last updated 4/26/2024
When considering any treatment, you should know about its potential problems: any dangers, and common side effects. Uncommon things that don’t endanger you are not discussed here (it would be a long list, for any medication).
Withdrawal
Antidepressants can cause withdrawal symptoms when you try to stop taking them. Some people have severe anxiety, mood swings, anger and sleep problems when they lower the dose. These usually occur with physical symptoms: nausea, dizziness, and “brain zaps” (a feeling like electric shocks are going through your head).
These withdrawal symptoms don’t happen to everyone. But they can be so bad, the person is unable to work or take care of their family or go to school. They have to taper the dose down slowly, over a year or two, to get off the medication.
How common is this severe withdrawal problem? That’s controversial. Some psychiatrists say that it affects only about 1 person in 100 (1%). Other experts say it’s far more common, perhaps as many as one person in 10 (10%). My guess is around 1 person in 20 (5%). Mild withdrawal symptoms are very common, occurring 20% to 50% of the time when people are stopping their medication. Some antidepressants are worse than others (a comparison of frequently used ones is linked below).
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 4/2024, 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 severe 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 aren’t known to 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 be ready to look at a comparison of the ones most frequently used.