Choosing the right antidepressant becomes very crucial and should best be left to the experts. Besides the efficacy, it is important to evaluate and judge the safety of the medication especially in the teenagers, the young adults, and the elderly.

Additionally, pregnancy and the breastfeeding period call for a more detailed care in choosing the antidepressant.

The risk of the serious side effects is more pronounced especially when taken over a long term, which is usually the case.

Like most medicines, antidepressants too, bear a risk of side effects. However, not all individuals experience these side effects and while one person may have side effects with one depression medication, another may not experience them with the same drug.

Different antidepressants work in different ways and therefore, their adverse effects differ. Depression drugs can also have an interaction with other medicines and your doctor should be consulted before you self-add any medication when on antidepressants.

Antidepressants don’t work well for mild depression. Mild depression can be overcome by psychotherapy (talk therapy), eating a balanced diet rich in fruits and vegetables, meditation and a regular programme of exercise (yoga will good) preferably in serene natural surroundings.

But, your doctor will put you on depression drugs if you suffer from moderate to severe depression.

Common side effects of antidepressants

Generally, the following side effects of antidepressants are seen.

  • Headache
  • Nausea
  • Blurring of vision
  • Insomnia (difficulty in sleeping)
  • Tiredness and weakness
  • Nervousness, restlessness, tremors, agitation and difficulty in sitting still
  • Impaired thinking
  • Change in appetite
  • Constipation or diarrhea
  • Difficulty in passing urine
  • Antidepressants and weight loss or weight gain. Read the full note on antidepressants weight gain and weight loss.
  • Increase in blood pressure and heart rate
  • Increase in cholesterol levels
  • Change in libido and difficulty to reach an orgasm (anorgasmia). Men may not be able to ejaculate.
  • Worsening of an existing glaucoma

Can antidepressants cause depression?

Though antidepressants have worked well in some patients, there are others who experience certain risks.

Antidepressants do make the depression symptoms disappear in most people over short-term, but when taken over long-term and then discontinued, there are certain dangers to it.

According to a new study published in the Frontiers of Psychology, depressed people who take antidepressants are far more likely to suffer from a relapse than people who have not taken antidepressants.

The study further states that antidepressant users have an approximately 42 percent chance of a relapse, as compared with a 25 percent possibility for those who avoid antidepressant pills.

This possibly happens when the person stops taking the medication and the brain overreacts and triggers a new depression. This happens when the depression medication is taken over long-term and discontinued.

This is a vicious cycle, wherein the medication has to be again continued to prevent depression from bouncing back.

The conductor of this research suggests that self help and talk therapy works equally well and there is no risk of a relapse. This, of course, is a matter of opinion and debate.

Risks of antidepressants for elderly people of 65 years and above 

Depression is widespread among the elderly. Diagnosing it and then choosing of the right antidepressant in its treatment becomes difficult especially in these people because of possible existing comorbidities such as chronic medical conditions and their medication use, disability, or cognitive decline.

It is very important that late-life depression is treated with antidepressants that are safe in the seniors and carefully chosen to meet each patient’s needs.

If left untreated, depression may result in elderly patients developing chronic medical illnesses such as cardiovascular disease, and worsening of any existing diabetes mellitus and Alzheimer’s disease.

Selective serotonin reuptake inhibitors (SSRIs)

Depression medications cause bone loss and increase the risk of falls and fractures in elderly people. Studies suggest that selective serotonin reuptake inhibitors (SSRIs) are more responsible for this complication, though it is subject to more research. Other risks include nausea, dry mouth, insomnia, agitation, diarrhea, ex­cessive sweating, and, less commonly, sexual dysfunction.

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) work in a similar fashion as the SSRIs but in addition to the above risks, SNRIs can cause sweating, tachycardia, and urinary retention.

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants (TCAs) work well as antidepressants but can cause side effects such as orthostasis, dryness of the mouth, sexual dysfunction, constipation, urinary retention, blurring of vision, confusion, and weight gain.

Monoamine oxidase inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) are not generally used in the elderly because of their adverse effects, which include sleep disturbance, orthostatic hypotension, sexual dysfunction, and weight gain.

Which antidepressants are safe for the elderly?

There are several antidepressants to choose from that have been shown to be effective in the elderly patients who are being treated for a major depressive episode without psychotic features.

Ideally, choosing the antidepressant for the elderly involves selecting one with the least side effect profile and the lowest risk of drug interactions, which the patient may be taking.

The selective serotonin reuptake inhibitors (SSRIs) and the newer antidepressants bupropion, mirtazapine, moclobemide, and venlafaxine (SNRI) are all relatively safe in the elderly.

Risks of antidepressants in the teens and young adults

There is an increased risk of committing suicide in teens and young adults who are on antidepressants. The FDA has, therefore, made it mandatory for all manufacturers of depression medicines to warn of such risks on their labels.

In a published analysis of over 3,400 patients, about thirteen percent of the young persons under 24 years of age who were prescribed an antidepressant drug developed thoughts of committing suicide typically within two weeks of starting the prescribed antidepressants.

There are reports of young persons, and even adults, who have committed suicide within as few as five days after having started the depression medication.

Another critical side effect in teenagers is called akathisia, which is seen in about one-third of these young people. It develops when the drug is started or when its dose is increased.

It makes the young patient extremely agitated, irritable, he/she is unable to sit or stand still.  There is difficulty sleeping and he/she may become aggressive.

Are antidepressants safe to take during pregnancy?

If you suffer from depression when pregnant, it is going to be a crucial decision to take. Your ob-gyn and the psychiatrist will have to work together, weigh the pros and the cons and come to the right decision that is right for you, your pregnancy and the baby.

Mild depression can be resolved by psychotherapy, a balanced diet and safe pregnancy exercises.

It is the severe depression that cannot be left alone. This is because severe depression can cause serious harm to your pregnancy.

Depression can make you lose interest in all things and that could lead you to not take care of your pregnancy.

Due to untreated depression, you may not take proper prenatal care and not eat the right healthy foods. You may even turn to alcohol and smoking for mental relief.

All this could result in premature birth, low birth weight and other problems for the baby, including an increased risk of postpartum depression.

Keeping these risks in mind, your doctor may decide to put on antidepressants for the sake of your pregnancy and the baby after weighing the risks and the benefits.

Indications for antidepressants during pregnancy include:

  • A history of severe or recurrent depression
  • A history of other mental illnesses, such as bipolar disorder
  • You have had thoughts of committing suicide

There are risks to the baby. Antidepressants can cause harm to the unborn or nursing child. Using depression medicines in late pregnancy can lead to withdrawal symptoms in the newborn.

These withdrawal symptoms are of short duration. Such symptoms include mild respiratory problems, a weak cry, restlessness and tremors.

According to WebMD, though there are reservations about taking antidepressants during pregnancy, research has indicated that the risk with certain depression medicines is very low and they are generally considered quite safe.

Which antidepressants are considered safe during pregnancy?

1.      Usually, the first choice will be the selective serotonin reuptake inhibitors (SSRIs) including citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft).

2.    Serotonin and norepinephrine reuptake inhibitors (SNRIs) are also another option during pregnancy, including duloxetine (Cymbalta) and venlafaxine (Effexor XR).

3.   Bupropion (Wellbutrin) would be an option only if the above two have not given the desired effects.

4.    Tricyclic antidepressants. This class of medications includes amitriptyline and nortriptyline (Pamelor) are generally not considered as an option.

Which antidepressants are not safe and should be avoided during pregnancy?

The SSRI Paroxetine (Paxil) is generally discouraged during pregnancy since Paroxetine may be associated with fetal heart defects.

In addition, monoamine oxidase inhibitors (MAOIs), phenelzine (Nardil) and tranylcypromine (Parnate) are generally discouraged during pregnancy because they might limit fetal growth.