Winscombe & Banwell Family Practice
Sertraline, citalopram, fluoxetine, mirtazapine, venlafaxine, duloxetine and their relatives. You will see these called antidepressants — that is their official name, but we also use them for anxiety, and sometimes for nerve pain. Being given one does not mean we have decided you are depressed. This page sets out what to expect in the first few weeks, what to watch for, and when to come back to us.
Before you start
You will not feel different tomorrow. Most people notice a change between three and six weeks after starting. Stopping early, because it does not appear to be working, is the most common mistake.
The unwanted effects usually appear in the first week, and the benefit follows later. That order is counter-intuitive, and it is why some people give up too soon. Most of the early effects settle.
A small number of people feel more anxious, restless or low in the first weeks. If that happens, please contact us promptly rather than waiting for your next appointment.
It is long, and parts of it read alarmingly; that is true of every medicine leaflet. It is still worth reading, because the warnings about changes in your mood appear near the front for good reason. Your pharmacy may also give you a short card, on paper or on your phone, listing the main things to watch for. Keep it somewhere you will see it.
The medicines
These medicines were developed for depression, and that is where their name comes from. They turned out to work for a good deal more than that. We prescribe them for low mood, for generalised anxiety, panic, social anxiety and obsessive-compulsive disorder, and — in the case of duloxetine and venlafaxine — for nerve pain, where the dose and the reasoning are different again.
So if you have been given one for anxiety or for pain, the leaflet will still say antidepressant. That is the label, not a diagnosis.
None of them are sedatives in the way sleeping tablets are, none are addictive in the way opioids are, and none change your personality. Nor do they work immediately: the effect builds over weeks rather than days, which is the point people most often find surprising.
Whatever the reason you are taking one, it works best alongside the other things that help — talking therapy, sleep, activity, and the people around you. You can refer yourself for talking therapy without seeing a GP first.
Almost everything else on this page applies whichever one you have been given. These are the differences worth knowing about.
Nausea, headache and disturbed sleep are common in the first week and usually settle. Sexual side effects are common while you take them. Sertraline is the one we most often start with.
These can raise blood pressure, so we check it before you start and again as the dose goes up. They are also the ones most likely to cause withdrawal effects from a missed dose, so it is worth not running out of tablets.
Sedating, so it is taken at night and often helps sleep within the first few nights — though the effect on mood still takes weeks. It commonly increases appetite and causes some weight gain, and it is much less likely than the others to affect sex.
The first medicine not suiting you is common, and it tells us something useful rather than being a dead end. We can change within a group or between groups; sometimes we overlap the two, sometimes we reduce one first.
The first weeks
Two things happen over the first couple of months, and they do not happen at the same time.
Move the slider to see what is usual at each point. Again, these are typical patterns rather than a schedule; people differ, and yours may not follow this exactly.
We routinely review people two to four weeks after starting, and we will normally arrange that with you when the medicine is prescribed. If you are under 25, or if we have discussed thoughts of harming yourself, it will be sooner — usually within a week.
A lot gets covered in one appointment, and this is an easy thing for either of us to lose track of. If nothing was booked, or you are not sure when yours is, please get in touch and we will sort it out.
The unwanted effects tend to arrive first and the benefit comes later. Nausea, headache, a dry mouth, looser stools, disturbed sleep and vivid dreams are all common in the first week. With mirtazapine the main early effect is drowsiness instead.
Take it with food if it makes you feel sick. Continue if you can — most of these settle. If they are severe, tell us rather than stopping on your own.
The most important part of this page
If your thoughts turn to harming yourself, tell someone the same day.
A small number of people feel more agitated, restless or low in the first weeks of one of these medicines, or after a dose change, before they start to feel better. For a few, that includes thoughts of suicide or self-harm. This applies whatever you are taking it for.
We talk about this with everyone starting one of these medicines, and again whenever the dose changes. It is uncommon, and there is a great deal we can do — but only if you tell us. Do not wait for your next appointment, and do not wait to see whether it passes.
If you have someone close to you, it is worth telling them you are starting this medicine and asking them to say something if they notice you becoming more agitated or withdrawn. People around us often notice before we do.
Day or night. Choose option 2 for the mental health crisis team.
Free, 24 hours a day, every day of the year.
A free 24-hour text conversation if you would rather not speak.
Or go to your nearest emergency department.
Worth knowing before you start
SSRIs and SNRIs commonly affect sex while you are taking them: reduced desire, difficulty reaching orgasm, erection problems, reduced genital sensation. Mirtazapine is much less likely to. This is one of the most frequent reasons people stop taking these medicines, and one of the least often raised in the consultation. Please do raise it; it is an ordinary thing to discuss here.
For most people these effects ease once the dose is reduced or the medicine is stopped. For a smaller number they continue afterwards. You may see this called PSSD in the leaflet, short for post-SSRI sexual dysfunction — sexual side effects that persist after the medicine has been stopped. The name mentions SSRIs, but the same thing has been described after venlafaxine and duloxetine.
We cannot tell you how likely that is, or how long it lasts, because there is no reliable figure for it. We would rather say so than offer you a number we cannot stand behind. Either way, it is better to know before starting than afterwards.
If this matters to you, it is a reasonable thing to weigh up before you start, and a reasonable thing to raise with us at any point afterwards.
Also worth knowing
Some people feel restless or more anxious in the first week or two. It usually passes. Tell us if it does not.
There is no absolute ban, but alcohol lowers mood and adds to drowsiness. Less is better, particularly at first and particularly with mirtazapine.
Tell us about anything else you take, including anti-inflammatories such as ibuprofen, migraine treatments, St John’s wort and anything bought over the counter.
If you are pregnant, might become pregnant, or are breastfeeding, talk to us. It is often still the right treatment, but the choice of medicine may differ.
Possible with any of these medicines, and more likely in older people. Confusion, unsteadiness or marked drowsiness after starting should be checked with a blood test.
Mirtazapine commonly increases appetite, and a few kilograms of weight gain is usual. Tell us if it is more than you are comfortable with — there are alternatives.
If you are taking it for your mood, usually at least six months after you feel properly well — stopping as soon as you improve is the commonest reason symptoms come back. For anxiety or for pain, we will talk through what the right length is for you.
Coming off
These medicines are not addictive, but your body does adjust to them, and stopping suddenly can give you dizziness, electric-shock sensations, irritability, vivid dreams or flu-like aching. This is withdrawal, not your symptoms returning. Venlafaxine and paroxetine are the most likely to do it, so we reduce those especially slowly.
It is largely avoidable. We reduce the dose in steps, slowly, at a pace that suits you — and if a step is uncomfortable we stay there longer or return to the previous one. The pace is set by how you feel, not by a timetable.
Whatever the reason, please do not stop taking it without speaking to us first.
That includes stopping because of side effects, because you feel well again, or because you have read something that worried you. In each case there is almost always a better option than stopping abruptly on your own.
If you have taken an overdose, or you feel you are about to harm yourself and cannot keep yourself safe. Also call 999 for a high fever with muscle stiffness, twitching, agitation and a racing heart after starting or increasing one of these medicines. Do not wait, and do not contact the surgery first.
Next step
If you have questions before you start, or something has come up since, contact us and we will make the time. You do not need to wait for your review.
About this page
Written using national NHS guidance on depression in adults and the latest UK safety advice on this group of medicines. This is general information for our patients and does not replace advice about your own care. For your particular medicine, the leaflet inside the box is the authority.