The Side Effects of Antidepressants

Antidepressants, like other psychoactive drugs, have been the target of much criticism. The most intense kind tends to be leveled at their secondary effects. However, what does science say on the subject? Find out here.

Written and verified by the psychologist Gorka Jiménez Pajares.

Last update: 22 April, 2023

In today’s world, we use medications increasingly frequently. More specifically, in the case of antidepressants, as our use of them has grown, our mental health has become more fragile. Moreover, using these drugs often generates side effects that may go unnoticed.

For example, hypertensive crises, dry mouths, sedation, or episodes of cardiac arrhythmias are just some of the consequences that might occur due to the taking of psychotropic drugs. They also affect cognition (the way in which the individual processes and interprets information from their environment).

Antidepressants

Antidepressants contain active ingredients that modulate the number of neurotransmitters that participate in a synapse. Neurotransmitters are messengers that transfer information. There are various kinds of antidepressants. They work in different ways depending on the neurotransmitters on which they intervene (Stahl, 2023). Some examples are as follows:

• Selective norepinephrine reuptake inhibitors (SNRIs). They work exclusively on this neurotransmitter molecule. One example is reboxetine.
• Monoamine oxidase inhibitors. They’re prescribed to control depressive and anxiety symptoms. Some examples are phenelzine, isocarboxazid, and selegiline.
• Dual antidepressants. They selectively act on two molecules (noradrenaline and serotonin. Therefore, they produce synergistic results. Venlafaxine and duloxetine are two examples.
• Dopamine and norepinephrine reuptake inhibitors (NIRD). One example of this pharmacological group is bupropion. Although it has antidepressant effects, its main use is for smoking cessation.
• Selective serotonin reuptake inhibitors (SSRIs). By blocking the mechanism that reuptakes serotonin, levels of the neurotransmitter are increased in the inter-synaptic space. This group includes escitalopram, paroxetine, and sertraline.
• Heterocyclic antidepressants. These are psychoactive medications known as first-generation antidepressants. Their mechanism of action consists of inhibiting the reuptake of both noradrenaline and serotonin. However, they can also exert effects on other substances. Examples of this group are amitriptyline or imipramine.

The side effects of antidepressants

A side effect is defined as ‘an effect of a drug or other type of treatment that is in addition to or beyond its desired effect’. They can vary, depending on the time of consumption, as well as the prescribed dose. A study published in the Revista Médica Electrónica claims that 2.2 million people annually report side effects that can be qualified as serious.

There are multiple reactions. Here are some of them (Sthal, 2023):

• Insomnia.
• Constipation.
• Blurred vision.
• Headaches.
• Sexual dysfunction.
• Dry mouth
• Sleepiness and fatigue.
• Excessive sweating.
• Memory problems.
• Agitation and irritability.
• Withdrawal syndrome.
• Weight loss or gain.
• Concentration problems.
• Increased risk of suicidal thoughts.

In fact, the list goes on. That said, it’s important to note that the positive side effects of interventions with antidepressants may outweigh the negative ones. If there’s any doubt, the psychiatrist is the professional who can best explain any intervention plan.

The antidepressant escitalopram, under review

A recent investigation published in Neuropsychopharmacology analyzed the effects of escitalopram. This antidepressant is a serotonin reuptake inhibitor. In other words, it promotes the increase of serotonin in certain brain regions. This produces its antidepressant and anxiolytic effects.

However, prolonged and long-term use of escitalopram leads to changes in our reinforcement mechanisms (Langley et al., 2023). It’s through reinforcement that we learn new behaviors or inhibit them. Therefore, a persistent intake of escitalopram could increase a patient’s sensitivity to positive reinforcement.

Furthermore, according to an article published in The Journal of Neuroscience (Seymour et al., 2012), chronic psychoactive drug users are more sensitive to rewards and less to punishments. These individuals also frequently report the sensation of mental dullness (Marazziti et al., 2019).

Although there are many different adverse effects of antidepressants, their use can still be justified. Psychiatrists are those with the power to decide. In fact, whilst concentration difficulties, constipation, and blurred vision are some of the negative sequelae, there are also certain beneficial side effects, particularly with the use of drugs such as escitalopram.