Puerperal Psychosis & related illnesses

Treatment of Depression with drugs

Treatment of depression, including post natal depression with drugs is commonplace. There's been a lot of debate in the news recently about the overprescription of so-called "happy pills" due to consumer demand more than anything else. That does not mean they don't work - clinically, they're proven to work.

If you're worried you've been prescribed drugs you don't need, carry on taking them and arrange to see your GP as soon as possible.

What are the drugs?

The most commonly prescribed drugs to treat depressive illnesses are called SSRIs and SNRIs. These drugs include:

The first name is the brand name, which you've probably heard, the second name is the drug name, which you probably haven't. Needless to say if you're prescribed fluoxetine, it's essentially the same thing as Prozac.

All these drugs are antidepressants, and are effective in treating mild to moderate depression.

Older tricyclic antidepressants like amitryptaline and imipramine can also be used, and a recent study in Aust NZ Psychiatry suggested they are more effective in severe depression. Generally the SSRIs are preferred because there are fewer drug-drug interactions and they're less toxic.

How do they work?

SSRI stands for Selective Serotonin Reuptake Inhibitor, whilst SNRI stands for Serotonin/Noradrenaline Reuptake Inhibitor. They do essentially what they say on the tin - but the trick is understanding the label.

When a nerve cell in your brain fires, it releases a chemical, called a neurotransmitter, which stimulate other nerves. There are many neurotransmitters, but the two we're concerned with here are serotonin and noradrenaline. Once they're released, they have to be got rid of, or you'd end up with everything firing at once.

When a neurotransmitter is released, it can be got rid of by being broken down chemically, or by physically pumping it back into the nerve cell. This latter process is called reuptake.

Thus a reuptake inhibitor inhibits this reuptake, the result being that there is more neurotransmitter in the brain acting for longer.

Fluoxetine and Paroxetine inhibit serotonin reuptake, so the amount of serotonin, dubbed the "happy hormone" in your brain is increased. Venlafaxine inhibits serotonin and noradrenaline reuptake, so the amount of both transmitters in the brain is increased.

The theory then goes that the patient feels happier.

The older tricyclic antidepressants work in a similar way - they correct chemical imbalances in the brain.

How long do they take to work?

The name "happy pill" is a misnomer. You won't feel better immediately - all antidepressants take time to work their magic. Typically, they start to take effect after two to four weeks. After that, the patient is likely to be taking them for a number of months before being weaned off.

Are they addictive?

No, they are not. It's good clinical practice to withdraw a patient taking antidepressant medication over about four weeks, so to ensure they're ready to come off of the drugs and that they don't slip back into depression. Many people can stop taking the drugs suddenly, but it's not recommended for this reason, and to prevent any potential withdrawal symptoms.

What are the side effects?

By law, drug companies have to report the potential side effects of taking their medication. They have to report everything, so reading the leaflet can be quite frightening, but the odds really are stacked in your favour. If you have concerns, speak to your pharmacist or GP.

The most common side effects from taking antidepressants are drowsiness, dry mouth, constipation, sweating and slight blurred vision. These symptoms generally pass within a week of taking the medication, but if you're in any doubt, speak to your pharmacist or GP.