Side effects of antidepressants

Drug Sedation Anticholinergic Effects Orthostatic Hypotension 

Note 0 = no side effect + = minor side effect ++ = moderate side effect +++ = major side effect ++++ 

The blockade of norepinephrine and serotonin uptake occurs immediately, but antidepressants are not effective clinically for 2 to 4 weeks. Long-term treatment with antidepressants causes  

The first-generation tricyclic antidepressants, the monoamine oxidase inhibitors, and the newer agents can cause sedation, insomnia, orthostatic hypotension, or nausea. Because of their anticholinergic properties, they may also produce cardiac toxicides (Table 43.2). 

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How does physical exercise alleviate depression One possibility is that it increases the release of endorphins that produce a sense of well-being, sometimes referred to as the runner s high . Another possibility is that it is a placebo effect. But even if it is a placebo effect, consider the differences between exercise and antidepressants in side effects. Side effects of antidepressants include sexual dysfunction, nausea, vomiting, insomnia, drowsiness, seizures, diarrhoea and headaches. Side effects of physical exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone, greater life expectancy, increased strength and endurance and improved cholesterol levels. So if both antidepressants and exercise work by means of the placebo effect, which placebo would you prefer ... 

For people who are depressed, and especially for those who do not receive enough benefit from medication or for whom the side effects of antidepressants are troubling, the fact that placebos can duplicate much of the effects of antidepressants should be taken as good news. It means that there are other ways of alleviating depression. As we have seen, treatments like psychotherapy and physical exercise are at least as effective as antidepressant drugs and more effective than placebos. In particular, CBT has been shown to lower the risk of relapsing into depression for years after treatment has ended, making it particularly cost-effective. 

These are uncommon side effects of antidepressant drugs, particularly when used at normal therapeutic doses. 

TABLE 2-3. Key features and side effects of antidepressant medications... 

The side effects of antidepressants, sometimes very unpleasant, olten lead patients to interrupt their treatment or to reduce the drug dose, which involves a great risk in view of the high relapse rate and danger of suicide in depression. The newer antidepressants, such as trazodone, fluoxetine and other SSRIs and moclobemide, are characterized by better tolerability and lower toxicity and are therefore preferred in the treatment of outpatients and elderly patients (Rudorfer and Potter, 1989). A detailed list of general and specific common side effects associated with the newer generation of antidepressants is seen in Table 1.7. 

This time course coincides with other events, including the time it takes for a patient to become tolerant to the side effects of antidepressants. Thus, desensitization of some neurotransmitter receptors may lead to the delayed therapeutic actions of antidepressants, whereas desensitization of other neurotransmitter receptors may lead to the decrease of side effects over time. 

Originally, it was hypothesized that desensitization of postsynaptic receptors may be responsible for the therapeutic actions of antidepressants. It is now clear that desensitization of some postsynaptic receptors is responsible for the development of tolerance to the acute side effects of antidepressants. Attention is currently being... 

Antidepressants do not appear to elevate mood in healthy volunteers (see Chapter 10), but neither, as we have seen, is there good evidence that they do so in depressed patients. Although reports of effects of SSRIs suggest that effects on sleep may sometimes differ between patients and volunteers (Mayers Baldwin 2005), in general side effects of antidepressants in patient trials are consistent with those found in healthy volunteers. For example, tricyclics show sedation and cognitive impairment (Deptula Pomara 1990 Herrmann McDonald 1978), while SSRIs show gastrointestinal upset and drowsiness in both patients and volunteers (Dumont et al. 2005). 

Kielholz, P. (1980). Side effects of antidepressants. International Committee for the Prevention and Treatment of Depression Bulletin, 4, 4-5. 

Baldwin D, Mayers A. Sexual side-effects of antidepressant and antipsychotic drugs. Adv Psychiatr Treat 2003 9 202-10. 

Side Effects of Antidepressant Drugs - Recent publications pertaining to the clinical side effects of antidepressant agents are by Hollister, Kahr et al. 5, Tschen et al. 6, Blair and Simpson and Simpson et al. 8. The toxicology of amitriptyline has been described by Myers et al. 9. 

Cookson J. Side-effects of antidepressants. Br J Psychiatry 1993 163 (Suppl. 20) 20 ... 

Figure 2.1 Like nearly all antidepressant drugs, TCAs can have significant side effects. Some of those side effects for different TCAs are listed here, along with their frequency. Sexual dysfunction is a common side effect of antidepressant drugs and has a high probability of occurrence in patients who take the drugs listed here. The chances of agitation and insomnia, on the other hand, are quite low.

Qinkgo hiloha This herb does not seem to offer any benefits to healthy adults, but it may be helpful to people with various disorders, including dementia and depression, and seems to be somewhat effective in treating the sexual dysfunction that often appears as a side effect of antidepressants. Some doctors prescribe it along with an SSRl. It seems to work by enhancing microcirculation, improving blood flow to the tiny capillaries to the brain and elsewhere. 

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