Withdrawal Reactions

Typical reactions are similar to having the flu, or getting dizzy, or having electric shock sensations in the head. Gradually cutting down the dose is the main treatment.

Sometimes, taking a small dose of the antidepressant when withdrawal reactions appear is very useful. This may mean an extra fragment of a tablet, or opening a capsule, disposing of most of the contents, then resealing and swallowing the capsule.

Some doctors give patients Prozac to lessen withdrawal reactions as this leaves your blood stream more slowly. But other doctors are concerned there are risks having 2 antidepressants in the bloodstream simultaneously.

Weight Gain

About 40% of patients taking antidepressants will gain weight. This site indicates which antidepressants are least likely and most likely to cause weight gain.

The ordinary measures of weight control will help, although the battle will be more difficult due to the effects of antidepressants on your metabolism, especially affecting the cell insulin receptors apparently. They absorb normal levels of sugar from the bloodstream and store it as fat in the cells. Keeping your calorie / kilojoule intake under control, drinking a lot of low kilojoule fluid, and exercising frequently will all help. But only a little in some people due to the insulin receptor theory.In some people, taking appetite suppressant medication helps, although there is concern about possible interaction between appetite suppressants and modern antidepressants, resulting in damage to the heart and blood vessels.

TOPIRAMATE , FORXIGA and METFORMIN are prescription medications which reduce weight in some people.

The best option, if at all possible, is to change to a different antidepressant, or reduce the dose of the antidepressant currently being prescribed. However, this runs the risk that the benefits of having controlled the depressive illness would be lost, as we cannot guarantee that lower doses or the next antidepressant will be as effective as what i currently being taken.

Daily exercise and writing down what you eat will help, especially writing down what you eat BEFORE you eat it.

Sexual Difficulties

About 60% of people taking the modern antidepressants operating on the serotonin pathway will develop sexual side-effects.

VIAGRA (and similar medications) has been effective in many men in allowing them to have an erection while taking modern antidepressants, and there are isolated reports of some women finding the medication useful in improving sexual responsiveness or regaining the ability to have an orgasm, but many women find Viagra is ineffective.

CIALIS is a long-acting similar medication.

But these medications do not help the issue of loss of sexual interest.

Various HERBAL MEDICATIONS have been claimed to be effective, but again it seems it is only in a small minority of people that any benefit appears.

WELLBUTRIN/ZYBAN added to modern antidepressants has been advocated by an authoritative scientific review (Cochrane review) as a reasonably good treatment.

REDUCTION IN DOSAGE OF THE ANTIDEPRESSANT:

Theoretically, this should improve the problem, but the reality seems to be that very little improvement occurs with dosage reduction. Furthermore, this technique brings with it the risk of return of the depressive symptoms. Depressive illness is like cancer, and total and prolonged obliteration of symptoms is the ideal treatment; no one would suggest a cancer patient reduces his or her chemotherapy for any reason, provided the patient can tolerate the therapy.

Periactin (Cyproheptadine) is an antihistamine medication widely available. However, this medication usually needs to be taken every night, and / or in high doses to try to overcome the chemical blockage underlying the sexual problems. Unfortunately, high doses of Cyproheptadine are very sedating in most people, with the tiredness lasting throughout the next day. Furthermore, this medication causes significant appetite increase and weight gain.

DEXAMPHETAMINE is a stimulant medication used in attention deficit disorder with hyperactivity in children, and rarely used in psychiatry as an energising agent. There have been occasional reports of sexual improvement in patients taking Dexamphetamine in addition to the modern antidepressants. However, it does appear this technique is not effective for the majority of people.

CHANGE OF ANTIDEPRESSANT: Do note that there are NO (or placebo level) sexual side effects with VALDOXAN, or ZYBAN/WELLBUTRIN. BRINTELLIX has low rates of sexual effects in low dose, rising to about one-third of patients taking 20mg per day. There are no sexual side-effects with Edronax (reboxetine) or Aurorix (moclobemide..not available in USA), but these are seen as weak antidepressants by many clinicians In my experience, patients who experience sexual problems on any one of the SSRIs, or SNRIs, (about 60%) are likely (with rare exceptions) to experience the same sexual problems with all other members of that group.

Drowsiness

Try taking less of the medication during the day, and most of the medication in the evening and/or at night, provided you are not groggy in the morning.

Try taking less of the medication during the day, and most of the medication in the evening and/or at night, provided you are not groggy in the morning. Most modern antidepressants are designed to be taken in the mornings.

Caffeine drinks and tablets may assist.

Stimulant prescription medications may assist such as Modafinil, Ritalin and Dexamphetamine.

If you also have trouble finding the right word when thinking or talking, and especially if you are making silly mistakes and your memory is suddenly much worse, you may be over-medicated. A slight reduction in dose can be usefully tried for 3-4 days.

I advise my patients to slightly adjust the doses of their own antidepressant medication, up or down, depending on whether they are experiencing return of depressive symptoms, or being over-medicated. The effects of dose changes are clear usually within 48-72 hours. Signs of overmedication are what I call the YES syndrome: Yawning Expression Problems Silly Mistakes Yawning/drowsiness: (depressed patients are tired but usually not drowsy) word-finding problems, silly mistakes and terrible memory. And medication-induced drowsiness tends to wear off late in the day when antidepressants are taken in the morning. Reducing the dose should resolve the symptoms within 48 to 72 hours.

Dry Mouth

The risk from this symptom is of rapid tooth decay and permanent enamel damage due to the absence of saliva. And drinking water does not solve the problem.

The risk from this symptom is of rapid tooth decay and permanent enamel damage due to the absence of saliva. And drinking water does not solve the problem.

INTENSELY BITTER DRINKS will briefly directly stimulate your salivary glands and cause them to produce saliva again, relieving the dry mouth sensation. Bitter lemon drinks or confectionery may achieve this effect. Squeezing lemon juice directly into water or soda water is a useful way of producing a bitter drink that will stimulate the salivary glands and temporarily reduce dry mouth.

Keeping a sugarless small sweet in your mouth may help.

The prescription medication UROCARB is often helpful.

CHEWING GUM will increase salivary flow for some time, but it is important to use only sugarless gum due to the absence of the protective effect of normal saliva. Biotene is a trademark of a gum which can be chewed for a long time without becoming unpleasant, usually sold in pharmacies.

BETHANECHOL (trade name Urocarb) is a simple antidote which will relieve the dry mouth side effects of antidepressants in the majority of people. This medication normally has no side effects itself, and needs to be taken in a dose of 10-20 mgs three times per day usually. While the timing of the medication is not an issue for the majority of people, some people find Bethanechol works far better if taken on an empty stomach, and half an hour before any food is consumed. If you have a dry mouth in the morning, taking Bethanechol at night will lessen the damage that can occur to your teeth during the night. You need a prescription to buy this medication.

ARTIFICIAL SALIVA SPRAYS will also be useful for short periods of time, and can be obtained in your pharmacy or drug store without a prescription.

Pilocarpine tablets may also assist, available from your doctor in some countries.

Excessive Perspiration

Modern antidepressants have a side effect in very many people of causing intense perspiration. For many people the situation is so bad that they have to change their night wear, or else they alternate from being intensely hot and perspiring to being very cold as the perspiration dries off during the night.

Our sweat glands in our skin are ordered to produce sweating by nerve impulses, and these nerve impulses are accidentally activated as a side effect of the antidepressants. A simple means of assistance for overnight comfort is to use a fan angled to bounce the air off the ceiling and down onto where you sleep.

PROBANTHINE (propantheline) is a very effective agent in many people at stopping perspiration, regardless of its source. The medication itself is quite a simple medication, and the only common side effect associated with this medication is dryness of the mouth. The medication normally lasts a number of hours after taking the tablet, so that some people find they only need to take the medication at night, or only on hot nights.

CATAPRES & HYTRIN are other agents that are very effective in low doses in many people in stopping perspiration. These medications are widely available under various brand names, as they have been used for many years to control high blood pressure, or to prevent migraine. Because of their role in reducing blood pressure, these medications should be taken in low doses only, when being used to control perspiration. Either you or your doctor should keep a check that your blood pressure does not become too low, as indicated by symptoms such as dizziness or feeling unusually weak and tired.