Side effects of antidepressants: Coping strategies

Introduction

Most antidepressants cause side effects. Many are transient, lasting just a few weeks before going away on their own. Still, side effects are the most common reason people stop taking antidepressants. Always tell your doctor about your side effects. Don't stop taking medication or reduce the dosage without consulting your doctor because doing so can also cause serious withdrawal symptoms or other adverse reactions.

Medication side effects can have a significant impact on your quality of life, and managing them can be a challenge. Click on the tabs at the left to see coping strategies for the most common side effects of antidepressants.

Nausea

Nausea is a common side effect of many antidepressants, and it's one of the most common reasons people stop taking these medications. Nausea typically begins within a week of starting treatment, but it often goes away on its own within a few weeks as your body adjusts to the medication.

Coping strategies

• Take the medication with food.
• Drink plenty of fluids throughout the day, such as unsweetened fruit juice, cool water or ginger ale that's lost its carbonation.
• Try an antacid or bismuth subsalicylate (Pepto-Bismol).
• If available, take a slow-release form of the medication.
• Talk to your doctor about a dosage change.

Increased appetite, weight gain

Weight gain may result from fluid retention, lack of physical activity or the return of a healthier appetite as you begin to feel better with treatment. In addition, some antidepressants are more likely than others to cause weight gain over the long term. Bupropion (Wellbutrin) and certain selective serotonin reuptake inhibitors (SSRIs) are generally less likely than other antidepressants to cause significant weight gain.

Coping strategies

• Eat healthy foods, such as plenty of fruits, vegetables and whole grains.
• Cut back on desserts, sugared colas and fast foods.
• Engage in regular exercise.
• Seek advice from a nutritionist or dietitian.
• Talk to your doctor about switching medications.

Sexual side effects

Sexual side effects include decreased sexual desire (libido), erectile dysfunction, delayed ejaculation and diminished orgasm. These effects can last throughout treatment. Selective serotonin reuptake inhibitors (SSRIs) are more likely than other antidepressants to cause sexual side effects, particularly delayed orgasm or inability to achieve orgasm (anorgasmia). Tricyclic antidepressants (TCAs) are more likely to cause erectile dysfunction.

Coping strategies

• Talk to your doctor about finding a dose that minimizes sexual side effects but still works for you.
• Consider a drug that requires only a once-a-day dose, and schedule sexual activity before taking that dose.
• Talk to your doctor about adding or switching to an antidepressant that may counteract these effects, such as bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL) or mirtazapine (Remeron, Remeron Soltab).
• Talk to your doctor about taking a medication intended to directly treat sexual dysfunction.
• Talk to your doctor about a "drug holiday" — stopping the medication for a day or so each week.

Fatigue, drowsiness

Fatigue and drowsiness are common, especially during early weeks of treatment with antidepressants.

Coping strategies

• Take a brief nap during the day.
• Get some mild exercise, such as walking.
• Avoid driving or operating machinery until the fatigue passes.
• Take the medication 1 to 2 hours before bedtime.

Insomnia

Some antidepressants have an energizing effect. While that may sound appealing, it can also make it difficult to get to sleep or stay asleep, which can ultimately make you feel more tired during the day.

Coping strategies

• Take medication in the morning.
• Avoid caffeinated food and drinks.
• Get regular exercise at least four or five hours before bedtime.
• Develop a relaxing bedtime routine.
• Talk to your doctor about temporarily taking a sedating medication at bedtime.

Dry mouth

Dry mouth is a common side effect of antidepressants that have anticholinergic effects — that is, they block the action of the neurotransmitter acetylcholine, in turn disrupting normal functioning of the digestive tract and other organ systems. Dry mouth can result from reduced mucous and saliva secretions.

Coping strategies

• Sip water regularly.
• Suck on ice chips.
• Chew sugarless gum.
• Suck on sugarless hard candy.
• Breathe through your nose, not your mouth.
• Brush your teeth twice a day.
• Visit your dentist regularly to help prevent tooth decay.
• Talk to your doctor about saliva substitutes.

Blurred vision

Blurred vision is a common side effect, but it usually goes away on its own within a couple of weeks. Like dry mouth, it's more commonly associated with antidepressants that block the neurotransmitter acetylcholine, which can dry out your eyes and cause blurriness.

Coping strategies

• Get an eye exam to rule out other causes of your eye problems.
• Talk to your doctor about using special eyedrops to relieve dryness.
• Talk to your doctor about a dose adjustment.

Constipation

Tricyclic antidepressants in particular are often associated with constipation because they block the neurotransmitter acetylcholine, which in turn disrupts normal functioning of the digestive tract and other organ systems. These anticholinergic effects are the same as those behind dry mouth and blurred vision.

Coping strategies

• Drink 6 to 8 glasses of water daily.
• Eat high-fiber foods, such as fresh fruits and vegetables, brans and whole grains.
• Get regular exercise.
• Take fiber supplements.
• Consider taking stool softeners if other measures don't work.

Dizziness

Some antidepressants are more likely than others to cause dizziness. In particular, tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) can cause low blood pressure (hypotension), resulting in dizziness. This is more common in older people.

Coping strategies

• Rise slowly from sitting or standing positions.
• Use handrails, canes or other sturdy items for support.
• Avoid driving or operating machinery.
• Avoid caffeine, tobacco and alcohol.
• Drink plenty of fluids.
• Take medication at bedtime.

Agitation, restlessness, anxiety

Some antidepressants can have a stimulating effect. Although you may welcome increased energy, an inability to relax or be still can be distressing.

Racing or impulsive thoughts coupled with an abnormally high level of energy may be a sign of mood instability that requires prompt adjustment in your treatment regimen. Talk to your doctor about a dose adjustment or medication change if these effects disrupt your life for even a few days.

Coping strategies

• Get vigorous exercise, such as jogging, biking or aerobics.
• Practice deep-breathing exercises and muscle relaxation.
• Consult your doctor about temporarily taking a relaxing medication.