Starting an antidepressant can be an important step in managing major depressive disorder (MDD), but finding the right medication is sometimes a bumpy road.
One reason is that antidepressants can cause unpleasant side effects. Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed class of antidepressants because they cause fewer side effects than other types of antidepressants such as serotonin and norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs), according to the National Health Service in United kingdom. But even with SSRIs, side effects are still very common.
Research shows that approximately 40 percent of people who take SSRIs report experiencing side effects of some kind. The researchers noted that about 25 percent of the side effects were “very troublesome” or “extremely troublesome.”
The types of side effects everyone experiences — and how long they last — vary from person to person and depend on the drug you’re taking, according to the Mayo Clinic. Some research suggests that genetics and the severity of depression may partly explain why some people experience some side effects more than others.
“Side effects of antidepressants are common, but fortunately, many side effects are temporary and go away with continued use of the medication,” says David Merrill, MD, an adult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Center. Wellness in Santa Monica, California.
It is important to tell your doctor about any side effects you have and to work out a plan together to manage them. Side effects can make it difficult for people to stick to their medications long-term, according to a review published in October 2020 in Annals of General Psychiatry.
If you start taking antidepressants, know that some rare (but serious) side effects, such as serotonin syndrome (high levels of serotonin in the body) or hyponatremia (abnormally low levels of sodium), can occur. Seek medical help immediately if you experience side effects such as agitation, disorientation, disorientation, muscle twitching, sweating, tremors, diarrhea, irregular heartbeat, seizures, or loss of consciousness, according to the UK’s National Health Service.
Here are six common side effects that people taking antidepressants are likely to experience — and how experts recommend you manage each.
1. Fatigue, drowsiness or tiredness
While fatigue is a common symptom of depression, it can also be a side effect of antidepressants, especially during the first few weeks of taking them, according to the Mayo Clinic. That’s because some antidepressants — such as doxepin, mirtazapine and trazodone — have sedative effects, according to a review published in August 2017 in the journal Neurology. Current Psychiatry Reports.
To help manage these effects, prepare ahead of time. “If at all possible, it’s best to start a new treatment when you have some down time or days off, rather than when you’re in the thick of it or under pressure to perform or meet deadlines.” suggests Dr. Merrill.
Some other ways to relieve fatigue, according to the Mayo Clinic:
- Do some exercise, such as walking or doing yoga. Over time, regular exercise can help you feel like you have more energy.
- Arrange for someone else to drive you places if you are too tired or sleepy.
- With your doctor’s approval, try taking an antidepressant at bedtime.
Some people taking antidepressants may experience insomnia – a sleep disorder that makes it difficult for them to fall asleep or stay asleep. That’s because some antidepressants, such as fluoxetine and venlafaxine, have stimulant effects that may disrupt sleep, according to the above review published in Current Psychiatry Reports . Research shows that these energizing effects can lead to symptoms of hyperactivity, such as hyperactivity, impulsiveness, or anxiety.
As with sleepiness, the insomnia associated with starting an antidepressant should go away on its own after a few weeks, according to Merrill. But in the meantime, consider trying these strategies to lessen this side effect, according to the Mayo Clinic:
- With your doctor’s approval, try taking an antidepressant in the morning.
- Avoid drinking caffeinated beverages, such as coffee, late in the day.
- Exercise – Breaking a sweat regularly can help you sleep better over time. Just be sure to exercise several hours before bed, as doing it too close to bedtime can have the opposite effect and keep you up much later.
- Ask your doctor about trying cognitive behavioral therapy for insomnia — as detailed at the Mayo Clinic — or medication to help you sleep if your insomnia persists.
3. Upset stomach
When you start taking certain types of antidepressants, such as SSRIs, they can lead to an upset stomach, with symptoms ranging from nausea to diarrhea to constipation. One reason this happens: “There’s more serotonin in the gut than in the brain,” says Merrill. Research shows that ninety-five percent of the serotonin in the body is made in the intestines.
“SSRIs can activate cells in the gut when the drugs are started,” Merrill adds.
Some helpful tips for calming an upset stomach, according to the University of Rochester Medical Center, include:
- for nauseaIt may help to take the medicine with food or before or after eating, depending on when you feel sick.
- for constipationTry to eat more fruits, vegetables, and fiber each day.
- for diarrhoeaTry to eat less fiber-rich foods, such as fruits and vegetables, than you currently eat.
4. New or worsening anxiety
Certain classes of antidepressants, such as SSRIs, may temporarily increase anxiety when you first start taking them. That’s because serotonin — the brain chemical affected by SSRIs — appears to temporarily activate a part of the brain associated with anxiety and fear, according to research published in August 2016 in nature. Although this study was done in mice, the researchers believe that this effect may occur in humans as well. Some antidepressants may also have stimulating effects, which can make you feel like you can’t sit still or relax, according to the Mayo Clinic.
Some relief strategies, according to the Mayo Clinic, include:
- Exercise regularly – Frequent physical activity is known to reduce anxiety.
- Try deep breathing exercises, such as yoga or muscle relaxation, to help calm your mind.
- If you are having trouble managing your anxiety, call your doctor and seek help.
5. Sexual side effects
Many people who take antidepressants experience side effects like decreased sex drive, erectile dysfunction, or delayed orgasms, says Peter Freed, MD, a psychiatrist in New York City and a media advisor for the Hope for Depression Research Foundation.
This may happen because SSRIs and other antidepressants that affect serotonin, such as SSRIs, can also affect levels of the body’s testosterone—linked to sexual arousal—and dopamine—linked to the achievement of orgasm—according to research published in July 2016. in mental health doctor.
Consider these strategies if you’re dealing with sexual side effects, according to the Mayo Clinic:
- Ask your doctor if you can take an antidepressant at a dose once a day, and then try to schedule sex before taking that dose.
- Ask your doctor if you could lower the dose of your current medication or switch to an antidepressant that has fewer sexual side effects, such as bupropion.
- Tell your partner about the sexual side effects you’re experiencing and work together to adjust your sexual routine accordingly.
- Ask your doctor about prescription medications such as sildenafil that can help treat erectile dysfunction.
6. Appetite and weight changes
Some antidepressants such as SSRIs are associated with increased or decreased appetite, sometimes resulting in weight gain or loss, according to the Mayo Clinic. Consider the following strategies if you’re experiencing changes in appetite or weight, according to the Mayo Clinic:
- Focus on eating nutritious foods such as fruits and vegetables, and reduce your consumption of saturated fats, trans fats, sweets and sugar-sweetened drinks.
- Work with a registered dietitian to come up with a nutrition plan that works for your specific health needs.
- Exercise regularly to maintain or reach a healthy weight.
- Ask your doctor if you can switch to an antidepressant that is less likely to cause changes in appetite or weight.
What to do if your side effects persist
If you’ve recently started taking an antidepressant and are experiencing side effects, it’s understandable that you feel uncomfortable or even sick of not feeling better. You may be tempted to stop taking your medications completely – but it’s important that you don’t. According to the Mayo Clinic, abruptly stopping an antidepressant can cause depression symptoms to return or cause withdrawal-like symptoms.
Often, your body just needs time to adjust to an antidepressant, which is why it’s important to give the medication enough time to work, says Merrill.
Tell your doctor about the side effects you’re experiencing – they can suggest strategies that may help you feel better while you’re taking antidepressants.
Some options that may help, according to the Mayo Clinic:
- Ask your doctor to adjust the dose of your antidepressant — or even start you on a lower dose. “We can start with a lower dose than usual to avoid the side effects of starting treatment, and then slowly increase the dose gradually over the following weeks,” says Merrill.
- Note if your doctor can switch your antidepressants. Finding the right antidepressant is often a process of trial and error. Some antidepressants may be less likely to cause certain side effects than others. For example, as mentioned earlier, bupropion is less likely to cause sexual side effects than many other antidepressants.
- Tell your doctor if you want to stop antidepressants completely. After weighing the pros and cons of stopping an antidepressant in favor of another treatment option, your doctor can help you safely taper off the medication over a few weeks, according to the Cleveland Clinic. Except in rare cases when the patient’s life is in danger, the doctor should be a “side guide helping the client to make the right decision for him,” says Dr. Farid.