Antidepressants are prescription medications that are commonly prescribed to address depression and mood disorders such as major depression, chronic depression, and bipolar depression. They are also used off-label for other symptoms and conditions. They regulate essential brain chemicals such as serotonin, norepinephrine, and dopamine, significantly influencing our moods and overall well-being.
There are many different classes of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic and atypical antidepressants, monoamine oxidase inhibitors (MAOIs), and others. Antidepressants are widely used to treat various symptoms and conditions; however, it’s important to note that they are not the only treatment option available. Alternative treatment options, such as transcranial magnetic stimulation (TMS) and esketamine (Spravato), can be just as effective in treating different conditions. This article will explore the different types of antidepressants and how they work, and we will also briefly discuss alternative treatment options.
Antidepressants
Antidepressants play a crucial role in managing various mental health conditions and are prescribed for a spectrum of disorders, including:
- Depression [5,18]
- Obsessive-Compulsive Disorder (OCD) [14]
- Social Phobia [14]
- Panic Disorder [14]
- Generalized Anxiety Disorder (GAD) [14]
- Post-Traumatic Stress Disorder (PTSD) [14]
- Neuropathic Pain [2]
Antidepressants have additional applications beyond their FDA-approved indications. For example, tricyclic antidepressants are used to address pain, insomnia, and migraines, while trazodone, a serotonin modulator, is prescribed off-label to manage insomnia [14].
Types of Antidepressants
Antidepressants, like any medication, may cause side effects. However, most people find these side effects gradually disappear as their bodies become more accustomed to the medication. Although many types of antidepressants share the potential for similar side effects, some may cause more severe side effects for certain individuals.
Common side effects for all types of antidepressants can include one or more of the following [14]:
- Sleepiness
- Insomnia
- Weight gain
- Sexual problems
- Anxiety
- Dizziness
- Headache
- Dry mouth
- Blurry vision
- Nausea
- Rash
- Tremor
- Precautions and Considerations
It is helpful to bring a list of all medications, including over-the-counter drugs (OTC), supplements, and herbs, with you when you visit your healthcare provider because there is the potential for harmful interactions.
Antidepressants may increase the risk of suicidal thoughts and behaviors in some individuals, especially teens and children.
Symptoms to watch out for may include the following [6]:
Behavioral symptoms:
- Giving away belongings
- Talking about death
- Organizing personal affairs
- Obtaining items for self-harm
- Decreasing social interaction
- Increasing substance use
- Withdrawing from activities
- Engaging in risky behavior
Psychosocial Symptoms:
- Feelings of helplessness
- Self-loathing
- Hopelessness
- Saying goodbye to loved ones.
- Increased emotional pain.
- Mood swings
- Personality changes
Physical Symptoms:
- Scarring
- Changes in sleeping patterns.
- Changes in eating habits
- Paranoia
- Altered perception due to terminal illness.
Cognitive Symptoms:
- Preoccupation with death
- The belief is that suicide is the only solution to emotional pain.
- Altered thought patterns.
- Severe anxiety
If you or someone you know is experiencing suicidal thoughts or behaviors, don’t delay. It is important to seek help immediately.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are a class of medications commonly used to treat depression and several other psychiatric disorders [3]. SSRIs work by increasing the levels of serotonin in the brain [3]. Unlike other antidepressants, SSRIs have minimal effects on other neurotransmitters like dopamine or norepinephrine, making these drugs a preferred option for treating depression because they tend to cause fewer side effects and are better tolerated by patients. Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil)[3].
While SSRI antidepressants are generally safe, side effects are possible. The more common side effects associated with SSRIs may include [3, 6, 14]:
- Nausea
- Vomiting
- Insomnia (sleep problems)
- Drowsiness
- Headache
- Dry mouth
- Anxiety
- Dizziness
- Agitation
- Gastrointestinal problems
- Weight gain
- Sexual problems, such as loss of libido (sex drive) and erectile dysfunction
Less Common Side Effects:
Although more severe side effects are usually rare, they are possible and may include [3,6]:
- Rash
- Cataracts
- Congenital disabilities
- Hyponatremia (low sodium in the blood)
- QT prolongation, leading to fatal arrhythmia (torsade de pointes).
- Serotonin syndrome is a potentially life-threatening condition that can lead to mental status changes, autonomic dysfunction, and dystonia.
- Coagulopathy (a condition that affects the blood’s ability to clot properly).
- Emotional blunting (a condition in which your emotions seem muted or less intense)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Serotonin-norepinephrine reuptake Inhibitors (SNRIs) are a class of medications commonly used for the treatment of various conditions, including depression, anxiety disorders, and chronic pain. [7].SNRIs affect the levels of two important neurotransmitters, serotonin and norepinephrine, in the brain [7]. By inhibiting the reuptake of these neurotransmitters, SNRIs help increase their availability, leading to improved mood and reduced perception of pain [7]. Venlafaxine (Effexor) and Duloxetine (Cymbalta) are two common SNRIs, although there are many others [14].
Side effects may include:
Common side effects:
- Dry Mouth
- Headache
- Weight gain
- Possible sexual dysfunction
Other possible side effects may include:
- Nausea
- Dizziness
- Constipation
- Insomnia
- Asthenia (weakness or lack of energy)
Less common side effects:
- Mood changes
- Agitation
- Worsening depression symptoms
- Hypertension (high blood pressure)
- Increased risk of cardiovascular events
- Gastrointestinal bleeding
- Breathing problems
Prolonged use of SNRIs may potentially lead to issues such as tolerance, dependence, or withdrawal symptoms upon discontinuation. Close monitoring is essential to manage any long-term effects that may arise.These effects are more prominently associated with certain SNRIs like sibutramine and tramadol [7].
Tricyclic antidepressants (TCAs)
Tricyclic antidepressants (TCAs) are a class of medications used to manage and treat major depressive disorder (MDD) [8].These medications block the reabsorption of chemicals in the brain that affect mood, attention, and pain, such as serotonin and norepinephrine. [8].
Common side effects [8, 19]:
- Dry mouth
- Blurred vision
- Constipation
- Dizziness
- Sweating
- Tremor
- Nausea
- Insomnia
- Nervousness
- Fatigue
- Palpitations
Other side effects may include:
- Increased appetite
- Weight gain
- Confusion
- Sedation
- Urinary retention
- Tachycardia (fast heartbeat)
- Orthostatic hypotension (low blood pressure when standing after lying down or sitting)
There is the potential for more severe side effects, such as an increased risk for cardiovascular problems, such as QTc prolongation, posing a risk, particularly in patients with preexisting heart disease. [8].
There are several different TCA medications, including amitriptyline (Elavil), amoxapine (Asendin), and doxepin (Sinequan, Adapin, Silenor), to name just a few [8].
Monoamine oxidase inhibitors (MAOIs)
MAO inhibitors are medications used to treat depression and other neurological and psychiatric disorders [11]. MAOIs work by blocking an enzyme in the brain called monoamine oxidase. This causes an increase in neurotransmitters such as serotonin, norepinephrine, and dopamine, which regulate mood and emotion [11]. Some MAOI medications include selegiline (Eldepryl or Zelapar), moclobemide (Manerix), tranylcypromine (Parnate), isocarboxazid (Marplan), or phenelzine (Nardil) [14].
Common side effects may include:
- Hypotension (low blood pressure)
- Periods of hypertension (high blood pressure)
- Weight gain
- Sexual dysfunction
- Myoclonus (involuntary, sudden muscle jerking)
- Insomnia (trouble falling asleep)
- Daytime sleepiness
- Drowsiness
- Dizziness
- Lightheadedness
- Headaches
- Constipation or diarrhea
- Hallucinations
- Dyskinesias (involuntary muscle movements, such as tics, tremors)
Other possible side effects may include:
- MAOIs can cause a substantial drop in blood pressure, which can make almost half of the people who take them feel dizzy. This is something to be careful about, especially in older patients.
- Eating certain fermented foods that contain tyramine, along with MAOI medications, can cause a dangerous condition called hypertensive crisis. This is known as the “cheese reaction.” However, using selective MAO-B inhibitors and reversible, selective MAO-A inhibitors can help prevent this reaction.
- When you take certain antidepressants or other medications that affect serotonin levels, it’s possible to develop a condition called serotonin syndrome. This is very serious and can cause a range of symptoms, such as changes in mental state, problems with your body’s automatic functions, and increased muscle activity. It’s important to be aware of the risks and talk to your doctor if you’re taking multiple medications that affect serotonin.
- Suddenly stopping MAOIs (a type of antidepressant) can cause antidepressant discontinuation syndrome. This can lead to symptoms like anxiety, agitation, trouble sleeping, feeling cold and sweaty, headache, irritability, feeling unwell, and nausea. Other side effects that people may experience include sexual problems, difficulty sleeping, headaches, and weight gain.
What are Atypical Antidepressants?
Atypical antidepressants are a group of medications used to treat depressive disorders and various other mental health conditions [14]. They work differently from traditional antidepressants and target specific neurotransmitters to modulate mood and behavior, and the way they work varies among the different medications in this class; for example, bupropion(Wellbutrin) inhibits the reuptake of dopamine and norepinephrine [14].
Agomelatine acts as an agonist at melatonin receptors and antagonizes serotonergic receptors, promoting the release of dopamine and norepinephrine [14]. Mirtazapine works by blocking certain receptors, leading to increased levels of norepinephrine and dopamine in specific regions of the brain [14]. Examples of atypical antidepressants include bupropion (Wellbutrin), mirtazapine (Remeron), and agomelatine (Valdoxan) [14].
Side Effects of Atypical Antidepressants:
- Sedation
- Drowsiness
- Dizziness
- Headache
- Weight gain
- Seizures
- Changes in mood or emotions
- Changes in the way someone thinks or feels
- Problems with mental functioning
- Sexual problems
When it comes to using atypical antidepressants, it’s essential to be careful if you have certain health conditions, such as a history of seizures. Regular check-ins with your doctor are also vital to ensure the medication is working correctly and not causing any problems [14]. In the event of an overdose, it is essential to seek medical attention immediately, as these medications can be toxic in large quantities [14].
A Timeline of Side Effects
The timeline for side effects related to antidepressants can differ depending on the medication and the individual’s reaction to it [13]. Although most side effects are typically mild and improve within a few weeks of starting the medication, others, such as sexual dysfunction and weight gain, may persist for more extended periods [13].
Initial Phases: Adjusting to Antidepressants
When starting an antidepressant regimen, individuals may experience mild and short-lived side effects within the first few weeks, such as nausea, dizziness, headaches, and changes in appetite or sleep patterns. Thankfully, as the body adjusts to the medication, most of these initial effects tend to fade away. However, some side effects like sexual dysfunction, weight gain, or drowsiness may persist throughout the treatment for some people. It’s important to note that not everyone will experience the same side effects, and their severity and duration can differ from person to person.
Mid-course: Transitioning Side Effects
As the treatment progresses, patients might notice a shift in the nature of side effects. While the initial discomfort might diminish, other effects could emerge or persist, such as sexual dysfunction, weight gain, or increased appetite. Certain classes of antidepressants can lead to distinct side effects. For instance, SSRIs are known for potential headaches, gastrointestinal problems, and insomnia, while SNRIs may induce nausea, dry mouth, and, in rare cases, elevated blood pressure. The TCA class, on the other hand, might lead to symptoms such as weight gain, sedation, dry mouth, and constipation.
Long-term Considerations: Managing Side Effects
It’s important to keep the conversation open with your healthcare providers throughout your treatment journey. By informing them about any side effects you experience, they can monitor the effects of your medication and adjust your treatment plan as necessary. It’s important to prioritize your mental health and work closely with your healthcare team to ensure the best possible outcome.
What to do when experiencing very intense side effects
If someone experiences very intense side effects from antidepressants, it is important to contact their healthcare provider immediately [9]. The healthcare provider may need to adjust the dosage or switch to a different medication to alleviate the side effects [9]. It is also important to follow the healthcare provider’s instructions and not stop taking the medication abruptly, as this can cause withdrawal symptoms [9].
While the majority of antidepressant side effects are mild and tend to diminish over time [9], certain individuals, especially children, teenagers, and young adults, might experience an escalation in suicidal thoughts or behavior, particularly during the initial weeks of treatment or when the dosage is adjusted [9]. Therefore, it is crucial to monitor individuals for any changes in behavior or mood and to seek medical attention immediately if any concerning symptoms arise [9].
Are antidepressants hard on your body?
Antidepressants are generally well-tolerated, but their effects on the body can vary depending on the type and duration of use. At the start of treatment, you may experience side effects such as nausea, dizziness, headaches, changes in appetite, and sleep disturbances. Some antidepressants may also increase the risk of coagulopathy and heart issues, which could lead to fatal heart problems [3].
There is also a possibility of serotonin syndrome [3, 7]. Physical side effects like weight changes, gastrointestinal problems, and an increased risk of cardiovascular events have been reported [3, 8]. Psychological effects, including anxiety, sleep problems, changes in mood, and agitation, are also possible [3, 7]. Moreover, antidepressants like SSRIs and SNRIs may cause sexual dysfunction and emotional changes, which can affect both sexual desire and emotional stability [3, 7].
It’s important to keep a close eye on any changes or side effects that you may experience while taking antidepressants. Regular monitoring is essential to manage these potential effects [13]. If you notice any intense side effects, such as severe headaches, excessive drowsiness, or nausea, it’s recommended that you speak with your healthcare provider right away. They may suggest adjusting your dosage or switching to a different medication to help alleviate the symptoms [9].
What antidepressant has the most side effects?
Side effects of antidepressants can differ from person to person and depend on the type of medication. However, some types of antidepressants are more likely to cause specific side effects, such as TCAs and MAOIs. Tricyclic antidepressants (TCAs)are an older class of antidepressants that are generally more likely to cause side effects than newer antidepressants. Monoamine oxidase inhibitors (MAOIs) are an older class of antidepressants that are typically used as a last resort due to their potential for serious interactions with certain foods and medications.
What is esketamine (Spravato)?
Spravato (esketamine) is a prescription drug that is administered as a nasal spray approved by the Food and Drug Administration (FDA) for the treatment of treatment-resistant depression (TRD) when used in conjunction with a traditional antidepressant [1]. While most antidepressants can take four to six weeks to reach their full effects, esketamine begins working within hours of being administered [1].
According to a study, some of the most frequently reported side effects of esketamine were nausea, dissociation, dizziness, and headache [17]. It should be noted that esketamine may not be suitable for everyone, particularly those with a history of substance abuse, as there is a risk of addiction associated with this medication [17].
Are there any alternatives to medications?
Multiple alternative treatments exist for certain conditions, such as Transcranial Magnetic Stimulation (TMS). TMS is a safe, non-invasive medical procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms. It is FDA-approved for the treatment of major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) [5]. TMS has shown potential in treating several conditions, including depression, general anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) [4-5], and may be used to treat other conditions.
Improving Mental Health
Antidepressants are commonly used to manage various mental health conditions. However, it is important to know that alternative treatments such as esketamine (Spravato) and transcranial magnetic stimulation (TMS) are also available, and they have the potential to improve symptoms and quality of life for a range of conditions. Collaborating closely with healthcare providers can help individuals make informed decisions about their unique health needs and choose the most suitable treatment option for their well-being. Maintaining open communication throughout treatment is essential to ensure the best possible outcome and overall mental health improvement.
Contact Neuro Wellness Spa today to explore the various depression treatment options available. Our team of experienced professionals is ready to provide personalized care and support on your journey to wellness. Whether you are seeking treatment for anxiety, depression, or other mental health concerns, we are here to help. Take the first step towards a brighter future by reaching out for help. Contact Neuro Wellness Spa to schedule a consultation and start your path to a healthier mind and body.
References
- Bahr, R., Lopez, A., & Rey, J. A. (2019). Intranasal Esketamine (SpravatoTM) for Use in Treatment-Resistant Depression In Conjunction With an Oral Antidepressant. P & T: a peer-reviewed journal for formulary management, 44(6), 340–375.
- Boyce, P., & Ma, C. (2021). Choosing an antidepressant. Australian prescriber, 44(1), 12–15. https://doi.org/10.18773/austprescr.2020.064
- Chu A, Wadhwa R. Selective Serotonin Reuptake Inhibitors. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554406/
- Cirillo, P., Gold, A. K., Nardi, A. E., Ornelas, A. C., Nierenberg, A. A., Camprodon, J., & Kinrys, G. (2019). Transcranial magnetic stimulation in anxiety and trauma-related disorders: A systematic review and meta-analysis. Brain and behavior, 9(6), e01284. https://doi.org/10.1002/brb3.1284
- Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet (London, England), 391(10128), 1357–1366. https://doi.org/10.1016/S0140-6736(17)32802-7
- Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., Viswanath, O., Urits, I., Boyer, A. G., Cornett, E. M., & Kaye, A. M. (2021). Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review. Neurology International, 13(3), 387–401. https://doi.org/10.3390/neurolint13030038
- Fanelli, D., Weller, G., & Liu, H. (2021). New Serotonin-Norepinephrine Reuptake Inhibitors and Their Anesthetic and Analgesic Considerations. Neurology International, 13(4), 497–509. https://doi.org/10.3390/neurolint13040049
- Moraczewski, J., Awosika, A. O., & Aedma, K. K. (2023). Tricyclic Antidepressants. In StatPearls. StatPearls Publishing.
- NIH, National Institute of Mental Health, Mental Health Medications. https://www.nimh.nih.gov/health/topics/mental-health-medications. June 2022.
- Remick, R. A., & Froese, C. (1990). Monoamine oxidase inhibitors: clinical review. Canadian family physician Medecin de famille canadien, 36, 1151–1155.
- Sabri MA, Saber-Ayad MM. MAO Inhibitors. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557395/
- Sansone, R. A., & Sansone, L. A. (2014). Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innovations in clinical neuroscience, 11(3-4), 37–42.
- Santarsieri, D., & Schwartz, T. L. (2015). Antidepressant efficacy and side-effect burden: a quick guide for clinicians. Drugs in context, 4, 212290. https://doi.org/10.7573/dic.212290
- Sheffler ZM, Patel P, Abdijadid S. Antidepressants. [Updated 2023 May 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538182/
- 15. Shelton R. C. (2019). Serotonin and Norepinephrine Reuptake Inhibitors. Handbook of experimental pharmacology, 250, 145–180. https://doi.org/10.1007/164_2018_164
- Sub Laban T, Saadabadi A. Monoamine Oxidase Inhibitors (MAOI) [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539848/
- Vasiliu O. (2023). Esketamine for treatment-resistant depression: A review of clinical evidence (Review). Experimental and therapeutic medicine, 25(3), 111. https://doi.org/10.3892/etm.2023.11810
- Verhoeven, J. E., Han, L. K. M., Lever-van Milligen, B. A., Hu, M. X., Révész, D., Hoogendoorn, A. W., Batelaan, N. M., van Schaik, D. J. F., van Balkom, A. J. L. M., van Oppen, P., & Penninx, B. W. J. H. (2023). Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders. Journal of affective disorders, 329, 19–29. https://doi.org/10.1016/j.jad.2023.02.064
- Wang, S. M., Han, C., Bahk, W. M., Lee, S. J., Patkar, A. A., Masand, P. S., & Pae, C. U. (2018). Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review. Chonnam medical journal, 54(2), 101–112. https://doi.org/10.4068/cmj.2018.54.2.101
