t sleep. Most people we spoke to were aware that it is easy to become dependent on sleeping tablets and said their doctors were cautious about prescribing them. Usually doctors will only prescribe a small supply at one time. Thomas’s doctor prescribed zopiclone but due to an error it went on a repeat prescription, and Thomas took them regularly for a period of time. ‘They’re quite addictive. They build up a dependency and I’d gone through quite a rough withdrawal period. The withdrawal effects from zopiclone are terrible. There are people who are on them for years and years and years because GP’s don’t dare to take them off them’. Caroline was unhappy about taking sleeping tablets before she was prescribed one of the newer types. She did a lot of research on the internet to find out more about them. ‘Before I found these short acting ones… if I took one I would feel drowsy in the morning’. 

Medicines for anxiety

Some benzodiazepines (including diazepam and lorazepam) can help ease the symptoms of anxiety but are only recommended for short term relief when someone is experiencing extreme distress. Although they can help with symptoms of anxiety, they should not be used for longer. This is because they can become addictive if used for longer than four weeks. After even this short time the body can become dependent on them and larger and larger doses may be needed to achieve the same effect. For these reasons, they are usually only prescribed to help people cope during a particularly severe period of anxiety. Benzodiazepines can cause side effects, including confusion, loss of balance, memory loss, drowsiness and light-headedness.
 
In the past people were often prescribed these medicines routinely before more was known about their addictive qualities. Older people we spoke to recalled being routinely prescribed Valium for long periods of time. John recalled taking it for some years before he realised that he had become dependent. ‘I stopped that medication altogether, it was, it was alright but I was beginning to feel that there wasn’t something right, you know, had I been taking too many tablets for too long a period?’ The withdrawal after long use must be planned carefully with the doctor as there are severe effects when these drugs are stopped the dose must be reduced slowly every 7-14 days, so the overall reduction can take many months. 
A few people we talked to had been prescribed benzodiazepines, usually diazepam, for short periods to cope with symptoms of anxiety, but on the whole people with these symptoms are more likely to be prescribed an antidepressant that that is known to help alleviate anxiety. Lucy Y’s depression was characterised by symptoms of anxiety, but she felt her antidepressant worked well to suppress those feelings. ‘It’s never been so bad that I’ve needed that... even so, if, even if the anxiety kicks and I started to have panic attack usually the antidepressants I’ve taken have sort of calmed that down quite considerably. What she [doctor] tends to prescribe when there’s a significant component of anxiety is citalopram... I was getting very, very anxious the last couple of weeks so she prescribed that and it’s been good’. In some patients, particularly with panic disorders, the anxiety may increase at the start of treatment with an SSRI but this should subside within the first two weeks. Taking a half dose initially may make it less likely to happen.
 
Antipsychotic medicines 

Antipsychotic medicines, also known as neuroleptics, may sometimes be prescribed in addition to, or instead of an antidepressant depending on the symptoms. They are not suitable or effective for everyone as side effects can affect people differently. Often people who are prescribed antipsychotic medicines have a complex medical history and may also have been diagnosed with other problems such as bipolar disorder, acute episodes of mania, hypomania, psychosis, or personality disorder. Antipsychotic medicines include risperidone, quetiapine and olanzapine. 
When Max was admitted to hospital after a breakdown he believes he was given an antipsychotic ‘to help calm me down’ but he didn’t know which one. Michael was prescribed risperidone when he experienced paranoia. Sonia has a complex medical history of severe depression, including eating disorders and self-harming. She takes fluoxetine and mirtazipine to help keep her mood stable, but her psychiatrist has also prescribed quetiapine, ‘to minimise my impulsive behaviour in terms of self-harm and to keep me calm’. Dina believed that olanzapine had interfered with her menstrual cycle. She feels doctors don’t give enough information about the medicines they prescribe. Janet felt that olanzapine left her feeling ‘zapped’ and although she didn’t want to take it, worried that without it she would feel even worse. ‘Do I take the olanzapine or do I not take it and feel frightened? Because the fear that I used to feel was terrible, I used to be frightened of the garden and the tree... I may grumble about not feeling very bright and alert but I know that really they probably do me more good and I would be worse if I didn’t have them, if I came off the olanzapine I would probably be terrified again of everything so I think they are a good thing.’ Olivia X had been sectioned when she refused to take medicines a psychiatrist recommended, and eventually was prescribed Seroquel (quetiapine). This was necessary to satisfy a judge that she was stable enough to regain custody of her children who had been removed from her care whilst she was in hospital.
 
(More information can be found in our ‘Experiences of psychosis’ section).
 
Mood stabilisers

Lithium may sometimes be prescribed as a mood stabilising medicine when a person has been diagnosed with bipolar disorder. People with bipolar disorder have a chemical disturbance in the brain which causes alternate periods of very high and very low mood, over periods of weeks or months. Sometimes these mood swings go in only one direction - either high or low - and this is called "unipolar disorder". Lithium can help some people who experience serious downward swings into depression, whether or not these lows are followed by highs. It is usually prescribed for a minimum of six months but people often need to continue taking it on a long term basis. The dose needs to be closely monitored to help prevent side effects, such as diarrhoea and vomiting. People taking lithium should have regular blood tests (at least once every three months) to check that levels of lithium are not too high or too low. Kidney and thyroid function will also need to be checked regularly. Janet had problems with increased calcium levels and is now monitored closely ‘If it goes, my calcium level goes up to three, that’s the dangerous area, I’m alright as long as my calcium’s below three’. Although she expects to continue taking lithium, she thinks if her calcium levels change her doctor may need to prescribe an alternative.
 
Dina had tried many different combinations of antidepressant and other medicines over several years but never found anything helped her to feel better until she began taking lithium. ‘The first time that I sensed any difference from a medication was when I started lithium’. Janet said it helped stabilise her mood but ‘you don’t really feel anything it’s just that it stops you going high... I felt that it masked things, you know, the edge was taken off, all the edges. I did feel that it took away... it masks your emotions but you don’t actually feel anything other than that’. 
Some people had strong feelings against taking lithium, because they believed it was ‘dangerous’ or ‘toxic’. Sonia said her doctor wanted her to take it but she refused. When Janet’s doctor first suggested it she said she’d prefer the option of an antidepressant. Michael rarely questioned the medicines he was prescribed but had not liked the side effects he got from taking lithium ‘I always believe, if they tell me to do something I’ll do it, the only one I’ve objected to is lithium’. 
Olivia X (below) had been taken to see a psychiatrist when her mood became erratic and her parents were worried about her. The psychiatrist diagnosed bipolar disorder and wanted her to take lithium, but she disagreed and refused to take it. She was unhappy with the way the psychiatrist had spent so little time with her before suggesting such a powerful drug. 
Over-the-counter remedies 

Herbal remedies such as St John’s wort are not prescribed by doctors, but can be bought over the counter. They may help relieve low mood and anxiety. However, these remedies may not be suitable for everyone, and some people should not take them. In particular they should not be taken alongside an antidepressant and many other medicines, such as those for HIV, epilepsy, bipolar disorder and oral contraceptives. This is because it affects the liver. It’s very important to check with the doctor or pharmacist before taking any herbal or over the counter remedies if you take other medicines. Emma had heard about St John’s wort but hadn’t taken it. ‘I have considered it but because I was on medication the St John’s Wort would react with it so you can’t... I just sort of stuck to what the doctor has prescribed’. Janet had tried Evening Primrose Oil in the past but was sceptical about herbal remedies. ‘I don’t have a lot of faith in these natural remedies, they’re not strong enough for some people, they’re alright for some people’. Thomas takes a sedating antihistamine to help with insomnia. 
Olivia Y (below) stopped taking citalopram and now takes a supplement that she buys in the health store, called 5HTP (hydroxytryptophan). It is an amino acid that occurs naturally in the body, and is thought to help alleviate symptoms of depression and anxiety, although more evidence on safety and effectiveness is needed before any strong conclusions can be made. It may cause side effects such as dizziness, nausea and diarrhoea. 
(See also ‘Antidepressant use and hospital care’ and our sections on ‘Experiences of psychosis’ and ‘Depression’).

Last reviewed June 2016.
​Last updated June 2016.