- Your 12 Biggest Antidepressant Problems, Solved
- 1. 'Ugh — Suddenly My Head Hurts'
- 2. 'My Stomach Is Upset, and I Have Diarrhea'
- 3. 'I Have the Shakes'
- 4. ‘I Have a Dry Mouth and Really Bad Breath’
- 5. 'I’m Still Sad'
- 6. 'I’m Not Sad, but I’m Not Happy Either'
- 7. 'My Antidepressant Is Making Me Gain Weight'
- 8. 'Sex Tonight? No Way!'
- 9. 'I’m Up All Night'
- 10. 'I Want to Stop Taking My Meds, but I’m Afraid My Depression Will Come Back'
- 11. ‘Now I Have Anxiety’
- 12. 'I Want to Die'
Your 12 Biggest Antidepressant Problems, Solved
Is this your scenario? You started treating your depression with antidepressants only to find that you’re still wrestling with a number of tricky-to-treat symptoms or experiencing annoying side effects. If so, you're not alone.
Each person's reaction to an antidepressant is unique — the side effects, strength, and efficacy of the same drug may be drastically different for you than for someone else.
And given that the Centers for Disease Control and Prevention (CDC) estimates that between 2015 and 2018 approximately 13 percent of American adults ages 18 or older had taken an antidepressant within the previous 30 days, it’s no wonder that there are lots of varying responses to those meds.
“Some people are exquisitely sensitive to antidepressant side effects,” says psychiatrist Heidi Combs, MD, an associate professor of psychiatry and behavioral sciences at the University of Washington, and the director of inpatient psychiatry at Harborview Medical Center in Seattle. Others can take just about any medication without running into problems.
The good news: If you're encountering problems, most of them can be easily managed or reversed. Here are the most common reactions and concerns you might run into while taking antidepressants — and how to resolve them.
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1. 'Ugh — Suddenly My Head Hurts'
During the first few days on your new prescription, you might find that you have a headache. All antidepressants have the potential to produce this side effect for a few days, says psychiatrist Boadie Dunlop, MD, associate professor of psychiatry and behavioral sciences and director of the mood and anxiety disorders program at the Emory University School of Medicine in Atlanta.
He suggests taking Tylenol (acetaminophen) to help, adding that this symptom usually gets better within the first week or two.
2. 'My Stomach Is Upset, and I Have Diarrhea'
People taking SSRI antidepressants — selective serotonin reuptake inhibitors, such as Lexapro (escitalopram) and Zoloft (sertraline) — might find that they have nausea, diarrhea, or constipation. You can manage nausea by taking the medications with food, Dr. Dunlop says.
Make sure you're eating enough fiber and drinking enough fluids; you also might consider taking an over-the-counter medication for diarrhea or constipation. headaches, these symptoms typically go away early in your treatment.
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3. 'I Have the Shakes'
A small number of people find that their medication causes shakiness or tremors. “These can persist and can prevent people from continuing with their medication,” Dunlop says. If you develop this symptom, contact your doctor to discuss changing your dose, or the drug itself.
4. ‘I Have a Dry Mouth and Really Bad Breath’
Dry mouth is a common side effect of antidepressants. For most people, dry mouth will improve within a few weeks of taking antidepressants or even earlier, says Karen Lim, MD, a double board-certified psychiatrist in general and child and adolescent psychiatry with Prairie Health, a telepsychiatry platform based in California.
In the meantime, Dr. Lim suggests sipping on water routinely, sucking on ice chips and sugarless candies, popping mints, and chewing sugarless gum.
“If dry mouth persists beyond your first few weeks on an antidepressant, or if it is particularly severe, I would speak to your doctor as soon as possible,” recommends Lim, adding that your dentist may also be able to help.
5. 'I’m Still Sad'
Of all antidepressant problems, this may be the thorniest to untangle. If you’re continuing to experience depression symptoms despite taking an antidepressant, there are a number of possible explanations to consider:
- You got the wrong diagnosis. “When someone has depression that doesn’t respond to treatment, the first thing you do is step back and make sure you have the right diagnosis,” Dr. Combs says. Your psychiatrist might do more tests to make sure some important clues weren’t missed the first time around. Medical conditions, including stroke, heart disease, hypothyroidism, and certain nutritional deficiencies, as well as some medications, can be the underlying cause of as many as 15 percent of all depressions, according to Harvard Health.
- Your medication hasn’t kicked in yet. Sometimes it takes time for antidepressants to become effective. Check with your doctor to find out whether you need to wait a bit longer.
- You’re drinking alcohol or using drugs. These substances can interfere with the effectiveness of your depression treatment, so you’ll need to quit if you want complete success.
- You’re not in therapy. Although medication can help, you might also need to talk with a therapist to help you figure out how to cope with issues in your life that are causing you to feel sad or anxious. Some evidence suggests that the combination of medication and psychotherapy is more effective than either method alone, reports the American Psychological Association.
- You’re taking the wrong medication. You might find relief by switching antidepressants or adding another medication, such as a thyroid drug or lithium. Talk about this with your doctor.
- You need to try something new. Ask your doctor whether you might benefit from other approaches — even unconventional ones. For example, dance movement therapy has been shown to help manage depression, according to research published in Frontiers in Psychology in July 2019.
6. 'I’m Not Sad, but I’m Not Happy Either'
Approximately 46 percent of people who take antidepressant medication experience emotional blunting — a feeling of being depleted of all emotions, including the good ones, according to survey findings published in October 2017 in the Journal of Affective Disorders.
You don’t have to lose your ability to feel joy in order to manage depression: Emotional blunting is best addressed by switching to a different class of antidepressants, adding a second medication, or talking with a therapist, Combs says.
7. 'My Antidepressant Is Making Me Gain Weight'
Some depression treatments do put you at risk for weight gain, according to research published in May 2018 in the British Medical Journal. After evaluating nearly 137,000 men and nearly 158,000 women, researchers found that taking an antidepressant is associated with a 21 percent increased risk of weight gain exceeding 5 percent of one’s body weight.
If you have a history of being overweight, you’re more ly to gain while on an antidepressant — “so choose an antidepressant that is weight-neutral,” Combs advises. If that’s not an option, she emphasizes getting counseled in diet and exercise. An added bonus? The National Institute of Mental Health (NIMH) notes that exercise can be an important part of your treatment.
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8. 'Sex Tonight? No Way!'
Many people struggling with depression lose interest in sexual activity, but some antidepressants can lower their libido further or make it difficult to respond sexually.
Doctors don’t always warn their patients about this effect, Combs says, and it can be very frustrating.
Some people are willing to accept it as a temporary trade-off for successful depression treatment, but most want solutions.
Consider switching antidepressants, trying a different dosing schedule, taking other medications to improve sexual response, or experimenting with new ways to increase arousal. Testosterone might be a solution for some women who have lost some interest in sex but need to stay on their antidepressant medication, according to research published in The Journal of Sexual Medicine.
9. 'I’m Up All Night'
Insomnia, sleeping too much, and other changes to your sleep cycle are all signs of depression, according to the NIMH. And when you can’t get a good night’s sleep, it can make it even harder to treat your depression effectively.
“Some antidepressants are identified as activating, and some are sedating,” Combs explains. Finding the right match for you is key. A sedating antidepressant, for instance, might be a good bet for someone who is having problems falling asleep.
It’s also important to look at other lifestyle choices that might be affecting your sleep, such as your sleep environment, physical activity (or lack of it), caffeine consumption late in the day, napping during the day, and alcohol use.
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10. 'I Want to Stop Taking My Meds, but I’m Afraid My Depression Will Come Back'
Once you start feeling better, you’ll probably want to quit taking antidepressants — but, Dunlop says, you need to be stable on antidepressants for at least six months first, to reduce the risk of experiencing another b depression in the future.
Although antidepressants are only temporary for most people, you should never stop taking them (or any prescription medication) without the guidance of a doctor. Usually, the best approach is to reduce your dose in increments. Stopping “cold turkey” could result in unwanted side effects and risk a recurrence of depression, Dunlop notes.
11. ‘Now I Have Anxiety’
Some antidepressants can have stimulating effects, resulting in restlessness, anxiety, and agitation, says Indra Cidambi, MD, medical director and founder of Center for Network Therapy, a New Jersey–based outpatient addiction and mental health treatment facility.
“One of the goals of antidepressants is, after all, to give you more energy to accomplish your daily tasks,” Dr. Cidambi explains. But sometimes people taking certain antidepressants just can’t relax or even sit still when they want to. If this is the case, it needs to be addressed, she says.
If you are experiencing increased restlessness or anxiety after starting an antidepressant, speak with your doctor. This could be a side effect called akathisia that needs to be addressed because feeling restless on top of sad can lead to increased self-harm.
Depending on the cause and severity of the restless or anxiety, your doctor may have different suggestions.
“Working out, yoga, or meditation is usually enough to drain away the excess energy, but if that does not work, one could ask their doctor to prescribe non-addictive sedatives or adjust the dosage of antidepressants,” Cidambi says. Sometimes, this may mean a different form of treatment is needed.
If you’re having high energy levels accompanied by racing or impulsive thoughts, it may be a sign of a more serious condition such as bipolar disorder, cautions Cidambi. She recommends talking to your doctor if you have these symptoms.
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12. 'I Want to Die'
With depression, there’s always a risk of suicidal thoughts, but these can also be a side effect of antidepressants, though a rare one. A Finnish study published in Human Psychopharmacology found that the risk for suicide is not significantly increased by the use of antidepressants, though other factors of depression, such as insomnia, do contribute to suicide risk.
Regardless of what might be prompting suicidal thoughts, call your doctor immediately if you start to experience worsening depression symptoms, including suicidal thoughts or thoughts of harming yourself or others, Dunlop advises.
If you’re running into a problem with your antidepressants, there’s ly a solution — so don’t ignore it. Get to the bottom of it.
Additional reporting by Michelle Pugle.