Let me start by saying that antidepressants are generally safe and well-tolerated.

They are commonly prescribed to treat depression and related mental health conditions.

While they can be highly effective, they may also cause aftereffects, which vary depending on the type of antidepressant, the individual taking it, and the dosage. Most of these complications will be harmless, but there are a few rare ones to look out for since they can be dangerous.

Let’s look at potential side effects, categorized by class of antidepressants:

1. Selective serotonin reuptake inhibitors (SSRIs)

Common examples: Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro), Paroxetine (Paxil), and Citalopram (Celexa)

• • Common side effects:
    • Nausea
    • Diarrhea or constipation
    • Drowsiness or insomnia
    • Dry mouth
    • Weight gain or loss
    • Reduced sexual desire or performance (erectile dysfunction or delayed orgasm)
    • Increased sweating
    • Nervousness or agitation
    • Dizziness
  • Rare side effects (but potentially dangerous):
    • Bruising or bleeding easily (rare but serious)
    • Serotonin syndrome (symptoms include confusion, rapid heart rate, and high blood pressure when serotonin levels are excessive)

2. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Common examples: Venlafaxine (Effexor), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq)

• • Common side effects:
    • Nausea
    • Dry mouth
    • Fatigue
    • Increased sweating
    • Constipation
    • Insomnia
    • Loss of appetite
  • Rare side effects:
    • Increased blood pressure (especially with higher doses)
    • Sexual dysfunction
    • Risk of serotonin syndrome

3. Tricyclic antidepressants (TCAs)

Common examples: Amitriptyline, Nortriptyline (Pamelor), Imipramine (Tofranil)

• • Common side effects:
    • Drowsiness
    • Dry mouth
    • Blurred vision
    • Constipation
    • Dizziness
    • Weight gain
  • Rare side effects:
    • Heart rhythm disturbances
    • Low blood pressure upon standing (orthostatic hypotension)
    • Urinary retention
  • Caution: TCAs can be toxic in overdose situations!

4. Monoamine oxidase inhibitors (MAOIs)

Common examples: Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan)

• • Common side effects:
    • Dizziness
    • Drowsiness
    • Insomnia
    • Dry mouth
    • Weight gain
    • Nausea
  • Serious risks:
    • Hypertensive crisis: This can happen if taken with foods high in tyramine, such as aged cheese, cured meats, or certain medications
    • Interaction with other drugs, including SSRIs and SNRIs, may lead to serotonin syndrome

5. Atypical antidepressants

Common examples: Bupropion (Wellbutrin), Mirtazapine (Remeron), Trazodone

• • Bupropion (Wellbutrin):
    • Common side effects:
      • Insomnia
      • Dry mouth
      • Weight loss
      • Agitation
      • Headaches
    • Rare risks:
      • Seizures (at high doses or with predisposing factors)
  • Mirtazapine (Remeron):
    • Common side effects:
      • Sedation (often used for insomnia)
      • Weight gain
      • Increased appetite
    • Less common side effects:
      • Dizziness
      • Dry mouth
  • Trazodone:
    • Common side effects:
      • Sedation
      • Dizziness
      • Dry mouth
      • Nausea
    • Rare risks:
      • Priapism (a prolonged and painful erection)

6. Serotonin modulators

Common examples: Vilazodone (Viibryd), Vortioxetine (Trintellix)

• • Common side effects:
    • Nausea
    • Diarrhea
    • Dizziness
    • Insomnia or drowsiness
    • Reduced sexual function (less than SSRIs/SNRIs)

General considerations

1. Initial side effects:
   • Many common side effects, such as nausea or insomnia, improve after the first few weeks as the body adjusts to the medication.
2. Withdrawal symptoms:
   • Abruptly stopping antidepressants, especially SSRIs or SNRIs, could cause withdrawal-like symptoms like dizziness, irritability, and flu-like symptoms.
     Always taper off under medical guidance.
3. Warning:
   • All antidepressants carry a warning for an increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults under 25.
     Certain antidepressants, such as SSRIs and SNRIs, are more dangerous and prone to increase the risk of suicide.

Possible psychological side effects

• Emotional blunting: Some individuals feel less emotionally responsive or “numb.”
• Paradoxical anxiety or agitation: A temporary increase in anxiety or restlessness, notably during the first few weeks of treatment.
• Manic or hypomanic symptoms: Antidepressants can trigger mania or hypomania in people with bipolar disorder in some exceptional instances.
• Derealization or depersonalization: A rare feeling of being detached from reality or oneself.

Potential neurological side effects

• Headaches: These mostly occur during the initial adjustment period.
• Tremors or muscle twitches: Some antidepressants, especially SSRIs and SNRIs, can cause involuntary movements.
• Seizures: Medications like Bupropion carry a higher risk at high doses or in people predisposed to seizures.
• Movement disorders: Rare cases of tardive dyskinesia (involuntary facial or body movements) or akathisia (a sense of restlessness) have been reported by some people.

Hormonal and endocrine effects

• Hyponatremia (low sodium levels): Low sodium concentrations are more common in older adults and people taking SSRIs or SNRIs.
  Symptoms include confusion, fatigue, and muscle weakness.
• Changes in blood sugar levels: Antidepressants may affect glucose regulation.
  This happens more frequently in people with diabetes.
• Prolactin elevation: Some medications, like certain TCAs or antipsychotics combined with antidepressants, raise prolactin levels.
  This can cause menstrual irregularities or breast tenderness.

Gastrointestinal effects

• Acid reflux or GERD worsening: Antidepressants can increase stomach acid production.
• Flatulence and stomach bloating: Though less common, they can occur alongside nausea and diarrhea.
• Appetite changes: Some people experience irregular hunger or cravings beyond simple weight gain or loss.

Cardiovascular effects

• QT interval prolongation: Some antidepressants, like Citalopram and Amitriptyline, could lead to heart rhythm issues in susceptible individuals.
• Heart palpitations: A sensation of skipped or racing heartbeats.
• Orthostatic hypotension: A sudden drop in blood pressure when standing.
  This happens more frequently with TCAs and MAOIs.

Sexual side effects (beyond the common ones)

• Anorgasmia: This stands for the inability to reach an orgasm, even with adequate stimulation.
• Reduced genital sensation: Some people report numbness or decreased sensitivity in the genital area.
• Post-SSRI sexual dysfunction (PSSD): Sexual side effects sometimes persist even after discontinuing the medication.

Dermatological effects

• Rashes or allergic reactions: Mild rashes or severe reactions (Stevens-Johnson Syndrome) are unusual but possible.
• Photosensitivity: Increased sensitivity to sunlight, which happens more regularly with certain TCAs and MAOIs.
• Hair loss: Some report thinning hair or increased shedding.

Immunological and rare systemic effects

• Increased risk of infections: Some antidepressants may slightly suppress immune function, though the evidence is limited.
• Liver toxicity: Uncommon but can appear with medications like Nefazodone (no longer widely used due to this risk).
• Kidney function impairment: Certain antidepressants could affect kidney health in older adults or those with preexisting conditions.

Uncommon behavioral and cognitive side effects

• Impulsivity: Increased impulsive behaviors, such as gambling or making risky decisions.
• Memory impairment: Temporary cognitive difficulties or forgetfulness.
• Sleepwalking or unusual dreams: Mostly happen with medications like Trazodone or TCAs.

Withdrawal and discontinuation symptoms

When stopping antidepressants, especially abruptly, individuals may experience:

• Brain “zaps” (electric shock-like sensations in the head).
• Flu-like symptoms (fatigue and muscle aches).
• Rebound anxiety or depression.

Diverse side effects

• Yawning: An oddly specific but reported side effect of SSRIs.
• Taste changes: Some individuals report altered taste sensations.
• Swelling: Edema in the hands, feet, or ankles.

Rare and severe complications

• Neuroleptic malignant syndrome (NMS): An uncommon but life-threatening condition with symptoms like fever, muscle rigidity, and confusion.
• Eosinophilia and systemic symptoms (DRESS): A severe allergic reaction causing widespread inflammation.

What to do about side effects?

• Communicate with your doctor: Many side effects can be managed by adjusting the dose, timing, or switching medications.
• Lifestyle adjustments: For instance, taking medicines with food to reduce nausea, and exercising to counter weight gain.
• Monitor for serious symptoms: Seek immediate medical attention if you experience symptoms like severe allergic reactions, chest pain, or serotonin syndrome.
  These can be dangerous, which is why you shouldn’t wait to receive medical attention. Make sure to quit your antidepressants instantly if you do happen to go through these aftereffects.

Conclusion

It’s crucial to talk with a professional as soon as possible if you or someone you know is experiencing severe or persistent side effects.

A doctor can adjust the dose, switch medications, or recommend other strategies to manage these pesky or dangerous aftereffects successfully.