For many people experiencing depression, antidepressants can literally be a lifesaver. While these medications can help lift people out of major depression, the side effects of antidepressants can be a difficult trade-off. How do these medications work, what are their common side effects, and how can you prevent them?
What are antidepressants?
Antidepressants are among the most widely prescribed medications worldwide. They are primarily used to treat depression, but they can also been shown to help with other disorders such as:
- Chronic pain
- Generalized anxiety disorder (GAD)
- Social anxiety disorder
- Obsessive compulsive disorder (OCD)
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Pain, especially diabetic nerve pain
- Hot flashes associated with menopausal symptoms
- Tourette syndrome
- Anorexia and bulimia
- Premenstrual dysphoric syndrome
- Migraine headaches
Antidepressants can reduce the symptoms of depression, but do not serve as a cure for depression. Almost twice as many women as men suffer from depression. As many as one-quarter of the U.S. population will experience at least one episode of depression during their lifetime.
What are the symptoms of depression?
An episode of major, or clinical, depression is characterized by a depressed mood most of the day for at least two weeks. Symptoms that may accompany depression are:
- Feelings of worthlessness and guilty
- Impaired concentration
- Significant weight gain or loss
- Insomnia (decreased sleep) or hypersomnia (excessive sleeping)
- Decreased interest in activities, which is also known as anhedonia
- Restlessness or feeling slowed down
- Recurring thoughts of death or suicide
- Irritability or anger
- Drug or alcohol abuse
Depression can be triggered by stressful life events such as:
- Grief from losing a loved on whether it be through death, divorce, or separation
- Social isolation
- Major life changes such as moving, graduation, changing jobs, and retirement
- Personal conflicts in relationships
- Physical, emotional, or sexual abuse
Those with a previous history of depression requiring hospitalization are at a high risk for future suicide and suicidal thoughts. Some studies have proposed that severe depression increases the risk of heart disease and diabetes. The economic burden of depression in the U.S. alone is estimated at $70 billion annually. The World Health Organization (WHO) estimates that by 2020, depression will be second only to heart disease as the leading cause of disability worldwide. The majority of those suffering with depression can be effectively treated with a combination of antidepressants and counseling or psychotherapy.
What are the possible side effects of antidepressants?
Since antidepressants are a large class of drugs, there are multiple, possible side effects of their use. Potential side effects of anti-depressants include:
- Dry mouth
- Joint pain
- Weight gain or loss
- Difficulty urinating
- Sexual side effects, like erectile dysfunction, delayed orgasm, and decreased libido
- Excessive sweating
- Low blood pressure
- Daytime sleepiness
- Tingling sensations on the skin
- Muscle aches
- Irregular heart rate
- Mania, which is periods of great excitement, euphoria, delusions, and overactivity in those with bipolar disorder
- Visual disturbances
Let’s look at some of the more common ones in more detail, especially those that are more pressing for pain patients.
1. Initial physical side effects of antidepressants
Some of the most common side effects of antidepressants begin even before the patient feels the positive effects of the medication. Physical side effects are usually mild but can include:
For someone with chronic pain, muscles aches or joint pain are the last thing that they want to experience or increase. Most people build tolerance to these side effects, however, and find they go away.
2. Migraine headaches
Chronic migraine sufferers may struggle with this common side effect of antidepressants, especially if they take triptans for migraine pain. SSRIs and triptans increase the brain’s production of serotonin, which can cause serotonin syndrome: flushing, rapid heart rate, and headache.
3. Insomnia or daytime sleepiness
The same mechanism that causes insomnia at night in these three antidepressants also causes sleepiness during the day. Antidepressants may also cause nightmares and sleep walking. This side effect may be short-lived, a plus for those who work outside of the home or care for a family.
4. Weight gain
This is one of the most common side effects of antidepressants and the main reason people stop taking them. Weight gain may be just a few pounds or, in the case of 25% of people taking Paxil, up to 7% of their body weight.
5. Sexual side effects
Of all side effects, sexual side effects are the most common. These can include:
- Decreased libido
- Erectile dysfunction
- Delayed ejaculation for men
- Inability to have an orgasm for women
Antidepressant-induced sexual dysfunction may cause patients to discontinue their use, which could affect their overall well-being. Drug holidays were shown to significantly improve sexual dysfunction in depressed patients taking the SSRIs sertraline (Zoloft) and paroxetine (Paxil), but not fluoxetine (Prozac).
6. Suicide and suicidal thoughts
Especially for teens and children, antidepressants increase the risk of suicide. This side effect of antidepressants may seem counterintuitive, but there seems to be a tipping point in some patients where they feel less helpless but still depressed. This may provide enough motivation and energy to attempt suicide.
7. Digestive issues
Depending on the type of antidepressant, patients may experience either diarrhea or constipation as their body adjusts.
How to cope with side effects of antidepressants
While the list of side effects of antidepressants may seem daunting, the benefits of these medications can be tremendous. There are many different ways to cope with the side effects of these medications.
1. Select the right medication
It may take several tries, but there are many options for antidepressants. Don’t settle for feeling bad because of the side effects. Each antidepressant works differently for different people. Keep looking until you find what works for you. What follows is a brief overview of the different classes of antidepressants.
The most commonly prescribed antidepressants belong to a class of medications called selective serotonin reuptake inhibitors (SSRIs). Some of these SSRIs can cause side effects so severe that patients stop taking them. These side effects may be exacerbated by any other medications being taken for pain.
Frequently prescribed serotonin reuptake inhibitors are:
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
Another class of antidepressants are serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs work to block the absorption of both serotonin and norepinephrine. The most commonly prescribed types of SNRIs are:
- Venlafaxine (Effexor and Effexor XR)
- Desvenlafaxine (Pristiq)
- Duloxetine (Cymbalta)
Tricyclic antidepressants (TCAs) block the reabsorption of noradrenaline and serotonin, prolonging the body’s natural mood boost caused by serotonin. Common TCAs include:
- Amitriptyline (Elavil)
- Imipramine (Tofranil)
- Doxepin (Sinequan)
- Trimipramine (Surmontil)
- Clomipramine (Anafranil)
Norepinephrine-dopamine reuptake inhibitors (NDRIs) are another class of antidepressant. The lone NDRI is bupropion (Wellbutrin). It increases levels of norepinephrine and dopamine, which can improve mood. Bupropion’s other uses include the treatment of seasonal affective disorder (SAD) and can be combined other medications to treat bipolar disorder. The drug is also marketed as Zyban.
Atypical antidepressants don’t fit into other classes of antidepressants. Examples include:
- Mirtazapine (Remeron)
- Nefazodone (Serzone)
- Trazodone (Desyrel)
These medications are frequently used in severely depressed patients whose symptoms have not been helped or can’t tolerate the side effects of SSRIs.
Over the years, other classes of antidepressants have been developed. You may have also heard of monoamine oxidase inhibitors (MAOIs), the first class of antidepressants to be developed. Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate). The MAOIs and other antidepressants treat depression by changing the levels of one or more neurotransmitters, which are naturally occurring chemicals in the brain. The MAOIs increase the levels of the neurotransmitters norepinephrine, serotonin, and dopamine. It is this increase in neurotransmitters that boost the mood of a depressed individual.
The monoamine oxidase inhibitors are prone to adverse effects and have to be taken with dietary restrictions as they can cause dangerously high blood pressure when taken with certain foods or medications. Because of this, MAOIs have been replaced by other classes of medications.
2. Address the physical first
Nausea and dry mouth can be uncomfortable and make adjusting to the new medication doubly hard. Take antidepressants with small amounts of food and drink plenty of fluids. Sucking on sugar-free candy can help with a dry mouth, as can over-the-counter dry mouth mouthwashes and toothpastes.
3. Get moving
Many people stop taking antidepressants due to an increased appetite and weight gain. Instead of going off the medication, treat this as an opportunity to overhaul your diet and exercise routine. Drink plenty of water and eat tons of fresh fruits and vegetables. Aim for at least one hour of activity every day for both physical and mental health.
4. Reframe intimacy
Sexual side effects are common and do not tend to go away after the initial adjustment period, Many patients cope with this by having open communication with their partners, scheduling intimacy before taking a once-a-day dose of antidepressants, and using other medications such as Viagra for men and estrogen cream for women. In some cases, switching antidepressants can help.
5. Switch your timing
Fatigue during the day and insomnia at night can not only compound the other side effects of antidepressants; it can also increase the perception of pain, a disaster for chronic pain patients. Changing the time that you take your antidepressant (a couple hours before bedtime for daytime fatigue, in the morning for insomnia) can help. Other strategies include:
- Taking a brief nap during the day and working in daily physical activity (daytime fatigue)
- Avoiding caffeine late in the day (insomnia)
- Considering mild sedatives (insomnia)
6. Avoid constipation or diarrhea with dietary changes
Again, this is an excellent time to re-evaluate diet. In addition to getting regular exercise, adding high-fiber foods and drinking of plenty of water can keep you healthy regardless of the type of digestive upset you are experiencing. Fiber supplements can also help with constipation, and slower-digesting foods such as brown rice can help cope with diarrhea.
7. Follow your doctor’s directions
Another concern when you stop taking these medications is antidepressant discontinuation syndrome. It affects 20% of patients who abruptly stop antidepressants after taking them for at least six weeks.
Symptoms of this syndrome may include:
- Flu-like symptoms
- Sensory disturbances
Follow your physician’s direction when discontinuing an antidepressant. A gradual decrease, or taper, when discontinuing antidepressants is recommended to decrease the chances of developing antidepressant discontinuation syndrome.
Some antidepressants work better than others for certain people. As a result, a trial and error approach is often utilized in the treatment of depression or other disorders, like chronic pain. Antidepressants have varied adverse effects. However, side effects of antidepressants should not stop you from getting the medication that you need. The best course of action is to talk to your doctor about your options to see which might work for you.
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