In a world where millions of people are going through physical and mental burdens, there is a need to find a path forward to better health.  As many have either had to turn to mental health medications for the first time, or have had to look for increased medication options, it’s important to discuss the impact that side effects of antidepressants can have on someone feeling better as quickly as possible.   

Before delving into the topic of side effects of medications, it's important to note that without depression, we cannot talk about antidepressants. Thus, let’s quickly define what “depression” means and what is denoted by “antidepressants.”

What Is Depression?

According to the National Health Institute of Mental Health (NIMH), depression is a serious mood disorder. It's a mental state that causes severe distortion to how you feel, think, or handle daily activities, including sleeping, eating, or working.

Depression can occur in many categories, which may include:

1. Persistent depressive disorder (Dysthymia): is a situation one gets in a depressed mood lasting for two years or more.
2. Postpartum depression: usually occurs with women within two weeks after child delivery.
3. Psychotic depression: occurs when someone suffers from severe depression and some psychosis—false beliefs, delusion, or hallucinations.
4. The seasonal affective disorder: occurs during the winter months when there is little or no sunlight.
5. Bipolar disorder: while bipolar disorder is slightly different from depression, it is also a consideration because people experiencing it often suffer from extremely low or high mood moments.

What are antidepressants?

Quite simply, antidepressants are medications taken to relieve the symptoms of depression, anxiety disorders, social anxiety disorder, seasonal affective disorder, mild chronic depression, dysthymia, or ease the pains of other mental conditions.

Usually, antidepressants aim to correct the several chemical imbalances of neurotransmitters present in the brain. These neurotransmitters are responsible for the regular change in mood and behaviour. 

Types of antidepressants

The kinds of antidepressants that are readily available to be prescribed include the following:

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

These are antidepressants that are often used to treat key depressions and disorders. 

Similarly, they treat obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), anxiety disorders, menopausal symptoms, chronic neuropathic pains, and fibromyalgia; but these applications are often used less commonly.

Examples of SNRIs include:

• Duloxetine (Cymbalta, Irenka)
• Levomilnacipran (Fetzima)
• Desvenlafaxine (Pristiq, Khedezla)
• Venlafaxine (Effexor XR)

 Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are antidepressants that are most commonly prescribed. They are also used to treat depression but have fewer side effects than others.

More often than not, what SSRIs do is block the absorption of serotonin in the brain. With this, the brain cells are suitable to better send and receive information, which, in turn, leads to a more stable mood. And they are "selective" because they affect only serotonin and no other types of neurotransmitters.

Examples of SSRIs include:

• Fluoxetine (Prozac or Oxactin)
• Escitalopram (Lexapro)
• Paroxetine (Paxil, Pexeva)
• Citalopram (Celexa, Cipramil)
• Sertraline (Zoloft)

Other types of antidepressants include:

Tricyclic antidepressants (TCAs)

These antidepressants are named "tri" because these medications have three rings in their chemical structure. They are used to treat anxiety, depression, and fibromyalgia , and can also help manage chronic pain.

Examples of TCAs include:

• Amitriptyline (Elavil)
• Doxepin (Sinequan)
• Amoxapine-clomipramine

 

Noradrenaline and specific serotonergic antidepressants (NASSAs)

These antidepressants treat anxiety disorders, personality disorders, and depression.

Examples of NASSAs include:

• Mirtazapine (Remeron, Avanza, Zispin)
• Mianserin (Tolvon)

 

Monoamine oxidase inhibitors (MAOIs)

These antidepressants are old. They are the most commonly prescribed antidepressants typically  before the introduction of SSRIs and SNRIs. MAOIs are primarily used in situations where other antidepressants have been trialled without success. 

Examples of MAOIs include:

• Phenelzine (Nardil)
• Selegiline (EMSAM, Eldepryl)
• Tranylcypromine (Parnate)
• Isocarboxazid (Marplan)

Note that there are many other classes of medications that can be used to augment antidepressant effect such as the class of medications called antipsychotics but this post will not elaborate on them.

Side Effects Of Antidepressants

Most antidepressants have associated side-effects. But the most commonly seen side effects–especially with selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) include:

• Anxiousness or  feelings of agitation
• Loss of appetite
• Diarrhea or constipation
• Low energy
• Dizziness
• Nausea
• Insomnia
• Headaches
• Dry mouth
• Indigestion and stomach aches
• Loss of libido
• Erectile dysfunction

 

While these are the most common side effects that can occur with antidepressants, many of them will dissipate  as your system gets used to the medication.  Note that it may take up to two weeks on average before you feel better. However, some side- effects such as sexual dysfunction and weight gain may linger.

Who Gets Side Effects?

Most people react somewhat differently to the same medications. What Mr. A gets as side effects may differ from what happens for Mr. B. While some people may not experience any side effects.. The following are possible factors that can influence your response to antidepressants:

1. Age:  Research has shown that elderly patients are more likely to experience side effects when taking antidepressants than younger ones.
2. Genetics:  This can be directly likened to pharmacogenetics—i.e. the composition of your genes can play a significant role in your body’s response to medications.  For example, your genetic makeup might contribute to you absorbing medication more slowly and thus you are more likely to suffer from side effects.
3. Drug-type: The kind of drug you take can also impact your response. Medications that are considered older such as tricyclic antidepressants and MAOIs have higher side effects than SNRIs, SSRIs, and other antidepressants.
4. Other medications:  when you take other medications while also taking antidepressants, they might interact which might contribute to increased side effects. In contrast, the other medications may also make the antidepressants less effective. Hence, it is important to communicate with your health care provider and let them know all of the current medications you are taking. 

Antidepressants and the risk of suicide

Over the years, there has been a surge in the rate at which suicidal thoughts are conceived. The Food and Drug Administration (FDA) had to request a black-box warning on antidepressants because of the high risk that these thoughts impact  the behaviours of children, teens, and adults under the age of 25.

Although antidepressants have somewhat been tied to the thoughts of suicide or behaviour, “it doesn’t necessarily have a definitive link with it,” according to Andrew Coulter, a psychiatrist at the Cleveland Clinic. He added that it has been discovered that "as antidepressant prescriptions increased, the suicidal rate has drastically reduced."

Due to the notion that untreated depression could itself lead to suicide, it has been generally said by a large consensus by psychological experts that the benefits of using antidepressants outweigh the risks and side effects.

There are many ways suicidal thoughts might develop. Listed below are some of the warning signs:

• Extreme mood swings
• Too much sleep or too little
• Unsanctioned use of drugs or alcohol
• Constant talks about getting hurt or killing oneself
• Unusual behavioural changes
• Social isolation

While the above are common with adults, children and teens also have their ways of showing signs of suicidal ideation.. Here are some of these signs:

• Extreme anxiety or agitation
• Recklessness and impulsive behaviour
• Isolation and withdrawal from the family

Should you notice any of these and think of your child or if any  of your loved ones might be at the risk of harming themselves, please seek emergency support immediately. 

Managing specific antidepressant side effects

While waiting out side-effects is a common approach when it comes to managing the side effects of antidepressants, this doesn’t work for many who don’t have the luxury of time or patience to wait. Thus, here are some tips that can help  manage the following specific side effects:

1. Weight gain:  should you be struggling with weight gain, it’s advisable that you stop consuming sugary drinks and avoid sodium in your diet. Meanwhile, you should   eat healthy meals and exercise regularly.. You might also consider paying a visit to a certified dietician and/or a professional physical health instructor.
2. Sex issues:  this is another problem that may arise due to taking antidepressants. For instance, you may experience a very low sex drive or even have trouble achieving an orgasm; contact and speak with your doctor if you are struggling with this issue  It's possible you might benefit from changing the dose of yout medication or switching to an entirely to a different medication.
3. Stomach disruptions:  if you are suffering from nausea, you should ask for help from your health provider. It's important that you clarify whether you should  take an antidepressant with food or beverages or not. 

If you are vomiting, feel nauseous, have diarrhea or constipation, talk to your doctor about considering a possible reduction in dosage of your antidepressant.

     4. Dry mouth:  you should avoid taking caffeinated beverages or alcohol.  This will make your mouth drier than normal. 

        Other tips you can heed to avoid a very dry mouth include:

• Staying hydrated
• Drinking sugar-free beverages or sucking on ice chips
• Using a humidifier in the bedroom at night
• Trying over-the-counter dry-mouth treatment methods.

       5. Sleep problems:  when you take antidepressants, it might keep you awake. But if you realize that you are feeling exhausted, you can consult your doctor to ask if you can change the time you take  your medications, for instance, from morning to night or vice versa. However, if this change doesn’t still work for your insomnia, a short course of medicine like melatonin can be administered to ensure you sleep.

 

Managing lesser-known antidepressant side effects

Though there are a lot of antidepressant side effects that are common. However, there are also less common side effects that might present when you take an antidepressant. These include:

• Bleeding:   many antidepressants can have conflicting results with the circulatory system. For instance, SSRIs may affect platelet clotting and increase your risk of bleeding. 
• Low alcohol tolerance:  it's always recommended to ingest alcohol slowly. This is important because sometimes, the extra sedative effect occurs when there is a combination of the two—alcohol and antidepressants.
• Low sodium level:  at times, antidepressants may find a way to tamper with your blood sodium level. When this happens, a condition called “hyponatremia” occurs. It's predominant with elders, and its risk gets higher in the first two to four weeks of commencing an antidepressant medication.

Meanwhile, while trying to adjust to a new antidepressant, try to watch out for certain symptoms of hyponatremia. These may include:

1. Drowsiness
2. Nausea
3. Vomiting
4. Fatigue
5. Restlessness
6. seizures

Treatment of antidepressants side effects.

Although antidepressants have side effects that can cause problems for people at first, they usually improve with time. Meanwhile, it's important to keep up with the treatment  as it may take several weeks before you begin to reap benefits from the medication(s).

Upon commencing treatment, you’ll be required to see a doctor or specialist and follow up with them regularly —this would be at least once or twice every two to four weeks. This will allow you to check  upon the progress of your condition and determine if the treatment is  working adequately. 

Other treatment methods.

While the use of medication to treat depression cannot be overemphasized, other effective methods can also be put into use alone or with medication management. For instance, for a start, you can decide to opt-in for things such as:

• Pharmacogenetic testing - find the right medication for you based on your DNA
• Integrative medicine
• Brain stimulation therapies
• Change in lifestyle
• Psychotherapy 

 

Conclusion

The rate at which people use antidepressants has tremendously increased, especially in the last 20 years. This is because, in the 21st century, people are gradually crawling into depression and need to get treatment. However, the earlier the treatment begins, the better. So, if you or your loved ones are experiencing any of the above-listed signs and symptoms of depression, you should immediately consult your doctor. If, however, you are currently on antidepressants, know that some of them have side effects, which you can get over by following instructions from your health provider. Finally, do not ignore that pharmacogenetic testing can help ensure you are on the right medication for you based on your genetics so you can potentially avoid some side-effects.