The most common clinical depression treatment is antidepressants. There are multiple antidepressant drug classes that each come with their own sets of potential side effects. However, these medications can affect each person differently due to their varying diets, lifestyles, and hormones. Here is an overview of the most common antidepressants, their health risks, side effects, and what you can do to combat them.
SSRIs and SNRIs
Selective serotonin reuptake inhibitors (SSRIs) include fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), and sertraline (Zoloft). Common serotonin-noradrenaline reuptake inhibitors (SNRIs) include duloxetine (Cymbalta) and venlafaxine (Effexor XR). The side effects for these two classes are similar and include the following:
- Indigestion and Loss of Appetite
- Diarrhea or Constipation
- Stomach Aches or Headaches
- Dizziness or Lightheadedness
- Sleeping Difficulties, Drowsiness, and Fatigue
- Feeling Anxious, Shaky, or Agitated
- Sexual Dysfunction resulting in decreased sex drive or libido, trouble reaching climax, and erectile dysfunction
Tricyclic Antidepressants (TCAs)
These are an older class of antidepressants that can cause more side effects than newer classes, so many doctors won’t prescribe them unless other medications haven’t worked. These include amitriptyline, imipramine, doxepin, nortriptyline (Pamelor), and desipramine (Norpramin). Here are their potential side effects:
- Blurred Vision and Dizziness
- Dry Mouth
- Difficulty Passing Urine and Stool
- Weight Gain
- Excessive Sweating or Night Sweats
- Heart Issues such as a rhythm problem or arrhythmia, palpitations, and fast heartbeat or tachycardia
Monoamine Oxidase Inhibitors (MAOIs)
This category of medication is often one of the first antidepressants prescribed. MAOIs typically have diet restrictions because they can interact with foods and medications to cause dangerously high blood pressure or hypertension. You have to avoid aged cheeses, sauerkraut, cured and lunch meats, soy sauce, miso, tofu, and draft beers. Their one advantage is that selegiline (Emsam) comes in a transdermal skin patch, which doesn’t always require diet modifications.
Before taking other prescriptions, over-the-counter medications, or herbal supplements, you must speak to your doctor or pharmacist. They can also give you a list of foods and beverages to avoid. MAOIs are effective but have a long list of side effects:
- Nausea, Diarrhea, or Constipation
- Dizziness or Lightheadedness
- Sleeping Difficulties and Drowsiness
- Dry Mouth
- Weight Gain
- Trouble Starting to Urinate
- Muscle Cramps or Spasms
- Low Blood Pressure or Hypotension
- Pins and Needles Sensations or Paresthesia
- Skin Reaction at Patch Administration Site
Dealing with the Side Effects
Eating small, frequent meals throughout the day will help with both your depression symptoms and your medication’s side effects. Drink plenty of water, eat plenty of fruits and vegetables, and continue to exercise. This will aid your digestion, nausea, and any bowel problems. If you are suffering from constipation, eat plenty of high-fiber foods. Speak to your doctor about a fiber supplement or stool softener if it persists.
If you get nauseous from your antidepressant, try taking it before bed so you sleep through any discomfort, or there may be a slow-release version that you tolerate better. Taking it at night can also help if it makes you sleepy or you have sexual dysfunction; You will perform better right before your next dose when the effects are at their lowest.
If you have trouble sleeping because of your antidepressant, it could be better to take it in the morning. Avoid caffeine if you are too wired to sleep. Also, avoid caffeine, alcohol, and tobacco products if you suffer from dry mouth, as they can worsen it. Carry water to sip regularly or chew sugarless gum. Try to breathe through your nose instead of your mouth to moisten your mouth.
If you are dealing with dizziness or blurred vision, you may need to avoid driving or operating machinery until your body adjusts to your medication. Use handrails for support and change positions slowly.
Potential Serious Health Risks
This is a rare problem that occurs when the level of the neurotransmitter serotonin in your brain gets too high. Symptoms include fevers, sweating, shivering, diarrhea, muscle twitching, agitation, and confusion. Typically, it happens when you take another medication or herbal supplement that raises your serotonin levels, such as another antidepressant or St. John’s wort. If you are experiencing any of these symptoms, speak to your doctor immediately or go to your nearest urgent care or emergency room. When left untreated, extreme symptoms are seizures, irregular heartbeats, unconsciousness, and death.
Long-term use of SSRIs and TCAs increases your risk of developing type 2 diabetes. However, many other factors can affect your risk, and it’s not something that everyone will develop.
SSRIs can block the effects of hormones regulating sodium and fluid levels in your body. A severe fall in your sodium levels can lead to a build-up of fluid inside your cells. Older adults are more vulnerable since their body struggles to regulate their fluid levels as they age. Mild symptoms include feeling generally sick, reduced appetite, headaches, muscle pain, and confusion. Again, seeking medical advice and treatment is crucial. Symptoms can progress from worsening confusion to disorientation, psychosis, seizures, and coma, or your breathing can stop resulting in death.
Increased Risk of Suicide
All antidepressants come with a black box warning, the strictest warning a prescription can have. The notice is for increased suicidal thoughts and behaviors during the first few weeks of starting the medication or when a dose is changed. You have a heightened risk if you are under 25 years old.
This is a serious risk because the antidepressants will help improve energy and motivation before the depressive feelings, so someone will have more energy to act on their suicidal thoughts before their overall mood improves. Watch closely for unusual behavior or worsening depression. Learn what to watch out for here. It is important to remember that antidepressants do reduce the risk of suicide in the long run, but mood improvement takes some time and requires patience.
Most side effects occur within the first few weeks of starting the medication and should subside as your body adjusts. If they persist, you can speak to your doctor about other treatment options. If you have tried multiple medications with intolerable side effects or encountered some health risks, you may be a good candidate for an alternative depression treatment. Keep a daily journal of your prescriptions, the side effects you experience, and your food and drink intake. It will help track how you respond to your medications and pinpoint factors that may make it worse. It will also help your doctors decide if you should try a different medication or other treatments.