At Alpine Recovery Lodge, we treat patients who need help overcoming addiction. Many of them have an accompanying diagnosis of mental illness, and for that reason, we also have to be aware of the ways that anti-depressant medications affect our patients.
Anti-depressants are one of the most commonly prescribed classes of drugs in the United States. According to the Centers for Disease Control, 11.8% of people took anti-depressants from 2009 to 2012.
Anti-depressant use is more common among women than men, but that doesn’t mean that women are more prone to depression. Rather, it is most likely a reflection that women are more likely than men to seek help for their depression.
Anti-depressants certainly help some people. But like all prescription drugs, they come with side effects.
Anti-Depressants and Sex
One of the least-talked about but most common side effects of anti-depressant medication is a reduction in libido and sexual appetite.
In this country, we have an odd way of looking at sex. On the one hand, advertisers use it to sell everything from beer to toothpaste. And on the other hand, we can be Puritanical and reticent when it comes to talking honestly about sex.
That may be one reason that people are reluctant to address the way that anti-depressant use affects sexual desire.
In men, the use of anti-depressants may also lead to difficulty getting and maintaining an erection, and to delayed ejaculation.
In women, anti-depressants can slow down arousal, affect vaginal lubrication, and make it hard to have orgasms.
These effects are most common with one particular type of anti-depressant, the selective serotonin reuptake inhibitor (SSRI). Doctors sometimes prescribe an erectile dysfunction drug for men or estrogen cream for women to offset the effects.
Anti-Depressants and Sleep
Another common but not widely discussed side effect of anti-depressant use involves sleep. Interestingly, taking anti-depressants can affect peoples’ sleep in two ways, seemingly opposite from one another.
The first potential side effect related to sleep involves drowsiness during the day.
People who start taking anti-depressant medication sometimes find that they feel drowsy and sluggish during the day. They may find that they need a nap or that it’s difficult to get going in the morning.
At the other end of the spectrum is insomnia. Sometimes, people who take anti-depressants find that they have a difficult time falling asleep. They may toss and turn, and that can lead to drowsiness the next day.
There’s no way to know how a particular anti-depressant will affect a person before they try it. They may need to talk to their doctors about timing their medications to alleviate sleep symptoms.
If the anti-depressant makes you drowsy during the day, it might be best to take the medication at night right before bedtime. That way, the initial drowsiness can contribute to sleep.
Likewise, if insomnia is an issue, the best option might be to take the anti-depressant first thing in the morning so that any insomnia-related side effects have worn off by the time you go to bed.
Anti-Depressants and Weight Gain
Very few people want to gain weight, and in fact, obesity is a major problem both in the United States and around the world. However, one of the most common side effects associated with anti-depressant medication is weight gain.
Research shows us that as many as 25% of people gain 10 pounds or more as a result of taking anti-depressant medication.
There are several reasons why taking anti-depressants can cause people to gain weight.
- Some anti-depressants cause the people who take them to retain water. Water weight is not permanent, but the feeling of having put on weight can be distressing.
- People who have severe depression often have little appetite. Sometimes, taking an anti-depressant can increase the appetite and lead to weight gain as a result of increased food intake.
- While research is still ongoing, there is some reason to believe that there may be a metabolic effect associated with taking anti-depressants.
The best way to offset the side effect of weight gain is to get at least 30 minutes of exercise per day and to eat a healthy diet.
Anti-Depressants and Suicidal Ideation
Since anti-depressants are supposed to make people feel better and fight depression, it may come as a surprise to learn that for some people, taking anti-depressants can lead to an increased risk of death by suicide.
Suicide is a huge problem in the United States. As of 2013, it was the tenth-leading cause of death for all age groups combined, and it’s the second most common cause of death among teenagers.
The risk of suicide increases with taking anti-depressants because, in some cases, it may lift depression just enough – especially at first – to give the patient the energy and motivation to plan a suicide attempt.
There is evidence to suggest that the risk is higher for adolescents and teenagers than for adults. For that reason, there is a black box warning from the FDA that advises patients of the risk.
The risk of suicide presents a Catch-22 situation. People with untreated severe depression may have suicidal thoughts but lack – at least in some cases – the motivation to act on them. Taking anti-depressants can decrease feelings of hopelessness, but the lack of hopelessness may also increase the chances that the patient will act on suicidal thoughts.
However, these statistics do not imply that taking anti-depressants can lead to suicide in people who have not previously experienced suicidal ideation.
The best way to reduce the risk of suicide as a result of taking anti-depressants is to see a doctor or therapist on a regular basis, and report any suicidal thoughts to them.
Anti-Depressants and Violence
Since anti-depressants can cause people to take violent action against themselves in the form of suicide or suicide attempts, it’s perhaps not surprising that there is evidence to suggest that it may also contribute to violence toward others.
A 2003 review of crimes involving people who were taking SSRIs revealed that there does appear to be a correlation – albeit a rare one – between the use of anti-depressant medications and violence.
According to the review, mania is an acknowledged side effect of all anti-depressants. Like many conditions, a diagnosis of mania is something that must be made on a spectrum.
In mild cases of mania, a patient may simply experience higher than normal levels of activity and artificially elevated moods. In severe cases, the mania may turn into psychosis.
While the risk of violence appears to apply to only a very small percentage of people who take anti-depressants, it’s important to acknowledge it and closely monitor patients who take them for signs of extreme mania, psychosis, or homicidal ideation.
The risk of paranoia and psychosis is confined to approximately 1% of patients with depression, and approximately 2.2% of patients who have bipolar disorder.
Anti-Depressants and Migraine Headaches
People who are prone to getting migraine headaches must be particularly careful when taking anti-depressant medication.
While anti-depressants do not appear to cause migraines, there is an issue because SSRIs affect serotonin production in a similar way to commonly-prescribed medications for migraines.
Just as having too little serotonin can be a problem, so can having too much. Migraine medications, which are called triptans, stimulate the body’s production of serotonin. Taking these medications together with SSRIs can cause something called serotonin syndrome.
The symptoms of serotonin syndrome are flushing, a rapid heart rate, and headaches. These symptoms may also occur with certain herbal remedies that affect serotonin levels, including St. John’s Wort.
Anti-Depressants and Pregnancy
Women who are pregnant must take special care if they are prescribed anti-depressant medication.
Research shows that babies born to women who take anti-depressants may be at risk for premature birth and low birth weight, among other things.
There is also a risk of certain withdrawal symptoms after birth. Some babies born to mothers who were taking anti-depressants experienced withdrawal symptoms, including:
- Shivering and jitters
- Seizures (only in rare cases)
Women who take anti-depressants should make sure that their OB/GYN or midwife knows that they are taking anti-depressants so that the baby’s health can be carefully monitored throughout the pregnancy.
Anti-Depressants and Short-Term Physical Symptoms
In addition to those things already mentioned, some people experience short-term physical symptoms when they first begin to take anti-depressant medication. For the most part, these symptoms are short-lived.
Some of the symptoms that are most common include:
- Stomach upset
- Muscle and joint pain
- Skin rashes
These symptoms seem to occur as a result of the body adjusting to the new medication. In most patients, the symptoms go away after an initial period of discomfort as the body develops a tolerance for the anti-depressant medication being taken.
There is also a low risk of involuntary movements for patients who take certain SSRIs, including fluoxetine and citalopram, which remain in the body for a long time. The movements may include muscle spasms, tics, and dyskinesia (repetitive muscle movements.)
Involuntary movements are most common in elderly patients as well as those taking the aforementioned SSRIs. The treatment may include anti-anxiety medication or anti-Parkinsonian drugs such as Cogentin. The alternative is to try switching to a different anti-depressant.
A Note about Side Effects
While these symptoms might sound serious and upsetting, it’s important to note that leaving depression untreated is dangerous.
Not everybody who has depression requires a prescription for anti-depressant medication. In some cases, patients may be able to get the treatment they need through individual or group therapy combined with self-care that includes things like meditation and exercise.
Depression affects a significant portion of the population. The process of finding the right treatment may take a while. Patients may need to try more than one anti-depressant medication before finding one that works without causing too many unpleasant side effects.
For people who have severe depression, anti-depressant medications can help prevent suicide and other long-term effects of depression.
The most important thing to remember is that depression is a disease that can be treated. Taking anti-depressants, and being honest with your doctor about how they make you feel, is a critical part of your treatment plan.