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pharmacy

Side effects of Antidepressants ...
If you and your doctor have determined that an antidepressant medication is the right choice for you, the side effect profile and potential for interaction with other medications should be taken into consideration. For this reason, it is imperative that a few “essentials” be followed. (These tips are good, general practices for anyone who is managing their own medical condition)
  1. Keep a current list of medications (including over-the-counter medications). Personal pocket medical journals are available.
  2. Use one particular pharmacy so that interactions may be detected quickly. Get to know your pharmacist(s) so he/she will better help manage your health conditions with an accurate medication history.
  3. Keep all follow-up appointments with your doctor so that needed adjustments can be made in a timely manner. Your doctor needs to monitor your response or lack of response, as well as side effects to determine optimal dosage or medication changes.
Most us of understand that medications can have side effects. Some individuals experience these effects and some do not. We are all different, and therefore we respond differently to certain medications. The side effects associated with antidepressant therapy may be quite bothersome. Some patients experience impairment of daily activities while others just consider them a nuisance. Some side effects may diminish with continued daily use and some may not go away until the drug is stopped. This is why it is very important to accurately discuss your medications with your doctor at follow-up appointments. Typically, it takes a minimum of four to six weeks for an antidepressant to relieve depression symptoms. During this time, side effects may be experienced immediately. Fortunately, most of them are manageable. Some common side effects of antidepressants include:

Dizziness
This is usually attributed to orthostatic hypotension, or a drop in blood pressure upon rising. Patients should be instructed to rise slowly from a lying or sitting position to allow time for blood pressure to adjust.

Drowsiness
This is quite common upon initiation of therapy. If possible, it may be advantageous to take the antidepressant dose at bedtime, but you need to check with your doctor or pharmacist.

Constipation
Changing the diet to include an increase in fiber such as whole grains, bran, vegetables, and fruits, or adding a stool softener to your drug regimen can manage bowel irregularity.

Dry Mouth
Patients may be advised to chew sugarless gum or suck on hard candy to relieve symptoms. They may also sip water throughout the day.

Sexual Dysfunction
This side effect usually needs an added therapy to alleviate. Your doctor may prescribe an additional medication to treat sexual dysfunction if switching medications does not help.

Nausea
Eating small meals throughout the day may control this.

Types of antidepressant medications include:
TCAs – TriCyclic Antidepressants
These medications have been around for quite a while (they are the oldest class of antidepressants) and are very effective for the treatment of depression. However, the side effect profile of this class of drugs is not always favorable. These medications have a high incidence of anticholinergic effects that include drowsiness, dizziness, constipation, dry mouth, blurred vision, and urinary retention. These antidepressants may be dosed at bedtime to limit these bothersome side effects.

Examples of TCAs are:
  • Amitriptyline (Elavil®)
  • Imipramine (Tofranil®)
  • Nortriptyline (Pamelor®)
  • Desipramine (Norpramin®)
  • Doxepin (Sinequan®)
  • Clomipramine (Anafranil®)
SSRI’s – Selective Serotonin Reuptake Inhibitors
SSRI’s are a newer class of antidepressant that have a better side effect profile, possibly because they act on only one neurotransmitter in the brain. However, insomnia or drowsiness, nausea, diarrhea and tremor are the most common side effects of this antidepressant class.

Examples of SSRIs include:
  • Fluoxetine (Prozac®)
  • Sertraline (Zoloft®)
  • Paroxetine (Paxil®)
  • Citalopram (Celexa®)
  • Fluvoxamine (Luvox®)
MAOIs – Monoamine Oxidase Inhibitors
This type of antidepressant as been around a long time, but the food and drug interactions associated with them often limit their use. The interactions are so severe, that this class of antidepressants was once removed from the U.S. market. However, they are now considered “a last resort,” if all other antidepressant medications have failed. Patients who are prescribed MAOI’s must follow a stringent diet (low in tyramine) and, avoid many prescription and over-the-counter medications, because of the risk of sudden, severe hypertension.

Examples of MAOI’s include:
  • Isocarboxazid (Marplan®)
  • Phenelzine (Nardil®)
  • Tranylcypromine (Parnate®)
Non-categorized
Several other antidepressant medications do not fit exactly into any of the aforementioned categories. These were conceived by the pharmaceutical industry for an effective treatment without the bothersome side effects or drug interactions, therefore the antidepressents have grown in popularity. However, each medication has its own issues when considering side effects. Ask your doctor or pharmacist for specific information regarding these alternatives:
  • Buproprion (Wellbutrin®)
  • Trazodone (Desyrel®)
  • Mirtazapine (Remeron®)
  • Venlafaxine (Effexor®)


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"Side effects of Antidepressants ..."
   authored by:
PHARMACY
Tamara Dulin, R.Ph., is a registered pharmacist with Nightingale Home Health Care in Carmel, Indiana. A 1991 graduate of Butler University College of Pharmacy, she has spent the majority of her career in consulting. She is a past president of the Ind...



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