Medicines to treat depression in brief
- If you think you might be depressed see your GP because there's a lot of help and support available to you.
- Getting support and treatment for your depression will reduce your risk of asthma symptoms getting worse.
- If the GP diagnoses mild depression the most effective way to treat it is a combination of self help and support groups rather than of anti-depressants.
- Evidence shows that a course of anti-depressants, alongside talking therapies such as CBT (Cognitive Behavioral Therapy), is the best way to treat depression that's moderate to severe, or severe.
- Anti-depressants usually work by targeting chemicals in the brain that affect mood and they work best alongside self-help or psychological support.
What's my depression got to do with my asthma?
- People with asthma often experience worse asthma symptoms when they're stressed or depressed. So it's really important to talk to your GP and find out about the support and treatments available to you. Studies suggest that if you’re given support to deal with your depression, you're more likely to stick to your asthma medicines and reduce or avoid asthma symptoms.
- Studies suggest that people with asthma, are more likely to experience depression. Asthma symptoms can sometimes get in the way of enjoying a good quality of life, and it's easy for people to feel stuck in a cycle of depression and worsening symptoms. People with severe asthma and young people with asthma are most at risk of stress, anxiety and depression because of their asthma. Knowing the best way to manage your asthma is one way to break this cycle.
How can your GP help you with your depression?
GPs will use different approaches depending on whether your depression is diagnosed as mild, moderate or severe. Most GPs will offer you a range of different treatment options - talking therapies, exercise therapy, support groups - before prescribing anti-depressants.
But if your depression is moderate or severe, anti-depressant medicines, in combination with counselling or Cognitive Behavioural Therapy (CBT), will give you the best chance of beating it.
It's important to see your GP if you think you're depressed so you can get the right diagnosis and the appropriate treatments for the kind of depression you have.
What anti-depressants are available?
There are almost 30 different anti-depressants licensed for use in the UK. You can find out about each one, and their side effects and cautions on the NHS choices website.
The anti-depressants you're most likely to be prescribed are SSRIs and SNRIs which are considered the safest:
- SSRIs (Selective serotonin re-uptake inhibitors) such as Fluoxetine (Prozac); Citalopram (Cipramil) or Paroxetine (Seroxat)
- SNRIs (Serotonin noradrenaline reuptake inhibitors) such as Duloxetine (Cymbalta) or Venlafaxine (Efexor, Vendadex)
Other kinds of anti-depressants, such as TCAs (tricyclic anti-depressants) and MAOIs (monoamine oxidase inhibitors) both belong to an older group of anti-depressants and wouldn’t usually be recommended unless someone has severe depression and other treatments haven’t worked for them. This is because there is a higher risk of side effects.
How do anti-depressants work?
Anti-depressants work by boosting levels of serotonin (and sometimes noradrenaline) in the brain. These are known as the 'feel good' chemicals which the body produces naturally. It's not known if a dip in levels of serotonin in the brain causes depression or if serotonin levels get low when someone is depressed. Either way anti-depressants reduce the symptoms of depression by boosting levels of serotonin.
Anti-depressants work best when combined with counselling or other kinds of talking therapies, such as CBT (Cognitive Behavioral Therapy). The medicine can work on the symptoms of depression, while the counselling or CBT can address the causes of the depression over the longer term and support you in managing your emotional well-being going forward.
How long do anti-depressants take to work?
It might take between two and four weeks to notice a difference, and it's important to take the medicine regularly. If you haven't noticed any improvement after this time see your GP again to review the treatment you’re on. A course of anti-depressants usually lasts six months. But your GP might recommend you continue taking them for another six months to cut the risk of your depression coming back. If you're prescribed anti-depressants remember to ask how long it will take for the treatment to start working, and how long you will need to take them.
Are anti-depressants addictive?
Anti-depressants are not considered to be addictive - unlike alcohol or nicotine, you won't need to take more anti-depressants to get the same effect, and you won't crave them when you stop taking them. However, some people do have 'withdrawal' symptoms when they stop taking anti-depressants and the best way to reduce these is to come off the medication gradually. You should never stop taking anti-depressants without talking to your GP first about reducing the dose gradually to avoid side effects that can happen if you stop taking them suddenly.
When are anti-depressants prescribed?
Anti-depressants are most likely to be prescribed when you have 'moderate to severe depression'. This means you're having several symptoms indicating depression and it's affecting how you get on with your life. If your depression is severe you're likely to need the support of a mental health team who can provide intensive psychological therapies as well as anti-depressants.
If you have mild depression your GP is unlikely to prescribe anti-depressants because they are not thought to be as effective as a combination of self-help, such as exercise, and the use of support groups.
Some anti-depressants are also prescribed for other mental health conditions such as panic disorders, anxiety, or OCD (obsessive compulsive disorder).
You should never take more than one type of anti-depressant at the same time. People can respond differently to different anti-depressants, and might find that one works better for them than the other. Your GP will prescribe one type and if it doesn't work for you, then maybe another type will. Your GP will take into account your clinical and family history before deciding what type of treatment may suit you.
Anti-depressants mostly come in tablet or capsule form, but some are available as liquid or oral drops.
Are anti-depressants suitable for everyone?
Anti-depressants are not usually recommended for pregnant or breastfeeding women, or for children under 18. Fluoxetine is the only anti-depressant licensed for young people aged 8-18 and will only be considered when a course of psychological therapy has been tried but hasn't worked. Anti-depressants, including fluoxetine, haven't been tested clinically in young people under 18 so there's less information available about possible side effects and risks.
Is it safe to take anti-depressants alongside my asthma medicines?
Whenever you're starting to take a new medicine you should always talk to your GP or a pharmacist about any medicines you're already taking, including any for your asthma. There might be some anti-depressants you need to avoid. For example, the anti-depressant fluvoxamine is not recommended for someone taking the asthma medicine theophylline.
There's no evidence yet that can specifically state which anti-depressant would be best for someone with asthma. However, there's such a wide range of depression medicines and treatments available so your GP will be able to find one that suits you.
What about side effects?
There are potential side-effects when you take anti-depressants. These include dizziness, nausea, digestive problems, blurred vision, and some other more serious, but much less common, side effects. NHS Choices lists all the anti-depressants available along with all their potential side effects and cautions.
SSRIs and SNRIs are the most widely used of all the anti-depressants and they are safer and have fewer side effects than other types used. Generally speaking the newer anti-depressants don't give people as many side effects.
If you're worried about any side effects you're experiencing, tell your GP straight away. Your GP or mental health team will decide to either monitor your symptoms, or stop, or change the type of medicine you're on.
St John’s Wort
You might have come across St John's Wort as a complementary treatment for mild depression. This is a herbal treatment available over the counter from chemists or health food shops. Although some people have used St John's Wort and found it helpful it isn't recommended by NICE (National Institute of Clinical Excellence) because it could react badly with other drugs, and because doses and strengths of the different products sold can vary so much. It's always a good idea to ask your GP or pharmacist for advice before taking any herbal or over-the-counter medicines. Just because a medicine is 'natural' or available over the counter doesn't mean it's always safe - it could interact with other medicines you're taking.
Last updated November 2016
Next review due November 2019