Side Effects of Antidepressants

Frequently used antidepressant drugs
--------------------Antidepressants: Types, uses and side effects

Also - Coming off antidepressants

There are three main classes of antidepressants being used.
Two older types that are still sometimes prescribed are tricyclic antidepressants and MAOIs. The newer type of commonly prescribed antidepressants, which includes Prozac, are referred to as SSRIs (Selective serotonin reuptake inhibitors) and have less side effects that the older two classes of drugs.

Additionally, there is the recently introduced selective serotonin and norepinephrine reuptake inhibitor (SNRI) drug class. While SSRIs block serotonin from being reabsorbed, SNRIs block both serotonin and norepinephrine. Up till now, 2 of these drugs have been approved as antidepressants in Germany: venlafaxine and duloxetine.

While these drugs are comparable with SSRIs in their benefit in depression, aenlafaxine is reported as working better than duloxetine, the side effects are worse with SNRIS than SSRIs. (eScience News, August 25, 2009).

Photo: Tom Varco. 2006

2.4 billion drugs were prescribed in visits to doctors and hospitals in 2005 in the US. Of those, 118 million were for antidepressants. High blood pressure drugs were the next most-common with 113 million prescriptions. Britain issued 31 million prescriptions of antidepressants in 2006.

Addressing symptoms - not the illness

The most important thing to remember about antidepressants is that they address symptoms, they do not treat the underlying condition, rather, they treat symptoms. With that in mind one needs to be realistic about what antidepressants can accomplish, there is no miracle drug, as Prozac was once thought to be.

And second, that it can be difficult to find the right drug combination. Antidepressants help up to 55% of those who use them, but approximately 45% will find little or not help with the use of antidepressants. The gains that are made with antidepressants are not necessarily dramatic. Also, it is very difficult to sustain the positive results of antidepressants over extended periods of time.

It can be difficult to successfully come off using antidepressants. Also, it can become difficult, once an antidepressant has lost its effectiveness, to find a replacement drug.

Sexual dysfunction through use of antidepressants, effects approximately 50% of users. This is the most common reason for discontinuation of their use.

Side effects, such as "feeling high," are not common, but reportedly can result from taking certain types of antidepressants. Feeling nervous and jittery is a side effect that also can result from antidepressant use for some.

Also of note is that the rate of success for placebos in comparison to antidepressants, in one mega-analysis was comparable.

The longer you take antidepressants, the less effective they become.

"We have data showing that there is loss of clinical effect in at least 1/3 of patients after only a few months of therapy. So the drugs do not really work as well as they did at the beginning," he says. "And what happens is at that point, you may add other drugs or you may increase dosage — and for a certain time, this works, but then you generally get back to the way things were." Dr. Giovanni Fava, a professor of clinical psychology at the University of Bologna, Italy.

Only Antidepressant Approved for Children

The only antidepressant currently approved for children is Prozac, (which also has side effects for both adults and children) although some doctors might also prescribe other drugs off-label, that is, which are not currently approved by the FDA (a legal practice). Also, of note is that children are often treated with multiple medications, drug-cocktails are common and controversial. No Child Left Different, by Sharna Olfman, offers insight into the problem of treating children with psychiatric drugs

Positive Benefits of Antidepressants - Time-frame

For some, the positive benefits of antidepressants are noticed rather quickly, for others, more commonly, it may take a matter of up to eight weeks. For some, the positive benefits of antidepressants cannot be sustained for more than a few months, for others, it might be sustained for years.

Some have experienced a "crash" after having been on antidepressants (such as Prozac), successfully for a year or two. (Prozac poop-out is one coined phrase). Others have "crashed" and had a very difficult time coming up again, after having been on antidepressants for a long period of time (5-9 years).

So while antidepressants have helped some people to overcome depression, for mild to moderate depression, exercise, diet and nutrition are almost always a better solution. Additionally, for some, interpersonal therapy, or cognitive-behavioral therapy is of more value and can be of greater benefit in terms of depression than antidepressants. Teens and children, especially, can benefit from interpersonal therapy, in many cases.

For those who have been abused as children, talking things out with a mate, close friend, minister, or professional is essential to recovery.

Antidepressants and most other pharmaceutical drugs for mental health are similar to aspirin, in that they treat symptoms but not the illness itself. Photo: Ragesoss. 2008

Sedation:
Both tricyclics and MAOIs can be sedating, as a common side effect, whereas, in general, SSRIs do not have as strong of a sedating quality.

Suicidality and antidepressants
Additionally, in children, teens and those in the 18-24 age group, use of all antidepressants carries the risk of doubling (from 2% to 4%) risk of suicidality. There seems to be no evidence of increased suicidality in general amongst those in the 24-55 year age group. However in seniors, some reports may indicate that there may be an increased risk of suicidality.

Generic: impramine Trade Name: Tofranil

Generic: amitriptyline Trade Name: Elavil

Generic: desipramoine Trade Name: Norpramin

Generic: nortriptyline Trade Name: Aventyl

Generic: protriptyline Trade Name: Vivactil

Generic: doxepin Trade Name: Sinequan

Generic: trimipramine Trade Name: Surmontil

Generic: clomipramine Trade Name: Anaframil

Use of tricyclic antidepressants
Used to treat relatively severe depression, especially of psychotic severity and unipolar (not bipolar, only depression). Also used in treatment of panic disorders, OCD, and bulimia. An older antidepressant, more than 50 years in use. Not popular, has been supplanted by SSRIs, but still used in certain situations, and when clients don't respond to SSRIs. Works similar to SSRIs, but has worse side-effects, especially in terms of sedation or cognitive slowing. They are used in clients who do not respond to SSRIs or other antidepressants.

Monoamine Oxidase (MAO) inhibitors

Generic: phenelzine Trade Name: Nardil

Generic: tranylcypromine Trade Name: Parnate

Generic: selegiline Trade Name: Eldepryl

Use: Depression, panic disorder, and social phobia.

Effects and side effects: Multiple side effects, some of them can be dangerous, including sedation. Dietary restrictions are necessary. Again, an older class of drugs, which are not as frequently used today as SSRIs.

Generic: fluoxetine Trade Name: Prozac

Generic: fluvoxamine Trade Name: Luvox

Generic: sertraline Trade Name: Zoloft

Generic: paroxetine Trade Name: Paxil

Use: Depressive symptoms, OCD, panic disorder, bulimia.

Effects and side effects
Positive effects can take about 3 weeks. The side effect profile is not as intense as tricyclics and MAOIs. Some side effects can be, nausea, insomnia, sexual dysfunction (in about 50% of those who take SSRIs, the most common reason persons discontinue their use).

Generic: bupropion Trade Name: Wellbutrin

Generic: nefazodone Trade Name: Serzone

Also to be noted that there are always new antidepressants being developed, and this article is a large sampling rather than a definitive list.

Source adapted from: Carson, C. C., Butcherr, J. N. Mineka, S. (2000). Abnormal Psychology and Modern Life. Eleventh Edition. Boston: Allyn and Bacon.

Conclusions: Women who take fluoxetine [Prozac] in the third trimester are at increased risk for perinatal complications. [premature birth]

Serotonergic Antidepressants antidepressants can contribute to bleeding and result in a 4 times higher rate of blood transfusions according to this clinical study from the Netherlands.
Relationship of Serotonergic Antidepressants and Need for Blood Transfusion in Orthopedic Surgical Patients. Arch Intern Med. 2003;163:2354-2358. https://archinte.ama-assn.org/cgi/content/full/163/19/2354

Antidepressants and Sexual Dysfunction

By far, the side effect which affects the most who take anti-depressants is sexual dysfunction. Some put the percentage at around 50%, some between 30-70%.

Mayo clinic states,
"Some people have sexual dysfunction with antidepressants such as Prozac, Paxil, Effexor, Cymbalta, Zoloft or Celexa, and some do not. We cannot predict who will have what side effect and to what degree at this time."

The article Antidepressants & Female Sexual Dysfunction states accurately, (off-site link).

"Half of the women with major depression included in the survey reported decreased sexual interest and reduced levels of arousal. And, unfortunately, sexual dysfunction also is a common side effect of antidepressant treatment, particularly pharmacotherapy with SSRIs. In fact, treatment-emergent SSRI-induced sexual dysfunction ranges from approximately 30 percent to 70 percent of patients treated for depression."

Some clinicians add Viagra to even the drug regimen of females (and males) to try to control this side effect.

"Tricyclics and monoamine-oxidase inhibitors (MAOIs) commonly affect all three phases of the sexual cycle, including libido, arousal and orgasms and should be suspect as causative agents." SSRI's also effect sexual dysfunction in both men and women.

From journal: Advance for Nurses. (Vol. 8 -Issue 13 - Page 29) www.advance.com

Quitting Antidepressants

Harvard Health Publications makes the following suggestions for those who want to come off antidepressants:

1. Take your time (rather than come off abruptly).

2. Make a plan

3. Consider psychotherapy

4. Stay active

5. Seek support

eScience News, (August 25, 2009).
https://esciencenews.com/articles/2009/08/25/antidepressants.benefit.snri.proven Antidepressant Drugs and Side Effects References

1. Antidepressants & Female Sexual Dysfunction. (Vol. 8 -Issue 13 - Page 29). Advance for Nurses. https://nursing.advanceweb.com/Editorial/Content/Editorial.aspx?CC=132767

2. Carson, C. C., Butcherr, J. N. Mineka, S. (2000). Abnormal Psychology and Modern Life. Eleventh Edition. Boston: Allyn and Bacon.

3. Birth Outcomes in Pregnant Women Taking Fluoxetine, (March 16, 2009). Christina D. Chambers, B.A., Kathleen A. Johnson, B.A., Lyn M. Dick, B.A., Robert J. Felix, B.A., and Kenneth Lyons Jones, M.D. University of Pittsburgh News Releases.

4. CDC: Antidepressants most prescribed drugs in U.S., (July 9, 2007). Cohen, E. CNN Health. https://www.cnn.com/2007/HEALTH/07/09/antidepressants/index.html

5. Going Off Antidepressants, (2010-2012) Harvard Women's Health Watch, Harvard Health Publications, Harvard Medical School. Retrieved February 25, 2012.

6. Britain Becomes a Prozac Nation, (May 14, 2007). Rose, David. Times Online. https://www.timesonline.co.uk/tol/life_and_style/health/article1784993.ece

7. Do Antidepressants Make You Sad?, (June 14, 2011). Schwartz, Casey. The Daily Beast.

Some new research suggests people who take antidepressants are more likely to experience relapses of depression.

8. SNRI Antidepressants, (August 8, 2009). eScience News. www.esciencenews.com

Further Reading

1. Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration, (February, 2008). Irving Hirsch, et. al.

1.Irving Kirsch, Department of Psychology, University of Hull, Hull, United Kingdom. 2.Brett J. Deacon, University of Wyoming, Laramie, Wyoming, USA. 3.Tania B. Huedo-Medina. 4.Alan Scoboria, Department of Psychology, University of Windsor, Windsor, Ontario, Canada. 5.Thomas J. Moore, Institute for Safe Medication Practices, Huntingdon Valley, Pennsylvania, USA. 6.Blair T. Johnson, Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, Connecticut, USA.

Conclusions of Study
Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication.

2. (Based on above study): SSRI Antidepressants 'Clinically Insignificant' For Most People,(February, 2008). PsyBlog

3. Study: Quitting Antidepressants May Not Increase Depression Among Pregnant Women - Yale Researchers Look At Effects Of Quitting Medication, (September 09, 2011). William Weir. Hartford Courant

4. The Medicated Americans: Antidepressant Prescriptions on the Rise, (February 2008). Charles Barber. Scientific American Mind.

Close to 10 percent of men and women in America are now taking drugs to combat depression. How did a once rare condition become so common?

Pages Related to Antidepressants and Side Effects

Antidepressants and bipolar disorder

Drugs for Psychological disorders - Psychiatric Drugs, types and uses.

Depression Self Help