Antidepressants — the most common side effects and how to cope with them

Why do antidepressants cause side effects?

The most commonly used medicines (from the SSRI and SNRI groups) raise the level of serotonin in the brain, and some of them also of noradrenaline. These same messengers, however, also act outside the brain — among others in the gut, the blood vessels and other organs. That is why, at the start of treatment, the body has to get used to the change, and most complaints are temporary.

Before you start — what to expect

Side effects usually appear in the first days, while the improvement in mood comes later — after 2 to 4, sometimes 6 weeks. This is an apparent paradox: first you may feel the complaints, and only then the benefits. That is exactly why the start of treatment is often the hardest and worth getting through.

Do not stop the medicine on your own, even if you feel worse in the first days. Tell your doctor about every complaint — usually small changes (the time of day, the dose, the way you take it) are enough to get through this period more gently.

The most common side effects and how to cope with them

Nausea and stomach complaints

This is the most common complaint at the start of treatment. It usually passes within 1–2 weeks. Taking the medicine with a meal, smaller and more frequent portions of food, and ginger in capsules help — usually 250 mg up to four times a day, that is up to about 1000 mg daily (fresh ginger and ginger tea work more weakly and are harder to dose). If the nausea is severe, the doctor may reduce the dose for a while.

Headaches

Common in the first days and usually passing. Hydration, rest and an ordinary painkiller for a few days are usually enough. Persistent or severe headaches are worth reporting to the doctor.

Sleep problems — insomnia or drowsiness

Some medicines have a stimulating effect and can make falling asleep harder, others are calming and cause drowsiness. That is why your doctor will choose the times you take your medicines so as to avoid the unwanted effect. Sleep hygiene also helps: regular hours, and limiting caffeine and screens in the evening.

Restlessness and agitation at the start of treatment

In some people, anxiety, restlessness or a feeling of being "wound up" increase in the first days. It usually passes after several days to a couple of weeks, and starting with a small dose reduces the risk. Report strong restlessness or agitation to your doctor.

Sexual problems

These are among the more common and more persistent side effects: a drop in libido, difficulty with arousal or reaching orgasm. They do not pass as easily as nausea, but there are several solutions — reducing the dose, switching to a medicine with less effect on the sexual sphere (for example bupropion, mirtazapine, vortioxetine or trazodone) or adding another medicine. Every change is agreed with the doctor. It is worth talking about — this is a common and solvable problem.

Changes in appetite and weight

Most of the commonly used antidepressants are weight-neutral — only some of them cause real weight gain. Regular physical activity and a balanced diet help. If the weight gain is significant or bothers you, talk to your doctor about changing the medicine.

Dry mouth, constipation and sweating

These occur more often with some medicines. Water and sugar-free gum ease a dry mouth; fibre, fluids and movement help with constipation; sweating usually eases with time. When the complaints are troublesome, report them to your doctor.

Emotional blunting

Some people describe a reduced intensity of emotions — both difficult and pleasant ones. It is sometimes felt as relief, but when it is bothersome, the dose can be reduced or the medicine changed. This is also worth discussing with your doctor.

Withdrawal symptoms — why you should not stop the medicine abruptly

Stopping treatment abruptly can cause withdrawal symptoms: dizziness, a sensation of "electric shocks" in the head, irritability, flu-like symptoms and sleep disturbances. This is not addiction, but a sign that the body has got used to the medicine. That is why the medicine is stopped gradually, according to a plan agreed with the doctor.

When to contact your doctor urgently

Most side effects are mild and passing, but some symptoms need a quick response. Contact your doctor if the following occur:

• worsening thoughts of giving up or of suicide, especially in the first weeks and in young people,
• strong restlessness, agitation or insomnia that makes normal functioning impossible,
• symptoms of serotonin syndrome: high fever, tremor or muscle stiffness, a fast heartbeat, confusion and heavy sweating — especially after adding another medicine,
• symptoms of an allergic reaction: rash, swelling, shortness of breath,
• an unusually good mood with excessive energy and a reduced need for sleep, which may herald a switch into a manic phase.

If the symptoms are severe or worrying, do not wait until your next visit — contact your doctor. In a life-threatening emergency, call 112.

This article is for information only and does not replace a medical consultation. The choice of medicine, the dose and any changes in treatment are always decided by the doctor together with the patient.