Antidepressants
Taking an antidepressant with medicines for other illnesses
Doctors need to be aware of all the medicines a person is taking in order to check if they can be taken together without any adverse (bad) effects.
The pharmacist may also review the medicines people are prescribed, particularly if they take several different types. Pharmacists are also able to offer advice and support.
Screening for depression is a routine part of managing long-term conditions such as diabetes, so many people take other medicines as well as an antidepressant.
We talked to people who were taking antidepressants alongside medicines for conditions such as arthritis, high blood pressure, high cholesterol, neurological disorders, stomach problems, heart problems, fibromyalgia, thyroid problems, acute asthma, and Crohn’s disease.
Experiences taking antidepressants with other medications
People who have to take several different medicines each day find that it helps to get into a routine so that they remember to take everything at the right time.
Some people count out each day’s medicines in advance or use a pill organiser with the days of the week marked on it.
Stephen, who took several tablets each day said he ‘had this little pill box with Monday to Friday because I’m also on tablets for blood pressure ... and there’s a statin which I take in the evenings as well'.
When people have become accustomed to taking several different medicines it often becomes routine to take them each day.
Victoria was diagnosed with Crohn’s disease and was used to taking a number of tablets every day. Jenny had acute asthma and took up to 19 different tablets each day. Without her medicine she would become very unwell so she knew it was in her best interest to remember to take them all.
See also ‘Reviewing antidepressant use’, ‘Managing the use of antidepressants’ and ‘The Pharmacist’.
Sometimes people who have been diagnosed with depression may also be prescribed sleeping tablets to help with insomnia or they may be prescribed a particular antidepressant that has a sedative effect.
Rachel took Montelukast to help with urticaria (allergies). She took this medicine at night as it can cause drowsiness and she said it helped with her sleep problems.
Sharon was prescribed a medicine for acne which can on rare occasions heighten depressive feelings, so her doctor increased the dose of her antidepressant when he prescribed it.
She told us she ‘had to start on Roaccutane, for acne ….so the fluoxetine was upped in anticipation of a dip, and it worked, it worked quite well - we managed to sort of keep it on an even keel’.
Peter had to take several different medicines each day to cope with ulcerative colitis, a condition that causes bowel and digestive problems. He took several tablets each day including his antidepressant and said he felt resentful about having to take so many pills.
It can be frustrating to have to take a medicine to help counteract side effects from another one. Janet had osteoporosis and a problem with her parathyroid gland (possibly caused by taking lithium) so had to take other medicines to regulate her calcium levels.
Clare takes medicines to counteract the effects of other medicines she’s taking.
Clare takes medicines to counteract the effects of other medicines she’s taking.
It’s interesting because apparently there’s something called I can’t remember what the phrase is but it’s that thing that were you’re on a medication you have to take another mediation to counteract the effects of medication you have to take and there’s, there’s a phrase for it it’s not over medication, something like that and one of things that I discovered was that these two medications both had constipation as, as a side effect.
Is that, so you take one for the arthritis?
Arthritis.
Then something else to counteract that?
I take the Naproxen twice a day (for arthritis) and I take my citalopram once a day so I have three tablets a day and they both have as a small side effect a sluggish bowel.
Is that the same for the citalopram?
Yes.
So it’s another side effect?
So I’m now I’m really good at drinking a lot of water, you know roughage but there are times when I have to take another medication to get the old body working properly.
So is that something you discussed with the doctor?
Actually it just.
As a side effect is it just from on the side of the leaflet?
No I just noticed it physically thinking oh God I’m really, you know, this is, this is not good. You know?
But you can usually manage it through diet though, roughage and so on?
I can yes I think at the time I was I wasn’t, my diet, I was on a diet trying to lose weight for the wedding so my diet wasn’t as good as it could be I think that was a factor as well so yes so again it was a kind of angst about oh God now I’m constipated three lots of prescriptions.
Janet feels different about the medicines she takes for her physical health, and those that are for her psychological health.
Janet feels different about the medicines she takes for her physical health, and those that are for her psychological health.
How do you feel overall about the fact that you have to swallow all these tablets or have you just got used to it over the years?
I’ve just got used to it yes. I mean they’re for two different things I mean one is for psychiatric things and the others for bones.
Yes.
And so I can’t really muddle them up and say they’re all a nuisance because they’re for different, different things.
So do they make, is it different, do you feel differently taking the ones for the bones as opposed to the psychiatric ones, do they make you feel do you have different feelings about taking them?
I do actually yes I think I feel that the olanzapine and the lithium and the lofepramine are more important but in fact they’re not more important but they're more important because they’re meant to enhance me which they never do, they going to make life better whereas the calcet and the Vitamin A and D are just as important but I never really feel they are.
Antidepressants are sometimes prescribed to help someone cope with difficulties posed by physical health problems.
Catherine took what she described as ‘a cocktail of medication’ for her fibromyalgia and chronic pain. Similarly, Jenny, who had acute asthma and a number of other serious health conditions felt that taking an antidepressant helped her cope with being so unwell.
Dina had Crohn’s disease and was originally prescribed steroids, but once she started taking antidepressants the steroids had to be replaced by other medicines, because as she said, 'steroids can sort of exacerbate psychotic sort of tendencies or whatever you want to call that I wasn’t able to take steroids’.
Catherine takes medicines to cope with her chronic pain. She continues taking Prozac (fluoxetine) even though she’d like to come off it, because it helps her cope.
Catherine takes medicines to cope with her chronic pain. She continues taking Prozac (fluoxetine) even though she’d like to come off it, because it helps her cope.
Fibromyalgia chronic pain, it’s actually a really, it’s what they class as a set of symptoms, it’s, it’s not a specific illness as such, it’s a set of symptoms where there’s chronic pain, widespread pain in the muscles and with it sleep disturbance, chronic fatigue is quite common, I experience chronic fatigue with that. I also experience Sjogren’s syndrome which is the dry mouth, dry eyes, dry skin and that’s quite common again to be with, to go with fibromyalgia. One thing maybe not quite so common is lymphedema in my left arm, swelling, they don’t really know if that’s really, if that’s related but they basically fibromyalgia chronic pain condition.
So would you say that part of the reason for carrying on with the Prozac now is to kind of alleviate the feelings that you have about that condition?
Yes, yes I would yes because the other thing is about that is I have attended the chronic pain services and ironically part of the process of, the services you use is psychological therapies which is CBT as well as physiotherapy and also I think many people who I’ve spoken to about fibromyalgia are also on antidepressants because they still think that the serotonin can be useful in fibromyalgia. Whether it, whether, I mean again it’s, it’s a, a difficulty whether you could say that having a long history of depression would ever have triggered off fibromyalgia because again there’s a thing about whether fibromyalgia, is it a psychological condition, is it a physical condition, is it both? There’s an ongoing.
And some of the symptoms are pretty similar too it sounds like from what you’ve just told me.
Yeah, yeah, so that, that can be, yeah that can be a bit of a difficulty but certainly my fear would be I would have a, I mean actually before I developed fibromyalgia I was already looking to coming off Prozac, so it wasn’t really as if there was a fear there at the time, I think the fear has come around from the fact that I have a physical condition to deal with while I’m working fulltime still, which is very, you know, it’s hard in itself a fulltime job and, you know. A lot of people with fibromyalgia aren’t fortunate enough to work at all, I am, so and I’m also now on a cocktail of pain medications so, you know I think the fear is valid I would say and kind of the Prozac thing and whether there’s a placebo thing or whatever I don’t know but, you know, for me it’s, it’s, I really don’t want to take that risk at the moment because I’m, I am working, I don’t want to disrupt that, what I have is still good and it would be a bit daft really to, to think about that just now.
The doctor and pharmacist should ensure that the antidepressant you are taking does not interact adversely (badley) with other medicines prescribed.
Experiences with doctors and communication with multiple medications
Reviewing medicines on a regular basis is good practice. Sometimes though, people said this had been overlooked, especially when the antidepressant had been prescribed on a long-term basis with regular repeat prescriptions.
Jenny, who took numerous medicines, preferred to keep her own record and check drug interactions using the BNF (British National Formulary).
When some people were admitted to hospital, they said they would take in their own supplies of the antidepressant they were taking, although other medicines were started on the ward.
Some felt satisfied that the specialists they saw about their physical health conditions worked together with their GP and that there had been good communication between the two.
Emma had a neurological condition and saw both a consultant at the hospital as well as her GP about different aspects of her health and was confident that they each know what the other was doing.
As one person said, the doctors 'know that I take the [oral contraceptive] pill... the medication that I take for my neurological disorder reacts with certain types of pill so my GP makes sure that that works out and then some of the antidepressants react with my brain drugs so they have to make sure they don’t interfere so there’s a lot of communication, I have to say I’ve got a really good medical team there’.
Others felt that there was a lack of ‘joined up care’ and that it would be helpful if health practitioners took a more holistic approach with prescribing medication.
Victoria said that although the specialists she saw about Crohn’s disease knew she took an antidepressant, it would be helpful if they asked her more about how it was affecting her emotionally.
She told us, ‘I think because it’s all ‘me’ so all my problems kind of link into one, because obviously they’re going on in the same body it might be nice if they kind of spoke to each other and kind of cross-referenced things.’
Thomas commented that ‘you can find that the prescribing for your psychiatric medications can be very different to the prescribing for your physical conditions’, and said that doctors can have different attitudes to prescribing medicines to deal with these distinctly different types of conditions.
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