Introduction

Antidepressants can cause unpleasant side effects. Symptoms such as nervousness, headache and upset stomach are common initially. For many people, these improve within a few weeks of starting an antidepressant. In some cases, however, antidepressants cause side effects that don't go away.

Talk to your doctor or mental health provider about any side effects you're having. Rarely, antidepressants can cause serious side effects that need to be treated right away.

If side effects seem intolerable, you may be tempted to stop taking an antidepressant or to reduce your dose on your own. Don't do it. Your symptoms may return, and stopping your antidepressant suddenly may cause a withdrawal-like reaction.

Click on the tabs at the left to see coping strategies for the most common antidepressant side effects.

Nausea

Nausea typically begins within a week of starting an antidepressant. It may go away after a few weeks, when your body adjusts to the medication.

Coping strategies

• Take your antidepressant with food.
• Eat smaller, more frequent meals.
• Suck on sugarless hard candy.
• Drink plenty of fluids, such as unsweetened fruit juice, cool water or ginger ale that's lost its carbonation.
• Try an antacid or bismuth subsalicylate (Pepto-Bismol, others)
• Talk to your doctor about a dosage change or a slow-release form of the medication.

Increased appetite, weight gain

You may gain weight because of fluid retention or lack of physical activity, or because you have a better appetite when your depression symptoms ease up. Some antidepressants are more likely to cause weight gain than others. Antidepressants that may be less likely to cause weight gain include:

• Venlafaxine (Effexor)
• Bupropion (Wellbutrin)
• Selective serotonin reuptake inhibitors (SSRIs) other than paroxetine (Paxil) — fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro)

Coping strategies

• Cut back on sweets and sugary drinks.
• Avoid fast food.
• Get regular exercise most days of the week.
• Seek advice from a nutritionist or dietitian.
• Talk to your doctor about switching medications.
• Keep a food diary — tracking what you eat can help you manage your weight.
• Eat smaller, more frequent meals.
• Eat more slowly.

Sexual side effects  

Most antidepressants cause sexual side effects that can last throughout treatment. They can include decreased sex drive and difficulty reaching orgasm. Some antidepressants may cause trouble getting or keeping an erection (erectile dysfunction). For many people, these are the most bothersome side effects of antidepressant therapy — and the most common reason people stop taking their medication. Selective serotonin reuptake inhibitors (SSRIs) are more likely to cause sexual side effects than are other antidepressants.

Coping strategies

• Consider a medication that requires only a once-a-day dose, and schedule sexual activity before taking that dose.
• Talk to your doctor about adding or switching to an antidepressant that may counteract these effects, such as bupropion (Wellbutrin).
• Talk to your doctor about a "drug holiday" — stopping medication for a day or so each week to temporarily ease symptoms.
• If you are a man, a medication such as sildenafil (Viagra), vardenafil (Levitra, Staxyn) or tadalafil (Cialis) may temporarily ease sexual side effects. In women, estrogen cream is sometimes used.
• Talk to your partner about your side sexual effects and how they change your needs. Adjusting your sexual routine may be helpful. For example, you may need a longer period of foreplay before having sexual intercourse.

Fatigue, drowsiness

Fatigue and drowsiness are common, especially during early weeks of treatment with an antidepressant.

Coping strategies

• Take a brief nap during the day.
• Get some mild exercise, such as walking.
• Avoid driving or operating dangerous machinery until the fatigue passes.
• Take your antidepressant one to two hours before bedtime.

Insomnia  

You may experience insomnia because some antidepressants give you an energy boost. While that may sound appealing, it can also make it difficult to get to sleep or stay asleep — and you may be tired during the day.

Coping strategies

• Take your antidepressant in the morning.
• Avoid caffeinated food and drinks, particularly late in the day.
• Get regular exercise — but work out at least four or five hours before bedtime.
• Talk to your doctor about taking a sedating medication at bedtime.
• If insomnia is an ongoing problem, ask your doctor whether taking a low dose of a sedating antidepressant such as trazodone (Oleptro) or mirtazapine (Remeron) before bed might help.

Dry mouth

Dry mouth is a common side effect of many antidepressants.

Coping strategies

• Sip water regularly.
• Suck on ice chips.
• Chew sugarless gum.
• Suck on sugarless hard candy.
• Breathe through your nose, not your mouth.
• Brush your teeth twice a day and see your dentist regularly. Having a dry mouth can increase your risk of getting cavities.
• Talk to your doctor about using a moisturizing mouth spray.

Blurred vision

Blurred vision is a common side effect, but it usually goes away on its own within a couple of weeks of starting an antidepressant. With certain antidepressants, it may be an ongoing bother.

Coping strategies

• Talk to your doctor about using special eyedrops to relieve dryness.
• Talk to your doctor about changing your antidepressant or lowering your dose.
• Get an eye exam to see whether blurred vision caused by an antidepressant may be worsened by an underlying eye problem.

Constipation

Constipation is often associated with tricyclic antidepressants (TCAs) because they disrupt normal functioning of the digestive tract and other organ systems. Other antidepressants sometimes cause constipation as well.

Coping strategies

• Drink plenty of water.
• Eat high-fiber foods, such as fresh fruits and vegetables, brans and whole grains.
• Get regular exercise.
• Take a fiber supplement such as Metamucil, Konsyl or Citrucel.
• Consider taking stool softeners if other measures don't work.

Dizziness

Dizziness is more common with tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) than with other antidepressants. These medications can cause low blood pressure, resulting in dizziness. This side effect is more common in older people.

Coping strategies

• Rise slowly from sitting or standing positions.
• Use handrails, canes or other sturdy items for support.
• Avoid driving or operating machinery.
• Avoid caffeine, tobacco and alcohol.
• Drink plenty of fluids.
• Take your antidepressant at bedtime.

Agitation, restlessness, anxiety

Agitation, restlessness or anxiety can result from the stimulating effect of certain antidepressants. Although having more energy can be a good thing, it may mean you can't relax or sit still even if you want to. Be alert for racing or impulsive thoughts along with high energy. If these develop, talk to your doctor right away because they may be signs of bipolar disorder or another serious disorder.

Coping strategies

• Get regular exercise, such as jogging, biking or aerobics. Talk to your doctor first about what would be a good type of exercise for you.
• Practice deep-breathing exercises, muscle relaxation or yoga.
• Consult your doctor about temporarily taking a relaxing or sedating medication, or switching to an antidepressant that isn't as stimulating.