During a workshop at the Wellbeing Centre at the CEJ, journalists asked clinical psychiatrist Dr Uzma Ambareen every single question that bothered them about antidepressants. These were her answers.

Will I feel sleepy if I take an antidepressant?

Dr Uzma: The old antidepressants used to make people sleepy but the new ones don't. The old antidepressants caused a lot of weight gain, drowsiness, laziness, confusion. If you took the old generation antidepressants you were always sleepy or drowsy and people would know you were taking them because you would be essentially drugged and lethargic.

The new antidepressants are not like that. They keep you functional. Some very successful people in the worldly sense are on antidepressants but no one can tell by looking at them. They function like anyone else.

These are myths about antidepressants that you will feel drowsy or other people will notice you are taking them. It isn't true anymore.

How long do you have to take an antidepressant?

Dr Uzma: Some GPs say take an antidepressant for two three months and then stop. This is not how it is done. Even after a good improvement in a person you have to do a minimum course of six to eight months.

You need to have periodical check-ups with your doctor. If you are stable during that time and your symptoms go away and resolve, then and only then, after consulting with your doctor can you stop taking these meds. They are tapered off. You should never just stop taking them suddenly.

People have the perception that the best medicine is the one which has an immediate effect.

Yes. This can be temporary. But something like clinical depression cannot be treated like this. The illness doesn't go away. For a while you might not get anxious but it will come back.

In symptomatic treatment, for example, you take a Panadol if you have a headache. But if you haven't treated the cause of the headache, when the Panadol wears off, your head will hurt again.

Some people have single episode depression. They do a course of antidepressants and then they are fine. It is possible that they have another episode years later but we do not know for sure until we have their history in front of us or we give them antidepressants and then try to take them off them. That's how we know if they fall into that category or not. There is no dependence or addiction issue.

What if someone just stops taking the antidepressant suddenly? Can that cause problems?

Dr Uzma: Not necessarily. You must know two things: You may have withdrawal symptoms. You might be very uncomfortable for a few days, feel some anxiety, feel irritable, not sleep well, have a headache, feel dizzy. But this will resolve itself.

If your symptoms come back then you will have to restart the medicine cycle again. Once the antidepressant is out of your system it is like starting all over again when you do a new course. That can become an issue.

Can you develop resistance to an antidepressant?

Dr Uzma: Some people do have treatment-resistant depression and it is not clear why it happens. If you have been on full dose antidepressants for a long time and are still not improving then this is called resistance. Basically it means that the brain chemicals have a problem where they are not responding [to treatment.

What happens if you skip or forget to take your antidepressant? Miss a day?

Dr Uzma: It depends on how long you skip. If it is a short period, you might not be able to tell any difference. But if you skip or forget for a long time, you can feel a change.

Do you need to change your diet if you're on antidepressants?

Dr Uzma: Usually you do not need to change your diet much. But one thing you should avoid is grapefruit as it has a chemical which doesn't interact well with antidepressants and other medicines such as heart medicines and antibiotics (Do ask your doctor). The doctor is supposed to tell you what you need to be careful of when taking any new medicine.

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.