Antidepressant medication Advice for adults
There is a great deal of misinformation about
The Therapeutic Goods Administration (Australia’s regulatory agency
antidepressant medication and there is no simple
for medical drugs) and manufacturers of antidepressants do not recommend antidepressant use for depression in young people
explanation of how antidepressants work.
Medication can be important in the treatment
There are, however, no government (i.e. Pharmaceutical Benefits Scheme) restrictions placed on the prescription of antidepressants
of moderate to severe depression and in some
and doctors are not prevented from prescribing them if they feel
anxiety and related disorders. This fact sheet
looks at what antidepressants do, how they work
There is concern that a small percentage of young people up to
and where to get more information and help.
the age of 24 years taking SSRIs for the treatment of depression may experience an increase in suicidal thoughts and behaviour. Research shows the risk to be roughly 4 per cent compared to
2 per cent for those taking a placebo (dummy pill). No deaths from
Research shows that more severe forms of depression are
suicide have been reported in any clinical trials. However, a young
associated with specific changes in the brain, including changes to
person will require close medical supervision and monitoring in the
some hormones and chemical message systems. In these forms of
early stages of treatment if an antidepressant is prescribed.
depression, there are alterations in the activity of the brain in areas
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under the influence of neurotransmitters serotonin and noradrenaline
which may cause a major depressive episode. This is associated with
antidepressants for the treatment of Depression in adolescents
the symptoms and disability seen with depression. Antidepressant
medication is thought to increase the levels of serotonin and
noradrenaline in some areas of the brain. However, depression is not simply a deficiency of these chemicals. Different types of
Like any medication, antidepressants can produce side-effects.
antidepressants work in slightly different ways, but they all have an
In some cases, taking antidepressants can affect existing symptoms
influence on parts of the brain related to emotions and motivation.
or treatments for other illnesses. It is important for people to let doctors know about any illness they may have and any medication
Pregnancy and breastfeeding
Antidepressant medication is often prescribed, alongside
The decision to take medication while pregnant or breastfeeding
psychological treatments, when a person experiences a moderate
is an individual one. It should be made in consultation with a doctor
to severe episode of depression and/or anxiety. Sometimes they
after considering the risks and benefits to both the mother and baby.
are also prescribed when other treatments have not been helpful.
If a woman is breastfeeding, generally specific types of medications
are preferred. While a number of factors will influence the choice of antidepressant, a group of antidepressants called tricyclics, as
well as sertraline, citalopram and fluvoxamine are most commonly
Making a decision about which antidepressant is best for a person
can be complex. This decision should be made in consultation with
Studies show that paroxetine is generally not recommended at
a doctor after careful assessment and consideration. People can
help the doctor’s assessment by providing as much information as possible about themselves and their medical history. The following
should be considered and discussed with the doctor before
When deciding on the most appropriate antidepressant medication,
it’s important to consider what symptoms they treat. Some classes
of antidepressant medication are more effective in treating specific depression-related symptoms, while other types can be helpful in
Depression is common and can affect people of all ages, however,
generally medication is not recommended as the first choice for the treatment of depression in children and young people.
1 Buist, A. ‘Guidelines for the Use of SSRIs in Pregnant Women’, Obstetrics and Gynecology, Vol. 7, No. 4, Summer 2005, pp.18-20.
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People who have bipolar disorder and experience an episode of
Reversible Inhibitors of Monoamine Oxidase –
depression will often be given a mood stabiliser alone. It can take
time for mood stabilisers to work. Sometimes antidepressants are used along with mood stabilisers to help ease the symptoms.
RIMAs have few side-effects and are non-sedating. They may be less effective for more severe forms of depression than some other
Antidepressant medication is generally not recommended for use by
antidepressants, but are helpful for people who are experiencing
itself in people with bipolar disorder as it can trigger mania.
problems with anxiety or are having difficulty sleeping.
This class includes: • moclobemide.
There are many different types of antidepressant medication. Your doctor may need to find the medication and dose which is most
Monoamine Oxidase Inhibitors (MAO-Is)
effective for you. Keep in mind antidepressants take time before
MAO-Is are seldom prescribed in Australia as people are required
they start to help (at least two weeks). Below is a description of
to keep to a special diet, otherwise serious side-effects can be
the different classes of antidepressants. Please note, this list only
includes the generic medication names and not the pharmaceutical brand names. Please look on your medication packaging to find
the name of the medication you are taking (this is usually written in
There are differences in effects and side-effects of the TriCyclic Antidepressants (TCAs) antidepressants listed below, which can be discussed with your prescribing health professional.
TCAs are effective, but have more harmful side-effects than newer drugs such as SSRIs. They are more likely to cause low blood
Selective Serotonin Reuptake Inhibitors (SSRIs)
pressure – so this should be monitored by a doctor. They are more
SSRIs are the most commonly prescribed antidepressants in
Australia and are often a doctor’s first choice for most types of
depression. Generally, SSRIs are well-tolerated by most people and
Noradrenaline-Serotonin Specific Antidepressants (NaSSAs)
NaSSAs may be helpful when there is difficulty sleeping and poor
Serotonin and Noradrenaline Reuptake Inhibitors
appetite. Generally, they are low in sexual side-effects, but may
SNRIs have fewer side-effects compared to the older antidepressants
(such as TriCyclic Antidepressants), are often prescribed for severe
depression and are safer if a person were to overdose. Noradrenaline Reuptake Inhibitors (NARIs)
NARIs are designed to act selectively on one type of neurotransmitter (noradrenaline). They are less likely to cause
sleepiness or drowsiness than some other antidepressants, but are
more likely to make it difficult for people to sleep.
This class includes: • reboxetine.
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• When the symptoms are directly due to depression, they
Like any medication, the length of time a person takes antidepressants
are likely to begin to improve following four to six weeks of
depends on the severity of the illness and how the person responds
effective therapy. For example, although SSRIs commonly
to treatment. For some people, antidepressants are needed only for a
make sleep disturbance/insomnia worse initially, they are
short time (generally six to 12 months) with psychological treatments
associated with improved sleep four to six weeks later.
and self-help techniques being sufficient. For others, antidepressants
• TCAs are commonly prescribed for their wide range of
are needed on an ongoing basis – in the same way that someone
general benefits, but are also the most toxic antidepressants
with asthma would use respiratory medication.
People often want to stop taking antidepressants quickly because
• SSRIs or clomipramine (a TCA) would be the first choice if
they are concerned they are addictive. This may be because they
obsessive compulsive symptoms are prominent.
confuse them with sedatives, a group of medications that are used
• All of these drugs have been shown to be effective
to help a person feel relaxed and, in some cases, fall/stay asleep.
antidepressants, but their effectiveness differs from person
Stopping some antidepressants quickly (e.g. some SSRIs and
SNRIs) can lead to a discontinuation syndrome, which consists of flu-like symptoms. Generally this lasts for several days and can be avoided if the medications likely to do this are stopped gradually,
on a doctor’s recommendation and under supervision. Sometimes
discontinuation symptoms are severe, including irritability, agitation,
Antidepressants can make people feel better, but antidepressants
Unlike antidepressants, sedatives are designed to be used only
will not change their personality or make them feel happy all the time.
for a short time. If used for long periods of time, sedatives may be
Like any other medication, some people who take antidepressants
craved and needed in higher doses in order for them to have the
also experience some side-effects. Common side-effects include:
same effect. This is not the case with antidepressants.
Stopping medication should only be done gradually, on a doctor’s recommendation and under supervision.
• sexual difficulties (e.g. difficulty becoming/staying aroused).
A General Practitioner (GP) is a good person with whom to
Some of these symptoms are short-lived. However, people taking
discuss your concerns in the first instance. Your GP will be able to
antidepressants who experience any of these symptoms should tell
conduct or arrange any necessary medical tests, provide treatment
their doctor, as there are ways of minimising these or other side-
or refer you to a mental health professional. It is recommended
effects. The likelihood of a particular side-effect happening varies
that you go to your regular GP or another GP in the same clinic
as they will have access to your medical file. If you don’t have a
Adverse side-effects may occur in a minority of people when taking
regular GP or clinic, a list of GPs with expertise in treating common
very low doses of antidepressants. This is because their bodies
mental health problems is available at www.beyondblue.org.au –
break down the medication more slowly than the majority of people.
click Find a Doctor or other Mental Health Practitioner or contact
There is a blood test doctors can order to predict if you’re likely
the beyondblue info line on 1300 22 4636 (local call cost from a
to react this way – and if necessary, they can adjust the dose of
landline) or firstname.lastname@example.org. Psychologists can assist people who are having difficulty controlling
It is not uncommon for people with depression to have suicidal
their emotions, thinking and behaviour. Clinical psychologists are
thoughts. Treating the depression effectively will reduce the likelihood
specialists in the assessment, diagnosis and treatment of mental
of a person hurting him/herself. In the period of time between
illness such as depression, anxiety and related disorders.
the person starting antidepressant medication and responding to
Psychiatrists are doctors who have undergone specialist
treatment – which can be more than two weeks – the person should
training to treat all mental disorders. They can make medical and
still be monitored by the doctor and his/her progress reviewed, as
psychological assessments, conduct medical tests and prescribe
the risk of suicidal behaviour may even be slightly increased.
medication. Depending on their expertise and type of practice, they can also provide psychological treatments such as Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT).
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Some have particular areas of speciality. If you would like a
consultation with a psychiatrist, you will need a referral from your GP. Mental health nurses are specially trained to care for people with
24-hour counselling, information and referral (local call)
mental health problems such a depression, anxiety and related
Black Dog Institute
disorders. They work with psychiatrists and General Practitioners
to review a person’s mental health, monitor medication and provide
Information on depression and bipolar disorder – including causes,
information about mental health problems and treatment. Some
treatments, symptoms, getting help and current research findings
have training in psychological therapies. If you would like a referral to a mental health nurse who works in a general practice, ask your GP. MensLine Australia Social workers in mental health are specially trained to work with 1300 78 99 78
people who are experiencing difficulties in life. Social workers can
support people with depression, anxiety and related disorders by
Counselling for men with family and relationship problems especially
helping them find ways to manage more effectively some of the
around family breakdown or separation – this service provides
situations that trigger these disorders such as family issues, financial
anonymous telephone support, information and referral (local call)
problems, work stress and living arrangements. Mental health social
Suicide Call Back Service
workers can also provide focused psychological self-help strategies.
1300 659 467 Occupational therapists in mental health help people who
Telephone support for those at risk of suicide, their carers and
have difficulties functioning because of a mental health problem
(such as anxiety or depression) to participate in normal, everyday
activities. Mental health occupational therapists can also provide
focused psychological self-help strategies.
Information and internet-based education and treatment programs for people with depression or anxiety
For a list of psychologists, psychiatrists, social workers and occupational therapists with expertise in treating mental health
Multicultural Mental Health Australia
problems, visit www.beyondblue.org.au and click Find a
Doctor or other Mental Health Practitioner or contact the
02 9840 3333 beyondblue info line on 1300 22 4636 (local call cost from
Provides mental health support for people from culturally and
a landline) or email@example.com. Therapeutic Goods Administration www.tga.gov.au
Information relating to all registered therapeutic goods, including prescription medicines, available in Australia
www.beyondblue.org.au Info line 1300 22 4636 or firstname.lastname@example.org Information on depression, anxiety and related disorders, available
• Medication can be important in the treatment of moderate
to severe depression and in some anxiety-related disorders. www.youthbeyondblue.com
• Stopping medication should only be done gradually,
beyondblue’s website for young people – information on depression,
on a doctor’s recommendation and under supervision. Learn more about self-help techniques beyondblue online fact sheet 6 – Reducing stress beyondblue has developed Clinical Practice Guidelines for:• Depression in adolescents and young adultsbeyondblue online fact sheet 7 – sleeping well
• Depression and related disorders in the perinatal period.beyondblue online fact sheet 8 – Keeping active
The guidelines were approved by NHMRC in February 2011 – visit www.beyondblue.org.au/guidelines for more information. beyondblue fact sheet 9 – Reducing alcohol and other drugs beyondblue online fact sheet 10 – changing your thinking beyondblue a Guide to What Works for Depression –
a comprehensive review of all known treatments for depression,
Info line 1300 22 4636 or email@example.com
including medical, psychological, complementary and lifestyle
Visit www.beyondblue.org.au Call 1300 22 4636 Email firstname.lastname@example.org
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Anesth Pain Med. 2011 July; 1(1): 10–14. Research Article Comparison of the Efficacy of Adding Clonidine, Chlorpromazine, Promethazine, and Midazolam to Morphine Pumps in Postoperative Pain Farnad Imani 1; Poupak Rahimzadeh 1,*; Seyyed Hamid Reza Faiz 21Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran2Depar