The definitive guide to treating common ailments
No 10: Which anti-depressants work best?
The problem: Since the advent of Prozac, many people assume the 'old' anti-depressants are, at best, less effective and, at worse, damaging. But drugs for depression are a very individual matter and research now shows that 'old' drugs are as effective as the new ones.
What is depression? Clinical depression usually involves feelings of despondency, dejection, fear and irritability. Symptoms include loss of interest in life, fatigue, poor concentration, self-reproach, loss of appetite and insomnia, lasting more than two weeks.
How can it be treated? Two ways: with drugs and 'talking' treatments such as counselling or psychotherapy. For some people a combination of the two is best.
Can drugs really help? Study results show anti-depressants are the most effective treatment for depression. They are not tranquilisers, which are prescribed to relieve anxiety, and they are not addictive. Even when there is an obvious reason for feeling down - such as a personal crisis - anti-depressants still help people cope better.
Are the 'new' drugs like Prozac better than the 'old' ones? Not necessarily. There are two main groups of anti-depressants: tricyclics, introduced in the 1950s, and selective serotonin reuptake inhibitors (SSRIs), which have appeared in the past decade. Prozac is the best known. SSRIs cost up to six times more and have been heavily promoted as being more effective with fewer side-effects. Yet large studies show tricyclics work equally well to cure depression.
So there's nothing to choose between them? All anti-depressants can have unpleasant side-effects. Tricyclics can cause dry mouth, constipation, urinary retention and drowsiness, while SSRIs may cause diarrhoea, tremor and insomnia. Some studies suggest people slightly prefer SSRIs since fewer stop taking their tablets However, this may also be due to a belief that the SSRIs are better. Some doctors believe people already suffering sleep problems may benefit from the sedative effect of the older drugs if taken at night.
Any other differences? Old-style anti-depressants are more toxic; if taken in a suicide attempt they are more likely to be fatal.
How long do they take to work? Both tricylics and SSRIs take at least two weeks to start working and must be taken for several months. Halting medication early is a big factor in depression returning.