Antidepressants

Using an antidepressant -SSRIs (Selective Serotonin Reuptake Inhibitor)

SSRI (Selective Serotonin Reuptake Inhibitor) are currently the most widely prescribed type of antidepressants. They are usually prescribed first over other antidepressants as side effects may be better tolerated than the older antidepressant medicines, and they cause less harm in overdose. It is thought that they relieve depression by altering the way that chemicals (called neurotransmitters) work in our brains to transmit signals between cells. SSRI’s are typically used to treat moderate to severe depression. It is difficult to know how a person will respond to any particular medicine, and it usually takes a number of weeks to know whether it works. Some people need to try several before they find one that suits them. Some may find that SSRI s don’t work for them, and may be prescribed a different type of antidepressant.

The most commonly prescribed SSRIs are:

citalopram (Cipramil)
fluoxetine (Prozac)
paroxetine (Seroxat)
sertraline (Lustral)

As with all medicines, antidepressants can be known by different names (the trade name or the generic name). People we spoke to referred to both, or either, at different times. Some did not realise for example, that when they had been prescribed fluoxetine, it was Prozac.

(For information on other types of antidepressants see 'Using an antidepressant - tricyclics and Using an antidepressant - SNRIs, Mirtazapine & MAOIs').

The majority of the people we interviewed had taken an SSRI at some point. Some had tried more than one, or several at different times. They described a wide range of effects ranging from positive to negative. At one end of the spectrum some said they felt ‘fantastic’, ‘consistently happy’, or ‘back to normal’ when they were taking an SSRI. Caroline described how paroxetine (Seroxat) worked for her, "suddenly it was like, just like having somebody sort of taking charge of you lifting you up". She explained that she still feels down sometimes even on an antidepressant but said "I’ve certainly had dips but I think I’ve always managed to get over them I’ve never, I’ve never got in that downward spiral."

Peter said fluoxetine levelled out’ his emotions and helped him...

View full profile

Age at interview: 28

Sex: Male

Age at diagnosis: 22

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

When you first went on the fluoxetine, the first time did it take a while to take effect did you find? Or were you told what to expect?

I think, I’m trying to remember to be honest I think it did take a little while to kick in certainly at least a week or maybe a couple of weeks before I felt it but yes I seem to remember it kicking in but, you know, in terms of what fluoxetine did for me it in no way comparable to what Vensir did for me I mean that sort of just changed my life.

So what fluoxetine did for you in terms of your mood how would you describe that then?

I’d describe it as reducing your emotional range I, if you …..on a plus/minus graph when I was really bad I could, I mean the pluses were never really an issue I could be five or six out of ten or seven or eight out of ten, it didn’t really matter and I never really worried about that too much. What was very tough was when you were in the minuses and I could feel a minus 10 and I went through a long period of feeling minus 10 and thinking even when things were going my way that I wasn’t, you know, having a happy day, basically having a happy time. And so I found with fluoxetine what it did was just reduce the emotional range a bit, the happiness thing didn't really wasn’t really affected hugely although I did find a little bit that I wasn’t amazingly unbelievably happy or incredibly enthusiastic about things which I was quite worried about at one stage but I found it didn’t go down to the minus 10 it only ever went down to the sort of minus three or four.

Kept you on a level.

Kept me on a level, kept me kind of coping with life a bit better, yes.

Caroline has had several episodes of depression and found SSRI...

Text only

Read below

Caroline has had several episodes of depression and found SSRI...

View full profile

Age at interview: 60

Sex: Female

See full profile

HIDE TEXT

PRINT TRANSCRIPT

I was going back to the same GP all the time, he said right I’m going to put you on maintenance and it’s worked really well… again I felt really, really sick for a few weeks, I felt but that just wore off and I’ve taken it ever since then and I’ve not had any attacks of depression since then I’ve felt and I feel perfectly normal.

On citalopram I just feel normal. And I, I mean considering what’s happened between, since 2004 yes I’ve been under quite from time to time various stresses and strains but I felt and there have certainly been a couple of times when I’ve had… oh various things… and I thought well….. despite the citalopram I think I’ll be going under now but I haven’t and I’ve been able, it’s kept me a much more stabilised I think so I feel very grateful to it. It’s been a really good experience taking depressant treatments and the only side effect that I’ve had is just the first couple of weeks you feel a bit sick but that wears off.

Stephen said it was difficult to pinpoint...

View full profile

Age at interview: 48

Sex: Male

Age at diagnosis: 44

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

I’m not sure I actually did realise, there was at no point where I thought ‘Oh I feel better,’ because it was so gradual. It was other people noticed, family and friends would say ‘you seem a bit more relaxed today Stephen,’ or whatever so. And I think I needed them to tell me because I didn’t know. That, I mean that’s one of the things with depression, you don’t know you’ve got it and you deny things, you don’t realise things but it’s other people. But it was only actually when they told me that I was looking better that I realised that they’d knew I’d been ill to start with. Because no one had ever said ...apart from this one friend, no one had ever actually said ‘you’re not right or ‘you seem a bit down today’. But when I actually was getting better they started to say that.

Sharon said that taking fluoxetine made life more manageable by reducing her symptoms "it takes the edge off of my feelings to help me... feel, I don't like to say ‘normal’, but to feel ‘normal’ emotions in a normal range... and I've got control back." Lou calls sertraline "my perspective tablets" and feels they help her to see things in a more positive way.

Stuart takes citalopram regularly to keep his mood stable...

View full profile

Age at interview: 52

Sex: Male

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

So I had to go back to back to citalopram which is what I’m on now, another SSRI. Whether that does anything or not I don’t know it’s, I know if I, I did try coming off it a year or two ago and I foolishly came straight off it without tapering the dose down as you should and I did get quite a, quite a reaction to that, you know, I did drop quite seriously down in mood and I had to come back on it again.

So basically I’m now on antidepressants really as a long term preventative measure so the GP’s that I’ve spoken to have said well if you’re happy to be on them given that you’ve had depression all your life you, and you’ve got a drug now that doesn’t have serious side effects you might as well stay on it and so taking antidepressants is just something I do now.

For me it’s a preventative. So I’m not taking it because I am depressed I’m taking it because I’m prone to be depressed and it is, you know, there are numerous studies saying that that if you, people who have chronic lifelong depression are much more prone to it continuing and that by taking antidepressants on an ongoing basis it reduces the chance of that, it reduces the frequency of that happening. Whether that’s true for me I don’t know because I’d have to come off.

Some people noticed differences in the way they responded to different SSRIs or even to the same SSRI when taken on different occasions. Not everyone knew why their doctor had prescribed one particular SSRI over another, but some said their doctor had prescribed one because it was particularly suitable to help with specific symptoms, such as anxiety or sleep problems. Some felt that doctors had favourites, or suspected that they prescribed the cheapest rather than the most effective.

Olivia Y felt that citalopram...

Text only

Read below

Olivia Y felt that citalopram...

View full profile

Age at interview: 33

Sex: Female

Age at diagnosis: 16

See full profile

HIDE TEXT

PRINT TRANSCRIPT

I’m not a naturally depressive person I’m a naturally anxious person. My mood drops when something happens whereas my anxiety I would say is more part of my character and it turns that into depression or they go hand in hand just on separate hands. So for me the citalopram actually gave me some little bonus’s in terms of my, my anxious side. very often just if you’re an anxious person it’s quite normal to have intrusive thoughts just like nasty thoughts pop into your head like for example if I see a dog without a lead I’ll assume it’s been abandoned and it’s starving and no one loves it or if I hear a child crying in the supermarket I’ll assume it’s being abused at home. These thoughts were just… on citalopram, I wasn’t having the same nasty thoughts and that was actually a big bonus so that was why I preferred this one, I felt citalopram fitted better with an also anxious personality.

Sometimes people experienced contradictory effects, feeling better in some respects, but worse in others. Rachel has tried several different SSRIs over the years which sometimes have ‘lifted’ her mood, but the disadvantage is that she can feel distant, numb and unable to experience emotions. ‘You’re making it through the day but you’re not living, you’re not being you’. Rachel still experiences depressive symptoms whilst taking an antidepressant but some days are better than others; at times she has stopped taking her antidepressant because she doesn’t like how it makes her feel.

Rachel has mixed feelings about taking the various different...

View full profile

Age at interview: 51

Sex: Female

Age at diagnosis: 11

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

Technically it did help because it did, because it was about, it felt like forever but the really sort of down serious point was for probably about three months and then it took at least a year to come back up to a managing level and I was good I stuck on the medication but the things that still troubled me about them where there. I mean I put on about three stone in weight rapidly…

I felt because I’m quite a creative person I make art and write poetry and stuff like that and yes they, they lift you off the very bottom where you’re suicidal but they shave off so much of the motivation and the, the for creativity they limit how much joy you can experience in your life. Because you just don’t have it it’s, you can’t feel things in the same way and for me it didn’t, you know, it certainly is the big, big thing for me is that I’ve always had this weighing up between having highs and lows but being able to experience those highs and living in this what I’d sort of call like middle of the road grey area.

Like Rachel, others also said they had felt ‘detached’ when they were taking an SSRI. The extent to which this could be tolerated varied. Emily didn’t mind too much because she felt it made it easier to develop a clearer perspective on her life. Tim said he felt ‘a sense of distance from the world a bit... kind of like what was happening wasn’t really happening’ Often these feelings lessen over time.

Andrew’s doctor warned him there might be some side effects at the start...

View full profile

Age at interview: 50

Sex: Male

Age at diagnosis: 49

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

The first six weeks was an odd experience, well no the first month, was quite an odd experience and I think my wife was a bit concerned about me.

In what way was it an odd experience?

I really felt like it was me, you know, like I was acting someone else’s life, it was like watching somebody else. And so I could sit completely still for half an hour and not even, not even know that I’d done it, you know?

So would it, is it like a sort of bit spaced out?

Yes it’s just like being spaced out yes. Well I’ve never really done drugs but it’s like being- just what you’d imagine it to be, just like you’re somebody else, your movements feel a bit odd I thought, because everyone’s different I’m sure you know it affects people quite differently I could be at work, we can talk about work in a minute if you like.

Yes.

But I could be at work and I could sit in front of the computer… and I’d be thinking… nothing really, you know, it just come to a halt almost. And a kind of warm feeling in my head and I mean they were the main sort of, I didn’t have any sleep problems, some people report difficulty sleeping I never had even with the depression I never really had sleep problems, I could sleep, probably found I was sleeping a lot well certainly sleeping a lot more with the depression, or nodding off falling asleep, feeling very tired. But with these things they didn’t seem to affect me, just a kind of slowness and you know that kicking in quite a lot. But I don’t get that now, I don’t really remember when it finished but I know after, certainly by about Christmas I was definitely feeling there was a massive change in, already then, in the way that I was dealing with the family, how calm I was.

Actually I’ve looked at some since, I looked at some forums on line where people have thinking about going on treatment or have just started. And I didn’t want to feel any worse and it did make me feel this in this odd place but it didn’t last long and I just thought I’ve got to do this, you know, I’ve got to. And the doctor had kind of underlined this to me that, he said you may not you may just find that you’re fine but he had said that it may make you feel a little bit odd at first. So I was primed and now all these months on I just think thank goodness I carried on, you know, and I really glad I persevered with it really, you know, I wouldn’t want to be in that place now.

When Lou took Seroxat (paroxetine) she said she felt ‘numb’...

View full profile

Age at interview: 39

Sex: Female

Age at diagnosis: 22

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

They started me on some Seroxat which I found gave me terrible side effects, I felt a lot worse and really quite mad after I started taking it. I persevered with it and it was okay up to a point, I felt very controlled, you know, like my emotions were you know if someone said oh you’ve won the lottery I’d go ‘oh right’, you know, and if someone said, you know, someone you cared about died, I’d go ‘oh dear’, you know there was no kind of... I didn’t feel I was able to experience a full array of emotions but I felt numb but not depressed anymore.

Everything I was feeling was amplified initially during the period when I first started talking those particular tablets until it then tailed off then it turns off, the side effects turn off to just feeling numb. And also really, really dry mouth, horrible taste in my mouth and insomnia couldn’t sleep, you know, racing thoughts and the anxiety was significantly worse.

I was much better after coming off them for a number of years until things got very bad, I was, everything in my life was rubbish really my relationships were awful my health was bad because I was probably drinking too much and partying too hard and I hated my job but I didn’t know what to do about it so everything was a bit rubbish. So I went to the GP and explained and said point blank ‘I’m not going to go on Seroxat again but can you help me?’ and I was prescribed sertraline, Lustral as it was then and immediately felt better, I didn’t have, a few side effects there was kind of a slightly clenchy mouth and clenchy jaw if anything I felt slightly euphoric for a couple of days and given that I was fearful that I would feel worse before I felt better that was kind of quite pleasant really and I felt like my normal self a better version of my normal self immediately.

When Gerry started taking sertraline...

Text only

Read below

When Gerry started taking sertraline...

View full profile

Age at interview: 31

Sex: Male

Age at diagnosis: 29

See full profile

HIDE TEXT

PRINT TRANSCRIPT

It was sertraline that I started on and now let me think. Then I, then I was on, yes so I started on sertraline and I started the talk therapy and really the combination of the two I’d started to pretty quickly feel better again. I want to say maybe, maybe three or, about three or four weeks after I’d been on, it would be about… yes since I’d got antidepressants… I’d start on the actual, for the first I’d say five to seven days they were very, very, I kind of realised that the power that the drugs had and caused a feeling like sort of, I can’t even remember what I really felt like, I just remember being quite distressed because I felt a bit spaced out for about the first five to seven days and being like’ oh should I persevere with this because, you know, it’s kind of not, it’s not really helping me’. But I’d read Google and I’d read a lot of people’s stories saying like it will sort of kick in after two to four weeks so I thought well I’ll keep on going. so I kept on going and it probably was about two or three weeks in, into my course of antidepressants when I did start to say well like hold on there’s a bit of a mood shift here, you know, I could feel the, the heaviness lift and I felt more relaxed I wasn’t having the, you know, I was still having anxious thoughts but I wasn’t, the actually physical manifestation of anxiety that sort of pang that used to hit me there, it wasn’t that, that abated you know, it kind of you know, they almost levelled me off.

Positive benefits also sometimes seemed less apparent after a while. Some people, even those who had tried several types, said they felt no benefits at all from taking an SSRI. Thomas took citalopram for about a year but eventually decided to stop because ‘I couldn’t think that it had improved my mood. It hadn’t done anything for me.’ Over a period of several years Roisin tried a variety of different SSRIs but said that ‘nothing seemed to work’. Some people may find that they respond more positively to another type of antidepressant (see 'Tricyclic antidepressants and SNRIs, Mirtazapine & MAOIs'). Some people found that despite feeling positive benefits for a time, it’s important to have a regular review with the GP, as he or she may be able to change the dose or prescribe something different (see also ‘Reviewing antidepressant use’, ‘Stopping taking antidepressants’ and ‘Changing antidepressants’).

Sharon has experienced recurrent episodes of depression...

View full profile

Age at interview: 37

Sex: Female

Age at diagnosis: 22

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

The doctor said to me, "How are you?" and I just burst into tears and said, "I hate it, I hate kids, I can't stand it, I can't do it anymore." And he said, "Ah take these tablets," basically [laughs] and started me; had a little discussion and started me on fluoxetine, twenty milligrams to start with and I thought ok, fair enough, it's enough just to get me out the dip and pick me up a little bit. Didn't notice any initial side effects. I had one panic attack which I'd never had before and that was, that was a bit odd but nothing else from that. Initially they kept me awake a bit and I had got very vivid dreams, very, very vivid dreams. So sometimes I didn't know if they were real or not. I had to sit back and think about my dreams and look for something in them that was random, like an elephant or something to work out, "No that was dream," and I stayed on that, I think it took about two months and I felt much better and my husband at the time said, "This is you, you're back to your old self, for Christmas."

I felt much, much better. And then I think I had to go; keep going back to the doctor for checks and I was on them for about six months to eight months till the summer, this is over Christmas ....and he said, "Start coming off them in the summer because the weather's better and you might feel a bit better which I did gradually and that was OK but then I got to the September/October and then started dipping again and I ignored it and it got worse and worse and it took two months for me to phone the doctor and make an appointment and he put me straight back on fluoxetine. And from then I've just sort of every time I've tried to come off one I've been OK for a while and then I've dipped again.

I was getting concerned, I started a… I moved and went to a different doctor who tried various different medications.

Because I didn't think the Prozac was working, I felt very angry a lot of the time on it, not as depressed but very angry. So I think I tried the Seroxat next which didn't seem to make much difference but again six months and then came off it. I went to see the community psychiatric nurse, it was the first time, when I'd moved up here because my doctor's had decided, "Oh you've had enough of these pills, you need to be off them now. Go and see them, talk to them, you'll be fine." So what was initially supposed to be a six week session turned into six months and I managed to come off the antidepressants again and was off them for two years which I thought was great and I was doing really well and then it hit again.

People we spoke to were often concerned about side effects. Side effects may occur with all of the different types of antidepressant medicines but not everyone will experience them. In our interviews people described a range of different side effects but the intensity or impact varied widely between different individuals and the degree of importance they placed on them varied. As well as the psychological effects of distance, numbness or a sense of detachment mentioned earlier, people described a range of different physical side effects including; sweating, sickness , nausea, dry mouth, a metallic taste , sedative effects, insomnia, weight gain, weight loss, loss of appetite, vivid dreams, trembling, yawning, and sexual dysfunction (see also ‘Coping with antidepressant side effects’).

Catherine took Prozac (fluoxetine) and felt it suited her, but...

View full profile

Age at interview: 41

Sex: Female

Age at diagnosis: 14

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

I think it was 1990, yeah 1990, I first went onto Prozac and actually that was probably the best move they’d made because the increase in energy was much, much more noticeable. It created a much better sort of, the apathy lessened the, the lethargy lessened, that kind of reduced, and I didn’t really have too many side effects at all from Prozac.

Did you have any?

I think the only thing I can remember at the time was occasionally fidgety but I didn’t, apart from that I didn’t experience anything else at all with Prozac. And I continued on that with the continued with the antipsychotic and the Prozac together for the next maybe about five, five or six years I stayed on that. I think in the midst of that there was, sometimes you kind of think that the antidepressants maybe don’t last they don't have a longevity to them, you take them for a few years and the kind of effects start to, to wear off so. While being on Prozac I was also given paroxetine but that was a complete nightmare.

It wasn’t very pleasant at all, it is not a pleasant drug.

Tell me about that.

Yeah I started to, again the, I lost all, I lost all interest, it took away my level of creativity, it took away any interest I had in things that I felt like, not that I was constantly bored but the fact that I felt bored but I wasn’t interested in doing anything anyway and I think I also lost kind of any ability to communicate in any kind of meaningful way, I felt very flat, you know, flattened by a tyre.

Took away your motivation?

Yeah motivation, thought processes, cognitive functioning that kind of thing was pretty, quite horrible. I didn’t actually stay on that medication for very long at all before coming off that and actually I was really quite glad to see the back of that.

Thomas stopped taking Cipramil (citalopram) because...

View full profile

Age at interview: 34

Sex: Male

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

She prescribed me Cipramil which was dispensed by my GP, but it was prescribed under the direction of my, of my consultant psychiatrist at the time. And I started that on 20mg which is the starting dose for Cipramil. I found it again a very troublesome medication. So I would find that I would sweat profusely. So I’d go in a shirt and trousers, as I’m always dressed -into meetings, and I would find that my shirt would be drenched within minutes. I would just sweat, sweat, sweat, sweat, sweat, that was very embarrassing. I’d have to carry around spare clothes with me to change because my shirt would be sodden with sweat.

I also - what really, really did it for me, was the sexual dysfunction. I got quite a lot of sexual dysfunction with citalopram. I found that very difficult to deal with, and I also got a feeling that I was just about to be sick. It was like eating, I don’t know, something like a double cheeseburger and it fills your stomach, and it should be so good, and then you feel permanently as if you’re about to be sick, but you never quite are. I suppose nauseous feelings. And I got a horrible metallic taste in my mouth. And nothing could quench that taste, apart from sugary drinks. So I would drink lots and of lots of coke. Anything with lots and lots of sugar in it. That would be the only thing that would cover the kind of metallic taste. It would always, always make me feel thirsty.

I weighed things up in my mind. So I would write down on a sheet of paper what were the positives and what the negatives were and for the Cipramil it was almost all negatives but that was coupled, with they became to be more reticent about prescribing Cipramil at the time, because I’d taken an overdose and so on. But I clearly saw there were many more negatives and almost no positives. I mean I couldn’t think that it had improved my mood. It hadn’t done anything for me. It had made me more sedated which wasn’t a good thing, I wanted to be active and doing things. And, and so I just wrote it on a piece of paper and took it from there really. And as I say I didn’t have all that much confidence in them at the time in what they were saying because they were fairly dismissive of the side effects I was getting, so I lost confidence in them and I decided to take matters into my own hand, and, and not take the Cipramil.

Last reviewed June 2016.
Last updated June 2016.