Antidepressants: common myths, and what the evidence actually says

01

“Once you start, you’ll get addicted”

Addiction means craving a substance and losing control over how you use it. The Royal College of Psychiatrists says antidepressants do not have the addictive properties of drugs like alcohol or opioids.

What can happen is physical dependence. Your body gets used to the medicine, so if you stop or cut down quickly, you may feel unwell for a while. These are called withdrawal or discontinuation symptoms. They can include dizziness, nausea, headaches, sweating, poor sleep, anxiety and brief electric-shock feelings that people call “brain zaps”.

The Royal College estimates that between a third and half of people who take an antidepressant get such symptoms to some extent. For many they are mild and settle within days or a few weeks. For some they are stronger and last much longer, and the risk seems higher after a high dose taken for a long time.

Withdrawal is not the same as the depression coming back. Withdrawal usually starts soon after a dose is lowered or stopped, while a relapse tends to build up over weeks or months. If you can’t tell which one you are feeling, ask your doctor.

02

“They’ll turn me into a zombie”

Some people fear they will become dull, sleepy or simply not themselves. The aim of treatment is to ease the depression, which is often what has made you feel unlike yourself.

Side effects are real, though, and it helps to know about them. Mood changes, including feeling emotionally flat or numb, are among the common side effects the NHS lists. If you notice this, say so. Your doctor can review the dose or talk through other options. You do not have to just put up with it.

03

“They work instantly” and “I’ll need them for life”

The NHS says they usually take one to two weeks to start having an effect and can take up to eight weeks to work fully. The Indian Psychiatric Society’s guidelines note that improvement is generally seen after four to six weeks. So give the medicine a fair chance, and keep your follow-up visits.

Once you feel well, you will usually be advised to carry on for a while. The NHS and the Royal College of Psychiatrists both say at least six months after your symptoms have gone, and the Indian guidelines suggest six to nine months after recovery. NICE, the UK guideline body, notes that continuing treatment can reduce the risk of relapse.

That is very different from lifelong treatment. Most people can later stop gradually, over a few weeks or months, with their doctor’s guidance. People whose depression has come back several times may be advised to continue longer, often for at least two years.

04

“Medicine is only for serious cases” and “It’s therapy or tablets”

Being offered an antidepressant does not mean you are “too far gone”. Treatment is matched to how severe the depression is. The World Health Organization says antidepressants are not needed for mild depression, where talking therapy is the first choice. For moderate and severe depression, medicine is a common option and can be combined with therapy.

Therapy and medicine are not rivals. Talking therapies such as cognitive behavioural therapy (CBT) help you work on patterns of thinking, behaviour and relationships. The Royal College points out that antidepressants ease symptoms but do not fix the life problems that may lie underneath, which is one reason the two are often used together. The Indian guidelines also recognise that some people need both.

05

Side effects, and why you should never stop suddenly

Common side effects include nausea, headaches, dry mouth, sleep changes, dizziness or drowsiness, changes in appetite or weight, and sexual problems. Many ease after the first couple of weeks as your body adjusts. If some linger, raise them with your doctor.

Do not stop an antidepressant suddenly or on your own, even if you feel better or the side effects bother you. Your doctor can plan a gradual reduction, usually over several weeks or months. The Royal College advises taking at least four weeks even if you have mild or no withdrawal symptoms, and slowing down rather than giving up if symptoms appear.

06

When to call your doctor

Get in touch with your doctor promptly if:

• your mood is getting worse, or you feel unusually restless, agitated or not yourself
• you have new or stronger thoughts of harming yourself or ending your life
• side effects are hard to cope with
• you want to stop or change your medicine

Thoughts of self-harm are uncommon, but they can appear when someone starts an antidepressant. The NHS says people aged 24 or under, and those who have had such thoughts before, may be most at risk. The US Food and Drug Administration requires a warning that antidepressants can increase suicidal thinking and behaviour in young people, with the risk seen during the first few months of treatment, and advises watching closely for worsening mood or unusual changes in behaviour. Families can help by staying alert in those early weeks.

It is also worth remembering that untreated depression carries its own risk of suicidal behaviour. Getting the right treatment, and asking every question you have, is part of staying safe.