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Things doctors don't always tell you about anti-depressants

Dr Uzma Ambareen explains the way the medication works in detail

What doctors often fail to tell patients, even psychiatrists, is that it takes three weeks for an antidepressant to actually affect you. Often people feel a change after the first dose but this is not real. A lot of times that is psychological.

Clinical psychiatrist Dr Uzma Ambareen had a candid session with journalists at a CEJ Wellbeing Centre workshop in December in which she explained some aspects of taking medication that are not commonly discussed. People have many reservations about taking antidepressants but with a little awareness, many of those concerns can be addressed.

For example, Dr Uzma explained that sometimes, it can take a week or two weeks to feel better when you start taking an antidepressant, but psychiatrists don't expect any good change for at least three weeks. In fact, it can also take eight weeks to feel the maximum effect. "Unfortunately, the practice that we have in Pakistan is that the doctor doesn't tell you how long the medicine will take before you feel better," she said. "You might expect to feel better immediately. Many people feel disappointed and frustrated if their new antidepressant doesn't seem to start working immediately."

It is possible that if you keep going to the doctor they may change your medicine or increase your dosage.

Are general practitioners authorized to prescribe these medicines? Do they get training?

According to Dr Uzma Ambareen antidepressants that are being prescribed now are so safe that a GP can prescribe them.

"There is a universal shortage of psychiatrists," she said. "In the West, and now the model of treatment and care we follow in Pakistan, to a great extent a GP can prescribe medicines for general anxiety and depression or it can be treated at a primary care level."

Drug representatives give them training. They tell the doctors how good their medicines are and what their patients need.

GPs, especially the ones here, have limited knowledge of anxiety and depression. So it is less likely that they will give you antidepressants by mistake. They try to treat things medically first. You must have noticed sometimes physical symptoms of depression are treated first: people will be prescribed drips, vitamin injections, full body medical checkups. People have vitamins or "taqat ki golis". But, by the way, they don't affect you immediately either. That is very psychological.

How do we monitor our dosage? How do we know we are getting better?

Dr Uzma explained that your doctor will monitor your dosage. They mostly go with recommended dosages because they have studied them and know what the starting dose is and how to increase it.

Different psychiatrists have different ways of treatment. Some start with a heavy dosage and decrease it. Others are extra careful and start with a low dose and build it up from there. "We try that low dose for at least six to eight weeks to see how patients react or respond to it. If it doesn't help, then we increase the dosage," she said.

Always consult a doctor before taking any antidepressants or medication. Do not self-prescribe.

Talk to a mental health professional, a psychiatrist who can guide you.

Reliable websites to consult:
Mayo Clinic
Harvard Clinic

This article is based on an IBA-CEJ workshop on 'Depression, anxiety, medicine' held December 11, 2019 in Karachi at the IBA with Dr Uzma Ambareen.

Profile of clinical psychiatrist Dr Uzma Ambareen
Dr Uzma is one of Pakistan's best known clinical psychiatrists. She has been part of the IBA-CEJ Wellbeing Centre free counselling service since 2018.

She did her residency training in Psychiatry from Hahnema University and Brown University, US and her fellowship in Public Psychiatry from Columbia University, US. Dr Uzma has been the Medical Director of The Recovery House in Karachi since 2013 and runs her own practice.

Since her return to Pakistan in 1998, she has been associated with the Pakistan Association for Mental Health. She has served as Clinical Director at the Institute of Behavior Sciences and subsequently at the Free Mental Health Clinic.

Apart from Psychiatric Rehabilitation, her areas of interest include community psychiatry, public mental health awareness, individual psychotherapy and family therapy.