Pt 2 of our antidepressant review examines the most common side effects of associated with different types of antidepressant medication

Anti-depressants Part 2

Side effects of antidepressants

The most common side effects are as follows:

Tricyclics

Tricyclics commonly cause dry mouth, a slight tremor, fast heartbeat, constipation, sleepiness, and weight gain. These effects are reduced if a low dose is given to start and the dose is then slowly increased. Other side effects which are more common in older people include confusion, inability to pass urine, and postural hypotension. They should be avoided in patients with heart conditions as they can cause irregular heartbeat. They can cause erective dysfunction and delayed ejaculation in men. Tricyclic antidepressants are dangerous in overdose as they can cause cardiac problems. This is especially true for amitriptyline which should not be used for depression. Amitriptyline is generally only used for nerve pain nowadays.

SSRIs

SSRI’s can cause nausea and anxiety initially; however, these side effects often wear off after a few weeks. They can cause indigestion, but this can be avoided by taking with food. They can cause sexual dysfunction such as loss of libido. There have been rare reports of episodes of aggression.

Most people only experience mild side-effects (if any). The side-effects usually wear off over a couple of weeks as the body gets used to the medication. The more serious ones - problems with urinating, memory problems, falls, confusion - are uncommon in healthy, younger, or middle-aged people.

SNRIs

The side-effects are very similar to the SSRIs, although Venlafaxine should not be used with a serious heart problem. It can also increase blood pressure, so this should be monitored, especially initially.

MAOIs

This type of antidepressant is rarely prescribed these days. This is because they can cause hypertensive response (dangerously high blood pressure) if foods containing tyramine are eaten with them. Foods containing tyramine include mature cheese, pickled herring, broad bean pods, yeast extracts including brands like Bovril^®, Oxo^® and marmite^®. Even stale or gone off food can cause this reaction. 

NASSAs

Mirtazapine is the most common drug used in this group. The side-effects are very similar to SSRIs. It can cause drowsiness and weight gain, but it causes less sexual problems than SSRIs.

Melatonergic agonists

Side effects include headache, migraine, and dizziness. It is considered to have less sexual side effects and fewer withdrawal symptoms than other antidepressants.

Common Antidepressants

Key

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To be continued next week

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