For medications against depression, side effects are common. They depend on the specific antidepressant and the individual tolerance of the person affected. Learn which side effects are to be expected with which active ingredients and what can help you in your everyday life.
Medications for Depression and Their Side Effects: Key Takeaways
- Typical side effects of medications for depression include nausea, headaches, inner restlessness, as well as problems falling or staying asleep. They usually subside after a few weeks once the body has adjusted to the medication.
- Side effects depend on the active ingredient: Some antidepressants cause gastrointestinal problems or alter sleep and sexual function, while others cause fatigue and affect weight.
- Patience for the effect: A noticeable improvement in your mood often only appears after two to four weeks—but the side effects can occur even before that.
- Caution is advised when simultaneously taking St. John's wort, alcohol, and certain painkillers such as ibuprofen, as these can increase the risk of bleeding or serotonin syndrome.
- Warning signs are symptoms such as high fever, confusion, or the recurrence of suicidal thoughts—in such a case, seek medical help immediately.
- For discontinuing the antidepressant, a slow, medically supervised tapering of the dose is very important because it prevents or at least reduces unpleasant symptoms.
- The digital health application (DiGA) deprexis can help support the self-management of your depression in everyday life, for example, through helpful knowledge and targeted exercises.
How Antidepressants Work
Each medication for depression is assigned to a specific active ingredient group based on its chemical compound. Each group acts in a different way on the neurotransmitters in the brain to relieve the symptoms of depression.
Neurotransmitters are chemical messengers that transmit information between nerve cells, or between nerve cells and muscle or gland cells, via synapses. They are crucial for controlling bodily functions, thoughts, and emotions by sending signals throughout the body.
Neurotransmitters and Their Role
Important chemical messengers for well-being are serotonin, dopamine, and norepinephrine.
- Serotonin is important for mood, sleep, appetite, and relaxation. A deficiency can promote feelings of anxiety and dejection.
- Dopamine provides pleasurable feelings and motivation. A deficiency can lead to dejection.
- Norepinephrine has an activating and wakefulness-promoting function. A deficiency can reinforce a lack of drive.
In cases of depression, imbalances in neurotransmitters such as serotonin, dopamine, and norepinephrine play a role, as they affect signal transmission between nerve cells. A deficiency of these messengers can lead to symptoms such as dejection, lack of drive, or joylessness.
Medication Treatment
Antidepressants target exactly this mechanism and aim to increase the concentration of these neurotransmitters in the brain to relieve symptoms. Many antidepressants work by inhibiting the breakdown or reuptake of neurotransmitters in the synaptic cleft. This leads to an increased concentration of the chemical messengers and improved signal transmission. The effect is not the same for everyone, which points to individual differences in neurotransmitter processing.
Side Effects of Medications for Depression
Antidepressants have many side effects because they do not only act selectively on a single neurotransmitter pathway, but often influence multiple neurotransmitter systems in the brain. In addition, there are individual differences in tolerance and an initial "surge of side effects" until the body has adjusted to the medication.
The side effects differ depending on the active ingredient group of the antidepressant:
SSRI and SNRI – Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors
- Typical effects: Gastrointestinal complaints, changes in sleep, and headaches—these are often temporary.
- Sexual dysfunction: Issues such as a reduced libido, delayed ejaculation, or difficulties achieving orgasm are widespread. Speak with your doctor about this: there are strategies available, such as adjusting the dosage, changing the time of intake, or switching to a different preparation.
- Blood pressure: SNRIs can additionally affect blood pressure and heart rate, making regular monitoring advisable.
NDRI – Norepinephrine-Dopamine Reuptake Inhibitors (Example: Bupropion)
- Advantage: Tends to cause fewer sexual dysfunctions.
- Disadvantage: Bupropion lowers the seizure threshold and thus increases the risk of seizures. Furthermore, it must not be taken if there is a current or past eating disorder, or during abrupt alcohol withdrawal.
- Common side effects of Bupropion: Insomnia and dry mouth occur frequently.
NaSSA – Noradrenergic and Specific Serotonergic Antidepressants (Example: Mirtazapine)
- Effects: Tends to cause drowsiness/fatigue and can lead to weight gain.
- Comparison: It causes nausea or sexual dysfunction less frequently than SSRIs.
- Mirtazapine user experiences: Users frequently report a calming effect and improved sleep.
TCA – Tricyclic Antidepressants
- Typical effects: Dry mouth, constipation, and dizziness.
- Usage: They are used rather rarely nowadays.
MAOI – Monoamine Oxidase Inhibitors
- Requirements: This active ingredient group requires a strict diet and close monitoring of drug interactions.
- Usage: They are also only used rarely nowadays.
Melatonin Agonist (Example: Agomelatin)
- Special consideration: Liver values must be monitored before and during treatment. The medication must not be used if liver disease is already present.
Overview of Side Effects for the Main Active Ingredient Groups
SSRI/SNRI (Selective Serotonin/Norepinephrine Reuptake Inhibitors)
- Drug Examples: Sertraline, Citalopram, Venlafaxine
- Temporary Side Effects: Nausea, gastrointestinal problems, headaches, inner restlessness, anxiety states, and sleep disturbances
- Long-Term Side Effects: Sexual dysfunction, weight gain, and increased blood pressure and pulse for SNRIs
NaSSA (Noradrenergic and Specific Serotonergic Antidepressants)
- Drug Examples: Mirtazapine
- Temporary Side Effects: Fatigue, dizziness, and an increased appetite
- Long-Term Side Effects: Weight gain
NDRI (Norepinephrine-Dopamine Reuptake Inhibitors)
- Drug Examples: Bupropion
- Temporary Side Effects: Insomnia, dry mouth, and headaches
- Long-Term Side Effects: Increased risk of seizures, sexual dysfunction
1. Self-Help in Everyday Life
Establish routines and take your medication at the same time every day. If you experience nausea, taking the medication with a meal can help. In cases of severe fatigue, and after consulting your doctor, you can also take the remedy in the evening; if you experience restlessness, taking it in the morning is usually better. Very importantly: exercise regularly, pay attention to your sleep hygiene, and drink plenty of fluids.
2. Speaking with Your Doctor
It is best to bring a list to your appointment that you have prepared over the preceding days. On it, you should note:
- Which side effects am I experiencing?
- Since when?
- How severe are they on a scale from 0 to 10?
- In which situations do they occur?
Also write down what reduces or worsens the complaints. The discussion will revolve around the question: "Should I endure the symptoms and wait it out, change the dose, switch the preparation, or try an additional treatment?".
3. Adjustments by the Medical Practice
Medically, various steps are possible. The most important thing here is that you do not experiment on your own. The time of intake can be varied, the dose can be adjusted step-by-step, the preparation can be switched, or a complementary preparation can be added. All of this always happens on the basis of an individual medical evaluation.
4. Discontinuation and Switching
Never stop taking the medication abruptly: a slow and, above all, medically supervised tapering reduces unpleasant discontinuation symptoms. Typical discontinuation symptoms include dizziness, irritability, and insomnia.
5. Digital Support
deprexis is a prescribable Digital Health Application (DiGA), an online program that works with the principles of cognitive behavioral therapy. deprexis can motivate you daily with knowledge and exercises to build health-promoting routines, monitor side effects more structurally, and stabilize your everyday life. Your doctor's office can issue a prescription, and your health insurance covers the costs. The DiGA can be used at any time and in any place.
