Main side effects of antidepressants
The main goal of treatment in depressive disorders is to achieve remission of symptoms and for the person to recover their functioning in different areas of life: family, social, work or education.
There are various psychological, psychosocial, and pharmacological treatments available for depression. Treatment with antidepressant medications is especially recommended for moderate to severe depression and should be individualized according to the person's age and needs; therefore, it should always be prescribed and monitored by healthcare professionals.
Psychological intervention in depression
Antidepressants, while effective, do not produce immediate results , and it generally takes two to three weeks to notice improvements in mood. Therefore, in the first few days or weeks of taking them, only potential side effects may be noticeable.
Types of antidepressants
There are several types of antidepressants, all of which are supported by scientific evidence:
- Selective serotonin reuptake inhibitors (SSRIs): fluoxetine, sertraline, citalopram, escitalopram, paroxetine, fluvoxamine.
- Selective serotonin and norepinephrine reuptake inhibitors (SNRIs): venlafaxine, duloxetine.
- Selective norepinephrine reuptake inhibitors (NRTIs): reboxetine.
- Specific noradrenergic and serotonergic agents (NaSSA): mirtazapine.
- Tricyclic antidepressants: clomipramine, nortriptyline, amitriptyline, imipramine, desipramine.
- Monoamine oxidase inhibitors (MAOIs).
- Norepinephrine and dopamine reuptake inhibitors (NDRIs).
SSRIs are among the most commonly prescribed medications, along with SNRIs and tricyclic antidepressants. Sometimes, anxiolytics or hypnotics are added to the treatment to address symptoms of anxiety or insomnia.
The results of antidepressants are not immediate, and it is possible that in the first few days or weeks of taking them only the possible side effects will be visible.
The duration of treatment is determined by the healthcare professional, who must consider the individual's clinical condition. As a general rule, it is recommended to maintain the medication regimen for a minimum of four to six months after improvement in a first episode, and up to two years in recurrent episodes.
Discontinuing antidepressant treatment should always be done under medical supervision. Abrupt stopping can trigger withdrawal symptoms, such as anxiety, diarrhea, or vivid dreams. To avoid these effects, the dose should be reduced gradually.
Side effects of antidepressants
Antidepressants, like most medications, can cause adverse or side effects, especially in the first few days of treatment. Slightly more than half of the people undergoing antidepressant treatment may experience some side effects during their course of treatment. If the person cannot tolerate the adverse effects, changing the medication may be considered.
In general, the most significant side effects of antidepressants are mild and disappear within a few days of starting the medication . If you have any concerns, it is always important to consult your dental healthcare team.
The main adverse effects are:
Affects the digestive system
- Nausea. In general, nausea may appear at the beginning of antidepressant treatment. In most cases, it disappears once the body has adapted to or tolerated the drug.
Recommendations:
- Take the antidepressant with food or meals. If possible, spread meals throughout the day, avoiding large meals at one time.
- Drink plenty of fluids, especially water.
- Diarrhea. Like nausea, it usually appears at the beginning of treatment and disappears once the body has tolerated the drug at the gastrointestinal level.
Recommendations:
- Drink water, herbal teas, and broths.
- Rice water: Boil one liter of water with a handful of rice for 20-30 minutes. Strain and let cool before drinking. (Store for 24 hours in the refrigerator)
- Carrot water: preparation similar to that of rice. (Storage: 24h in refrigerator)
- Take oral rehydration solution.
- Drink milk, preferably in the form of natural yogurt.
- Do not consume alcoholic or carbonated beverages.
- Constipation. Constipation is associated with tricyclic antidepressants because they disrupt the normal functioning of the digestive tract and other organ systems. Other antidepressants can also cause it.
Recommendations:
- Drink plenty of water.
- Eat foods rich in fiber, such as fresh fruits and vegetables, bran, and whole grains.
- Exercise daily.
Antidepressants can cause some adverse effects such as diarrhea, constipation, or nausea, which can be minimized by following some dietary guidelines.
Weight gain
Weight gain can be a relatively common side effect of antidepressants. This problem can potentially lead to conditions such as obesity, diabetes mellitus, dyslipidemia, and metabolic syndrome, all of which are cardiovascular risk factors.
Recommendations:
- Maintain a balanced diet, rich in fruit and vegetables, and avoid trans and saturated fats.
- Avoid consuming sugary or alcoholic drinks.
- Engage in regular physical activity. Ideally, this should consist of 30- to 40-minute sessions of moderate intensity three to five times per week.
Fatigue and drowsiness
Fatigue and drowsiness are common, especially during the first few weeks of treatment with an antidepressant.
Recommendations:
- Do some physical activity daily, such as walking for about 30 minutes.
- Avoid driving and operating heavy or dangerous machinery until the feeling of fatigue and drowsiness passes.
- Take the antidepressant treatment at night, if there are no therapeutic inconveniences.
Insomnia
Some antidepressants can cause insomnia, meaning a persistent difficulty in falling asleep, staying asleep, or maintaining sleep quality.
Recommendations:
- Take the antidepressant in the morning, if there are no therapeutic contraindications.
- Avoid consuming alcohol, nicotine, caffeine, and other stimulants in the late afternoon and evening.
- Avoid napping during the day or limit its duration to no more than 20-30 minutes. Use an alarm clock if necessary.
- Maintain a regular sleep schedule.
- Maintain flexible bedtime and wake-up times.
- Make sure the bedroom is comfortable, dark, well ventilated and quiet.
- Wear clean, comfortable clothes to bed.
- Take a bath or shower, a glass of warm milk or some sedative infusion (linden, valerian) before going to bed.
- Avoid heavy dinners and leave a gap of between one and a half and two hours between finishing dinner and going to bed.
- Learn simple relaxation techniques (abdominal breathing, visualization).
Guidelines for combating insomnia
Dry mouth
Dry mouth is a common side effect of many antidepressants and most psychotropic drugs.
Recommendations:
- Drink water regularly.
- Drinking water with natural lemon; it hydrates and activates saliva secretion.
- Chew sugar-free gum or candy.
- Avoid tobacco, alcohol, and caffeinated beverages, as they can increase the sensation of dry mouth.
- Breathe through your nose, not your mouth.
- Brush your teeth at least twice a day, floss daily, and visit your dentist regularly. Dry mouth is a risk factor for tooth decay.
- Lubricate your lips with lip balm.
When taking antidepressants for the first time, you may experience a temporary worsening of depression and even an increase in suicidal or self-harming thoughts.
Dizziness and unsteadiness
Dizziness is more common with tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) than with other antidepressants. These medications can cause low blood pressure, which can lead to dizziness.
Recommendations:
- If you are in bed or sitting, get up slowly.
- Perform changes in body position and movement in a non-abrupt manner.
- Use handrails, canes, or other sturdy items for support, if necessary.
- Avoid driving or operating heavy or dangerous machinery.
- Avoid consuming caffeine, tobacco, and alcohol.
- Drink plenty of fluids, especially water.
- Take the antidepressant treatment at night, if there are no therapeutic inconveniences.
Headache
At the start of treatment, you may experience occasional headaches. Although they sometimes persist, they disappear in most people after a few weeks.
Recommendations:
- Take any type of painkiller: paracetamol, ibuprofen…
- Avoid smoking and consuming alcohol.
- Avoid exposure to intense stimuli: light, noise, smells.
- Use relaxation techniques.
Restlessness and anxiety
Motor agitation, irritability, or anxiety itself can be the result of the stimulating effect of certain antidepressants during the first few days or weeks of starting to take them.
Recommendations:
- Exercise regularly, do aerobic exercise (walking, cycling, etc.).
- Practice relaxation exercises (deep abdominal breathing, Jacobson's progressive relaxation...).
- Do not consume alcohol, caffeine, or other stimulants.
- Maintain organized routines and schedules.
Impact on sexuality
Many antidepressants cause sexual side effects, such as decreased sex drive (libido), erectile dysfunction, or difficulty reaching orgasm. Selective serotonin reuptake inhibitors (SSRIs) are more likely to cause sexual side effects than other antidepressants.
Recommendations:
- Discuss the problem with your doctor or psychiatrist to assess the possibility of switching to an antidepressant that may have fewer side effects or adjusting the medication dosage to reduce or alleviate the problem.
- Keep in mind that this problem is quite common and can be corrected. Sexual dysfunction is usually more severe at the beginning of treatment and decreases as it progresses.
- Discuss the topic with your partner in order to approach sexual relations in the best way and with satisfaction.
Suicidal risk and antidepressants
Several studies indicate an increased risk of suicide during the first eight weeks of treatment, particularly in individuals under 25 years of age. This is possibly due to a decrease in inhibitory factors, which may lead to both the verbalization of suicidal thoughts and the actual act of suicide.
When you first start taking antidepressants, you may experience a temporary worsening of depression and even an increase in suicidal or self-harming thoughts.
Recommendations:
- From the moment an antidepressant is started, thorough and regular monitoring by the healthcare team (psychiatrist, family doctor, nurse, etc.) is important, especially in the first few weeks, to detect possible suicidal thoughts and behaviors.
- If the person taking the antidepressant treatment or their environment detects a risk of self-harm or suicidal ideation, they should inform the medical team or go to the nearest emergency department.
Warning signs of suicide from antidepressants:
- Suicidal thoughts or attempts.
- Clinical worsening in both depressive and anxious symptoms
- Sensation or state of motor agitation, restlessness and aggressiveness.
- Difficulty sleeping.
- Sudden changes in behavior.
Main conclusions
- Antidepressant treatments can produce multiple adverse or side effects, in most cases during the first days and weeks of taking them.
- In general, these adverse effects disappear once the body tolerates the drug.
- If you have any doubts, experience persistent side effects, or worsen your condition, never stop taking the medication, either suddenly or without informing your medical team or psychiatrist.
- Discontinuation of the drug may cause withdrawal symptoms and worsen the underlying psychopathological condition.
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