Major depressive disorder, also known as clinical depression, affects over 19 million Americans annually, making it one of the most prevalent mental health challenges today. If you or someone you care about is navigating this condition, seeking treatment is a critical step toward recovery. While antidepressants play a significant role in managing symptoms by regulating neurotransmitters like serotonin, understanding their potential side effects is equally important.
Antidepressants are often prescribed alongside psychotherapy, with selective serotonin reuptake inhibitors (SSRIs) being the most common option. Popular medications such as fluoxetine, citalopram, and paroxetine fall into this category. Other classes include serotonin-norepinephrine reuptake inhibitors (SNRIs) and norepinephrine-dopamine reuptake inhibitors (NDRIs). These newer antidepressants are generally considered safer and more effective than older treatments like tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs).
However, even the newer medications can cause side effects, ranging from mild discomfort to more severe reactions. Understanding these potential side effects and maintaining open communication with your psychiatrist can help you manage your treatment effectively. Below, we delve into nine common side effects of antidepressants to be aware of.
1. Nausea, Indigestion, and Stomach Upsets
Feeling queasy or having an upset stomach is one of the most common issues people face when starting antidepressants, especially with SSRIs or SNRIs. Around 40% of patients report nausea, diarrhea, or even vomiting in the early days of treatment. These medications can also cause stomach cramps or changes in digestion, such as diarrhea or constipation.
It’s not unusual to notice a loss of appetite during this time, and older antidepressants, like tricyclic antidepressants (TCAs), are especially known for causing constipation. While these symptoms can feel uncomfortable, the good news is they’re usually temporary and tend to ease within a week or two as your body adjusts.
If you’re dealing with these side effects, try taking your medication with food or sipping on water throughout the day to ease your stomach. If the symptoms stick around or feel unmanageable, it’s a good idea to check in with your doctor to explore alternatives or adjustments.
2. Sexual Dysfunction
Sexual dysfunction is a common side effect of antidepressants, significantly impacting both quality of life and emotional well-being. Many individuals on SSRIs experience reduced sexual desire and physical challenges due to how these medications increase serotonin levels, which can slow the brain’s response to sexual stimuli. This often leads to issues such as difficulty achieving or maintaining an erection in men, vaginal dryness in women, and delayed or absent orgasms in both sexes.
These side effects can be particularly frustrating and may even affect treatment adherence. If sexual dysfunction becomes a concern, doctors may explore solutions like adjusting the dosage, adding complementary medications to counteract these effects, or switching to an alternative antidepressant that might better suit your needs. Open communication with your healthcare provider is essential to finding a balance between effective depression management and maintaining a fulfilling intimate life.
3. Weight Gain
Weight gain is a well-known side effect of some antidepressants, with an increase of 10 pounds or more commonly reported after about six months of use. Older medications, such as tricyclic antidepressants (TCAs), are particularly linked to increased appetite and weight gain, which was a significant factor in the shift toward newer antidepressant options in the 1990s. However, even the newer drugs like SSRIs can have this effect. Interestingly, while SSRIs might initially lead to weight loss, long-term use has been associated with gradual weight gain.
The exact reasons behind this weight gain remain unclear. It may be connected to changes in metabolism, increased hunger, or overeating. Additionally, depression itself can influence weight fluctuations, with some individuals losing their appetite while others find themselves overeating due to serotonin imbalances, which affect appetite regulation.
To manage this side effect, your doctor might recommend dietary adjustments and regular exercise. If weight gain becomes a concern, they may also consider switching you to a different medication after evaluating how well the current one is working for you.
4. Dry Mouth and Blurred Vision
Dry mouth and blurred vision are common side effects, particularly linked to older antidepressants like tricyclic antidepressants (TCAs). These drugs work by blocking certain neurotransmitter receptors, which can interfere with the normal production of tears, leading to blurred vision. The reduction in moisture production also affects the mouth, causing dryness that can be uncomfortable or even lead to bad breath and an increased risk of dental issues.
These symptoms are often temporary and tend to improve within a few weeks as your body adapts to the medication. Staying hydrated, using artificial tears, or chewing sugar-free gum can help alleviate the discomfort. If the symptoms persist or interfere with daily life, discussing alternatives or adjustments with your doctor is recommended.
5. Sleep Disturbances
Antidepressants frequently affect sleep patterns due to their influence on neurotransmitters like serotonin and dopamine, which play a critical role in the sleep-wake cycle. Many of these medications suppress or disrupt the REM sleep phase, leading to a variety of sleep-related side effects that differ from person to person.
For instance, some individuals taking fluoxetine may experience insomnia, struggling to fall or stay asleep, while others report excessive daytime sleepiness or lethargy. Sleepwalking and frequent nightmares have also been linked to SSRIs, further disrupting restful sleep and contributing to fatigue and stress.
If sleep disturbances caused by antidepressants become severe or persist beyond the initial weeks of treatment, consulting your doctor is essential. They may suggest switching to a different type of antidepressant or adjusting the dosage to help restore a healthier sleep cycle.
6. Suicidal Tendencies
One of the most serious potential side effects of antidepressants is the emergence of suicidal thoughts or self-harm behaviors, particularly during the first few weeks of treatment. This paradoxical effect can occur as the medication begins to alleviate some depressive symptoms, restoring energy and motivation before improving emotional resilience. As a result, individuals may start to act on feelings of hopelessness or despair that they were previously too immobilized to address.
This risk is particularly heightened in young people under 25 who are starting antidepressants for the first time. Regular follow-ups and close monitoring by a healthcare provider are essential during this period to detect any warning signs early. It’s equally important to involve trusted family members or friends who can provide support and observe changes in behavior that might indicate a need for immediate help.
For children and adolescents, extra vigilance is crucial, as they may not always articulate their struggles. Open communication and prompt action can make a significant difference in preventing these distressing outcomes. If any concerning signs arise, reaching out to a physician or mental health professional right away is vital.
7. Serotonin Syndrome
This is a rare but serious side effect linked to SSRIs and SNRIs caused by excess levels of serotonin in your brain. This usually happens when you take these antidepressants with other medication increases serotonin levels, say other antidepressants or medicines with lithium used to treat bipolar disorder, or even triptan medications used to treat migraine headaches. Taking antidepressants with natural remedies could also be a trigger, which is one reason you must keep your doctor posted about any alternative medicines you take. Serotonin syndrome can cause symptoms like:
- Confusion and agitation
- Hallucinations
- Shivering, sweating, and muscle twitching
- Fever
- Blood pressure fluctuation
- Diarrhea
If you see these symptoms together or in tandem, see your doctor immediately. Severe serotonin syndrome could even cause fits, arrhythmia, and loss of consciousness and is a medical emergency.
8. Hyponatremia
Hyponatremia, or dangerously low sodium levels, is a rare but serious side effect of antidepressants, especially in older adults taking SSRIs. These medications can disrupt the hormone responsible for regulating fluid and sodium levels in the body. Since aging naturally reduces the body’s ability to manage fluid balance, elderly patients are more susceptible to this condition.
Early signs of hyponatremia include nausea, vomiting, headaches, confusion, and fatigue. If left untreated, it can escalate to more severe outcomes, such as seizures or even a coma.
If you or a loved one notices these symptoms, particularly while on SSRIs, seek medical attention immediately. Regular monitoring and open communication with your doctor can help detect and manage this side effect before it becomes serious.
9. Relapse or Tachyphylaxis
Sometimes, antidepressants that initially work well may stop being effective over time—a condition known as tachyphylaxis or “Prozac poop-out.” This can happen after years of treatment as the body develops a tolerance to the medication, making it less effective at managing symptoms. It’s a frustrating experience for many who feel their progress is slipping away.
One common reason for this is stopping or skipping doses. When people start feeling better, they might think they no longer need their medication, but this can disrupt its effectiveness in the long run. Other factors include the natural fading of the placebo effect—when initial relief is partly due to belief in the treatment—and undiagnosed conditions like bipolar disorder, which require different approaches to treatment.
If you notice your antidepressant isn’t working as well, don’t lose hope. Talk to your doctor about adjusting your treatment plan. A new medication, a dosage change, or even exploring other therapies can help get you back on track. The key is to stay open and proactive in finding what works best for you.
Antidepressants And Drug Interactions
If you have been prescribed an antidepressant and you already take medications for other conditions, make sure you mention it to your psychiatrist. Some drugs may combine to aggravate or create undesirable side effects. For instance, the interaction of SSRIs with medicines containing alcohol can result in increased and prolonged sedation. Similarly, when combined with aspirin, these drugs may increase the risk of gastrointestinal bleeding.
It may seem disconcerting that something that should bring you relief from depression could have such grave risks and fallouts. But what needs to be stressed is that some of these are temporary while others can be managed with a change of medication. Alternative options like cognitive behavior therapy may also work out for you. The important thing is to be aware and prompt in responding to these.
