last updated 4/28/2025
Antidepressants have helped many people. They could help you. But as with any medication, you need to compare the risks with the possible benefits.
So here’s a list of common problems. Uncommon things that don’t endanger you are not discussed here.
Withdrawal
(updated 4/2025) Antidepressants can cause withdrawal symptoms when stopping them, including anxiety, mood swings, anger and sleep problems. These usually occur with physical symptoms: nausea, dizziness, and “brain zaps” (a feeling like electric shocks are going through your head).
According to one study, at least some withdrawal happens to about 1 person in 3 when they taper off their antidepressant. According to another recent study, about 1 person in 6 (16%) has severe withdrawal symptoms when stopping their antidepressant.
Some antidepressants cause withdrawal more often (like venlafaxine/Effexor), and some less (like fluoxetine/Prozac) often. Tapering off over a month or more lowers the risk of withdrawal, but some people have to taper over much longer periods (especially with venlafaxine).
Sexual problems
Some antidepressants can interfere with sexual function: decreased sexual feelings, problem having an orgasm, and for men, difficulty getting or maintaining an erection.
The most likely to do this are:
- fluoxetine/Prozac
- sertraline/Zoloft
- citalopram/Celexa
- escitalopram/Lexapro
- venlafaxine/Effexor
- desvenlafaxine/Pristiq
- duloxetine/Cymbalta.
One antidepressant, bupropion/Wellbutrin, does not cause sexual problems. A comparison of all these medications is linked below.
Recently another concern has emerged, namely that sexual problems caused by antidepressants might continue even after the antidepressant is stopped (so-called post-SRI sexual dysfunction, PSSD). How often this happens is very controversial. As of 6/2024, a we don’t have a good study to go by. (Well, there’s one, but the research approach is kind of indirect. Their answer: less than 0.5% — about 1 in 240 people).
Weight gain
Most antidepressants, except for bupropion, can cause slow weight gain. (True, nowadays nearly everybody is slowly gaining weight. But antidepressants can make that more likely and slightly faster).
Making things worse
All antidepressants can make some kinds of depression worse. For people who are in the middle or the right side of this mood spectrum:
antidepressants can cause a “mixed state” where depression combines with anxiety, anger, agitation, attention problems and insomnia; or make episodic depressions come back more frequently. Rarely, antidepressants can cause a manic episode, which can be dangerous for relationships, jobs and savings. All these can happen to anyone who takes an antidepressant, but are more likely for people whose depression is not in the deep blue part of the mood spectrum. The MoodCheck questionnaire can help figure out where you are on this spectrum.
Does this mean “don’t use them”?
No. It means you have to consider the risks as well as the potential benefits. Talk with your provider(s) about what you’ve learned here.
Other options
First, consider non-pill options: changing your activities and thoughts — on your own, with a workbook, with an online therapy program or a live therapist who’s either remote or face-to-face. These strategies are detailed on the self-change and psychotherapy pages.
Then, there are antidepressant tools that aren’t pills (and don’t cause withdrawal or sexual side effects). There’s light therapy, which has two versions. One is cheap, harmless, simple, and is complete by the time you wake up: a “dawn simulator“. The other, using a light box, takes 30 minutes per morning but is easy to stop, compared to antidepressant pills.
“Transcranial magnetic stimulation” (TMS) works too, but is harder to find and usually expensive. Ketamine is still under research and requires caution about long-term use. Psilocybin is even more unknown (but wow, interesting).
Conclusion
Tricky, isn’t it? Antidepressants have helped some people a lot. A lot. They’ve hurt some people too. If you’re heading toward an antidepressant, you might want to look at a comparison of the ones most frequently used.