Antidepressants are medicines prescribed to treat depression, anxiety disorders, obsessive-compulsive disorder (OCD), and certain other conditions. They work by affecting levels of chemical messengers (neurotransmitters) in the brain, including serotonin, noradrenaline, and dopamine. The most commonly prescribed types are selective serotonin reuptake inhibitors (SSRIs, such as sertraline, citalopram, and fluoxetine) and serotonin-noradrenaline reuptake inhibitors (SNRIs, such as venlafaxine and duloxetine). Older classes include tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), which are used less commonly due to their side effect profiles.
After cardiac arrest, mental health difficulties are common. A significant proportion of survivors experience depression, anxiety, and post-traumatic stress disorder (PTSD). Antidepressants are frequently prescribed as part of treatment for these conditions. The choice of antidepressant in cardiac patients requires careful consideration, as some classes, particularly certain TCAs, can prolong the QT interval and increase arrhythmia risk. SSRIs and SNRIs are generally preferred in cardiac patients due to their more favourable cardiovascular safety profile.
Antidepressants are not a quick fix: they typically take 2 to 4 weeks to produce a noticeable effect, and the full benefit may take 6 to 8 weeks. They are usually taken for a minimum of 6 months after symptoms resolve before considering stopping, to reduce the risk of relapse. Doses are started low and increased gradually, and antidepressants should not be stopped suddenly without medical guidance as this can cause discontinuation symptoms.
Antidepressants work best when combined with psychological therapies such as cognitive behavioural therapy (CBT). For cardiac arrest survivors, access to psychological support through cardiac rehabilitation or specialist survivorship services is important alongside any medication. If an antidepressant is not effective after a sufficient trial, a GP or psychiatrist can review the dose or switch to a different medicine.
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