Experiences of antidepressants

Coping with antidepressant side effects

Not everyone has side effects but side effects of antidepressants can cause problems particularly when people start taking a new one. It can take several weeks before any benefits become noticeable. The doctor should give advice about what to expect when he or she prescribes a new antidepressant, and review progress regularly. There is written information about each medicine in the packet, which lists possible side effects and pharmacists are also able to provide advice. If side effects persist or are unbearable the GP may suggest trying another antidepressant which may suit someone better.
 
Research shows that like Simon (below), people often stop taking antidepressants in the first month after starting one, particularly if they experience side effects. Sonia had panic attacks soon after starting on Seroxat (paroxetine), and discontinued after a short while ‘I hadn’t had panic attacks before I started taking it... I didn’t like the way it made me feel. So I didn’t actually stay on it for very long’. Starting on half a dose for the first two weeks may help to reduce this type of side effect and the benefits of treatment should outweigh any problems after a few weeks. If they don’t people are advised to go back to see their GP.
People want to know what to expect before they started taking an antidepressant. With the benefit of hindsight some of the people we interviewed said they hadn’t realised when they first started an antidepressant that you could try different types if side effects were too difficult to cope with or unsettling. People felt reassured when their doctor had provided information and talked to them to prepare them, especially about the possibility of initial side effects. Some wondered whether doctors were reluctant to give their patients too much information about side effects to avoid alarming them. If people do not realise or anticipate that it can take a while to adjust to an antidepressant they may not recognise new symptoms as side effects of their medicine. The instructions may advise that the medicine is taken with or after food, or at a certain time of day, to prevent some side effects, or minimise their impact.
The patient information leaflet that comes in the packet provides details of potential side effects but some found it alarming to read because it covers such a wide range of possibilities. Commonly people used the internet or other sources of information to find out more, especially about others’ experiences, either before they started taking the medication, or if they were experiencing noticeable side effects. It can help to know how others’ have reacted, while being aware that people respond differently. (See ‘The Patient Information leaflet’, ‘Antidepressants: finding information’ and ‘Expectations about taking antidepressants’).
Some people had no noticeable side effects. Others had tried different antidepressants and had different reactions to each, and some had quite different experiences of the same antidepressant when they had taken it at more than one time in their lives. Where people described side effects the intensity or impact varied widely and so did the degree of importance they placed on them. For some, side effects wore off after a short while, whilst others said they never went away. Clearly, side effects are more tolerable if there are also improvements in overall wellbeing. Often decisions about whether to continue taking an antidepressant are made by weighing up the benefits of taking medication against the side effects that people experience. Thomas said he made a list of ‘the pros and cons’. Rachel balanced her dislike of feeling numb against the fact that at times her mood was more level.
Physical side effects people said they had experienced included; sweating, sickness, nausea, dry mouth, a metallic taste , itchy eyes, sedative effects, insomnia, migraine, headache, sugar craving, weight gain, weight loss, loss of appetite, vivid dreams, restless legs, trembling, yawning, anxiety, hallucinations, panic attacks, lack of concentration and sexual dysfunction. Some people didn’t worry too much about them, or they found ways to tolerate or counteract them. When Lou first started taking sertraline she couldn’t stop yawning and had a ‘clenchy jaw’. She looked it up on some online forums and found that other people also had these types of symptoms. Lofepramine makes Janet constipated, but she has been prescribed a laxative, which helps. But others found certain side effects impossible to tolerate.
One side effect that people can find difficult to cope with or accept is ‘sexual dysfunction’. Some people told us that antidepressants had affected their relationships and sex lives. Symptoms such as loss of libido, or inability to climax can impact on close relationships, and can be difficult to balance against feeling well overall. Sharon said that most antidepressants she had tried had ‘shut off’ her sexual feelings which had caused difficulties in her relationships with her husband, but that for her, feeling well was more important. Thomas found this side effect difficult to accept ‘It’s part of me, you know, as a man and so on... it impacts on your self-esteem’.
It’s important to speak to the doctor or pharmacist about side effects if they occur, so that they can be more easily managed. Some people felt their doctor had not offered enough support other than telling them to ‘stick with it’. Pharmacists can offer helpful advice about managing medicines.Thomas felt it would have been helpful to have advice about managing the side effects he was experiencing, rather than be told to persevere and hope they went away. ‘I wanted some way of treating the horrible taste I had in my mouth or some way of dealing with the feeling of always kind of wanting to be sick or just sweating’. Adjusting the dose, or changing the medicine might help, but Sonia said that each time her medicine was changed she had to adjust to new side effects, which could be difficult.
Sometimes a side effect of an antidepressant can be positive, for example sleep problems are common with depression. People with insomnia can find the sedative side effects of some antidepressants help them to establish a sleep routine and sometimes a particular antidepressant will be prescribed for this purpose. Others found that their antidepressants had left them feeling so sedated they couldn’t function at all. Changing the time of day that the medication is taken can help with this, or the doctor may alter the dose or change to different antidepressant if the problems persist.
People with depression may often also have problems or issues around eating; some of the people we spoke to believed that taking an antidepressant had affected their appetite. Sonia craved sugar when she took mirtazapine and gained weight, which she said was not helpful given that she had an eating disorder since she was 17. Lofepramine curbed her appetite, which she liked because it helped her to maintain her weight, but looking back felt it was not sensible to give someone with an eating disorder a drug that could stop them wanting to eat. ‘I had absolutely no desire to eat at all and, you know, I wanted to lose weight I wanted to not eat’. Catherine said she had gained a lot of weight on mirtazapine and that it had affected her self- esteem. Flora lost weight and had no appetite when she took citalopram, and said she lost the motivation or inclination to cook or shop for the family.
People also described psychological side effects such as feeling numb, distant, detached or inability to concentrate. The degree to which people found this acceptable or tolerable varied. People described feeling ‘detached from reality’, ‘not myself’ and ‘zombie like’. Sharon felt ‘floaty’ as if she was ‘in a permanent state of drunkenness’ when she took mirtazapine, and that although it was a relief not to feel anything for a while, ‘you can’t go on like that, it’s not how you live’. Some said they had felt worse rather than better for example because the antidepressant had seemed to heighten or accentuate feelings of anxiety, paranoia, or suicidal thoughts. These types of effects may or may not lessen over time. Rachel said antidepressants helped her to some extent in that they kept her from feeling hopeless, but when she was taking them she always felt numb and distant ‘they shave off so much of the motivation and... creativity, they limit how much joy you can experience in your life’. It can be very difficult to know how much these types of feelings are a symptom of the depression itself, or a side effect from the medication.’

(See 'Telling the difference between depression symptoms and antidepressant side effects')

The GP should review how you are feeling a few weeks after you first start on an antidepressant, or earlier if the side effects are distressing. You can also discuss these issues with the pharmacist who may be able to suggest simple ways to alleviate side effects such as changing the time of day you take them, changing the dose, or suggesting you try a different antidepressant. Sometimes people decide to stop taking them without seeing the GP. Stopping suddenly can induce symptoms (discontinuation symptoms) which may be similar to unwanted side effects so it is recommended to come off them slowly, and to get advice.

Last reviewed June 2016.
​Last updated June 2016.
 

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