The main use for antidepressants is treating depression. They are also used for some other mental health conditions and to treat long-term pain.
In most cases, people with moderate to severe depression are given antidepressants as a first form of treatment. They are usually given along with a talking therapy such as cognitive behavioural therapy (CBT). CBT is a type of therapy that uses a problem-solving approach to help improve thought, mood and behaviour.
Antidepressants are not usually recommended for treating mild depression because research has found that they have limited effectiveness.
However, exceptions can be made if:
- symptoms of mild depression have lasted for more than two years
- you have experienced previous episodes of moderate or severe depression
Initially, a selective serotonin reuptake inhibitor (SSRI) will usually be prescribed. If your symptoms have not improved after four weeks, an alternative antidepressant may be recommended. Depending on your personal circumstances, this may be a certain type of antidepressant such as:
- a different type of SSRI
- a serotonin-norepinephrine reuptake inhibitor (SNRI)
- a tricyclic antidepressant (TCA)
- a monoamine oxidase inhibitor (MAOI)
Other mental health conditions
Antidepressants can also be used to help treat other mental health conditions, including:
- anxiety disorder
- obsessive compulsive disorder (OCD)
- panic disorder
- serious phobias, such as agoraphobia and social phobia
- bulimia
- post-traumatic stress disorder (PTSD)
As with depression, SSRIs are usually the first choice of treatment for these conditions. If SSRIs prove ineffective, an alternative type of antidepressant can be used.
Long-term pain
Even though tricyclic antidepressants (TCAs) were not originally designed to be painkillers, there is evidence to suggest that they are effective in treating chronic (long-term) nerve pain in some people.
Chronic nerve pain, also known as neuropathic pain, is caused by nerve damage or other problems with the nerves, and is often unresponsive to traditional painkillers, such as paracetamol.
Amitriptyline is the TCA that is usually used to treat neuropathic pain. Conditions that may benefit from treatment with amitriptyline include:
- complex regional pain syndrome
- peripheral neuropathy
- multiple sclerosis
- conditions where a nerve becomes trapped, such as sciatica
Antidepressants have also been used to treat cases of chronic pain that do not involve the nerves (non-neuropathic pain). However, they are thought to be less effective for this purpose.
As well as TCAs, SSRIs and SSNIs can also be used to treat chronic non-neuropathic pain.
Conditions that cause non-neuropathic pain that may benefit from treatment with antidepressants include:
- fibromyalgia
- chronic back pain
- chronic neck pain
Bedwetting in children
TCAs are sometimes used to treat bedwetting in children as they can help relax the muscles of the bladder. This increases bladder capacity and reduces the urge to urinate.
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When antidepressants are used
