Antidepressants and their side effects

[David]

What triggered off this thread with me is that I received an email in my mailbox about lawsuits related to Paxil. Apparently Paxil can cause something called akathisia (severe inner restlessness) that in turn is associated with suicidal tendencies. It is alleged that the manufacturer of this drug did not reveal all the information about this drug in relation to prescribing it in children. Not only is it said to be ineffective in treating children and adolescents; it also increases suicidal thoughts in them. Scary, all right. Right now a lot of parents and adult patients are filing lawsuits against the manufacturer. It is already known that you should get emergency medical attention in the event of an allergic reaction like - skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

[Marie]

One of the main reasons why people stop their prescribed course of antidepressants is the side effects. It is not as if antidepressants are mild drugs. Combined with depression, which still does not have a perfect cure because of its variable nature, there is no specific antidepressant that can be routinely prescribed. Different people react differently. Side effects vary. It works for some people and doesn’t, for others. Those SSRIs became popular since they were considered safer over the Tricyclics. Tricyclics are toxic when a particular dose is exceeded. But then, there’s a definite connection between suicide and SSRI drugs. The side effects of antidepressant medication can be numerous, simply because there is no complete understanding about them. For that matter, even the companies that make these drugs don’t claim to know exactly how these drugs work. Not encouraging at all!

[Kim Wilde]

SSRIs are basically preferred (Paxil, Prozac, Luvox, Zoloft, Celexa) by docs and psychiatrists because experience has shown them to be safer. Guess that’s good because there are cases where the antidepressants given to treat depression are the ones that actually make the patient suicidal. But there are two major problems with SSRIs – these carry bigger risks when combined with other drugs – you cant take them with MAOIs. SSRI may be considered safe in overdose, but there are cases where they induce masochism or contemplation of suicide. SSRIs also have the following side effects: Nausea, diarrhea, headaches; in fact you can also expect sexual side effects - common with SSRIs, such as loss of libido, failure to reach orgasm and erectile problems. There is something called ‘Serotonin syndrome’ that is also a cause for major concern when SSRIs are used.

[Jeff]

Yeah – see – serotonin syndrome is because of MAOIs mostly – as they bring down the serotonin metabolism, inhibiting the uptake of serotonin. The problem itself is caused by serotonin synthesis increasers like L tryptophan, and SSRIs that inhibit serotonin uptake also. If you browse the subject you will find that most cases were a result of MAOI plus meperidine, tryptophan, dextromethorphan – which is an ingredient of many OTC medicines, a tricyclic antidepressant, or an SSRI antidepressant. In fact, the long half life of SSRI and duration of irreversible MAOI effect that is seen with these medications enhance the chances of serotonin syndrome even weeks after the drugs have been stopped. The odd thing is serotonin syndrome is triggered by medications least suspected to be serotonergic. Apparently there is research to prove that meperidine and dextromethorphan are culprits when it comes to precipitating acute serotonin syndrome.

[Leo]

I’ve heard that most cases of serotonin syndrome are fairly mind and can be solved in a day’s time. But the crux of the matter is the doc recognizing the symptoms – suppose he doesn’t? What if he ends up prescribing an even larger dose of serotonin enhances or another serotonin-raising drug – then its scary to even imagine what can happen because of this. To prevent the syndrome, I think the patients should give the doc a list of whatever drugs they take routinely – and this ought to have details of their prescription drugs, over the counter meds, dietary supplements and – yes – recreational drugs too, so that the doc can take a good look at this and then prescribe any additional drug that may be required.

[Susan]

Yes, I think that makes sense. So if the patient is already on certain drugs, the doc might first consider whether the new prescription will be safe. And most people also have the tendency to ask the pharmacist if the medication or an over the counter medicine is okay to combine with the other medicines they are taking already. If the syndrome does develop, the first thing to do is to stop the drugs that are causing it. Immediate care is essential, that too in a hospital. Probably the patient might require treatment for signs like a raised blood pressure, high body temperature, etc. The severe cases might be treated with drugs that inhibit serotonin along with sedation. If the patient is agitated, most doctors don’t recommend using physical force to control them since this could trigger off muscle contractions, which results in lactic acid build up – and a serious body temperature rise.

[David]

Before going the antidepressant route, most counselors and doctors recommend the counseling route. Before getting all tied up with MAOIs and SSRIs – people first need to understand why they are depressed in the first place. This apparently helps them in the process of getting better. That’s the way human beings respond to a problem – by knowing why. It is only then that they can find a solution. I don’t really know though – I feel that this line of thought for depression may or may not work. It needs a lot of encouraging. What if it just makes the depression worse? Counselors encourage depressed people to talk about the past to ‘get it out of their system’ or ‘deal with it’. As far as I know, most depressed people already do this.

[Marie]

When it is a question of finding out ‘why’ – I doubt if there is any particular one reason for depression. Even if you knew that reason, it wont make the depression just disappear. Anyhow, how would you know that you’ve identified the right reason? Mulling over the past again and again just makes the depressed person more emotional, and worry more. This could simply make things worse. Whoever is involved with helping the depressed person do this, is trained not to give any specific direction – I don’t know how that will help, because the patient will just end up rambling – and definitely wont like it when interrupted. Seems passive to me. I think it would be better if the counseling was directed in some way, to help the person get better, giving them a method they can use to get over their depression.

[Kim Wilde]

It’s common to suggest a combination of drugs and counseling for depression. But there are many studies that highlight that if the patient gets the right direction and help with counseling, the drugs may not be necessary at all! The goal is to overcome depression, and this involves being familiar with the signs of a future event, when it happens. It is important to develop and learn the skills of handling depressive thinking – so that you can be sure about working at a depression-free life. My point is, a good counselor can help the patient achieve this. The counselor can use various approaches to help the patient recognize what he or she does, how things are perceived, relation to others, conviction that things will improve and working at finding solutions.

[Jeff]

As reasons go, the one most commonly quoted for depression as a result of some illness, that is treated with drugs. This is not very convincing – but most people feel that there is a high rate of relapse after drug treatment, hence it is necessary to treat depression as a disease, a chronic one, at at that. It needs long term treatment and probably high dose medication. So the consensus is that drugs treat just the symptoms – not the depression. But consider this – if you don’t treat depression, it can last for as long as 8 months! For depression medication to take effect, it takes about 6 weeks – and thereafter, it has to be continued for 6 months at least. If relapse is to be avoided, the medication could go on for two years too!

[Susan]

Correct! It worries me also. Not easy being depressed! Other treatments that combine cognitive, behavioral and other therapies don’t result in relapse as much as drugs. Relaxation techniques are wonderful, since they calm the person and put them more in a frame of mind to accept therapy and be interactive. The patient’s lifestyle should be examined – who knows, maybe their basic emotional needs are not really being met. Then there are the side effects of drugs. More and more people are questioning the increase in use of antidepressants – the dependence on them. A lot of physicians see it as the first course of action for depression. As a long-term solution, it’s not without its problems. Sure, they are effective – but sometimes it just makes the situation worse.

[Leo]

Antidepressants are proved to be able to effectively control depression in some case, partially control in some cases and totally ineffective in some. The most negative aspect of drugs as a treatment for depression is the relapse part – and nothing can prevent that. Alternative treatments have a much higher rate of success in getting rid of depression. It means no danger of relapse. Often depression is suspected to be the result of a chemical imbalance – but it usually is not. Depression usually depends on people’s situations and how they react to them. They just have to take into account the benefits of medication in spite of the side effects, then. Probably a balance can be reached to see where the trade off is.

[Marie]

What to do about antidepressant side effects? Some may be bothersome while others have to be treated. It’s a fact that you have to weigh the benefits of the drug with its side effects. But if the side effects get too overbearing, you’ll have to just stop the medicine. So, it is better to bear in mind which side effects could get worse with you when first starting the medicine, or when the dosage is increased. Sometimes the body adjusts over time. Most doctors advise you to stick to the medicine even if there are mild side effects, since these are likely to go away on their own. In any case, the medicine should not be stopped without consulting the doctor as that can actually trigger off other problems.

[Kim Wilde]

True. You just cant stop the medicine on your own if the side effects are uncomfortable since this can make your symptoms even worse – leading to a relapse of your depression, wasting all the time and effort. Doctors advise you to take the medicine with a meal if it upsets your stomach. If you feel sleepy during the day because of the medication, or makes you sleepless at night, the doc might suggest an appropriate time to take it so that you can avoid the unwanted side effects. Alcohol with depression medicine is a definite no, because it can interfere with the efficacy of the medicine. Ultimately, your doctor who is treating you is the best judge – you might have your dosage lowered – or just have your medication changed.

[Leo]

Some doctors just wont take this seriously – in which case it is necessary to be a little insistent. On no account should these side effects be ignored anyway – nor should they just be accepted. Most doctors will be prepared to work out a way in which you can resolve these issues, since the main idea is to have you recover from depression. Other than that – there are ways in which you can avoid the side effects of antidepressants. A good diet can really go a long way in helping you – cereals and other high fiber foods like apples, celery, and salads prevent constipation. To avoid a dry mouth, you can have sugarless gum. Drink a lot of water. Instead of three heavy meals a day – its better to split it into smaller meals – say 5-6 a day. This helps avoid nausea.