Are antidepressants addictive?

Dr Mark Porter replies

I am so sorry to hear what you have been going through. Depression can mean you are probably not thinking as clearly as you might normally, but you really should have shared your concerns with your own doctor – not least because she now thinks you are taking medication that you aren’t.

She will not think any less of you for being reluctant to take the citalopram, and I am sure she would appreciate the opportunity to allay your concerns. In the meantime, I shall have a go.

Depression is very common, with major life events like retirement being recognised triggers, and you are far from alone.

Indeed, as many as one in six adults in the UK will be prescribed antidepressants over the next 12 months. So we have a lot of experience when it comes to possible side effects, which should be listed in the patient information sheet that came with your citalopram.

However, these (often very long) lists of potential problems – anything from sleeping difficulties to an upset stomach – can be off-putting, and it is important to bear in mind that most people take them without any trouble.

Facts about citalopram

 Here are a few that I highlight with my patients.

First, they take a while to work and, paradoxically, you can feel worse mood-wise for the first few weeks. And when they do start to kick in, don’t expect miracles. Antidepressants do help most people, but the benefits are often subtle and they are best used alongside other strategies like support, counselling and talking therapies.

Two potential side effects that don’t get mentioned as often as they should is how they might affect your stomach and sex life.

• Citalopram-type antidepressants (the SSRI family, which includes Prozac) can, occasionally, cause stomach bleeds, particularly in people who are on other gastric irritants like aspirin or anti-inflammatories such as ibuprofen or naproxen; or anticoagulants like warfarin and apixaban. So, if you do get indigestion after starting them, please report it to your GP.
• They can also impair libido and enjoyment of sex (although depression can too). In fact, their effect on delaying orgasm – in men and women – is so marked that related drugs are sometimes used to treat premature ejaculation in men.

Citalopram and addiction

Finally, your concerns regarding addiction. They are not addictive. However, they can be quite difficult to stop due to withdrawal effects like increased anxiety and restlessness.

Citalopram is one of the better types in this regard, but if you have been on it for nine to 12 months or more (as most people are), then it’s a good idea to wean off slowly over a number of weeks.