These days, it’s not strange to hear about a friend or loved one starting an antidepressant. But are side effects of antidepressants worth it?
Everyone’s heard of these medications — though no one is quite sure why, how or if they work effectively, antidepressants are one of the most prevalent medications in the modern world. In the U.S., the number of people on antidepressants rose from 7.7 percent to 12.7 percent overall between 1999–2014, which is nearly a 65 percent increase. Over three of those 12.7 people per 100 say that they’ve been on an antidepressant for “10 years or more.” (1)
With all the new prescriptions, many patients still find the side effects of antidepressants to be frustrating. Do the benefits outweigh the risks?
What Is an Antidepressant Drug?
Antidepressants are a class of psychoactive (psychotropic, or brain-altering) drugs intended to reduce the signs of depression. They were formulated based on a now-proven-false assumption called the chemical imbalance myth, which presumes that chemical imbalances cause mood disorders. (2)
Antidepressants aren’t truly as helpful as many of us has been led to believe, though. Many physicians and researchers have expressed concern that the benefits of these drugs simply don’t make up for the major side effects of antidepressants. (3, 4, 5)
A clinical trial review in 2002 defines the “true drug effect” of antidepressants at around 10–20 percent, meaning 80–90 percent of patients in antidepressant drug trials responded only to a placebo effect or had no actual response. (6)
These medications fall into several categories, including SSRIs or “selective serotonin reuptake inhibitors” (the most popular choice for most practitioners), SNRIs (serotonin and norepinephrine reuptake inhibitors) and tricyclic antidepressants (TCAs), which are considered outdated.
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Sertraline (Zoloft)
- Paroxetine (Paxil, Pexeva, Brisdelle)
- Escitalopram (Lexapro)
- Vortioxetine (Trintellix)
- Venlafaxine (Effexor XR)
- Duloxetine (Cymbalta, Irenka)
- Reboxetine (Edronax)
- Cyclics (tricyclic or tetracyclic, also referred to as TCAs)
- Amitriptyline (Elavil)
- Amoxapine (Asendin)
- Desipramine (Norpramin, Pertofrane)
- Doxepin (Silenor, Zonalon, Prudoxin)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
- Maprotiline (Ludiomil)
- Rasagiline (Azilect)
- Selegiline (Eldepryl, Zelapar, Emsam)
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Bupropion (Zyban, Aplenzin, Wellbutrin XL)
- Trazadone (Desyrel)
- Brexpiprazole (Rixulti) (antipsychotic used as an adjunctive therapy for major depressive disorder)
9 Common Side Effects of Antidepressants
In a 700 patient survey, researchers found that 38 percent of patients on SSRIs reported side effects — only 40 percent of that number reported these issues to their physicians and about 25 percent of the patients with side effects described these as “very bothersome” or “extremely bothersome.” (12)
According to research, these side effects may create great discomfort but don’t necessarily lead to earlier death (in most cases). However, many people taking antidepressants don’t want to continue their regimen because of these tolerability problems, which can lead to antidepressant withdrawal symptoms and risk of a relapse or recurrence of the condition without physician supervision. (13)
Some of the most common and/or severe side effects of antidepressants include: (14, 12, 13)
1. Suicidal Thoughts
Shockingly to many, antidepressants may cause increased suicidal ideation, also known as suicidal thoughts. While this was known as far back as the 1980s, it took decades for the information to be made public. The first time a pharmaceutical company admitted they knew about this increased risk of suicide was in a “Dear Healthcare Professional” letter released in May 2006. (15)
While some skeptics claim this to be simply an impact of depression itself, multiple studies seem to make it clear that SSRIs do seem to increase risk of suicide beyond the mood disorder itself. In addition, most evidence points to the fact that discontinuing medication often alleviates these thoughts. (16, 17, 18, 19, 20)
Some research suggests these thoughts manifest after a patient begins displaying symptoms of akathisia and disinhibition, both of which I’ll cover shortly. (19)
The FDA added a “black box warning” to antidepressants in 2004, applying to those 18 years old and younger, later upping the age to 24 in 2007. (21) There is some evidence that even healthy adults with no history of mental illness can develop suicidal thoughts after taking an antidepressant, suggesting this warning may need to be extended to people of all ages. (23, 24)
2. Stomach Upset
General digestive problems are extremely common with antidepressants. Some sources find that nausea is the most frequently reported side effect of antidepressants overall. (25) Other known digestive problems that can be caused by antidepressants are vomiting and diarrhea.
Frequent headaches are one of the well-known side effects of antidepressants.
People on antidepressants may feel like they’re always tired. This may be described as sleepiness, fatigue or insomnia.
6. Sexual Dysfunction
Sexual problems like impotence or a lack of libido are also one of the most frequently reported side effects of antidepressants. One source lists a high end of up to 80.3 percent of people on antidepressants who might experience some kind of sexual dysfunction. (26)
7. Extrapyramidal Symptoms (Parkinsonian Side Effects)
While these results aren’t as common, they’re some of the most concerning on the long list of antidepressant side effects. “Extrapyramidal symptoms” means issues with normal movement and verbal function. These are possible side effects with both TCAs and SSRIs. (27, 28)
Extrapyramidal symptoms or Parkinsonian side effects of antidepressants include:
- Tardive dyskinesia: jerky or stiff bodily or facial muscle movements
- Akathisia: restlessness/constant movement
- Myoclonus: sudden and involuntary muscle contractions
- Rabbit syndrome: rhythmic lip or mouth movements that look similar to a rabbit chewing (29)
- Dystonia: involuntary twisting muscle contractions
8. Weight Gain
Those on antidepressants may gain weight and be unable to lose weight while on the medication.
9. Behavioral Changes
Similar to restlessness, other side effects of antidepressants include a change in normal behavior in an individual, causing irritability, aggressive behavior, loss of inhibition and impulsivity.
Antidepressant Withdrawal Symptoms
In addition to side effects of antidepressants, it’s common for people to have major withdrawal symptoms if and when they choose to stop taking these drugs. This is discussed in more depth in the article about specific antidepressant withdrawal symptoms, but there is some overlap between these and the antidepressant side effects to understand.
The New York Times released an article in 2018 exposing many stories of those with severe antidepressant withdrawal, finding that it’s very common for the average consumer to be uninformed before starting these medications and that some of the symptoms of withdrawing from antidepressants aren’t even well understood.
Common antidepressant withdrawal symptoms include:
- Fatigue and sleep disturbances
- Brain zaps and paresthesia
- Cognitive impairment
- Suicidal thoughts
- Irritability and mood problems
- Sexual dysfunction
- Gastrointestinal issues
- Movement disorders
- Mania and/or anxiety
- Anorexia nervosa
- Runny nose
- Excessive sweating (diaphoresis)
- Speech changes
- Nausea and vomiting
- Problems with sensory input (like tinnitus)
- Aggressive or impulsive behavior
- Bedwetting (nocturnal enuresis)
- Drop in blood pressure (hypotension)
- Muscle pain or weakness (myalgia)
Because of the vast risks involved in coming off an antidepressant, you should never try to stop taking these medications on your own. Withdrawal should happen under the care of your prescribing physician and will generally involve tapering off your dosage slowly.
7 Natural Remedies for Depression
If you feel confused or upset by a lack of “good options” when it comes to managing your depression, you are not alone. However, there are a number of legitimate natural remedies for depression that science supports as making a significant impact on the condition — most of which are associated with no side effects at all.
1. Eat a Healthy, Well-Balanced Diet
Sound too simplistic? It’s not — a diet that contains whole foods (like fruits and vegetables) and healthy fish is associated with a lowered depression risk. (30)
My suggestion is to focus your diet on fruits, vegetables, high-quality proteins, healthy fats and fermented foods. Healthy bacteria, like the probiotics in fermented foods and kombucha, can help protect you against leaky gut, a condition in your gut that is linked to depression and anxiety. (31, 32)
2. Get the Benefits of Exercise
Exercise may outperform antidepressants in reducing these symptoms, especially in the long-term. If you’re at risk for depression or already struggle with it, start an exercise regimen that works for your life. The indications that suggest this benefit don’t refer to a specific type of exercise, rather to getting your body moving and strengthened in general. (33, 34, 35)
3. Seek Professional Help
While it used to be quite taboo, many people now understand the importance of admitting they have issues with mood, like depression. Multiple types of therapy for depression have been studied with positive results, both with and without treatment with SSRI drugs or other antidepressants at the same time.
The most common type of therapy is known as cognitive behavioral therapy, which produces a “large effect size” on the symptoms of depression (and other conditions) and may outperform antidepressants. (36)
4. Try Depression-Busting Supplements & Potential New Therapies
There are many supplements that researchers have found may effectively reduce or eliminate depression signs. These include:
- Omega-3s (like in fish oil) (37, 38)
- Vitamin D3 (39)
- Chai hu (40)
- Ginkgo biloba
- Suan zao ren
- Passion flower (41)
- Kava root
- St. John’s wort (42, 43)
- Inositol (44)
- Probiotics (45)
5. Utilize Essential Oils
There are essential oils for depression that you can incorporate into your daily routine. Keep in mind that each oil is different and should only be purchased from a reputable company selling 100 percent therapeutic grade oils. Some oils are meant to be ingested while others are not.
Try using these research-supported essential oils to treat depression:
6. Emphasize Relationships and Support System
Being in a strong support system of family and friends is one free, side-effect-free way to lower your risk of depression. (51) While depression may typically drive you to end or de-emphasize relationships, this isn’t going to help in the long-term. Ask friends for accountability to keep you and them involved in each other’s lives.
7. Stay Informed
Many scientists in the field of depression research admit they are dissatisfied with the effectiveness of antidepressants and other current options in the conventional treatment of depression. There are a number of groundbreaking studies being conducted for better depression remedies.
I want you to know you’re empowered to advocate for yourself and your own mental health. One part of this is staying informed about the most up-to-date information you can when it comes to depression.
Two interesting unconventional treatments for depression currently undergoing research are:
Many patients complain of the side effects of antidepressants they experience in the course of trying to beat depression.
Some of the most common and most concerning side effects of antidepressants include:
- Suicidal thoughts
- Stomach upset
- Sexual dysfunction
- Extrapyramidal symptoms (Parkinsonian side effects)
- Weight gain
- Behavioral changes
There are a number of natural remedies for depression that include altering your diet, exercising regularly, seeking professional counseling/therapy, using depression-busting supplements, utilizing essential oils and emphasizing personal relationships.
Please note: Do not change your antidepressant prescription schedule without the supervision of your prescribing physician.