The Facts About Antidepressants

If you are experiencing depression, you're not alone: Globally, about 246 million people are affected by this mental illness. There are treatments available, such as antidepressants, which are often very effective. However, it's important to understand the potential side effects—sexual and otherwise—that can come along with them.

Antidepressants are medications used to manage mental health conditions such as clinical depression, anxiety, panic attacks and more. There are several different kinds of antidepressants, and the type and dosage that are best for you is determined by a medical professional. For some people, taking an antidepressant may be adequate to treat their mental health issues. Others may find that an antidepressant is most effective when coupled with therapy.

Antidepressants, while beneficial, are known to have several potential side effects, some of which may affect your sexual health. These side effects can be overcome by switching medicines or adjusting dosage. Side effects may improve over time or remain as long as you take the medication, depending on the individual.

There are a few different types of drugs most commonly used to treat depression, such as:

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are commonly prescribed because medications in this class are known to be safer and cause fewer side effects. SSRIs include medications such as:

• Citalopram (brand name: Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs include medications such as:

• Desvenlafaxine (Pristiq and Khedezla)
• Duloxetine (Cymbalta)
• Levomilnacipran (Fetzima)
• Venlafaxine (Effexor XR)

Atypical antidepressants

Drugs that fall into the class of atypical antidepressants include:

• Bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin and Forfivo XL)
• Mirtazapine (Remeron)
• Nefazodone (Serzone)
• Trazodone (Desyrel, Desyrel Dividose and Oleptro)
• Vortioxetine (Trintellix)

Tricyclic antidepressants

The class of tricyclic antidepressants is effective but has been known to have a higher likelihood of severe side effects than others. These are typically used only if other antidepressants don't work. Examples of tricyclic drugs include:

• Amitriptyline (Elavil)
• Desipramine (Norpramin)
• Doxepin (Silenor)
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)
• Protriptyline (Vivactil)
• Trimipramine (Surmontil)

Monoamine oxidase inhibitors (MAOIs)

Severe side effects can occur as a result of taking MAOIs, so they're typically prescribed only if other medications have proved ineffective. A strict diet must be followed while taking an MAOI, as they can lead to fatal interactions with certain foods. Examples of MAOIs include:

• Isocarboxazid (Marplan)
• Selegiline (Emsam, Eldepryl and Zelapar)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)

Depression is thought to be caused by an imbalance of serotonin in the brain. Serotonin is a neurotransmitter responsible for regulating mood, sleep and metabolism. Antidepressants work by balancing the chemicals in your brain, therefore, helping to lift your mood and alleviate some symptoms of depression and anxiety.

There are numerous options for antidepressants, thus, doctors typically start by prescribing something they know to be effective with the fewest or mildest side effects. However, it's not uncommon for individuals to switch medications once or twice—or more—before they find the one that works best for them.

How well antidepressants work for you is determined by many factors, but one of the most significant is the severity of your depression, according to information published by the National Center for Biotechnology Information. Studies show antidepressants work better in cases of chronic, moderate and severe depression, whereas these medications are not as helpful for mild cases of depression.

Your journey to finding the antidepressant that's best for you requires a consultation with your healthcare provider. There are many different types of antidepressants, and they all work in different ways and may be better at addressing some symptoms than others. Your doctor considers a few different factors when deciding which antidepressant to prescribe. First, they may prescribe a drug known to be effective in treating the symptoms you struggle with most. For example, if insomnia is one of your depression symptoms, your doctor may prescribe an antidepressant known to help with trouble sleeping.

It's important to choose an antidepressant that won't cause harmful interactions with other medications you're already taking. Other factors that can help you and your doctor determine which antidepressant might work best for you include whether you're pregnant or breastfeeding, your past history with antidepressants, how effective a certain antidepressant has been for close blood relatives and the affordability of the medication.

Antidepressants, like most medications, carry the potential for side effects. Some common side effects of antidepressants are:

• Constipation
• Diarrhea
• Difficulty urinating
• Dizziness
• Dry mouth
• Headache
• Nausea
• Restlessness
• Sexual dysfunction

Before starting any antidepressant, you should talk to your doctor about the potential side effects you may experience. If your antidepressant causes side effects that impact your health or quality of life, talk to your doctor. The solution may be as simple as adjusting the dose, taking additional medication to mitigate side effects or switching to a different antidepressant.

Though serotonin-based antidepressants can do wonders for your mental health, research has found they can cause sexual dysfunction in men and women alike. Antidepressants can affect your hormone levels, and some can negatively affect your libido more than others.

SSRIs, the most commonly prescribed type of antidepressant, have been found to sometimes lower or eliminate libido altogether and can make it difficult or impossible to achieve orgasm. Women taking this type of antidepressant have reported vaginal dryness and painful sex, while men have experienced erectile dysfunction (ED) and/or premature ejaculation.

You should never stop taking your antidepressants without consulting your doctor first. Fortunately, there are solutions to the sexual dysfunction that may be caused by your antidepressant. Common suggestions include giving it some time to see if the side effect resolves itself over the course of a few weeks or months, switching medications, getting your dosage adjusted or taking additional medication to help mitigate the side effects.

If you're pregnant or considering pregnancy, you may be wondering whether it's safe to take antidepressants while carrying a baby. Ultimately, this is a decision you must make for yourself in consultation with your doctor. Before writing the prescription, your doctor can counsel you on the risks and benefits of taking an antidepressant during pregnancy.

The main concern is the risk of possible birth defects and complications the medications can pose for babies and mothers. According to Mayo Clinic, the overall risk for these problems is low, though certain antidepressants (such as paroxetine) should be avoided during pregnancy because they carry higher risks of complications.

It's common to take both an antidepressant and an oral contraceptive. Experts say there's no direct interaction between oral contraceptives and antidepressants, and the two medications don't cancel out each other's effectiveness.

Available data is limited, but a 2016 systematic review of studies on both SSRIs and tricyclic antidepressants indicated that concern for clinically significant interactions between psychotropic drugs and hormonal contraceptives is low. The review didn't include any articles on SNRIs or MAOIs, and the authors expressed a need for further research to be done on the subject.

SSRIs, a popular class of antidepressants, work by controlling the flow of serotonin to the central nervous system. While the boost in serotonin that these medications trigger can relieve symptoms of depression, they can also affect other neurotransmitters in the body, namely, dopamine and testosterone. SSRIs affect the levels of testosterone and dopamine in the brain.

ED can develop as a result of taking an SSRI, as testosterone is the hormone responsible for sexual arousal, while dopamine is an important neurological component to achieving orgasm. Men often experience ED, delayed ejaculation and possible low libido as a result of taking this type of antidepressant.

Fortunately, sexual side effects caused by antidepressants can be managed.

If you're struggling with sexual side effects as a result of taking an antidepressant, talk to your doctor. A simple adjustment of your dose may be enough to do the trick. If not, switching to a different antidepressant or taking additional medications may help you overcome sexual dysfunction. It's also possible for sexual side effects to fade over time, so it might be useful to wait a few weeks before deciding how to move forward.

Antidepressants can also serve to help treat the following:

• Agoraphobia (fear of crowds, going outside, public places)
• Bulimia
• Generalized anxiety disorder
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Social anxiety

Certain kinds of antidepressants are used for other purposes, too, such as to treat migraines, neuropathy, fibromyalgia, and chronic neck and back pain. Additionally, individuals with Alzheimer's disease often find relief from depression symptoms through the use of antidepressants.

While it's true antidepressants are the primary treatment for clinical depression, there are other ways for people to manage their depression symptoms. Cognitive behavioral therapy (CBT) has proved to be an effective way to manage depression in many people.

Though a combination of pharmaceutical treatment and talk therapy is often necessary to address moderate to severe depression, other practices, such as maintaining a balanced diet, exercising regularly, spending time outdoors, meditating and practicing mindfulness, can go far in helping to manage the symptoms of depression.

What do antidepressants do to you?

Antidepressants help alleviate the symptoms of depression, lift your mood and help regulate your sleep patterns and metabolism by bringing balance to the chemicals in your brain. You should talk to your doctor to find out if medical treatment is right for you.

How do antidepressants work?

Depression is thought to be caused by a neurological imbalance of serotonin in the brain. Serotonin is a neurotransmitter responsible for regulating your mood, sleep and metabolism. Antidepressants work by helping to balance the chemicals in your brain, therefore, helping to lift your mood and alleviate some of the symptoms of depression.