Besides the desired mood-lifting effect, antidepressants naturally also have side effects. Interactions with other drugs must also be taken into account, as well as the presence of certain diseases, for example, which could be a contraindication. The type of side effect depends very much on the type of antidepressant.
In the following some of these adverse effects will be listed according to the antidepressant. These are only a selection and occur with varying frequency. – Dry mouth, increased sweating, nausea, headaches
- Disorders of the gastrointestinal function with constipation
- Micturition disorders with urinary retention
- CNS symptoms such as disorientation, confusion, motor restlessness (also occurs primarily in cases of intoxication with TZA)
- Triggering epileptic seizures
- Influence on heart activity with cardiac arrhythmia (in case of poisoning also life-threatening)
- Blood formation disorders: blood count should be checked every 1-2 months
- Absolute contraindications are the combination of all antidepressants with antidepressants of the MAO inhibitor group as well as an existing suicide risk, as some TZA have a psychomotoric activating and stimulating effect
- Further contraindications: glaucoma, urination disorders, abuse of alcohol and sleeping pills, epilepsy
More about SSRI and alcohol can be found at Citalopram and alcohol – is it compatible?
- Psychotic states of excitement with anxiety, restlessness
- Nausea, vomiting, diarrhoea
- Heightened bleeding tendency
- Syndrome of inadequate ADH secretion with weakness, dizziness, headache
- Increased risk of malformation when taken during early pregnancy
- Here too, caution in case of suicide danger (see TZA)! – like SSRI
- Additional increase in blood pressure and heart rate
- Triggering of the serotonin syndrome
- Tiredness, drowsiness
- Headache, dizziness, nausea
- Dry mouth
- Liver dysfunction
- Blood count changes
- Anxiety, irritability, arousal
- Dizziness, nausea
- Low blood pressure
Caution is also required with lithium.
It has only a narrow therapeutic range. This means that the dose that works and the dose at which strong side effects up to coma can occur are in a narrow range. Thus, the concentration in the blood must be measured regularly to avoid possible side effects and consequences. Side effects include : Acute poisoning with lithium can even lead to seizures and even coma, beginning with vomiting, severe diarrhoea and mental confusion. – Tremor of the hands
- Hypothyroidism or goiter of the thyroid gland with normal thyroid function
- Increased urination, increased thirst
- Nausea, diarrhoea
- Weight gain
- Changes in ECG and EEG
Side effects of antidepressants
Studies have shown that depression is more common during pregnancy. These occur mainly in the last third of the pregnancy. Weight loss or malnutrition associated with depression is a risk factor for low birth weight.
For this reason, the continuation of antidepressant therapy during pregnancy may be indicated. So far, there are no sufficient test results available to confirm the safety of treatment with antidepressants during pregnancy. Nevertheless, experience and the individual studies carried out in recent years or decades show that therapy with the common antidepressants (tricyclic antidepressants, selective serotonin reuptake inhibitors) does not increase the risk of physical and mental developmental disorders of the baby.
An individual antidepressive therapy coordinated with the treating physician is necessary. A reduction of the dose, a change of the preparation or a switch to psychotherapy may be indicated. The doctor must weigh up the benefits of a therapy and the associated risks together with the patient individually.
In the drug therapy of depression during pregnancy, tricyclic antidepressants and SSRIs are the drugs of first choice. SSRIs are the most commonly prescribed antidepressants due to their generally better tolerability and slightly lower risk of suicide and can also be used for long-term therapy. There are still few study results available on the effect of St. John’s wort on mother and child – possible effects on the birth process are being discussed.
Individual studies published in recent years show typical withdrawal symptoms in babies in the first days after birth. Temporary movement disorders, mild epileptic seizures, palpitations and sweating have been reported. However, these symptoms subside spontaneously within a few days after birth.
Nevertheless, a reduction of the dose in the last weeks before birth may be necessary. Further studies have shown a slightly increased risk of premature births with long-term therapy with SSRIs. In addition, a connection between antidepressant therapy and brain development is also being discussed, as altered serotonin levels in the baby’s body can also influence brain development.
A slightly increased risk for autism and ADHD (Attention Deficit Hyperactivity Disorder) is discussed. An organ frequently affected by side effects during antidepressant therapy is the bladder. Depending on the preparation, both an increased urge to urinate with the symptoms of an irritable bladder and an increased urinary retention can occur.
The symptoms usually begin a few days after the start of therapy. Often the side effects diminish continuously in the course of long-term therapy. Depending on the symptoms, the side effects can also be treated with medication and thus avoided.
There is no evidence of possible permanent damage to the bladder. During therapy with tricyclic antidepressants (amitriptyline, clomipramine, nortriptyline), the influence on the autonomic nervous system leads to an altered tension of the bladder sphincter muscle. Both urinary retention (inability to empty the bladder with urinary retention), which occurs mainly in men with an enlarged prostate, and urinary incontinence (with the symptoms of an irritable bladder) are possible.
In the treatment with SSRIs (especially duloxetine), difficulties for the patient to empty the bladder (urinary retention) are also frequently reported. In rare cases, therapy with tricyclic antidepressants also leads to an increase in intraocular pressure. This is due to a change in the pupil width and the resulting obstruction of the outflow of aqueous humor.
There is a risk of the development or worsening of narrow-angle glaucoma. Without treatment there is a risk of permanent damage to the eye. In individual cases, surgery may be necessary to treat glaucoma.
Many other side effects of the common antidepressants in the eye area are possible. However, these usually occur only very rarely and often in combination with an already existing disease of the eyes. For example, conjunctivitis can be favoured by long-term therapy with SSRIs.
Frequently, a regular tremor occurs in the course of therapy with antidepressants. In principle, this side effect is possible with all common antidepressants (tricyclic antidepressants, SSRIs, MAO inhibitors, etc.) and can be pronounced differently from patient to patient.
The hands are particularly affected. For this reason, there is a risk of confusion with tremor, which can occur in other neurological diseases. In SSRIs, continuous tremor can also occur as a withdrawal symptom when the respective preparation is abruptly discontinued.
However, the tremor usually subsides within a short time (days to weeks). There are no long-term effects on the human body due to tremor. While taking any antidepressants (tricyclic antidepressants, SSRIs, MAO inhibitors, etc.
), the consumption of alcohol should be avoided in any case. Particularly when alcohol is combined with tricyclic antidepressants or MAO inhibitors, life-threatening side effects have been described in some cases. Most antidepressants are metabolised in the liver.
Both the activation and the degradation is carried out by liver enzymes. This places a heavy burden on the liver in its function. Since alcohol is also metabolized in the liver, considerable interactions can occur.
Both the effect of alcohol and that of antidepressants can be massively influenced. The described side effects of the antidepressants can increase massively and in some cases take on life-threatening proportions. Depending on the preparation, a wide range of side effects can occur and all organs can be affected in their function.
A strongly reduced breathing, severe cardiac rhythm disturbances and clouding of consciousness are possible. Possible personality changes have also been reported. Also the known side effects of alcohol consumption (dizziness, nausea, movement insecurity) can possibly increase to such an extent that unconsciousness up to coma is possible.
The following articles may also be of interest to you: Amitriptyline and alcohol, citalopram and alcoholAnother common side effect is sexual dysfunction. Especially when treated with SSRIs (citalopram, fluoxetine, paroxetine, sertraline), sexual dysfunction and loss of libido (sexual desire) is often reported. The exact causes are not yet known.
The effects of altered serotonin levels in the central nervous system on the sexual organs are being discussed. The side effects in sexuality during therapy with SSRIs are more frequent in men. Nevertheless, women can also be affected.
Patients often report a constant sexual unwillingness to have sex, difficulties in inducing or maintaining an erection or sexual arousal, and weak or lack of orgasms. Sexual dysfunction can also occur during therapy with tricyclic antidepressants. However, these are significantly less common than with SSRIs.
Patients also report regular sexual unwillingness and a possible reduction in potency. Many of the frequently prescribed antidepressants have an effect on the patient’s weight. Depending on the patient, there is a risk of worsening depression if weight gain occurs.
While many antidepressants lead to weight gain, there are, conversely, also some preparations that are weight-neutral or even aim to lose weight. Tri-cyclic antidepressants (especially amitriptyline) lead to weight gain by increasing the appetite. Depending on the patient, this can amount to several kilograms per month.
In addition, the strongly sleep-inducing antidepressant mirtazapine also leads to weight gain. Studies have shown weight loss when treated with individual SSRIs (especially fluoxetine) as well as bupropion and reboxetine. This effect is due to a generally reduced appetite, particularly with high-dose therapy. At the same time, the dryness of the mouth and changes in taste that occur during treatment can lead to increased loss of appetite. Numerous other antidepressants (including duloxetine, MAO inhibitors, other SSRIs) are generally weight-neutral and have no significant effect on appetite.