Managing Side Effects of Antidepressants - By Dr. Meghan Dougan, ND

Weighing the Benefits: Drug vs Side Effects

Antidepressant medications are sometimes necessary for those struggling with major depressive disorder, but it should be noted that settling with their side effects is not a requirement. Some of these side effects can be so debilitating for people that it results in stopping medication altogether. One study reported that of those people experiencing side effects, 48% resulted in discontinuation of antidepressant medication (1). But stopping medication isn’t the only option and it shouldn’t be when that medication is able to hold depressive symptoms at bay. Managing side effects can help improve quality of life in those on antidepressants. Some of the most common side effects of antidepressants include drowsiness, sexual dysfunction, dry mouth, and weight gain (2).

Defying Drowsiness

It can be difficult to determine whether drowsiness is a symptom of the depression itself or whether it is occurring as a side effect of medication. Either way, there are various lifestyle changes that can be used to address that day time fatigue. The first thing to look at is something called “sleep hygiene”. This means optimizing your sleep routine. Ways to do this include minimizing screen time before bed, ensuring the room is completely dark at night, decreasing caffeine intake throughout the day, and avoiding daytime napping. For some people, slowly increasing exercise can also help increase energy levels (3).  

Let’s Talk about Sexual Dysfunction

Antidepressants can affect sexual function from all angles including libido, excitement, arousal, and orgasm. These side effects often remain hush-hush, but are some of the most bothersome impacting quality of life, quality of relationships, self esteem, and recovery from depression (4). Naturopathic treatments to sexual dysfunction include L-arginine, an amino acid with a mechanism of action similar to Viagra, and various herbs that promote sexual function. Damiana and Withania are two herbs that have traditionally been used as aphrodisiacs. Another herb, Ginkgo is used to promote blood circulation and has been studied in the context of sexual dysfunction from antidepressants with varying results (4). However, with appropriate therapeutic dosing these herbs can be used alongside antidepressants. Some types of antidepressants including SSRIs and SNRIs are more likely to result in sexual dysfunction (5), so switching to a different class of antidepressants can have beneficial effects on sexual activity.

What about Weight Gain and Dry Mouth

Weight gain and dry mouth are difficult side effects to tackle, but not impossible. Some weight gain can actually be beneficial in those people that undergo weight loss as a result of depression. But for those that experience an excess of weight gain this can be a troublesome side effect that again affects self esteem. Drug choice can minimize chances of unwanted pounds since some are more prone to causing weight gain than others. The most helpful tools for weight gain we have are lifestyle modifications such as diet and exercise. With dry mouth, again treatment options are limited. A quick trick that some people find helpful is chewing gum as it appears to increase saliva production (6). Choosing xylitol-based gums spares your teeth from the sugar and promotes good oral health at the same time.

Talking to your Health Care Provider

Know that you’re not alone in experiencing these side effects or others such as headache, insomnia, blurred vision, anxiety, nausea, diarrhea or constipation. Doctors tend to underestimate how common these side effects are since many people choose not to disclose them or think they’re ‘normal’.

When starting antidepressant medication, most side effects will occur by 2 weeks, around the same time the medication will start working or not. Following up with your health care provider at this point can help redirect treatment if necessary since each medication is different and each person tolerates antidepressants differently.

A little known fact is that many Naturopaths maintain prescription rights, meaning we can help manage antidepressant treatments and minimize side effects.

To book an appointment with a Naturopath at Juniper Family Health please call 778-265-8340 or book online here.  

 References:

1. Van Geffen, E., van der Wal, S., van Hulten, R., de Groot, M., Egberts, A., Heerdink, E. (2007). Evaluation of patients’ experiences with antidepressants reported by means of a medicine reporting system. European Journal of Clinical Pharmacology, 63(12), 1193-1199.

2. Hu, H., Bull, S., Hunkeler, E., Ming, E., Lee, J., Fireman, B., Markson, L. (2004). Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. The Journal of Clinical Psychology, 65(7), 959-965.

3. Kelly, K., Posternak, M., Jonathan, E. (2008). Toward achieving optimal response: understanding and managing antidepressant side effects. Dialogues in Clinical Neuroscience, 10(4), 409-418.

4. Higgins, A., Nash, M., Lynch, A. (2010). Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug, Healthcare and Patient Safety, 2, 141-150.

5. Clayton, A., Croft, H., Handiwala, L. (2014). Antidepressants and sexual dysfunction: mechanisms and clinical implications. Postgraduate Medicine, 126(2), 91-99.

6. Furness, S., Worthington, H., Bryan, G., Birchenough, S., McMillan, R. (2011). Interventions for the management of dry mouth: topical therapies (Review). Cochrane Database of Systematic Reviews, 12.