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1. Common side effects when starting any psychiatric medication, especially the SSRIs, are headache, nausea, sweating, dry mouth, sleepiness or insomnia, and diarrhea or constipation. Sometimes it's a coin-toss on the last sets, as you might get to alternate. These are generally transitory effects and pass within a couple weeks. These are incorrectly known as anticholinergic, the term actually applies to a class of meds that effects specific neurotransmitters. A few of them actually do hit your acetylcholine receptors heavily enough to be classified as anticholinergic drugs, but most don't, you just get the exact same side effects, so what the hell. It's like calling someone who breaks into a computer a hacker.

 

2. Most antidepressants can take up to a month to work. Sure, you get the side effects right away, but you may not feel the positive benefits for a month. Unless the side effects are really adverse, have some patience. Don't give up, but don't keep upping the dosage either, because that just makes it harder to switch meds if you need to. Stay at a relatively low dosage at first. You should know after a month if something is going to work or not.

 

3. Reuptake poop-out is starting to become common knowledge in the psychiatric community, especially for SSRIs. But any medication that acts as a reuptake inhibitor can work great for weeks, months, even years, then just quit. For most people this is not an issue. If you're taking an SSRI you can just move on to the next one until the poop-out happens again, but if you're taking another class of reuptake inhibitor working on another neurotransmitter, your options are going to be much more limited. While people on SSRIs can rotate them like tires, if norepinephrine or dopamine is the neurotransmitter you need to tweak, you may have to go off-label to some unusual medications.  Poop-out also happens with
TCAs, but I don't know if the same rotation trick works or not.

 

4. If you do have to switch meds because of either poop-out or adverse effects, or it just wasn't the right neurotransmitter, keep in mind that mileage may vary considerably. Sometimes you won't notice a thing, say if you move between Celexa (citalopram hydrobromide) and either Lexapro (escitalopram oxalate) and Prozac (fluoxetine hydrochloride), just as long as the dosages are in line. But with other meds, especially if you're crossing the boundary of neurotransmitters, you'll run into all sorts of fun as your brain adjusts to the switch. If you do change from a med that works on one neurotransmitter to another, it's best to get completely clean of the first med before starting the next, otherwise you'll risk the side effects of a new med on top of the side effects of discontinuing an old med.

 

5. Antidepressants are addictive!  Addictive isn't really the right word, you develop an intense physical and psychological dependency without a craving and urge to abuse them (unless you're bipolar, then you may abuse them), but addictive is close enough.  Some are more addictive than others. Effexor (venlafaxine hydrochloride) is the most addictive of the commonly prescribed antidepressants and is the drug everyone hates to have taken if they ever need to stop. The SSRIs as a class are next, with Paxil (paroxetine hydrochloride) being the most addictive of that bunch. Read about SSRI discontinuation syndrome to learn more. SSRIs are some of the most physically addictive drugs in existence. To suddenly stop taking them is to feel so very much worse than you were feeling before you ever considered taking meds. There's a term, "brain shivers." You'll know it if you ever experience it. Mouse and I have kicked opiates and we have kicked SSRIs cold turkey. We'll take the opiate kick. If you're taking an atypical antipsychotic along with Effexor (venlafaxine hydrochloride) or an SSRI, the discontinuation is often not nearly as bad, so if you have some Seroquel (quetiapine) on hand for insomnia, you'll want to take some for your SSRI discontinuation. Not everyone experiences SSRI discontinuation syndrome, and for those who do the effects range from mild to extreme. Not all doctors recognize this as an issue, so that sucks even more. Be sure to read the section about how long it takes for a med to clear out of your system and wait that long to taper down to the next stage in your dosage. And, as Paula writes in her article, invest in a pill splitter.

 

6. Extreme caution should be used if bipolar disorder is suspected or diagnosed and antidepressants are being considered. Although any antidepressant can trigger a mania, the odds are better it will happen SSRIs, and less likely to happen with meds that work only on dopamine or norepinephrine. Some doctors think that antidepressants should never be used with bipolar, and I used to go along with that until I spent a month in the bipolar 2 part of the spectrum. There are no blanket statements when it comes to psychiatric medications, everyone has to be evaluated individually. I personally think that if an antidepressant is called for, the test for the right neurotransmitter should be done of course. But if you can't get your doctor to sign off on that, try an NRI first, then a dopamine med like Wellbutrin (bupropion hydrochloride) or Mirapex (pramipexole dihydrochloride), and only if they don't do it do you hit the SSRIs.

It's not just the use of antidepressants that can cause mania either.  If you have to stop taking them, that can cause mania as well.  Damned if you do and damned if you don't.

 

7. Care should also be taken if you're epileptic, you must be cautious when mixing antidepressants and epilepsy. Make sure that your neurologist is consulted before you start taking any antidepressant. You may have to increase your intake of anticonvulsants, which, in turn, make you more depressed, and round and round it goes. The dopamine affecting meds are the worst, and that means Wellbutrin (bupropion hydrochloride) above all others. Glaxo makes it appear that the SR version isn't as bad as the immediate release version when it comes to seizures, but there's something about the way the information is worded in the PI sheet for the SR version when compared to the immediate release version. It just reads like they filtered out anyone who had a hint of seizure disorder, or even a family history of seizure disorder, from the clinical trials. I've read quite a few reports of people who have had no known history of seizure disorders describing symptoms of absence seizures, partial onsets and other petit mal events when taking the maximum dosage of Wellbutrin SR.

 

8. Booze. I will cover this more in another article. You know the drill, you shouldn't drink when on meds, but come on. Just because I've given up booze doesn't mean I'm going to get all preachy on you. Basically with the newer antidepressants, booze isn't that big a deal. Except for maybe Zoloft (sertraline hydrochloride).  You shouldn't drink as much as you used to, nor as often, especially with Effexor (venlafaxine hydrochloride) and Wellbutrin (bupropion hydrochloride). Details in the article on booze and on the pages for individual meds. But if you're taking only one or two newer antidepressants and you don't have a problem with booze, you can still have a few drinks now and then. Or your glass of wine or bottle of beer, sake or soju with dinner. Cheers! However, if you're mixing in an atypical antipsychotic with an antidepressant, as is getting very popular, you'll have to cut out the booze all together. Alcohol and atypical antipsychotics don't mix.

 

9. Amino acids are powerful things, at least when what is in the capsule is what is promised on the bottle's label. You never know in the US. Many of them convert to neurotransmitters in your brain, which is why they get sold as antidepressants, amongst other things. So you shouldn't mix l-Tryptophan / 5-HTP / Tryptan with SSRIs, multiple reuptake inhibitors or Remeron. Just don't. Unless your doctor tells you to, of course. That's your doctor and not anyone else. Otherwise you're seriously screwing with your serotonin levels and wildly unpredictable results may occur, including the potentially fatal serotonin syndrome. That's right, you could die from the advice some hippie at Ye Olde Vitamin Shoppe gives you about taking 5-HTP along with your Prozac (fluoxetine hydrochloride). Mixing l-tyrosine and Strattera (atomoxetine HCl) or Edronax (roboxetine) is slightly less risky, but you're still setting yourself up to overdosing on your own neurotransmitter. Unlike serotonin syndrome I can't point you to a handy guide to the symptoms of too much norepinephrine. Another problem is that you may not know how much more in the way of extra neurotransmitters you're going to get. I'll cover them in detail in an article specifically on supplements. As I write above I'm not against them, I take amino acids myself, with the advice and consent of my doctor. I'm just against taking them stupidly.  You should either do amino acid therapy, or antidepressant therapy, but not both.

10. Not all forms of depression and/or anxiety respond to antidepressants.  Dr. Amen uses anticonvulsants, standard antipsychotics and atypical antipsychotics,  and even lithium to treat different forms of depression, anxiety and depression & anxiety combinations.  Don't be afraid to go off-label!

11. I'll also be writing an article about antidepressants and kids, even though this is not a site for kids and meds.  For information about kids and meds I direct you to What Meds?.  However there is one and only one antidepressant in the US that has approval for pediatric use and that's Prozac (fluoxetine hydrochloride).  For very good reason - its 9.3 day half-life.  If the kid misses a day or two in being med compliant, it's not that big a deal with Prozac.  With almost any other med, playing hooky with meds for a day or two is really bad news.  It's just way more complicated than that, because diagnosing kids is difficult.  But if an antidepressant is called for and if serotonin is the right neurotransmitter to mess with, Prozac (fluoxetine hydrochloride) is the only med to use.

12. People are constantly asking me what the equivalents are for different classes of antidepressants.  And it literally is an apples and oranges comparison.  But since apples and oranges are both types of fruits, there are commonalities.  Loren Regier and  Brent Jensen of Queen's University School of Medicine, Kingston Ontario have put together a handy Antidepressant Comparison Chart.  Of course it applies only for meds available in Canada, eh.  But it does cover SSRIs, TCAs, MAOIs, Multiple Reuptake Inhibitors and whatever else they have in the Great White North.
    
    Thanks to Trusted Minion groovyone for finding these charts for me.
    
    You'll also want to check Nom de Plum's Summary of Psychotropic Medications for lots of information on the old-school meds like TCAs and MAOIs.