Antidepressants can be very helpful for treating and/or minimizing symptoms of major depression. Although these drugs may significantly improve a person’s mood, they may also cause unwanted side effects. Many side effects from antidepressants are relatively easy to cope with, and tend to subside after a person has been on a drug for a few weeks. Over time the body seems to adapt to the new drug and side effects tend to go away.
However, there are usually a few side effects that actually develop or intensify as a person continues antidepressant treatment. For a majority of individuals, the most troublesome side effects include: weight gain and sexual dysfunction. Other side effects can include dizziness, headaches, dry mouth, and insomnia. In many cases, these side effects can become so overwhelming that a person decides they are more of a problem than their initial depression.
In many cases, a person who gains a significant amount of weight from taking a medication may decide that the weight gain is actually contributing to deeper feelings of depression. It can also be psychologically distressing to have little interest in sex and/or be unable to orgasm. Below is a full breakdown of various side effects as well as factors that contribute to them.
Factors that influence antidepressant side effects
There are many factors that can influence side effects that are experienced upon taking an antidepressant medication. These factors include things such as: individual variation, the dosage of the drug, how long you took it, the specific antidepressant, as well as whether you are on any other drugs.
1. Individual Variation
Although there are common side effects associated with each antidepressant, not everyone will react the same way to a certain drug. Two people could both try the exact same SSRI at the same dose and one person may gain a significant amount of weight, while the other individual may not gain any weight (or may actually lose weight). Responses to medications are often based on individual physiology and personal factors. This is why most doctors recommend experimenting with different medications so that you know which drug you tolerate best.
In most cases, increases in dosage of a certain drug will lead to more severe side effects. For example, someone who takes just 5 mg of an SSRI may find that this low dose is helping to reduce their depressive symptoms with no side effects. If they were to titrate the dose up to 20 mg, they may experience significant lethargy and weight gain. Usually the greater the dosage, the more your nervous system’s natural processing is being influenced by a drug.
3. Time Span
The length of time that you’ve been taking a certain antidepressant can also influence the side effects that you are experiencing. Most people tend to notice that there are several types of side effects associated with antidepressants. Usually there are early side effects, which tend to subside once your body adapts to the drug, standard side effects that occur throughout treatment, and long term side effects – those that develop after the drug has been used for a long term.
- Early side effects: These tend to last a few weeks during the initial adjustment phase. As the drug is introduced to your body, it initially may not know how to react. Once it has received the drug for a few weeks, it becomes used to it and many early side effects fade.
- Standard side effects: These are the side effects that never seem to go away throughout treatment. These may occur during the early stages of treatment and be a nuisance as long as you continue taking your medication. Examples of common standard side effects include: weight gain and low libido.
- Long term side effects: These are the side effects that tend to develop with long term use of the antidepressant. In many cases these develop months or years after a person has been taking a certain drug. For example, they may one day notice abnormal blood pressure, joint pain, and/or muscle weakness. These may be exacerbated if the dosage of the drug is increased.
4. The Antidepressant
What antidepressant are you taking? There are many different types of antidepressants including: SSRI, SNRI, atypical, tricyclic, and MAOI. Understand that the specific class of the antidepressant can influence some of the side effects that you experience. Additionally specific drugs within a certain class can have completely different side effects.
For example, a person on the drug Cymbalta may have completely different side effects than when they go on Effexor, a drug in the same SNRI class. Keep in mind that certain drugs tend to cause more side effects than others. For most people, there’s really no telling what side effects you will experience from a certain antidepressant until you test it for yourself.
You may notice certain side effects resulting from particular classes as well. For example, someone on Wellbutrin may not experience any weight gain, but may feel more agitated and have a tough time with insomnia compared to being on an SSRI. On the SSRI a person may gain weight, but have no issues with insomnia. In other words, there can be tradeoffs in side effect profile based on the particular class.
5. Interactions (Other drugs)
Are you taking any other drugs that could be the culprit for causing your side effects? In many cases people aren’t even aware that other medications can interact with their antidepressant and lead to side effects. For example, if you are taking an analgesic, anxiolytic, antipsychotic, or cocktail of various psychotropic medications with your antidepressant, it may be difficult to pinpoint which drug is causing the side effects.
In some cases, the side effects cannot be traced to a particular drug because they are created by an interaction between the cocktail of drugs. If you were on one drug, and you add another to the cocktail, the new drug may be causing side effects, but it could also be that the drug is interacting with your current medication to cause them. For this reason it’s important to be as specific as possible when discussing your experience with a psychiatrist.
Another example would be that drinking alcohol while taking an antidepressant may make you considerably more dizzy, drunk, and affect your overall experience. Keep in mind that illicit drugs as well as alcohol can play a role in influencing how you feel and side effects.
Antidepressant Side Effects: List of Common Possibilities
Below are a list of common side effects that people report when they take antidepressants. Understand that the list below is a collective of side effects reported from all classes and antidepressant drugs. Most people only experience a few side effects throughout their treatment for depression.
- Agitation: A common side effect of many antidepressants is feeling agitation. This feeling is often like a nervousness that is uncomfortable and impossible to escape. In many cases it is triggered by the chemical response being generated in your brain by the antidepressant drug.
- Anger: Although antidepressants can mellow some people out and make them less prone to feelings of anger, in many cases they can actually make people angrier than normal. Little things may really make some people mad while they take a certain antidepressant. In some cases people can build up such intense feelings of anger that it would better be described as “rage” or “fury.”
- Anxiety: Many antidepressants can help anxiety, but even the ones that are often “supposed” to help can actually make it worse. At the end of the day, it’s somewhat of a crapshoot in regards to what antidepressant is going to improve anxiety. Additionally even people who had depression without anxiety can end up developing anxiety as a result of chemical changes in the brain brought on by an antidepressant.
- Brain zaps: Experiencing electrical shock sensations or “brain zaps” is all too common with antidepressants. It is most associated with SSRI withdrawal, but some individuals experience these shocks while they are taking their medication. In many cases people experience these when they are new to a specific drug and they tend to fade away.
- Constipation: Some drugs can make a person constipated and unable to pass bowel movements. This can be difficult to deal with especially if you had normal bowel movements prior to taking your medication. After awhile this side effect will likely fade in intensity.
- Depersonalization: Many people become depersonalized or feel like they’ve become someone else while taking a drug. In many cases feeling depersonalized is uncomfortable and can make certain people feel as if they will never be normal again. The depersonalization is often caused by chemical changes from the antidepressants and feelings of anxiety.
- Depression: Ironically the same drugs that are used to treat depression can actually make it worse. For most physical conditions, nearly all medications devised to treat a particular ailment work to improve it. For mental health conditions like depression, whether a drug works or not is a gamble. In many cases a person will try a drug and realize that the chemical changes it is making is actually contributing to feeling more deeply depressed.
- Diarrhea: Some drugs may make your bowels go crazy, which inevitably results in diarrhea. This is very common with the newer antidepressant Viibryd. In cases of diarrhea, most psychiatrists will recommend buying over-the-counter Imodium and taking it daily to combat this side effect.
- Dizziness: Feeling dizzy is most often reported during the early stages of treatment and/or if a person ever has to increase their dosage. In most cases, dizziness tends to subside as a person adapts to their particular antidepressant. If you consistently feel dizzy to the point that you cannot function, you will need to switch medications.
- Dry mouth: This is an extremely common side effect reported with older classes of antidepressants such as the TCAs and MAOIs. You may notice that your mouth becomes very dry and that no saliva is there to lubricate your mouth. In this case, do your best to deal with it and continue staying hydrated with the hopes that it improves.
- Emotional blunting: Many people report feeling as if they have become emotionally numb as a result of antidepressants. Not everyone has this reaction to antidepressants, but many people that try them end up feeling like they’ve transformed into a zombie as a result of having no emotions. In this case the antidepressant is basically acting as a patch over painful emotions rather than improving natural emotions. A different drug will likely need to be tried if you are experiencing a blunted affect.
- Fatigue: Certain antidepressants can make people feel more lethargic, tired, and sedated. If you constantly have low energy and know that the drop in energy level is a result of antidepressant treatment, you will need to weigh the pros and cons. If you are feeling better, but cannot stay productive at work because you are void of energy, this can be a problem.
- Headaches: This is a common side effect associated with any medication, even non-antidepressants. If you are constantly getting headaches from your medication, it could be because you haven’t been on it long enough for them to subside. If the headaches are strong, you may want to consider taking some sort of medication for them.
- Hypomania: Some antidepressants can make people feel a little bit on the euphoric end of the spectrum when a person starts treatment. Not to be confused with mania, hypomania is when an characterized by elevated mood, talkativeness, energy, and confidence. This is different from mania in that it does not typically interfere with a person’s functioning.
- Increased appetite: Many antidepressants are known to increase appetite. In some cases the appetite increase may be due to a person feeling happier on the drug. However, in many cases the boosted appetite is caused by chemical changes in the brain made by a particular drug. Do not be surprised if you notice that you are eating more than you were prior to taking an antidepressant.
- Insomnia: Although some drugs can help a person fall asleep easier at night, others can make it difficult to fall asleep at a proper time. Antidepressants can sometimes make a person feel too keyed up and have too much energy to get some sleep. In some cases the insomnia is temporary, but with more activating medications, this is considered normal.
- Irritability: Another common side effect associated with antidepressants is irritability. If you find yourself becoming very irritable and little things are starting to get on your nerves, know that this is a side effect. Certain medications can make people become extremely irritable and crabby. Usually if a person does become irritable during treatment, it may be a sign that the medication is not working.
- Low libido: Many antidepressants work great for boosting mood, but can completely take interest away from sex. If you notice that your libido has significantly dropped, it is likely due to the drug that you are taking. If your low libido becomes bothersome, consider trying a medication that’s more stimulating.
- Mania: Among individuals with bipolar disorder, antidepressants can sometimes trigger what’s referred to as a “manic switch.” In other words, a person may be depressed, take a medication, and it triggers a seemingly rapid change in mood from being severely depressed to euphoric, with significant energy, talkativeness, and impulsivity. Although this may not sound like a bad side effect, the mania can actually be detrimental to the individual’s functioning.
- Mood swings: Some people become more prone to mood swings when they take an antidepressant. Not only can these drugs make a person feel irritable, but they can also make someone feel anxious, angry, agitated, excited, etc. This is not referring to bipolar mood swings, rather it is in reference to changes in mood (usually negative) caused by medication.
- Nausea: Certain drugs can cause people to feel nauseous, especially when they first start treatment. Some nausea is common when you initially begin taking a drug, but this side effect tends to subside after your body adapts to the drug. If you have nausea that persists after the first month of your treatment, you may want to consider a different medication.
- Palpitations: These medications can have an impact on arousal and physical functioning. The combination of these changes can lead to what are known as “heart palpitations.” You may notice that your heart feels as though it is racing or beating abnormally loud. In some cases this side effect is exacerbated by anxiety.
- Restlessness: If you notice that you’ve become exceptionally restless and find it difficult to sit still after taking an antidepressant, you aren’t alone. Many people note that they are unable to remain calm because a drug has their nervous system too stimulated. Restlessness can be common with any medication, but most people are able to tolerate it.
- Seizures: Certain antidepressants are linked with increased risk of seizures. Although most drugs are unlikely to cause this side effect, you may want to avoid certain medications if you are prone to epilepsy. The medication most associated with causing seizures is Wellbutrin. A majority of doctors and pharmacists are aware of this risk.
- Sexual dysfunction: If your interest in sex and sexual performance noticeably decline, it’s likely due to the medication that you are taking. Many SSRIs can cause sexual dysfunction and inability to orgasm. Not being able to orgasm can be very frustrating. If your sex life is important to you and you are having sexual problems from your medication, talk to your doctor about possible solutions or a medication change. Some men believe that this may be a result of antidepressants lowering testosterone.
- Sleep changes: You may notice that your sleep cycle begins to change after you start taking a medication. Some people end up sleeping considerably more on their antidepressants and others end up having a more difficult time getting sleep. You may also find that the drug you take either improves or reduces the quality of sleep you have been getting.
- Suicidal thoughts: An underreported side effect associated with antidepressants is an increased risk of suicidal thoughts. In many cases, antidepressants can actually create a deeper depression and increase suicidal thinking. If you notice yourself feeling more suicidal after taking a medication, talk to your doctor about switching to something else. Read the article “Can antidepressants cause depression and suicidality?” for further information.
- Sweating: You may notice after you start taking an antidepressant that you are sweating more than ever. In some cases you may sweat profusely throughout the day and/or during the night. This is a result of the drug making physiological changes and your body attempting to adapt to these changes. In most cases, the sweating is reduced and tolerable as treatment continues.
- Vision changes: Although most antidepressants will not cause any sort of eye damage, they can affect your field of vision. You may notice that your vision becomes blurry, you are seeing “floaters,” and your eyes seem different than normal. In most cases your eyes are perfectly fine, but the chemical changes in your brain are affecting your visual processing.
- Vomiting: Antidepressants can make some people feel sick to the point that they actually vomit. Usually this is a bad reaction to a drug that can be triggered by intense nausea. Although this isn’t as common of a side effect as others, you may not be able to tolerate certain medications. If you constantly feel sick and are vomiting, be sure to talk to your psychiatrist about it.
- Weight gain: It is common to pack on a few pounds after taking an antidepressant. Statistics show that up to 25% of people (1 out of 4) will gain some weight on an antidepressant medication. In one study, people taking an SSRI were shown to gain about 2.5 lbs. per year. Unless a person is taking Wellbutrin, nearly all of these drugs can contribute to weight gain from 2 to 10 lbs. a year on average. There is a clear connection between antidepressants and weight gain, but a few antidepressants can cause weight loss (e.g. Wellbutrin).
- Weird dreams: You may notice after you have been taking your medication that you have vivid and/or really weird dreams. Prior to taking your medication you may have not noted any odd dreams. Understand that dream changes can occur due to the fact that the antidepressant is changing chemicals in your brain, which in turn can affect your dreams.
How To Reduce Side Effects of Antidepressants
Antidepressants can be great for helping people cope with major depression, but to say that their side effects can be a nuisance is an understatement. In order to reduce side effects of antidepressants, you can take a number of different approaches. Below are some common strategies utilized to minimize side effects.
- Antidepressant profile: Take the time to research an antidepressant that has a relatively favorable side effect profile compared to most. When researching various drugs, look for the ones that have side effect profiles that you can deal with. Also be sure to talk about various options with a psychiatrist. Psychiatrists are professionals that (should) stay updated with the latest literature regarding antidepressant side effects.
- Start with the lowest dose: Begin taking the drug at the lowest possible dose and gradually work your way up to a dose that you feel is producing an antidepressant effect. Most knowledgeable psychiatrists know that different individuals, especially those who are medication-sensitive respond very well to lower doses. At a lower dosage, you will likely have less total side effects with reduced potency.
- Consider augmentation strategies: In many cases a certain antidepressant may cause an unfavorable side effect that can be offset with administration of another drug. For example, someone taking an SSRI may find it very effective for depression, but have a tough time coming to terms with the side effects. In this case, that individual may talk to their psychiatrist and decide to add Wellbutrin to their medication regimen to help offset the weight gain and sexual dysfunction. Antidepressant augmentation strategies should be pursued based on the specific unwanted side effects a person is experiencing.
- Switch classes: If you have already tried several drugs within a specific antidepressant class and keep experiencing the same unwanted side effects, you may want to test the waters with a different class. Certain classes like SSRIs are notorious for causing weight gain and problems with sexual functioning. An SNRI medication may have a more favorable side effect profile and better tolerated. There are many different types of medications available, so be sure to discuss these possibilities with your psychiatrist.
- Eliminate medications: If you are taking other drugs, consider that they may be contributing to the side effects. For example, if you are taking an antipsychotic and an SSRI, the combination of the two may be contributing to significant weight gain. If you don’t necessarily need the antipsychotic, it may be time to cut bait with that drug and stay on the SSRI for monotherapy. The goal is to be on as few medications as possible to eliminate potential side effects as a result of interactions. In all cases, prior to quitting a certain drug you will obviously want to talk to your psychiatrist about possibilities.
- Avoid high doses: The more a person increases their dose, the more they simultaneously increase their risk of side effects. At higher doses both sexual dysfunction and weight gain become common. Additionally if there are other reported side effects from a certain medication, many will be more prevalent at high doses. Unfortunately many people require higher doses to treat severe depression. If you ever have to “double” your dose because you have become tolerant to a certain dosage, expect more side effects.
- Exercise: Getting exercise helps your body and brain promote natural functioning. There are many psychological benefits of exercise that can boost your mood. If you are taking an antidepressant, getting adequate exercise may help prevent certain side effects like weight gain from occurring.
Antidepressant Side Effects (Cons) vs. Benefits (Pros)
It is always important to weigh the benefits (pros) associated with your antidepressant treatment with the side effects (cons). If you feel as if the benefit you are getting from the drug isn’t enough to justify putting up with horrible side effects, it may be time to withdraw from your medication and/or try a new drug (or class of drugs). If you are a person who has had limited success with antidepressants and you found one that works, but is causing major side effects, you may want to just put up with them because you finally are free from depression.
The reality is that nearly all antidepressant medications are going to cause some sort of side effects. The two side effects that people care most about are the dreaded weight gain and the sexual problems. And even if you don’t experience weight gain or sexual problems, you may experience something different like dry mouth and/or dizziness. There’s really no telling how you’re going to react to a certain drug until you try it.
As the general public becomes more educated on various antidepressants and their side effects, it is my guess that people will look to drugs with the best side effect profiles as first-line treatment options. These days SSRIs are considered to have the best side effect profiles, but the weight gain and sexual dysfunction from these drugs is sometimes tough to cope with. More people are starting to turn to atypical antidepressants like Wellbutrin and Viibryd which are associated with less side effects.
Although SSRIs can be a nightmare for some in regards to side effects, some people end up trying them and experiencing nothing significant. In other words, there are a small percentage of people who actually get relief from depression and experience no significant side effects from the drug. If you are one of these people, consider yourself lucky.
What do you think about antidepressant side effects? Have you found them worth the antidepressant effect of the drug that you took? Or did you find them so overpowering that you had to switch to a different medication or just quit taking them for awhile? Feel free to share your thoughts in the comments section below.