Ask your pharmacist antidepressants part 3

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ieThis is a continuation of last week’s article and is the last of three articles on the subject.

Medication is only part of the solution for those suffering from depression; antidepressants should only be used in conjunction with other treatments including counselling and cognitive behavioural therapy. Antidepressants should not be used for mild depression; they should only be used for moderate to severe depression.

How long do they need to be taken for?
Antidepressants do not necessarily treat the cause of the depression or take it away completely. Without any treatment, depression will get better after about 8 months in most people. If they are stopped before 8 or 9 months is up, the symptoms of depression are more likely to come back.

The current recommendation is that it is best to take antidepressants for at least six months after you start to feel better. If you have had two or more attacks of depression then treatment should be continued for at least two years.

What if depression comes back?
Some people have severe episodes of depression over and over again. Even when they have got better, they may need to take antidepressants for several years to stop their depression coming back. This is particularly important in older people, who are more likely to have several periods of depression. For some people, mood stabilisers such as Lithium may be recommended.

Antidepressants during pregnancy
While it is advised to take as little medication during pregnancy as possible, the benefits of antidepressants sometimes outweigh the risks during pregnancy in more severe cases. Non-drug methods such as Cognitive Behavioural Therapy should be tried before drugs in pregnancy.

If medication is needed, for example in cases of suicidal feelings, SSRI’s are the most commonly prescribed. Tricyclics are best avoided in pregnancy.

Antidepressants in breastfeeding mothers
A baby will get only a small amount of antidepressant from mother's milk. Babies older than a few weeks have very effective kidneys and livers. They are able to break down and get rid of medicines just as adults do, so the risk to the baby is very small.

While it is up to your doctor, most doctors allow mothers taking antidepressants to breastfeed as the amount of drug entering the breast milk is very small.

Important points when taking antidepressants
They should be taken every day otherwise they will not work. They don't work straight away. Most people find that they take 1-2 weeks to start working and maybe up to 6 weeks to give their full effect. It is important to persevere; stopping too early is the commonest reason for people not getting better and for the depression to return.

Keep in touch with your doctor in the first few weeks. With some of the older Tricyclic drugs it's best to start on a lower dose and work upwards over the next couple of weeks. The dose of SSRI antidepressant generally does not have to be increased slowly. It doesn’t help to increase the dose above the recommended levels. Many people are put off by the initial side-effects such as nausea. Many of them wear off in a few days.

They should not be stopped unless the side-effects are very severe. If side effects are severe, you should notify your doctor immediately. The doctor should be informed about any major changes in mood when the dose of antidepressant is changed. Alcohol should be taken in moderation only. Alcohol on its own can make depression worse, but it can also make people slow and drowsy when taking antidepressants.

Upcoming talk on depression and mental health
Whelehans Pharmacy have organised an expert panel to discuss depression and mental health in the coming weeks in Mullingar; some of the leading local experts on this subject will be talking. Speakers will include Consultant Psychiatrist from St Lomans Mental Health Service, Dr Ciaran Corcoran; Specialist Psychiatric Nurse Colette Moriarty and Pharmacist Eamonn Brady. 

This talk will be open to all and will be free of charge. The exact date and venue is to be confirmed soon so keep an eye on this column in the coming weeks for more details. In order to avoid disappointment, you can put your name down on the waiting list for this event by calling Whelehans at 04493 34591.
  
This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans