Depression and Anxiety Medicines: How They Work, What to Expect and Never Stopping Suddenly

Feeling sad or worried is part of life. But when low mood or anxiety lasts for weeks, drains your energy, and makes work, sleep and relationships harder, it is no longer just a bad patch. Depression and anxiety are medical conditions, and they are very common. In Pakistan, though, many people hide them out of shame, or are told to just pray more, or to stop thinking too much.

This guide explains how depression and anxiety show up, how treatment works, what the common medicines do and what to expect when you start them, why you should never stop them suddenly, and what to do in a crisis.

Signs of depression

• Low or empty mood for most of the day, nearly every day, lasting at least two weeks.
• Loss of interest or pleasure in things you used to enjoy.
• Changes in sleep (too much or too little) and appetite or weight.
• Tiredness, slowness, or restlessness.
• Feelings of guilt, worthlessness or hopelessness.
• Trouble concentrating or making decisions.
• Physical complaints: headaches, body aches, stomach problems, with no clear physical cause. Many people in Pakistan first describe depression through the body.
• Thoughts that life is not worth living, or of harming yourself. This needs help right away.

Signs of anxiety

• Constant worry that is hard to control, often about many things.
• Restlessness, feeling on edge, irritability.
• Racing heart, sweating, trembling, shortness of breath, a tight chest or a lump in the throat.
• Muscle tension, stomach upset and trouble sleeping.
• Sudden attacks of intense fear (panic attacks), or avoiding places and situations.

Anxiety and depression often occur together. Physical illnesses such as thyroid problems, anaemia, low blood sugar and heart rhythm problems can also look like anxiety, so a doctor may check your blood tests. See our guide to thyroid problems.

How are they treated?

Treatment depends on severity. Mild problems may improve with talking therapy and lifestyle changes. Moderate to severe depression and anxiety usually benefit from medicine, often along with therapy.

• Talking therapy, especially cognitive behavioural therapy (CBT), helps you change unhelpful thought patterns and learn coping skills.
• Medicines correct the chemical balance in the brain that affects mood and anxiety.
• Lifestyle: regular sleep, daily walking or exercise, sunlight, less caffeine and no alcohol, healthy meals, and time with supportive people.
• Family and community support: talk to someone you trust.

Antidepressants: how they work

Antidepressants are not addictive and they are not sleeping tablets or happy pills. They gradually raise the activity of mood-regulating chemicals in the brain. The most common groups are:

• SSRIs (selective serotonin reuptake inhibitors): usually the first choice, such as sertraline, escitalopram, fluoxetine and paroxetine. An example of an escitalopram brand is Lotolex.
• SNRIs such as venlafaxine (Efexor XR), which act on two chemicals.
• Mirtazapine (mirtazapine), which can help sleep and appetite.
• Older tricyclic medicines such as amitriptyline, now used less often for depression, and often at low doses for nerve pain and sleep.

Browse the depression and anxiety categories. These are prescription medicines. If you have a prescription, you can upload it here.

What to expect when starting

• It takes time: most people notice an improvement after two to six weeks, and full effect after eight to twelve weeks. Do not give up in the first week.
• Early side effects are common and usually settle within one to two weeks: nausea, headache, restlessness, trouble sleeping or drowsiness, dry mouth, sweating and sometimes more anxiety at first.
• Later side effects may include weight change, sexual side effects, and sweating. Tell your doctor, because changing the dose or medicine can help.
• Take it at the same time each day, morning or evening depending on whether it makes you alert or sleepy.
• Continue for at least six to twelve months after you feel well, as doctors usually advise, to prevent relapse. Some people need longer.

Important safety points

• Watch for worsening mood or suicidal thoughts, especially in teenagers and young adults in the first weeks, or after a dose change. Tell your doctor and family immediately.
• Never stop suddenly. Stopping abruptly can cause dizziness, electric-shock sensations, nausea, anxiety and flu-like symptoms (discontinuation symptoms), and the illness can return. Your doctor will reduce the dose slowly.
• Avoid alcohol. It worsens depression and interacts with the medicines.
• Tell your doctor about all medicines and supplements. Some combinations, for example with tramadol or herbal St John’s wort, can cause a dangerous reaction (serotonin syndrome).
• Pregnancy and breastfeeding: do not stop on your own. Talk to your doctor about the safest option.

Medicines for anxiety

• SSRIs and SNRIs are also first-line for long-term anxiety, panic attacks and social anxiety.
• Buspirone and some others are non-sedating options in certain cases. See buspirone.
• Beta blockers such as propranolol may calm physical symptoms such as a racing heart in situations like public speaking.
• Benzodiazepines such as alprazolam, clonazepam and diazepam calm anxiety quickly, but they can cause drowsiness, memory problems, tolerance and dependence. They are meant for short-term use under strict medical advice. Do not take them for months, do not combine them with alcohol or sleeping tablets, and never share them. Read our guide to insomnia and sleeping tablets.

Things that help beyond medicines

• Go for a walk every day, even ten minutes. Exercise is a proven mood booster.
• Keep a regular sleep routine.
• Eat regular meals, and do not isolate yourself. Contact a friend or relative every day.
• Practise slow breathing: breathe in for four counts, hold, and out for six counts.
• Limit caffeine and avoid alcohol and tobacco.
• Break big tasks into small steps.
• Pray, meditate or do whatever calms you, along with treatment, not instead of it.
• Check for vitamin D and B12 deficiency if you feel constantly tired. See our guide to vitamin D deficiency in Pakistan.

When it is an emergency

If you or someone you know is thinking about ending their life, has a plan, or has harmed themselves, do not wait. Stay with the person, remove access to anything dangerous, tell a family member, and take them to the nearest emergency department or contact a mental health professional immediately. You are not a burden, and help is available. Having these thoughts is a symptom of illness, not a character flaw.

When to see a doctor

• Low mood or anxiety for more than two weeks that interferes with life.
• Panic attacks, or fear that stops you from going out.
• Physical symptoms that tests cannot explain.
• Using alcohol or tablets to cope.
• Postnatal low mood, or a sudden change in behaviour in a family member.

Frequently asked questions

Are antidepressants addictive?

No, they do not cause craving or addiction. They can cause discontinuation symptoms if stopped suddenly, which is why they must be reduced gradually.

Will antidepressants change my personality?

No. They are meant to bring back your normal mood, not to change who you are.

Is depression just weak faith or weak will?

No. It is an illness, like diabetes or asthma. Faith can be a strength during recovery, but it does not replace treatment.

How long will I need medicine?

It varies. Many people take it for six to twelve months after recovery. Those with repeated episodes may need longer.

Order prescribed medicines from Khasmart with delivery across Pakistan.

This article is for general information and is not a substitute for advice from your doctor or psychiatrist. It does not include doses; your doctor decides the medicine and amount. If you are in danger, go to the nearest emergency department.