Antidepressants, Side Effects, And Suicide
Antidepressants are medications used primarily to treat depression, but doctors may also prescribe them for anxiety, obsessive-compulsive disorder, certain chronic pain conditions, and other mental health disorders. Different medications work in different ways by influencing chemical messengers in the brain.
Some commonly prescribed antidepressants belong to a group called selective serotonin reuptake inhibitors, or SSRIs. Examples include sertraline, fluoxetine, and escitalopram. Other antidepressants, including SNRIs and several medications that work through different mechanisms, may be recommended depending on a person’s symptoms, medical history, and response to treatment.
These medications can cause side effects, although the experience varies considerably from one person to another. Possible effects include nausea, headaches, dizziness, tiredness, changes in sleep, increased sweating, appetite or weight changes, and sexual side effects. Some people experience very few problems, while others may need a different medication because the side effects are difficult to tolerate.
One of the most serious concerns associated with antidepressants involves suicidal thoughts and behaviors. The U.S. Food and Drug Administration requires a prominent warning about this risk for children, teenagers, and young adults. Research has found that some younger people may experience an increase in suicidal thinking or behavior after beginning treatment or after a dosage is changed.
It is important to distinguish suicidal thoughts from suicide deaths. The warning does not mean that taking an antidepressant automatically causes someone to attempt or die by suicide. Rather, certain younger patients may experience an increase in suicidal thoughts or behaviors. At the same time, untreated depression itself can substantially increase a person’s risk of suicide, which makes treatment decisions complex.
The period shortly after starting an antidepressant deserves particular attention. A person may begin to experience increased energy or agitation before their depression has significantly improved. Any sudden change in behavior, especially increased agitation, severe restlessness, impulsiveness, worsening depression, or talk about death or suicide, should be taken seriously.
Although the FDA’s strongest suicide-risk warning focuses on younger patients, adults of any age should communicate significant mood or behavioral changes to their healthcare provider. A medication that works well for one person may not be appropriate for another, and doctors sometimes need to adjust the dose or try a different treatment.
People taking antidepressants should also understand that these medications generally should not be discontinued abruptly without medical advice. Stopping suddenly can produce uncomfortable discontinuation symptoms and may cause the original depression or anxiety symptoms to return. A healthcare professional can establish an appropriate tapering schedule when stopping a medication is appropriate.
Antidepressants also do not necessarily provide immediate relief. Depending on the medication and the individual, improvement can take several weeks. Because of this, follow-up appointments can be important, particularly during the early stages of treatment. Patients should be encouraged to report both improvements and problems rather than assuming that side effects must simply be tolerated.
Family members and friends can also play an important role. If someone who recently started or changed an antidepressant begins behaving dramatically differently, becomes unusually agitated, or talks about suicide, those changes should not be dismissed. Prompt communication with a healthcare professional can help determine the safest course of action.
Ultimately, antidepressants are neither universally dangerous nor universally effective. They are medical treatments with potential benefits and potential risks. The decision to use one should take into account the person’s diagnosis, age, symptoms, other medications, medical history, and previous experiences with treatment.
Anyone experiencing new suicidal thoughts or feeling at immediate risk of harming themselves should seek emergency assistance rather than waiting for a routine appointment. In the United States, people can call or text 988 to reach the Suicide & Crisis Lifeline. For an immediate, life-threatening emergency, call 911 or go to the nearest emergency department.
