“Touch black paints, have black fingers”.
Chinese Proverb
VIDEO
FAA to allow pilots to fly while on antidepressants
Safety of antidepressants
My husband is in recovery from alcoholism. Is it safe for him to be treated with psychiatric drugs?
In most cases, yes it is. Once he is well clear of the alcohol problem, most antidepressants are quite safe and are not addictive. Most psychiatric drugs cannot be abused. The big exception to this rule would be the so-called minor tranquillisers: the benzodiazepines (diazepam, chlordiazepoxide, lorazepam, temazepam, etc.). These certainly do have abuse potential.
Remember your husband is vulnerable to any addictive substance, not just alcohol, and these medications could be risky for him unless they are carefully controlled. If he is a member of AA, read the pamphlet The AA member – medications & other drugs. AA philosophy calls tranquillisers ‘dry drinks’ and members of AA groups are often strongly against any sort of medication that alters how you perceive reality, in particular the tranquillisers.
Sadly, some well-meaning members of AA groups, trying to avoid unnecessary medication, have talked other members out of having their depression treated with antidepressants, and some ill people have killed themselves as a result. AA’s official attitude toward medication is definitely that it is necessary for certain illnesses including depression.
My previous doctor used to give me Valium when I went to see him about stress and depression, but the new one will not. Why is she so reluctant?
Minor tranquillisers (mainly the family of drugs called benzodiazepines) certainly were used too much. When they came out in the 1960s, they were so much safer than the older drugs for calming people, such as the barbiturates, that they were overprescribed. Their addictive potential was not recognized initially. Now we know better. Whilst they do calm you down and help you get off to sleep, they will not help depression itself. They have no antidepressant effect.
However, a short course of these drugs during a crisis can be very useful; of course, self-help and friendly support is the best drug, but sometimes you cannot just switch off and get a good night’s sleep when you’re stressed and low. If sleeping tablets are prescribed, it is best to try and limit them for use over a number of days, rather than weeks: 3 days’ treatment may well be enough to break the pattern of bad sleep or tension. Some people sleep better if they know they have a small supply of sleeping tablets to eke out, even if they scarcely use them.
Your doctor isn’t alone in trying to minimise the use of these drugs. They have an excellent safety record but have certainly been overprescribed. They are not a treatment for depression. I was taking Valium for years, and have had real trouble stopping it. My doctor says I actually have an underlying depression, and has started me on an antidepressant, which seems to help.
I now attend a Tranquilliser Users’ Support Group, which gives me good support, but they are very against people taking antidepressants, and tell me I should stop them. Who is right?
Well-meaning organisations such as some of the alcohol and tranquilliser self-help bodies do sometimes have this attitude. Although they have the best of intentions, and are generally trying to help people to live their lives without what they see as the crutch of medication, they are wrong. In our experience, many people who have in the past been prescribed tranquillisers such as Valium on a long-term basis do actually have symptoms of underlying depression, or other conditions such as social phobia or agoraphobia, which will be helped by proper, full courses of standard antidepressants. Stopping antidepressants part of the way through a course may actually make the condition more difficult to treat subsequently, and some people come to harm in this way. So although the work of groups such as these is very supportive, do not let anyone tell you that you should not be taking your antidepressants, or that they are addictive.
Side-effects
Will I get side-effects?
All medication causes side-effects. The quest is to find an antidepressant that is effective and tolerable. The same medication may not work for one person, but works brilliantly for another. You cannot tell before you start treatment which tablet is best suited to which person. Always take the medication as advised. If you have any queries, do ask the doctor or pharmacist. Pharmacists are quite rightly proud of the service they offer, explaining queries about medication. It is a very important part of their work.
What happens if the tablets don’t agree with me?
If you cannot get on with your treatment, do say. Always tell the doctor if you have stopped taking the tablets or are worried. We know that a large number of people, possibly as many as 50%, will discontinue their medication over the course of 6 months. About a quarter of people who stop medication do so because of unpleasant side-effects. Within the range of antidepressants, the overall rate of dropout because of side-effects of medication is a little greater with the older tricyclic drugs compared with the newer SSRIs. The differences are not large. Very often side-effects of medication are transient, and will decrease if you persevere with the drug. Some people will need what looks like a high dose of medication, others are lucky enough to respond to less. Each person responds to drugs in an individual and slightly different manner.
Are people more likely to harm themselves when they start antidepressants?
Antidepressants do not cause people to harm themselves and, on the contrary, save many lives by preventing depression getting to the stage where suicide is contemplated. Someone who is severely depressed to the point of wishing to harm themselves may, however, act on this feeling when an antidepressant starts to work, simply because they start to get a little more drive and get the energy to put their plans into action. Someone who is this unwell should be under close specialist care, perhaps in hospital. If a friend or relative is this low, and talking about self-harm, tell their doctor.
Will an antidepressant make me feel high or stimulated?
I don’t like to think that I might feel out of control. Almost always the answer is no. Antidepressants are not mood-altering drugs, like Ecstasy and amphetamines are. If somebody who is not depressed is given an antidepressant, their mood will not change. Moods will only be shifted by antidepressants if you are depressed – the shift will be from low to normal mood. However, if you have a predisposition to elated mood swings as part of a manic-depressive illness, several antidepressant drugs can cause ‘high’ mood. This is unusual, but can pose a serious problem.
How can I get rid of the side-effects of my antidepressant medication?
You may be noticing dry mouth or constipation if you are on a tricyclic, and indigestion or nausea if you are taking an SSRI. You are likely to develop tolerance to these symptoms as time passes, so be patient. If nausea is a problem, it may be helpful if you start your SSRI at half dose until you get used to it. A dry mouth can be helped by chewing gum. Some constipation – usually mild – is quite a common side effect with antidepressants.
Prevention is the best remedy: drink 2-3 pints of fluid daily, and take plenty of fruit and fibre in your diet. Lactulose is one of the milder laxatives sometimes prescribed for this symptom, and is also available over the counter from a chemist.
