If you’re going through depression or have been depressed in the past, the thought of antidepressants has probably entered your mind at one point or another. Even if you’ve never considered taking the so-called happy pills, a doctor or someone else may have recommended them to you.
To take or not to take… that is a good question.
Treating your depression with antidepressant medication can be a wise choice. But it’s a decision that requires some thought.
Antidepressants change the way your brain works. It’s a big deal. And sometimes, antidepressants change stuff about your body that you’re not prepared for. It’s important to have enough information about these impactful pills before you make your decision (information that is not always offered at the doctor’s office).
This article will tell you more about what you can expect. Specifically regarding the side effects of antidepressants, withdrawal symptoms, tolerance, emotional blunting and what happens when you mix different types of drugs. We’ll finish with three other treatment options.
The side effects of antidepressants
Antidepressants can be very helpful and sometimes life-saving for a person with depression. There’s no need to say that you should never take them. It’s just important to be well-informed before doing so.
Antidepressants change the way your brain works and come with a big bag of possible side effects.
There are many different types of antidepressants and even more brands. Unfortunately, there’s no way of knowing beforehand which pill will work for you or give you the most tolerable side effects. To complicate things further, different types of antidepressants give different side effects, but a particular antidepressant doesn’t cause the same side effects in all people. In some cases, your doctor needs to change the prescription several times before you find an antidepressant that works for you and that your body tolerates.
Some people don’t experience severe side effects of antidepressants and others find them so trying that they terminate the treatment early. It’s good to be aware of the possible side effects of antidepressants before you make your decision. If you suddenly start sweating heavily or gain weight, at least you’ll know why it’s happening. So, to avoid surprises, check out this list of common side effects of antidepressants (NB you probably won’t experience all of these!):
- Sleepiness during the day
- Weight gain
- Diminished sexual interest, desire, performance and satisfaction
- Joint pain and muscle pain
- Muscle spasms/twitching
- Dry mouth
- Profuse sweating
- Skin rashes
- An upset stomach
- Suicidal thinking and suicidal behaviour (applies to children, adolescents and young adults)
Taking antidepressants is generally safe for adults, but as you can see, not always pleasant. Higher doses of medication are associated with more severe side effects, so your doctor will probably get you started on a low dose if you decide to try it.
Always read the patient information leaflet so you know what to expect from a drug. Also, you can do a web search for “package leaflet for (name of antidepressant)” or “FDA label for (name of antidepressant)” to find the warnings by the drug manufacturer regarding side effects of a particular antidepressant.
Now you know a little bit more about the possible side effects, but it’s difficult to make a decision without hearing about the benefits, right? The next section gives you a quick update on the effectiveness of antidepressants.
Is it worth it?
How effective are antidepressants?
The effectiveness of antidepressants is debated among experts and there’s no way of knowing in advance if a certain type of antidepressant will help you. Finding the right medication can be a tedious process. But when you do, you should be able to feel an improvement within 4-6 weeks.
Today, most medical researchers agree that antidepressants are effective in around 50% of cases. That means that half of all depressed people who take antidepressants will notice a 50% reduction in their symptoms or more. In comparison, around 25-30% of people taking placebo pills will have the same results.
For more information about the effectiveness of antidepressants, check out Do antidepressants work?
So, your chances of improving with antidepressants are about 50% and you may experience some unpleasant side effects in the process. But what happens when you stop taking the pills? The next section will tell you all about withdrawal.
What happens when I stop taking antidepressants?
Withdrawal symptoms can be as uncomfortable as the side effects of antidepressants. Your brain gets used to having the extra chemicals from the pills. And we can’t expect it to quietly accept the new conditions when we suddenly stop feeding it with antidepressant substances.
Even when tapering correctly, withdrawal symptoms can be very uncomfortable. Both doctor and patient sometimes misinterpret the withdrawal symptoms and believe that depression is coming back. And some people think that they’re incapable of coping without the medication because of withdrawal. Every time they try to quit, they feel awful. These misinterpretations can make people stay on antidepressants for years and years. Try not to. When depressed, you’re recommended to take antidepressants for 6 months to 1 year after feeling better.
So, how do you know if it’s withdrawal or depression coming back? Well, usually depressive symptoms take longer to show up than a day or two. If you’re having problems within just a few days, it’s probably withdrawal. To really find out how your body copes without the medication, you should stay off the drugs for 1-2 months.
56% of people on antidepressants experience some of these withdrawal effects when lowering their dose:
- Stomach upsets
- Flu-like symptoms
- Trouble sleeping
- Brain zaps (feeling as if there’s an electric shock in your head)
- Feeling irritable
- Feeling confused
As with the side effects of antidepressants, some people get mild or no withdrawal symptoms and others experience severe problems. And there’s really no way of knowing beforehand how your body will react. Sometimes, withdrawal symptoms last for 1-2 weeks, and sometimes people struggle with them for months. If you have extreme difficulties coming off your medication, your doctor can choose to temporarily prescribe another antidepressant to alleviate the symptoms.
Here’s how you stop taking antidepressants in the nicest way possible (your brain will thank you):
- Think “slow in, slow out”. If it takes several weeks for the medication to work, it’s only reasonable that it takes a long while to get it out of your system.
- ALWAYS talk to your doctor before making any changes to your medication.
- NEVER stop taking antidepressants abruptly.
- Together with your doctor, gradually lower the dose over several weeks or months (perhaps taper your dose by a quarter every 4-6 weeks)
If you want to know more about withdrawal symptoms (including brain zaps) and how to taper your medication, check out this video by Dr Marks. (NB Some experts prefer to call it “medication discontinuation syndrome”, but withdrawal is what they’re talking about.)
Or, watch Dr Berney and Dr Marshall talk about withdrawal in the Psychreg Podcast.
Will I build up tolerance or experience emotional blunting?
It’s possible to build up tolerance to antidepressants and, according to Dr Marks, it happens in around 25% of people. Tolerance means that you become less responsive to your medication over time. Doctors don’t know exactly why this happens. One theory is that prolonged exposure to antidepressants makes receptors in the brain less sensitive to the chemicals in the drug.
Another problem with medication is emotional blunting. Emotional blunting is a common side effect of antidepressants and happens to 30-50% of people taking them. After a while, you may feel emotionally numb or dull. You feel “flat”, as if you don’t really care about anything or as if nothing is really important. As you can imagine, emotional blunting can easily be misinterpreted as if your depression is getting worse. So, it’s good to be aware of it before you start taking antidepressants.
Both tolerance and emotional blunting can sometimes be solved by adjusting your dose or switching to another antidepressant. But remember, never make changes to your medication without speaking to your doctor.
The next section will tell you about what happens when another drug is interfering with your antidepressant medication.
The surprising side effects of mixing antidepressants with other drugs
If you’re taking another form of medication and thinking about antidepressants, there is reason to be very cautious. Even though doctors usually prescribe medications with well-known side effect profiles, it’s very difficult for medical professionals to predict exactly how two different drugs will interact with each other. Combining antidepressants with other forms of medications can create unexpected side effects.
According to Dr Russ Altman who is studying unexpected drug interactions, mixing Pravastatin/Pravachol (a drug for high cholesterol) and Paroxetine/Paxil (an antidepressant) creates an unexpected and unhealthy spike in glucose levels. High glucose levels are associated with an increased risk for diabetes and, over the long term, associated with damage to organs and tissues.
Dr Altman explains more in his TED-talk What really happens when you mix medications?
In addition to Pravastatin/Pravachol, antidepressants should not be mixed with:
- St. John’s wort (a herbal remedy)
- Monoamine oxidase inhibitors, such as Phenelzine/Nardil and Clomipramine/Anafranil
- Lithium (a common treatment for Bipolar disorder)
If you’re on a medication that should not be mixed with antidepressants, you may want to try a medication-free treatment option. The next section will show you some of the most effective ones.
Depression treatments without the side effects of antidepressants
So, if you can’t take more medication or if you just don’t want to deal with the side effects of antidepressants, what are your options? Luckily, there are several treatments for depression that do not include pills.
Psychotherapy. There is no doubt that antidepressants can help you recover, but it’s important to note that medication doesn’t necessarily treat the cause of the depression. Psychotherapy (talk therapy) and antidepressants are equally effective, and the two in combination is a significantly more effective treatment than antidepressants alone.
Talk therapy with a psychologist will not only get you out of depression, but also give you tools for how to manage life in new ways and break old patterns of behaviour. Psychotherapy is a valuable opportunity to get to know yourself better, to decide what you want to keep on doing and what you want to let go of.
Don’t know who to call? The Chelsea Psychology Clinic in London is full of experienced psychologists and offers a number of evidence-based talk therapies.
tDCS. Transcranial Direct Current Stimulation (tDCS) is a form of gentle brain stimulation that treats depression.
No, no, it’s not electroconvulsive therapy (ECT) and it doesn’t produce any memory problems. The tDCS current (0,5-2 mA) is 400 times weaker than the current used in electroshock therapy and can be administered at home with a tDCS headset. The headset delivers a low-strength electric current to help activate the brain cells in the frontal lobe of the brain. You put on the headset and stimulate for 30 minutes 2-5 times a week. The treatment is medically approved for depression and you can get it here.
TDCS can also be used in combination with antidepressants. The combination is significantly more effective than antidepressants alone.
Read more about What is transcranial Direct Current Stimulation (tDCS)?
TMS. Transcranial Magnetic Stimulation (TMS) has proven to be effective against ‘treatment resistant’ depression and can help those who can’t tolerate the side effects of antidepressants.
During a TMS procedure, your doctor changes the activity of brain cells in your frontal lobe with a magnetic field. The magnetic field is about the same strength as the one used in an MRI scan and the procedure typically lasts for 30-60 minutes. TMS is a medically approved (FDA approved) treatment for depression and is always administered at a healthcare clinic.
Read more about Can Transcranial Magnetic Stimulation (TMS) treat depression?
Antidepressant medication helps around 50% of those taking it.
It’s important to be aware of the possible side effects of antidepressants, such as insomnia, weight gain, diminished sexual desire, headaches, sweating and nausea.
Antidepressants have a great impact on your body and you should expect some withdrawal symptoms when trying to get the chemicals out of your system. Withdrawal symptoms include flu-like symptoms, anxiety, sleeping problems, brain zaps and sweating.
If you’re taking another form of medication and thinking about antidepressants, there is reason to be very cautious. Even though doctors usually prescribe medications with well-known side effect profiles, it’s difficult for medical professionals to predict exactly how two different drugs will interact with each other.
Psychotherapy, tDCS and TMS are medically approved, medication-free treatments for depression. All of them can be used in combination with antidepressant medication.
I sincerely hope this article gave you some valuable information about antidepressants.
Thank you for your attention!