While the specific cause of depression is not well understood, most researchers think that brain chemistry has something to do with it. Antidepressants work by altering the balance of certain chemicals in the brain, but with that come some risks and side effects that you should know about.
Most common side effects
Antidepressants carry with them a host of unpleasant side effects, some of which can turn into serious problems of their own. Some other side effects, like abnormal eye movement during non-REM phases of sleep (referred to as “Prozac eyes” by many sleep specialists), are permanent. A 2002 Toxic Exposure Surveillance System report revealed that of 26,733 patients on SSRIs, 27 percent developed significant morbidity and 93 died.
Most of these side effects are relatively benign, but there are more serious side effects to worry about. One study by University of Manchester outlined the many more severe side effects of antipsychotics and antidepressants, including: acute dystonia (brief or sustained muscle spasms), parkinsonism (neurological syndrome characterized by tremors), akathisia (extreme restlessness), tardive dyskinesia (involuntary, repetitive movements caused by medication), tardive dystonia (sustained muscle contractions as a result of medication), increased risk of seizure, serotonin toxicity (see below) and discontinuation symptoms (see below). Antidepressants can also cause REM sleep behavior disorder, which causes you to act out your dreams and can result in serious injuries.
Serotonin syndrome
This can be a life-threatening condition caused by high levels of serotonin in the body. It’s typically caused by combining drugs that affect serotonin levels, though it can also occur when you first start or increase medication that affects serotonin. A common dangerous combination is taking SSRIs or SNRIs (used to treat depression) with triptans (used to treat migraines). Even taking certain cough medicines (dextromethorphan) can increase this risk in combination with other serotonin medications. For a list of SSRIs, SNRIs and triptans <<click here>>.
Research done at Washington State University earlier this year (2008) found that during 2003 to 2004, 1.3 percent of patients prescribed a triptan or an SSRI or SNRI were prescribed the potentially fatal combination of the two together, a total of 694,276 patients affected.
Discontinuation syndrome
Although not common, some patients may experience withdrawal symptoms when stopping an antidepressant, particularly if the treatment is stopped too abruptly. The Mayo Clinic notes that it can be difficult to distinguish withdrawal symptoms from reemergence of depression, but that this should not be considered the same as withdrawal from an addictive substance. For these reasons, the NIMH advises gradual withdrawal of antidepressants when discontinuing treatment.
One study noted that many patients are continuing use of SSRIs well beyond the recommended duration of treatment in part due to fear of withdrawal symptoms. However, an article written by King’s College London indicated that withdrawal symptoms are in fact milder than the public generally assumes and can be easily managed by slowly tapering off medication.
Paroxetine (Paxil) appears to be the most prone to discontinuation syndrome, perhaps because it is the most potent inhibitor of serotonin reuptake among SSRIs. Paroxetine efficacy is similar to other SSRIs, though it is approved for a wider variety of disorders, including major depression, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, post-traumatic sterss disorder and social phobia.
Risk of suicidality
The FDA reported results from a series of clinical trials that showed a 4 percent risk of suicidality in children and adolescents taking antidepressants, as compared to a 2 percent risk with placebo.
According to the NIMH, fluoxetine (Prozac) is currently the only antidepressant approved by the FDA for use in children ages 8 and older.
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