Recently, a colleague told me about one of his patients who suffered a relapse of major depression. Her symptoms were so severe that she was hospitalized for several days. When we talked later about what might have triggered the relapse she said her patient had stopped taking her antidepressant because the side effects became intolerable.
The problem is not uncommon, but my colleague wishes her patient had mentioned it earlier. Then they could have investigated alternatives.
Side effects make antidepressants intolerable for about 10% to 15% or patients, and may encourage countless others to occasionally skip pills, tinker with dosages, or stop taking a drug without their doctors' knowledge.
If you're having trouble with your medication, talk to your doctor or therapist, who can help you sort out the problem. Sometimes alleviating side effects takes a few simple steps.
Here are some suggestions for dealing with common side effects of antidepressants:
Dry mouth. Drink a lot of water, chew sugarless gum, and brush your teeth frequently.
Constipation. Eat whole grains, bran cereal, prunes, and hearty servings of fruits and vegetables. Drink plenty of water.
Trouble urinating. If you have difficulty starting urination, your doctor may be able to adjust your medication to relieve this problem.
Dizziness. Sudden changes in position can lead to a sharp drop in blood pressure that causes dizziness. To counter this effect, rise slowly from a chair or when getting out of bed. Also, drink plenty of fluids.
Daytime drowsiness. This problem usually occurs at the beginning of treatment and may not last long. In some cases, it may help to take medication at bedtime, but ask your doctor about this first. If you feel drowsy, don't drive or use heavy equipment.
Trouble sleeping. Sleep often improves a few weeks after starting a medication, but sometimes a mild sleep aid or a switch to another medication is necessary.
Nausea. Often, nausea disappears within a few weeks of starting a medication. It may help to take the drug shortly after a substantial meal.
Agitation. You might feel uncomfortably nervous or restless after you start taking a drug. Jittery feelings may pass within a few weeks after starting a drug. But in relatively rare cases, agitation will persist; sometimes it's an early symptom of worsening depression or mania.
Headache. Headaches may come and go. Some persist, but they usually disappear within a few weeks of starting the medication.
Sexual difficulties. Sometimes sexual problems are transient or not related to the drug. Talk with your doctor about sexual problems that don't pass soon. Another medication may be a better choice, or psychotherapy may be the right approach.
If side effects continue to bother you, your doctor may change your dosage, shift the time of day that you take the medication, or split the dosage into smaller amounts to be taken over the course of the day. Or your doctor may recommend combining the drug with another one, switching to a different drug, or replacing drugs with therapy or other forms of treatment.
With a little time and teamwork involving both you and your clinician, it's usually possible to find a treatment that works.
How have you dealt with side effects of medication? Were you able to stay on the first medication prescribed or did you make a switch?
Dr. Michael Miller has been on staff of the Beth Israel Deaconess Medical Center, a large teaching hospital in Boston, for more than 25 years. He is also an Assistant Professor of Psychiatry at Harvard Medical School.
Depression
Nearly 1 in 10 adults will suffer from some form of depression in a given year, affecting not only them, but also their friends and family. Thankfully, years of research and recent breakthroughs have made this serious illness easier to treat. With Understanding Depression, a special health report from Harvard Medical School, you can stay up-to-date on the latest information on depression symptoms and treatments to improve your life—or the life of someone close to you.
Are you Living With Depression? Connect with others with similar health concerns and issues. Click here to join the group.
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Comments: 9
I had a pretty bad spell last year and was having trouble remembering all kinds of stuff, including taking my meds...and often wondering if I had already taken them. After a while I got tired of the withdrawal-like effects and bought a few of the 7-day pill dispensers, in a couple colors. White\clear for morning and darker transparent ones for the evening and pre-loaded them.
And a a 3-compartment "emergency" dispenser in my purse with a couple doses, in case my morning routine was disrupted too much and I realise I missed my dose.
Things have gotten a bit better the last few months - and it is GENERALLY easier to be compliant with the meds.
It is also important to work with a therapist or psychiatrist to help you monitor the situation, since depression can make you less perceptive of the swings and changes.
I'm not sure what depression is, or if I've ever experienced it.
Thanks very much for your comments.
I suggest anyone glancing through this post to take a look at Deborah's entry, which includes some great advice that anyone can use.
She talks about ways to manage the daily burden of remembering to take your pills. You don't have to be 110 years old to need this kind of reminder! Everyone from 15 to 115 years of age can have trouble remembering to take their pills -- and having a system like Deborah's is a great thing. Pill dispensers are cheap. And to have a backup system (a small vial or case to carry some extras around) is a great idea too.
Deborah also points out that it is helpful to have a mental health professional to check in with regularly, to review your treatment.
You raise a very important point, that medications can be very expensive.
There are two angles on this. The key one is insurance — too many people in the United States are not insured, have inadequate access to care, and simply can't afford the treatment. Even if they have an opportunity to be evaluated by a mental health professional, they then can't afford the medication.
In my view, this problem of access makes our country less civilized. It really has to change.
The second issue is the huge difference in cost between newer drugs and older ones. As many readers know, once a drug patent expires, any drug company can come in and produce the medicine — so-called "generic" drugs.
These older, generic drugs actually have a great advantage — they have been around a long while, so there are few surprises about them. We know a lot about their advantages and disadvantages. With few exceptions, the generics are as effective as the medicine produced by the original manufacturer.
It is in fact important to control costs — that is, if the help you can get from a cheaper medicine is equal to the help you'll get from a more expensive approach, there is no reason to pay more!
Sometimes, however, the only drug that works (or the one that works best for you) is a drug that was introduced recently. And the newer drugs tend to be much more expensive.
I'm rambling a bit here, but it fits with the point of the article: It takes a lot of work, careful thought, persistence and some rambling to figure all this stuff out.
I need to respond to your brief comment about depression and its treatment.
I understand how -- for you -- counseling might be a better option than medication. And you are right -- it is often quite difficult for people to understand what depression is about if they have never experienced it themselves (or been close to someone who has).
But I caution everyone: Don't generalize from your own personal experience to the reality of the general population.
And here is what the evidence shows:
For many people, medication is a much better treatment than psychotherapy. For others, psychotherapy is a better option. Some need a combination.
Now that I am on a new medication I can' do that. I ran out by accident and was off of it for two days and had some real problems. So I have learned not to do that if I want to keep an even keel.
I am glad to know about this group. I wasn't aware of it before.