Antidepressants may not be safe for everyone. There are some important things to consider before you start taking antidepressants and while you are taking them. Your doctor will discuss these with you.
Pregnancy and antidepressants
Antidepressants are not usually recommended in pregnancy, especially in early pregnancy. This is because there might be risks for you or your baby.
But it's important that depression is well treated because it can affect both your and your baby's wellbeing.
Depression and anxiety can sometimes get worse during pregnancy and after your baby is born.
Speak to your GP about taking antidepressants. They will help you understand the risks and benefits so you can decide on the best treatment for you and your baby.
Breastfeeding and antidepressants
Taking antidepressants while you are breastfeeding is not usually recommended. But some antidepressants can be taken when breastfeeding.
Sometimes the benefits of antidepressants outweigh the risks. Talk to your doctor about this.
Children and young people
Antidepressants are not usually recommended for children and young people under 18. In rare cases, they can cause thoughts about suicide and self-harm in this age group.
There are concerns that some antidepressants can also affect brain development in children and young people.
Your GP may refer your child to a specialist psychiatrist.
The specialist may prescribe antidepressants if:
- talking therapies have not worked
- they will be used along with talking therapy
Alcohol
Do not drink alcohol if you're taking antidepressants. Alcohol is a depressant and drinking alcohol can make your symptoms worse.
If you drink alcohol while taking TCAs or MAOIs, you may become drowsy and dizzy.
You're less likely to experience negative effects while taking an SSRI or an SNRI. But avoiding alcohol is often still recommended.
Contact your GP or pharmacist about drinking alcohol while taking antidepressants.
Drugs
Do not take recreational drugs if you're taking antidepressants, particularly TCAs. This can cause unpredictable and unpleasant effects.
In particular, you should avoid taking:
- cannabis - smoking cannabis while taking a TCA can make you feel very ill
- amphetamines (speed)
- cocaine
- heroin
- ketamine
Recreational drugs can make symptoms of depression or other mental health conditions worse.
Other antidepressants
You should not take 2 different types of antidepressants together. For example, an SSRI and a TCA. Only do this if your doctor tells you to. Taking certain combinations of antidepressants can make you very ill.
Your doctor may change you from one type of antidepressant to another. They will gradually reduce the dose before starting you on the new type.
Taking antidepressants with herbal remedies
St John’s wort is a popular herbal remedy used for treating depression.
There is some evidence that it can help, but many experts do not recommend it. The ingredients vary among brands and batches. This makes it hard to tell how well it is works and how it interacts with other medicines.
It can also cause serious health problems if taken with other medicines including:
- antidepressants
- anticonvulsants
- anticoagulants
- combined contraceptive pill
Talk to your GP or pharmacist if you plan to take St John's wort with prescribed medicine.
Do not take it if you're pregnant or breastfeeding. It's not clear if it's safe.
Cautions for specific antidepressants
Some types of antidepressants may not be suitable for you if you have other health conditions.
SSRIs
SSRIs may not be suitable if you have:
- bipolar disorder and you're in a manic phase (a period where you're extremely excitable)
- a bleeding disorder, or if you're taking medicines that can cause bleeding such as warfarin
- type 1 or type 2 diabetes
- epilepsy - only take them if your epilepsy is well controlled, and stop if your epilepsy gets worse
- kidney disease
SNRIs
SNRIs may not be suitable if you have:
- a history of heart disease
- poorly controlled high blood pressure
TCAs
TCAs may not be suitable if you have:
- had a heart attack recently
- heart disease
- liver disease
- an inherited blood disorder called porphyria
- bipolar disorder
- schizophrenia
- a growth on your adrenal glands (pheochromocytoma) that is causing high blood pressure
- an enlarged prostate gland
- glaucoma (increased pressure in the eye)
- epilepsy