Do the benefits outweigh the side effects?

As a general rule, all medicines cause side effects, and like with any medical treatment for any health condition, the key is to work out whether the benefits of that treatment outweigh the side effects. So with that initial comment, what are some of the side effects of antidepressants? And the side effects of the antidepressants, in fact, depend a little bit on the type of drug that’s being prescribed.

Side effects of SSRIs

So let’s talk about one type of, group of drugs called SSRIs. And examples of those drugs are Prozac, Zoloft, Cipramil. Those medicines typically, actually are very well tolerated and typically have very few side effects. But often in the early days, one will find nausea, an inability to sleep, they can be quite stimulating. And sometimes they can cause a sort of jittery or anxious feeling, a little bit like drinking too much coffee. But mostly in the early days, these symptoms or side effects are present, and then they dissipate. Importantly, though, those side effects are rare, not common. And importantly, we’re able to reduce those side effects by starting the person on a low dose and gradually increasing the medicine. Side effects of SSRIs are not that common often in the early days, and typically the benefits of treatment will outweigh the side effects.

Side effects of tricyclic antidepressants

The other big group of antidepressants is tricyclic antidepressants, which are nowadays prescribed a lot less often than SSRIs. Tricyclic antidepressants tend to be sedating as a side effect. That can be of utility, particularly if the person is not sleeping well. Dry mouth is common, and blurry vision is also quite common with tricyclic antidepressants. Unlike the other medicines, SSRIs, these side effects tend to be persistent and aren’t necessarily short-term in their existence. So as a general rule, psychiatrists prefer to prescribe people with SSRIs, and then at a later date, if they don’t respond to those, have medicines such as tricyclic antidepressants as a backup or alternative treatment.

Dr Matthew Cullen, Psychiatrist, St Vincent’s Hospital, Sydney

Last Reviewed: 20/08/2020

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