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Best antidepressants for anxiety and weight loss


Antidepressants that Cause Weight Loss: What You Need To Know

Antidepressants are commonly prescribed, FDA-approved medications used to treat depression, anxiety, and other related mental health disorders.

Though antidepressants can be effective at treating these conditions, they can also cause a range of side effects, including weight loss.

In this article, I’ll describe what antidepressants are, their effect on weight, and which antidepressants are known to cause weight gain or weight loss.

Finally, I’ll explain whether antidepressants have ever been prescribed specifically for weight loss and whether you can safely prevent weight loss due to antidepressants. 

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What are Antidepressants?

Over 264 million people worldwide live with depression and an estimated 40 million people in the U. S. experience an anxiety disorder in any given year.

Thankfully, both anxiety and depression can be treated with antidepressants, cognitive behavioral therapy, or a combination of treatment modalities.

Antidepressants are a popular prescription treatment for several mental health conditions, including:

  • Major depressive disorder (MDD)
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Premenstrual dysphoric disorder (PMDD)
  • Posttraumatic stress disorder (PTSD)
  • Social anxiety disorder (SAD)

Most antidepressants work by affecting chemicals in the brain called neurotransmitters, including serotonin, norepinephrine, and dopamine.

There are five main classes of antidepressants which affect these neurotransmitters in different ways:

  • Selective serotonin reuptake inhibitors (SSRIs): SSRIs are often the first-line treatment prescribed by doctors for depression and anxiety. SSRI medications generally cause fewer side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants. As suggested by their name, SSRIs work by increasing the activity of the chemical serotonin in the brain. Examples of SSRI medications include sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro) and vilazodone (Viibryd).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): SNRIs work by blocking the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain. Examples of SNRI medications are duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima). 
  • Tricyclic antidepressants: Tricyclic antidepressants can cause more side effects than SSRIs or SNRIs. For this reason, doctors will generally prescribe tricyclic antidepressants only if previous prescriptions of SSRIs or SNRIs failed to improve symptoms, or for specific symptoms for which they are known to be more effective. Examples of tricyclic antidepressants include imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, and desipramine (Norpramin).
  • Monoamine oxidase inhibitors (MAOIs): Like tricyclic antidepressants, MAOIs are generally prescribed only if other medications have failed to work. MAOI use can have serious side effects and must be supported by a strict diet, as interactions with some foods—including certain cheeses, pickles and wines—can be dangerous or even fatal. MAOIs cannot be combined with SSRIs. Examples of MAOIs include tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan). 
  • Atypical antidepressants: Antidepressants that don’t fit into the other four classes of medication are grouped into this category. Some common examples of atypical antidepressants include trazodone, mirtazapine (Remeron), vortioxetine (Trintellix), and bupropion (Wellbutrin SR, Wellbutrin XL).

If you’re prescribed an antidepressant medication, be sure to take it only as directed by your doctor.

Don’t take a different dose than what was prescribed and don’t take it for a longer or shorter period of time than recommended by your doctor.

Once you’ve been prescribed an antidepressant, keep in mind that it may take two to eight weeks for the medication to start taking effect.

Some mild side effects can occur within the first two weeks of starting the medication, but many will resolve after that. 

Can Antidepressants Cause Weight Loss?

Most antidepressant medications are more commonly associated with weight gain, but there are three that have been connected to weight loss:

  • Bupropion (Wellbutrin)
  • Fluoxetine (Prozac)
  • Duloxetine (Cymbalta)

Studies on the effect of fluoxetine (Prozac) on weight are varied, with only some people experiencing weight loss. And while it may cause weight loss in the short-term, but after six months or longer can lead to an increase in weight.

Similarly, the research on the impact of duloxetine (Cymbalta) on weight loss is unclear. Duloxetine can decrease appetite, which can lead to weight loss in some people. However, research has yet to show a compelling and consistent connection between duloxetine (Cymbalta) and weight loss.

Of these three medications, bupropion (Wellbutrin) is the most consistently associated with weight loss.

Several studies, including a 2019 meta-analysis of 27 studies, found that bupropion (Wellbutrin) was the only commonly used antidepressant associated with weight loss.

In the analysis, all of the antidepressants caused an average increase in body weight of 5%, except for bupropion (Wellbutrin).

Bupropion (Wellbutrin), an atypical antidepressant, works by altering the brain chemicals norepinephrine and dopamine.

In addition to being the only antidepressant consistently associated with weight loss, it’s also associated with fewer rates of sexual side effects and sexual dysfunction than SSRIs and SNRIs. 

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Which Antidepressants Cause Weight Gain?

Though most antidepressants can cause weight gain as side effect, some antidepressants seem more likely to cause weight gain than others, including:

  • Amitriptyline (Elavil)
  • Imipramine (Tofranil)
  • Nortriptyline (Aventyl)
  • Paroxetine (Paxil, Pareva)
  • Mirtazapine (Remeron)
  • The effect of SSRIs on weight is mixed.

Despite the fact that many SSRIs cause weight loss during short-term treatment, other studies show that these drugs may cause long-term weight gain. The effects of these drugs will need continued study before we know more.

Why Do Antidepressants Affect Weight?

There are different theories as to why antidepressants affect weight.

Some believe that the medication’s impact on neurotransmitters in the brain have an indirect impact on metabolism.

Others believe that weight gain or weight loss is an indirect side effect of the medications’ efficacy or inefficacy of treating the condition. 

For example, some people use food and overeating to cope with anxiety and depression.

In this case, when they start antidepressant medication, they no longer feel the need to eat emotionally, which can lead to weight loss.

The opposite reaction is possible, too. For people who lose their appetite as a result of their depression, effective treatment for their symptoms may help their appetite return, causing a modest weight gain.  

Have Antidepressants Ever Been Prescribed for Weight Loss?

Neither weight loss nor weight gain is a guarantee when taking antidepressants.

Like many medications, side effects can vary depending on the patient. Additionally, antidepressant medications have not been approved for weight loss by the Food and Drug Administration (FDA).

Finally, antidepressants can cause rare but serious side effects, including:

  • Nausea
  • Vomiting
  • Dizziness
  • Agitation
  • Confusion
  • Fever
  • Fainting
  • Hallucinations
  • Changes in blood pressure
  • Rapid heartbeat
  • Tremors 
  • Seizures

With these potential serious side effects in mind, antidepressants are not prescribed for weight loss.

If you’re looking for antidepressants that cause weight loss, perhaps you should consider K Health’s online weight management program instead, with medications designed specifically to support weight loss.

How to Prevent Weight Loss Due to Antidepressants

When taken as directed, antidepressants can be effective in treating both depression and anxiety.

If you lose an excessive amount of weight after starting an antidepressant, talk to your doctor about the medication’s benefits and side effects.

If the benefits don’t outweigh the weight loss side effects, you can also ask if adjusting the dose—or switching medications—might be helpful. Discuss the pros and cons with your doctor before making such a decision.

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

  • Anxiety Facts and Statistics. (2020).
    https://adaa.org/understanding-anxiety/facts-statistics

  • Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study. (2018).
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964332/

  • Is increased antidepressant exposure a contributory factor to the obesity pandemic? (2016).
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872449/

  • Bupropion: A systematic review and meta-analysis of effectiveness as an antidepressant. (2016).
    https://journals.sagepub.com/doi/10.1177/2045125316629071

  • Depression. (2020).
    https://www.who.int/en/news-room/fact-sheets/detail/depression

  • Effects of antidepressant and antipsychotic use on weight gain: A systematic review. (2019).
    https://pubmed.ncbi.nlm.nih.gov/31524318/

  • What is Anxiety and Depression? (n.d.).
    https://adaa.org/understanding-anxiety

Can antidepressants cause weight loss? Types and side effects

Antidepressants are effective for treating mental health conditions, but they can affect body weight. Although most antidepressants can cause weight gain, a few may lead to weight loss.

Doctors commonly prescribe antidepressants to treat mental health conditions such as depression and anxiety.

Serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are second-generation antidepressants. They generally have fewer serious side effects and better tolerability than first-generation antidepressants, such as tricyclic antidepressants (TCAs).

The SSRI fluoxetine (Prozac) and the SNRI duloxetine (Cymbalta) can lead to a decrease in appetite and slight weight loss during the first months of treatment. Bupropion (Wellbutrin), which works by blocking norepinephrine and dopamine, may also have this effect.

This article explores the link between antidepressants and weight change. It also outlines other side effects and explains how to prevent weight loss.

Weight gain is a more common side effect of antidepressants than weight loss. A 2019 review of 27 studies found that, on average, individuals experience a 5% increase in weight after starting antidepressant therapy.

Various factors could cause a person to gain weight. The possible causes include:

  • Some antidepressants increase appetite, so a person may consume more calories than their body needs.
  • When a person feels depressed, they may become less active and burn fewer calories than they consume.
  • Antidepressants may affect metabolism, causing the body to burn calories more slowly.

Some antidepressants may contribute to weight loss by decreasing a person’s appetite, leading them to consume fewer calories than they burn. In addition, mental health symptoms can affect a person’s eating habits and activity levels, and treating the underlying condition may lessen or stop these effects.

Learn about how many calories a person needs.

A few antidepressants cause no weight gain or lead to weight loss. These include:

  • Bupropion: In a 2016 study, participants who did not smoke lost an average of 7. 1 pounds (lb) after 2 years of treatment with bupropion compared with those taking fluoxetine. However, those who smoked gained 2.2 lb on average.
  • Fluoxetine: A 2022 review found that in adults with overweight or obesity, taking 60 milligrams (mg) of fluoxetine daily can lead to an average weight loss of 2.7 kilograms (kg) — equivalent to almost 6 lb — during the first 6 months of treatment. There is no weight loss effect for people taking low dosages for a longer duration.
  • Duloxetine: An older 2006 study found that people taking duloxetine for major depressive disorder lost weight in the short term but gained a small amount during longer-term treatment.

It is common for side effects such as weight loss to stabilize as the body adjusts to the medication.

A 2018 study found that the use of antidepressants was associated with weight gain over at least 5 years.

The noradrenergic and specific serotonergic antidepressant (NaSSA) mirtazapine (Remeron) is most likely to cause weight gain. It is an atypical antidepressant. A 2016 study involving 36 people taking mirtazapine found that these participants gained an average of 11.6 pounds after 2 years.

The following SSRIs may cause weight gain:

  • paroxetine (Paxil)
  • sertraline (Zoloft)
  • citalopram (Celexa)

Although it may result in weight loss for some people, fluoxetine (Prozac) can also cause weight gain in others. The effect of this drug on body weight may be dependent on the dosage a person receives and the duration of their treatment.

These older antidepressants may also cause weight gain:

  • amitriptyline
  • imipramine
  • nortriptyline (Pamelor)
  • trazodone (Desyrel)
  • monoamine oxidase inhibitors (MAOIs)

Learn more about antidepressants that can cause weight gain.

The Food and Drug Administration (FDA) does not approve antidepressants for weight loss, so doctors do not prescribe them for this use. However, doctors do consider the potential weight change effects of medications when prescribing them.

Doctors can prescribe anti-obesity medications to help people with obesity lose weight. The options include:

  • phentermine (Adipex-P)
  • lorcaserin (Belviq)
  • topiramate (Topamax)
  • naltrexone (Revia)
  • liraglutide (Saxenda)

People with a low or moderate weight do not need to lose weight, and excessive weight loss can be harmful. To maintain a weight within the healthy range, a person should eat a nutritious, well-balanced diet.

This involves avoiding or limiting foods high in fat, salt, and sugar, as they can increase the levels of low-density lipoprotein (LDL) cholesterol and blood glucose.

Instead, a person should try to eat meals and snacks consisting of:

  • 5 portions of fruits and vegetables daily
  • whole grain starches and carbohydrates with every meal, including oatmeal, potatoes, cereals, brown rice, whole wheat pasta, and whole grain bread
  • full-fat dairy
  • fish, eggs, poultry, meat, or other protein sources
  • 6–8 glasses of water per day, but not directly before a meal, as this may limit how much a person feels able to eat

Milkshakes with protein powder are a good way to boost calorie intake. People can also snack on nuts, peanut butter toast, yogurt, or fruit between meals.

Antidepressants may cause side effects for some people. The type and severity can depend on factors such as age, gender, and other health conditions. The side effects may lessen as the body adjusts to the medication.

The most common side effects include:

  • nausea
  • vomiting
  • weight gain
  • diarrhea
  • sleepiness
  • sexual dysfunction
  • headaches
  • dry mouth
  • sweating
  • vision changes
  • constipation
  • sleeping problems

The following side effects are rare and require immediate medical attention:

  • suicidal thoughts
  • confusion, agitation, and muscle twitching
  • seizure
  • irregular heartbeat
  • unconsciousness

If someone experiences serious side effects, they should call 911 or visit the emergency room.

If other side effects worsen or cause concern, a person should make an appointment with a doctor.

People under the age of 25 years are most at risk of suicidal thoughts when they first begin taking antidepressants. It may be wise for an individual to tell a friend or family member that they are on antidepressants so that this loved one can check in from time to time.

If antidepressants are causing concerning weight loss, it is important to contact the prescribing doctor.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

Weight gain is a common side effect of antidepressants, but a few medications may cause weight loss instead. These medications include bupropion, fluoxetine, and duloxetine.

Some antidepressants may affect appetite, leading to weight changes. A person may also change their activity levels and eating habits due to mental health condition such as anxiety or depression.

Weight changes often happen in the initial months of treatment, with a person’s weight stabilizing as their body adjusts.

Doctors do not prescribe antidepressants specifically for weight loss, but they will consider an individual’s health needs when selecting a medication.

Antidepressants may cause various side effects. If a person experiences worrying or serious side effects, they should seek medical attention.

Fighting depression: 10 modern drugs

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Fighting depression: 10 modern drugs

Depression is an urgent problem, the number of visits to doctors is growing every year. It can be solved by contacting a psychotherapist and taking antidepressants . These are drugs that regulate the production of hormones and biochemical processes in the body. It is strictly forbidden to prescribe them to oneself , as these are complex drugs with certain restrictions, side effects effects . The doctor must authorize their appointment and control the intake. We will tell you which of them are the most effective and common in medicine, how many they have pluses and minuses.

What is meant by

depression

Doctors have known it since ancient Greece and Egypt. Hippocrates described it as melancholy - a condition that is accompanied by anxiety, despondency, insomnia, refusal of food, irritability. Most often, the cause is childhood trauma or severe, frequent stress in adulthood. There are many provoking factors: the death of a loved one, deterioration of living conditions, alcoholism, brain diseases. Such cases are referred to as psychogenic depression.

The second type is endogenous. The problem appears not from large external shocks, but because of internal causes. A person is constantly dissatisfied with himself, subjecting himself to criticism. Many patients have panic attacks , haunted by a feeling of fear, anxiety.

How long the period of depression lasts

Many people mistake ordinary periods of low mood for depression. If they do not last long and are quickly replaced by periods of recovery, then we are not talking about a depressive state. The problem is obvious when the symptoms persist for months and dramatically change a person's life. Then you need to see a doctor.

What happens to the body

The most common theory is that there is a malfunction of neurotransmitters located in the brain. These substances transmit signals from neuron to neuron and are responsible for a person's mood. Dysfunction leads to a slowdown in the rate of this transmission and a decrease in the number of neurotransmitters themselves. Serotonin, which is called the "hormone of happiness", suffers the most. For clarity, this biochemical process can be compared, for example, with a drop in blood sugar levels in diabetes mellitus.

How is

treated depression

Depression has been treated in different ways. In the ancient world - emetics and laxatives. In the Renaissance - wine and sunbathing. In the Age of Enlightenment - external stimuli, for example, insects. The 19th century brought new recipes - in particular, a solution of camphor in tartaric acid. The treatment also included the use of drugs, which are now no longer allowed for sale, and some are recognized as narcotic.

Obviously, all these drugs had no effect on increasing the amount of serotonin. And the treatment is precisely to normalize its production. This was done after creating modern antidepressants , which have a minimum of side effects, are safe for the body and are not addictive. These are medicines, whose action is aimed specifically at balancing the disturbed balance of neurotransmitters: serotonin, norepinephrine, dopamine.

Prescription

If a healthy person takes antidepressants , there will be no effect . For a depressed patient, taking them will help:

  • improve psychological state;
  • get rid of irritability;
  • panic fear;
  • increase mental and physical activity;
  • overcome the dreary mood.

Psychiatrists prescribe antidepressants for chronic back pain, headaches. And also with irritable bowel syndrome, incontinence and other cases when the body stops producing its own painkillers. Medication helps restore pain suppression mechanisms.

These drugs can only be taken with a doctor's prescription, as many of them are strong stimulants. Self-administration may cost dearly - the condition may worsen. Only a doctor will correctly calculate how many medicines to take per day. In parallel with the treatment by a psychiatrist, a neurologist, a consultation of a psychotherapist is required.

Precautions

  • Prescribed drug start drinking from a small dose - the first couple of days they take a quarter of a tablet. Gradually increase the dose to normal. So the body adapts better. Finish the course by reducing the dose.
  • The first effect of appears only 2 weeks after the start of administration. Sustained action - after six months. All this time, you need to take remedy, without making passes, breaks.

  • Products are not combined with melatonin, St. John's wort, products and dietary supplements based on sibutramine, 5-HTP. Their combination can raise serotonin to dangerous levels. Also, you can not combine them with monoamine oxidase inhibitors, for example, Cipralex. When writing a prescription, the doctor takes these points into account.

  • Drinking antidepressants is better in parallel with visits to a psychotherapist. If the drugs normalize the biochemical processes in the body, then this doctor will help normalize the psychological state after depression.

The best antidepressants

In medicine, they have long argued that some drugs give only a placebo effect. The purpose of the study was to find out which of them are the most effective and valid . The project involved 116 thousand patients, and its results were published by the authoritative edition of the Lancet. We offer a list of the best.

1. Agomelatine

New generation drug. Agomelatine is used for severe depressive disorders, high levels of anxiety. Enhances the release of dopamine and norepinephrine, stimulates melatonin receptors. The standard therapeutic dose is 25-50 mg 1 time / day. Helps to restore the normal structure of sleep, get rid of anxiety and panic attacks attacks

Pros

+ Does not adversely affect attention and memory.

+ No lethargy during the day.

+ No sexual deviations.

+ No relation to blood pressure.

+ Do not reduce dosage upon discontinuation.

Cons

— In 1-10% of cases, increased sweating, diarrhea, constipation.

- Possible increased fatigue, drowsiness.

- There are no evidence-based safety studies in people with renal or hepatic insufficiency, therefore, such patients are advised to refrain from taking drugs with active ingredient agomelatine.

2. Amitriptyline

Tricyclic antidepressant. Moreover, the World Health Organization considers Amitriptyline the most reliable in this group. The standard dose is 200-250 mg / day. The action is to block the reuptake of neurotransmitters. A good remedy for moderate to severe disorders of the endogenous type. Additionally, it has a sedative and hypnotic effect. Effective in the treatment of neuropathic pain, for the prevention of migraine.

Pluses

+ Preparations with active ingredient amitriptyline are inexpensive.

+ High reliability, minimum side effects.

+ Relatively safe during breastfeeding.

Cons

- Possible side effect in the form of blurred vision, dry mouth.

- Lowering blood pressure.

- Some patients experience constipation.

- Drowsiness.

3. Escitalopram

It belongs to the group of modern serotonin reuptake inhibitors (SSRIs). Most often, it is recommended to take for anxiety, panic attacks. It is taken once, the standard dose is 10 mg per day. Escitalopram has a milder effect and is prescribed to patients for whom tricyclic drugs are contraindicated.

Pluses

+ Lasting effect comes after 3 months.

+ Indicated for patients with disorders of the cardiovascular system.

+ Soft action.

Cons

- In some patients, the functions of the gastrointestinal tract are disturbed, which is most often expressed in diarrhea.

- Anxiety may increase during the first 2 weeks, therefore it is recommended to start treatment with low doses and gradually increase them.

- Contraindicated in pregnancy and lactation.

4. Mirtazapine

A drug of the tetracyclic group. Mirtazapine - good stimulant for anxious depressions, has a moderate sedative effect. The average amount is 30 mg / day, it must be consumed once. Usually it is prescribed to patients who lose interest in life, cease to experience joy, pleasure. Effective in the correction of sleep, in particular, early awakenings.

Pros

+ Earlier onset of action than SSRIs (1 week).

+ Works well with most general medicines.

+ Full effect in 4 weeks.

+ Does not affect sexual function.

Cons

- The active substance mirtazapine is contraindicated in diabetes mellitus, arterial hypotension, increased intraocular pressure.

— During the appointment, you must drive carefully and engage in potentially hazardous types of work.

- 18% of patients experience drowsiness, 15% dry mouth, 5% weight loss. Other side effects occur in 1-3% of cases.

5. Paroxetine

Belongs to the SSRI group, is used most often for severe anxiety, panic, social phobia, nightmares, stress after trauma. Paroxetine can resolve the problems of anxious depression, anxiety-phobic disorders. Take once a day at a dose of 20 mg.

Pros

+ The most powerful stimulant among SSRIs.

+ Anxiety and insomnia pass quickly.

+ Minimal side effects in the form of vomiting, diarrhea.

+ Suitable for patients with cardiovascular problems.

Cons

— Not suitable for patients with severe motor, mental inhibition.

- Reduces libido.

- Harmful to the fetus when taken during pregnancy.

6. Fluoxetine

One of the most commonly used antidepressants in the SSRI group. Known as Prozac. Fluoxetine is also known as a good mood stimulant. Patients have a feeling of fear, tension, anxiety, gloomy dislike for others. Depending on the indications, the average daily dose is 20-60 mg.

Pluses

+ There is practically no effect on the work of the heart.

+ Does not cause sedation.

+ Effective for patients with motor retardation and excessive daytime sleepiness.

Cons

- May cause weight loss.

— Hypoglycemia is possible in diabetes mellitus.

- Contraindicated in severe renal impairment.

7. Fluvoxamine

Another SSRI drug. Fluvoxamine is similar to Prozac Fluoxetine but is fast acting and may cost cheaper. The effect is in a more active slowing down of the reuptake of serotonin by neurons. It is indicated for depression of various origins, as well as obsessive-compulsive disorders. The average daily dose is 100 mg.

Pros

+ Lower price than traditional Prozac.

+ Faster action than him.

+ Relatively minor side effects (diarrhea, dry mouth, drowsiness).

Cons

- Contraindicated in diabetes.

- Pregnant women - with caution, lactation - prohibited.

- Causes nausea in some patients.

8. Sertraline

One of the widely used and universal drugs of the SSRI group. They treat almost any depressive condition, panic disorder, social phobia. However, in severe clinical cases, sertraline may not be effective enough. The standard dose is 50 mg/day.

Pros

+ No cardiotoxicity.

+ The patient's psychomotor activity does not change.

+ Does not increase body weight.

+ Combines well with other groups of antidepressants.

Cons

— In the first 2 weeks there may be problems with sleep, diarrhea.

- Side effects of a sexual nature.

- Contraindicated in pregnant women.

9. Escitalopram

The drug is classified as an SSRI. Its difference is in its effectiveness in depression, which is accompanied by involuntary movements (tic, tremor, chewing, smacking). Escitalopram is prescribed to patients with panic, anxiety, phobias, obsessive thoughts or actions. The daily dose is 20 mg.

Pluses

+ Effective in tardive dyskinesia.

+ One of the most powerful SSRIs.

+ More pronounced thymoleptic effect (improvement of mood) compared to many antidepressants of the same group.

Cons

- In some patients, anxiety increases within 2 weeks after starting treatment.

— Gastrointestinal disorders, insomnia, agitation are possible.

— Use during pregnancy only in extreme cases, incompatible with feeding.

10. Venlafaxine

Belongs to the SNRI group. In addition to blocking the reuptake of serotonin, venlafaxine has a similar effect on another neurotransmitter, norepinephrine. The medicine is prescribed for depressive conditions of various origins, social phobias, anxiety, panic. Usually take 150 mg per day.

Pros

+ Better tolerated by patients than most tricyclics.

+ More pronounced effect than classic SSRIs.

+ Fewer contraindications.

Cons

- Traditional side effects of most antidepressants: nausea, drowsiness, dry mouth, diarrhea or constipation.

- May increase eye pressure.

- The most severe withdrawal syndrome among antidepressant drugs.

This list is not to be used as a recommendation. In any case, consult your doctor before purchasing. Be healthy!

What you should know about antidepressants

Ekaterina Kushnir

treats anxiety disorder

I have generalized anxiety disorder.

For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

The doctor prescribed an antidepressant from the SSRI group - these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my illness.

The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

At the same time, it should be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control.

See a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

Fact No. 1

Antidepressants may make symptoms worse at first

Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation - the so-called causeless motor agitation, the inability to sit still. It's not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it.

Antidepressant-induced anxiety syndrome - a systematic review in the British Journal of Psychiatry

There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks.

The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

Everything was fine for the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic - I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken.

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8 myths about antidepressants

I have never had such panic attacks before medication - my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

After that, I was already waiting for these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of drugs. And they ended faster, and then they completely disappeared.

My letter to a psychiatrist. I was scared: I expected an increase in background anxiety, but not panic attacks. I even thought about giving up the medicine

Fact No. 2

The effect of antidepressant treatment will not be immediate

Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient "sertraline", the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

SSRI dosage - NHS

What doses of antidepressants will be optimal - an article in The Lancet

The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work.

It is better to prepare for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember - this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

Fact No. 3

Antidepressants are usually taken in combination with other drugs

Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer.

Antidepressants together with benzodiazepines work better for depression - BMJ magazine

My doctor prescribed a rather mild drug. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned - even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby.

As a result, I simply endured all the side effects of therapy - they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

My prescriptions for drugs. I never used one, because there was no such medicine in pharmacies

Fact No. 4

Side effects are not always, but they are

Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs - tricyclic antidepressants and monoamine oxidase inhibitors - cause more side effects. Doctors usually use them when milder first-line drugs don't work or when they can't be prescribed.

Side effects of antidepressants - the National Health Service of the UK

Side effects of various antidepressants - Uptodate

Side effects of antidepressants and their impact on the treatment of a large depressive disorder - the journal NATURE

STRICTIC STRICTION OF READING INSTROMENT - UPTODATE 9000 effects of antidepressants - advice from the Mayo Clinic staff

Choosing an SSRI drug does not guarantee the absence of side effects - many people tolerate treatment easily, but sometimes a change in drug may be necessary.

For the first couple of weeks of taking it, there is a risk that you will not feel well - it's worth thinking about. It may be worth scheduling the start of therapy on vacation.

I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

It was hard to work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i.e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy.

There are mixed data on how common side effects of antidepressants are. If we summarize them, then the numbers look something like this:

  • nausea - about 25% feel it;
  • diarrhea - it happens in 15% of people, and 5%, on the contrary, will have constipation;
  • about 20% of people have sweating and feeling hot;
  • sexual dysfunction, decreased libido may occur in 80% of cases;
  • insomnia - in 11% of cases;
  • headache and dizziness - in about 10-11% of cases;
  • weight gain - not all drugs give this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

Side effects not listed above are very rare. I was "lucky", and I faced one such - a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses.

I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened - it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1. 5, and it became -3.5.

I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses.

Side effects should not be tolerated - if something is very disturbing, frightening or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

If there is no danger, the doctor can adjust the dose or increase it more gradually - this often helps to cope with unpleasant effects.

I wrote to the doctor again when my visual acuity decreased

Fact No. 5

Antidepressants need to be taken long term

Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

Anxiety Therapy - UpToDate

For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years - it depends on how long it takes to reach the working dosage of the medicine.

The cost of a package of the most famous antidepressant "Zoloft" is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R - maybe more or less, depending on which drug is selected.

Psychotherapy review - UpToDate

Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru

The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often.

You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance - it's free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and consolidate the effect of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more.

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Fact No. 6

Antidepressants should not be stopped abruptly

Antidepressants do not develop dependence. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images.

Withdrawal symptoms after taking serotonin reuptake inhibitors - Journal of Clinical Psychiatry

How difficult it is to stop taking antidepressants - American Psychological Association

Stopping antidepressants in adults - UpToDate

If you for some reason have stopped taking your pills treatment, they should be canceled only under the supervision of a doctor.

Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake.

Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days - it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

Fact No. 7

If you need to change the drug, everything will start over

It is far from always possible to immediately find the right antidepressant - sometimes the side effects do not go away and you need to take a new one.

Changing antidepressants in adults - UpToDate

Serotonin syndrome - MSD

Most often it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects - the same or different. We will have to wait again until they pass.

You won't be able to change the drug on your own, since all antidepressants are sold only by prescription - and that's good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs.

For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors - due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.

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Fact No. 8

Among antidepressants there are original drugs and generics

Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

Theoretically, the action of generics should not differ from the action of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials.

Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy, so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.

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As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug - and, indeed, the side effects softened.

In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics is not always very different.

Originals and generics of some SSRIs

Active ingredient Original Original cost Generics Cost of generics
Sertraline Zoloft About 700 R, 100 mg tablets Serenata, Sirlift 500-600 R 100mg tablets
Escitalopram Cipralex 3000 R 10 mg tablets "Selektra", "Elycea" 500-1300 R 10 mg tablets
Fluoxetine Prozac About 350 R, 20 mg tablets Profluzak, Fluoxetine 100-200 R, 20 mg tablets

CERTRALIN

Original

"Zoloft"

The cost of the original

about 700 r, tablets 100 mg

generic

"Serenata", "Serlift"

Cost of

9000 500-600 r. , tablets 100 mg

Escitalopram

Original

Cipralex

Original price

3000 r, tablets 10 mg

Generics

“Chektra”, “Elice”

The cost of generics

500-1300 r, tablets 10 mg

Fluoxetine

“Prose”

Cost value cost cost original

About 350 R, tablets 20 mg

Generics

Profluzak, Fluoxetine

Cost of generics

100—200 R, tablets 20 mg

one remained unclaimed

Fact No. 9

Do not take alcohol along with antidepressants

Drinking alcohol while taking antidepressants can exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

Why you shouldn't mix antidepressants and alcohol - Mayo Clinic

Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet - it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited.

With other antidepressants, moderate use may not be dangerous and even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.

The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.

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Fact No. 10

Antidepressants are incompatible with certain drugs and have contraindications

It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed for those who have recently had a heart attack, suffer from glaucoma, or porphyria.

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