Antidepressant medication
Advice for adults
FACT SHEET 11
There is a great deal of misinformation about antidepressant medication and there is no simple
explanation how antidepressants work.
Medication can be important in the treatment of moderate to severe depression and in some anxiety
and related disorders. This fact sheet explains what antidepressants do, how they work and where
to get more information and help.
" of the lack of scientific evidence for the effectiveness of
HOW DO ANTIDEPRESSANTS WORK?
antidepressants in this age band.
Research shows that more severe forms of depression are
The increased risk of suicidal behaviour seen with antidepressants
associated with specific changes in the brain, including changes to
includes young adults up to the age of 24 years. There are,
some hormones and chemical message systems. In these forms of
however, no Government (i.e. Pharmaceutical Benefits Scheme)
depression, there are alterations in the activity of the brain in areas
restrictions placed on the prescription of antidepressants and
under the influence of serotonin and noradrenaline which may
doctors are not prevented from prescribing them.
cause a major depressive episode. This causes the symptoms and
disability associated with depression. Antidepressant medication is
There is concern that young people up to the age of 24 years
thought to increase the levels of serotonin and noradrenaline in the
taking SSRIs for the treatment of depression may experience an
brain. However, depression is not a deficiency of these chemicals.
increase in suicidal thoughts and behaviour. The risk is roughly
4 per cent compared to 2 per cent for placebo. No deaths from
suicide have been reported in any clinical trials. However, a young
WHEN IS ANTIDEPRESSANT
person will require close medical supervision and monitoring in the
MEDICATION USED?
early stages of treatment if an antidepressant is prescribed.
Antidepressant medication is often prescribed, alongside
For more information see beyondblue s Fact sheet for young
psychological treatments, when a person experiences a moderate
people: Antidepressants for the treatment of depression in
to severe episode of depression and/or anxiety. Sometimes they
young people.
are also prescribed when other treatments have not been helpful.
Chronic illness
WHICH ANTIDEPRESSANTS ARE Like any medication, antidepressants can produce side-effects.
In some cases, taking antidepressants can affect existing symptoms
THE MOST HELPFUL?
or treatments for other illnesses. It is important for people to let
This decision should be made in consultation with a doctor after
doctors know about any illness they may have and any medication
careful assessment and consideration. A person can help the
they are taking.
doctor s assessment by providing as much information as possible
about themselves and their medical history.
Pregnancy and breastfeeding
The decision to take medication while pregnant or breastfeeding
Age
is an individual one. It should be made in consultation with a doctor
Depression is a common condition that affects people of all ages,
after considering the risks and benefits to both the mother and baby.
including children and young people. Psychological therapies are
If a woman is breastfeeding, specific types of medications are
the recommended first option for the treatment of depression in
generally preferred. While a number of factors will influence the
children and young people.
choice of antidepressant, a group of antidepressants called
The Therapeutic Goods Administration (Australia s regulatory agency
tricyclics, as well as sertraline, citalopram and fluvoxamine are
for medical drugs) and manufacturers of antidepressants do not
most commonly prescribed for breastfeeding women.
recommend antidepressant use for depression in young people
Studies show that paroxetine is generally not recommended at
under the age of 18. This is because:
this time.1
" in trials, there were concerns about increased suicidal behaviour
in young people taking a pill which contains no drugs (placebo).
The difference was roughly 4 per cent compared with 2 per
1
Buist, A.  Guidelines for the Use of SSRIs in Pregnant Women , Obstetrics and Gynecology,
cent. The risk was greatest during the first two months
Vol. 7, No. 4, Summer 2005, pp.18-20.
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Antidepressant medication
Advice for adults
FACT SHEET 11
Symptoms Reversible inhibitors of monoamine oxidase 
A (RIMAs)
When deciding on the most appropriate antidepressant medication,
it s important to consider what symptoms they treat. Some classes
This class includes:
of antidepressant medication are more effective in treating specific
" moclobemide.
depression-related symptoms, while other types can be helpful in
managing anxiety disorders.
Monoamine oxidase inhibitors (MAO-Is)
People who have bipolar disorder and experience an episode of
This class includes:
depression will often be given a mood stabiliser alone. It can take
time for mood stabilisers to work. Sometimes antidepressants are
" tranylcipramine
used along with mood stabilisers to help ease the symptoms.
" phenlzine.
Antidepressant medication is generally not recommended for use by
(Special diet required  seldom prescribed currently in Australia).
itself in people with bipolar disorder as it can trigger mania.
Tricyclic antidepressants (TCAs)
TYPES OF ANTIDEPRESSANTS
This class includes:
There are many different types of antidepressant medication. Your
" nortriptyline
doctor may need to find the medication and dose which is most
effective for you. Below is a description of the different classes of
" clomipramine
antidepressants. Please note, this list only includes the generic
" dothiepin
medication names and not the pharmaceutical brand names.
Please look on your medication packaging to find the name of the " doxepin
ingredient you are taking.
" imipramine
There are differences in effects and side-effects of the
" amitriptyline.
antidepressants listed below, which can be discussed with
your prescribing health professional.
Noradrenaline-serotonin specific antidepressants
(NaSSAs)
Selective serotonin reuptake inhibitors (SSRIs)
This class includes:
This class includes:
" mirtazapine.
" sertraline
" citalopram
Noradrenaline reuptake inhibitors (NARIs)
" escitalopram
This class includes:
" paroxetine
" reboxetine.
" fluoxetine
" fluvoxamine.
Serotonin and noradrenaline reuptake inhibitors
(SNRIs)
This class includes:
" venlafaxine
" duloxetine.
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FOR HOW LONG DO PEOPLE NEED
Please note:
TO TAKE ANTIDEPRESSANTS?
" When the symptoms are directly due to depression, they
are likely to begin to improve following four to six weeks of Like any medication, the length of time a person takes
effective therapy. For example, although SSRIs commonly antidepressants depends on the severity of the illness and how the
make sleep disturbance/insomnia worse initially, they are person responds to treatment. For some people, antidepressants are
associated with improved sleep four to six weeks later. needed only for a short time (generally 12 months) with psychological
treatments and self-help techniques being sufficient. For others,
" TCAs are commonly prescribed for their wide range of
antidepressants are needed on an ongoing basis  in the same way
general benefits, but are also the most toxic compounds
that someone with asthma would use respiratory medication.
available if taken in large quantities.
People often want to stop taking antidepressants quickly because
" SSRIs or clomipramice (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
to person.
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,
WHAT SIDE-EFFECTS DO
on a doctor s recommendation and under supervision. Sometimes
discontinuation symptoms are severe including irritability, agitation,
ANTIDEPRESSANTS HAVE ON THE
dizziness and confusion.
PERSON TAKING THEM?
Unlike antidepressants, sedatives are designed to be used only
Antidepressants can make people feel better, but it will not change
for a short time. If used for long periods of time, sedatives may be
their personality or make them feel happy all the time.
craved and needed in higher doses in order for them to have the
same effect. This is not the case with antidepressants.
Like any other medication, some people who take antidepressants
also experience some side-effects. Common side-effects include:
Stopping medication should only be done gradually, on
a doctor s recommendation and under supervision.
" nausea " headaches " anxiety
" sweating " dizziness " agitation
WHERE TO GET HELP
" weight gain " dry mouth
" sexual difficulties (e.g. difficulty becoming/staying aroused).
" A doctor who is a General Practitioner (GP) is a good first step.
In some cases, the person may then be referred to a mental
Some of these symptoms are short-lived. However, people taking
health specialist like a psychiatrist or psychologist. For a list of
antidepressants who experience any of these symptoms should tell
GPs with expertise in treating depression, anxiety and related
their doctor, as there are ways of minimising these or other side-
disorders visit the beyondblue website www.beyondblue.org.au
effects. The likelihood of a particular side-effect happening varies
and click on Find a Doctor or other Mental Health Practitioner
between people and medication.
or call the beyondblue info line on 1300 22 4636 (local call).
It is not uncommon for people with depression to have suicidal
" Psychiatrists are doctors who specialise in mental health. They
thoughts. Treating the depression effectively will reduce the
can make medical and psychological assessments, conduct
likelihood of a person hurting him/herself. In the period of time
medical tests and prescribe medication. Many psychiatrists use
between the person starting antidepressant medication and
psychological treatments such as Cognitive Behaviour Therapy
responding to treatment  which can be more than two weeks
(CBT) and Interpersonal Therapy (IPT).
 the person should still be monitored by the doctor and their
progress reviewed, as the risk of suicidal behaviour may even be
slightly increased.
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Antidepressant medication
Advice for adults
FACT SHEET 11
" Psychologists, Social Workers and Occupational
Lifeline
Therapists specialise in providing non-medical (psychological)
13 11 14
treatment for depression and related disorders. A rebate can
24 hour counselling, information and referral (local call)
now be claimed through Medicare for psychological treatments
when a GP, psychiatrist or paediatrician refers a person to
Mensline Australia
a registered psychologist, social worker or occupational
1300 78 99 78 or www.menslineaus.org.au
therapist. A rebate can be claimed for part of the cost for up to
24 hour professional couselling for men with family and relationship
12 individual consultations (18 in exceptional circumstances)
problems especially around family breakdown or separation  this
and 12 group sessions in a calendar year. For more details,
service provides anonymous telephone support, information and
ask the referring medical practitioner. For a list of mental health
referral (local call)
professionals who provide psychological treatment for which a
Medicare rebate can be claimed, go to the beyondblue website
www.beyondblue.org.au and click Find a Doctor or other Suicide Call Back Service
Mental Health Practitioner.
1300 659 467
Telephone support for those at risk of suicide, their carers and
MORE INFORMATION
those bereaved by suicide
beyondblue: the national depression initiative
Climate.tv  interactive e-health
www.beyondblue.org.au
www.climate.tv
Information on depression, anxiety and related substance-use
Developed by medical experts, this is a self-management system
disorders, available treatments and where to get help
for people with depression and anxiety.
beyondblue info line 1300 22 4636
Information on depression, anxiety and related substance-use
CRUfAD
disorders, available treatments and referral only (local call)
www.crufad.org
www.youthbeyondblue.com
Information about depression, anxiety and its management
beyondblue s website for young people  information on depression,
anxiety and how to help a friend
Mutlicultural Mental Health Australia
Learn more about self-help techniques
www.mmha.org.au 02 9840 3333
beyondblue Fact sheet 6: Reducing stress
Information on depression in languages other than English
beyondblue Fact sheet 7: Sleeping well
beyondblue Fact sheet 8: Keeping active
beyondblue Fact sheet 9: Reducing alcohol and other drugs
beyondblue Fact sheet 10: Changing your thinking
Black Dog Institute
www.blackdoginstitute.org.au
Information on depression and bipolar disorder  including causes,
treatments, symptoms, getting help and current research findings
THINGS TO REMEMBER
" Medication can be important in the treatment of moderate to
severe depression and in some anxiety-related disorders.
" Stopping medication should only be done gradually, on a
© beyondblue: the national depression initiative, 2009.
PO Box 6100, Hawthorn West VIC 3122 doctor s recommendation and under supervision.
T: [phone]
beyondblue info line 1300 22 4636
beyondblue and the National Health and Medical Research Council (NHMRC) are currently revising
F: [phone]
the management guidelines for depression in children, adolescents and young people. New
E: [e-mail]
information is frequently emerging in the field and a comprehensive review has not been published for
W: www.beyondblue.org.au some time. The new guidelines are expected to be available in 2010.
03/09
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For more information www.beyondblue.org.au or beyondblue info line 1300 22 4636