Managing the Side Effects of Depression Treatment

If you’re being treated for depression, your doctor may prescribe an antidepressant. These medications can be very helpful in relieving your symptoms. Psychotherapy, also known as talk therapy, can help, too.

Like all medications, antidepressants can have side effects. But they’re generally well-tolerated, says Andrew Coulter, MD, a psychiatrist at the Cleveland Clinic.

Common Side Effects

The types of antidepressants that doctors prescribe the most are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, atypical antidepressants, and monoamine oxidase inhibitors (MAOIs).

Each type has its own side effects. The most common ones include:

Many of these side effects will go away as your body gets used to the medication. It takes 2 weeks on average, but most go away within a few days, Coulter says. Some, like sexual issues and weight gain, may last longer.

Who Gets Side Effects?

Everyone reacts differently to medication. Your side effects may not be the same as those of someone else who takes the same thing. Some people don’t notice any problems.

Things that may affect how you respond to antidepressants include:

• Other medications. Some drugs might interact, Coulter says. This can lead to more side effects if your other medications are increasing the level of your antidepressant. On the other hand, the other medications may cause your antidepressant to be less effective. He says this is why it’s important to make sure that all your health care providers have a complete list of the medications you’re taking, both prescription and over-the-counter.
• Age. “Elderly patients are more likely to have some kind of a side effect than younger ones,” Coulter says.
• Genes. Your genes affect the way your body handles drugs. In other words, if your body absorbs medication slowly, you’re going to be more prone to side effects, Coulter says.
• The type of drug. Older medications like tricyclic antidepressants and MAOIs tend to have more side effects than SSRIs, SNRIs, and atypical antidepressants.

Antidepressants and the Risk of Suicide

The FDA requires a black box warning on antidepressants because of a higher risk of suicidal thoughts and behavior in children, teens, and adults under the age of 25 who take them.

Even though antidepressants have been tied to suicidal thoughts or behavior, “there’s not necessarily a definitive link,” Coulter says. “We’ve found that as antidepressant prescribing has increased, the suicide rate has gone down.”

Because untreated depression itself can lead to suicide, most experts agree that the benefits of antidepressants often outweigh the risks. Your doctor will talk about them with you.

Although it’s not related to antidepressants, the risk of suicide in general is also higher in people over the age of 65. This risk goes up more with age. These older adults are only 12% of the U.S. population, but they account for 18% of suicide deaths. Having a psychiatric disorder like depression seems to be the biggest risk factor for suicide in this age group.

Dealing With Specific Side Effects of Antidepressants

When it comes to managing side effects of depression treatment, “my first piece of advice usually is ‘try to wait it out,’” Coulter says. If time doesn’t help, you can try these tips for specific side effects.

Sexual issues

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Sexual side effects, such as a lower sex drive or trouble having an orgasm, are fairly common with antidepressants. “Unfortunately, that leads to people going off medication that may otherwise be working,” Coulter says.

Talk to your doctor if you’re noticing sexual problems. “If we don’t know about it, we can’t help,” Coulter says. One option is for your doctor to lower your dose a bit. Or they may switch you to another antidepressant, since some can be worse than others when it comes to sexual side effects.

There’s also the possibility of adding a medication such as bupropion (Wellbutrin), buspirone (Buspar), or sildenafil (Viagra) to your treatment plan. Coulter says these can reduce your sexual side effects so you can stay on an antidepressant that’s working for you.

Weight gain

If you’re struggling with weight gain, Hafeez advises avoiding sodium, cutting back on sugary drinks, eating healthy foods, getting regular exercise, and talking with a registered dietitian.

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Antidepressants can keep you awake, or you may find that you’re drowsy and sleeping too much. The first thing to look at is timing, Coulter says. If you’re taking your medication in the morning and you’re tired all day, ask your doctor whether you can take it at bedtime instead. Or if you’re taking your medication at night and can’t sleep, ask about switching it to the morning.

If taking your medication in the morning still doesn’t help your insomnia, your doctor may be able to give you a short course of medicine like melatonin to help you fall asleep.

This is another situation where you may have something else going on that’s causing problems, such as sleep apnea or restless legs syndrome, Coulter points out. Be sure to talk to your doctor if your sleep problems don’t get better.

Dry mouth

Caffeinated beverages and alcohol can make your mouth even drier, so limit these or steer clear altogether, Hafeez says. Other tips:

• Stay hydrated.
• Suck on ice chips, or drink sugar-free beverages.
• Use a humidifier in your bedroom at night.
• Try over-the-counter treatments for dry mouth.

Lesser-Known Side Effects

Some other side effects from antidepressants aren’t discussed as often. But they’re still important to look out for.

Lower alcohol tolerance. Coulter recommends drinking alcohol more slowly and drinking less as you get used to your antidepressant. “Sometimes, there’s an extra sedative effect when you combine the two,” he says.

Bleeding. Antidepressants, particularly SSRIs, can affect platelet clotting and raise your risk of bleeding, Coulter says. Watch out for new easy bruising or nosebleeds, especially if you have a history of gastrointestinal bleeding.

Lower sodium levels. “Sometimes, antidepressants can interfere with your blood sodium level, which can cause headache or confusion,” Coulter says. Low sodium levels, called hyponatremia, are more common in elderly people. The risk is also a lot higher in the first 2 to 4 weeks after you start an antidepressant.

Coulter recommends watching for symptoms of hyponatremia when you’re adjusting to a new antidepressant. Along with headache and confusion, these include:

Call your doctor if you notice these symptoms.

Treatment Effects That Aren’t Physical

Disliking medication. Some people hate having to take medicine to feel better. Coulter says this can lead to not taking it the way you’re supposed to, or quitting altogether. Talk to your doctor about the risks, benefits, and alternatives of medication and how it fits into your lifestyle, he suggests — especially because medication isn’t the only recommended treatment for depression.

Emotional blunting. You may notice that you feel emotionally numb when you take an antidepressant, Hafeez says. Unfortunately, this is a common side effect. To manage it, she recommends:

• Talking to a therapist about ways to boost your mood
• Asking your doctor about lowering your antidepressant dose
• Taking part in activities that boost serotonin, like exercise, massage therapy, and light therapy

Relying on medication alone. Lots of people use antidepressants as their only treatment for depression, Coulter says. “As psychiatrists, when we look at patients, we don’t just look at their biology. We think about their psychology and their social context. Because depression impacts all of these domains, you can’t only treat the biology,” he says. When you’re depressed, Coulter says, there’s more than likely something that you need to talk about or work on in psychotherapy. This is why it’s an important part of depression treatment.

Talk to Your Doctor Before Stopping an Antidepressant

Quitting your antidepressant cold turkey can be physically uncomfortable, especially if you’ve been on it for a while, Coulter says. And if you’ve been taking a higher dose, you can get something called discontinuation syndrome. As the medication leaves your body, you start feeling headache or flu-like symptoms.

Stopping your medication means you also risk the return of your depression symptoms. You may feel better now that you’re taking it, but this doesn’t mean you don’t need it anymore. You’ll need to keep taking your antidepressant to prevent a relapse.

If the side effects are too much, talk with your doctor. Keep in mind that the first medicine you try may not be the right one for you, Coulter says. It might take some trial and error to find which antidepressant and dose work best.

You may get to a point where you want to stop your medication. Talk to your doctor first. That way, Coulter says, you can discuss other treatment options and agree on a schedule to taper off over time to keep discomfort to a minimum.

Look Into Other Treatments

Remember, medication is only one of the treatments for depression. You might also try things like lifestyle changes, integrative medicine, brain stimulation therapies, and different forms of psychotherapy. These can be part of your treatment plan along with — or instead of — antidepressants.

Nosal works with teens and young adults and encourages “a more minimalistic approach with medication” in these groups. She likes to include holistic methods, such as cognitive behavioral therapy (CBT), exercise, diet changes, meditation, and family therapy.

“There are many ways to try to integrate healthier nutritional and physical well-being habits and see how those impact one’s emotional and mental states,” Nosal says.