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Side-Effects of Antidepressants:
How to Cope

Sexual dysfunction. While loss of erectile or ejaculatory function in men and loss of libido and anorgasmia in both sexes may be complications of any antidepressant, these side effects appear to be most common with the MAO inhibitors and SSRIs, like fluoxetine and sertraline. Before taking action, it must be clarified whether the sexual dysfunction is a result of the antidepressant or the underlying depression.

Since switching the SSRI/SNRI or lowering the dose often gives unsatisfactory results, a number of adjunctive medications can be tried to improve SSRI-induced sexual dysfunction. Treatments that may be considered include neostigmine, cyproheptadine and yohimbine.

"Dizziness," "sedation," and "feeling medicated." Dizziness (particularly upon standing) may be caused by low blood pressure secondary to antidepressant medications. Patients complaining of "feeling foggy" may be experiencing anticholinergic-induced cognitive disruption. Some patients who say they feel "overly medicated" are actually overly sedated. Many antidepressants are prone to induce this symptom. Amitriptyline, doxepin and trazodone are experienced as most sedating, nortriptyline and amoxapine as less sedating, and fluoxetine, sertraline, bupropion, protriptyline and desipramine as least sedating. Sedation often diminishes in the first weeks of treatment, and patients experiencing only minor difficulty from this side effect should be encouraged to allow some time to pass before changing antidepressant agents, all other factors being equal. Some patients tolerate their medication better when it is given as a single dose before bedtime.

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Anticholinergic side effects. All tricyclic antidepressants have some degree of anticholinergic action; desipramine has the lowest potency in this regard. While MAO inhibitors are not anticholinergic, their side effects may resemble anticholinergic symptoms. The most common undesirable consequences of cholinergic blockade are dry mouth, impaired ability to focus at close range, constipation and urinary hesitation.

Weight Gain. Tricyclic antidepressants, MAO inhibitors, and lithium all have the capacity to induce weight gain. Bupropion (Wellbutrin), fluoxetine (Prozac), sertraline (Zoloft) and trazodone (Desyrel) do not usually induce weight gain.

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