Dr Vohra's · Updated
The types
SSRIs (selective serotonin reuptake inhibitors: sertraline, escitalopram, fluoxetine, paroxetine, fluvoxamine) are the usual first choice for depression and anxiety because they are effective and relatively safe. SNRIs (venlafaxine, duloxetine) add noradrenaline and help with pain and energy. Others, such as mirtazapine (sedating, increases appetite), bupropion (activating, used in some countries for smoking) and tricyclics, are chosen for specific profiles. The psychiatrist picks based on your symptoms, other medicines and side-effect tolerance.
Week by week
Week 1 to 2: side effects are at their peak and benefits have not started. Common: nausea, dry mouth, headache, jitteriness or drowsiness, changes in sleep. Taking the tablet with food and at the right time of day helps. Rarely, anxiety or agitation increases at first; tell your psychiatrist, especially if you are under 25, because of a small early increase in suicidal thoughts in young people that monitoring addresses.
Week 2 to 6: sleep and appetite often improve first, then energy, then mood. Week 6 to 8: the time to judge. If there is little change, the psychiatrist raises the dose or switches; about half of people respond to the first antidepressant and most to the second.
How long to take them
After a first episode of depression: at least six months after you feel well, often nine to twelve. After two or more episodes: two years or longer. Anxiety disorders: usually six to twelve months after response. Stopping early is the main cause of relapse.
Stopping
Antidepressants are tapered over weeks to avoid discontinuation symptoms (dizziness, flu-like feelings, electric-shock sensations, irritability), which are unpleasant but not dangerous and are prevented by a slower taper. Fluoxetine's long half-life makes it easiest to stop; paroxetine and venlafaxine need the slowest tapers.
Sexual side effects, weight and alcohol
Reduced libido or delayed orgasm affects a substantial minority on SSRIs and is treatable by dose change, timing or switching; it is worth raising rather than stopping silently. Weight gain is more common with mirtazapine and paroxetine than with others. Alcohol in small amounts is not dangerous with most antidepressants but worsens depression and sleep, so the advice is to avoid it while recovering.
Frequently asked questions
- Are antidepressants addictive?
- No. They do not produce craving or a high and are not misused. Discontinuation symptoms on abrupt stopping are a different thing and are prevented by tapering.
- Will antidepressants change my personality?
- No. People describe feeling like themselves again. Feeling emotionally flat is a side effect in some and is addressed by adjusting the dose or medicine.
- Can I drive?
- Most people can once they know how the medicine affects them. Sedating antidepressants need care in the first days.
- How do I book at Dr Vohra's?
- Call or WhatsApp +91 99992 49223, email help@drvohras.com, or use the contact form. In person at 29/24, East Patel Nagar, New Delhi 110008, or online across India.
- What if this is an emergency?
- Call Tele-MANAS 14416 or KIRAN 1800-599-0019 (24x7, free) or 112. Dr Vohra's is not an emergency service.