When determining the best course of action for treating depression, it’s always important to consider the balance between the benefits and side effects of each treatment option. Antidepressants — SSRIs, MAOIs, TCAs , and others— provide solutions for many patients, but do not come without side effects. Lexapro and Zoloft, for example, are often linked with drowsiness, nausea, insomnia, and a range of gastrointestinal issues. Discontinuing use of antidepressants can also trigger withdrawal-like symptoms in some patients, and some of these can be quite severe, such as suicidality.
With the help of your doctor, finding the right balance is essential. In situations where antidepressant side effects outweigh the lifestyle benefits they provide, TMS — ortranscranial magnetic stimulation — can offer an effective alternative with fewer and shorter side effects. Be sure to consider all available research and options and discuss them with a health care professional before deciding whether a treatment option is right for you.
One of the earliest forms of antidepressant introduced to the market, tricyclic antidepressants alter communications between neurotransmitters in the brain that affect mood. Launched in 1959 to treat major depressive disorder (MDD), Imipramine (Tofranil®) passed FDA approval and created a new class of drugs known as tricyclic antidepressants, or TCAs.
The side effects of tricyclic antidepressants are among the most severe, and it can take some time to determine the least disruptive variety for your body. Side effects of tricyclic antidepressants include blurred vision, drowsiness, constipation, dry mouth, lightheadedness, and urine retention. Particular care should be taken when sitting up or standing suddenly, as lowered blood pressure caused by the medication can increase the risk of dizziness. Other reported TCA antidepressant side effects include changes in appetite and weight, sex drive and performance disruptions, excessive sweating, and even tremors.
As with all medications, the side effects of TCAs differ depending on the patient and specific drug. For example, the TCAs Elavil, Silenor, and Tofranil have a higher rate of drowsiness and weight gain, while nortriptyline and desipramine tend to have more manageable levels of side effects in general.
Doctors only prescribe monoamine oxidase inhibitors (MAOIs) when patients can avoid specific drug and food interactions, and when other antidepressants have proven ineffective. The more extreme side effects of MAOIs can last several weeks after discontinuing use, due to the method by which these drugs can irreversibly alter peripheral brain tissues.
Patients most commonly report MAOI antidepressant side effects such as dry mouth, headache, drowsiness, dizziness, light sensitivity, and digestive issues such as constipation, nausea and diarrhea. Similar to tricyclic antidepressants, many patients also report sexual disruptions such as a decrease in sex drive or difficulty in reaching orgasm. Muscular concerns, including involuntary spasms, cramps, and tingling, are also often reported.
Some of the most commonly prescribed MAOIs include brand names such as Marplan, Nardil, and Emsam. When taking any form of MAOI, patients must work with their doctors to avoid any intake of tyramine, a common compound that can be found in wine and beer, as well as cured meats and cheeses.
Of all the antidepressant varieties collectively taken by one in nine Americans, SSRIs — or selective serotonin reuptake inhibitors — are the most commonly prescribed. Many recognizable brands such as Lexapro and Zoloft fall into this category, all of which increase serotonin production in the brain. Cymbalta, an antidepressant that regulates both serotonin and norepinephrine, is categorized as an SNRI, but Cymbalta side effects are comparable to those of the closely related SSRI group.
In spite of being the most prescribed antidepressant type, certain SSRIs come with more specific warnings from the FDA. For example, citalopram — commonly sold under the brand name Celexa — has been found to cause irregular heart rhythms. Doctors must monitor the dosage of these brands to prevent complications, especially when the patient is over the age of 60. Additionally, weight gain is commonly seen among the side effects of SSRIs such as Zoloft, Prozac, and Paxil, although these effects are most commonly associated with long-term use. The side effects of Lexapro include drowsiness, nausea, dizziness, insomnia, headaches and blurred vision. Insomnia caused by these drugs may also occur, as well as headache and blurred vision. Sexual changes are also reported among the side effects of Zoloft and similar medications, including the common side effect of decreased sex drive or impotence.
Due to the fact that each SSRI differs slightly in chemical makeup, doctors and patients have the option of trying alternative brands when one brand’s side effects outweigh its benefits.
Patients should discuss with their provider any other medications taken alongside any SSRIs, including herbal supplements, and pain medications that affect the levels of serotonin produced in the brain. Though uncommon, an unhealthy accumulation of serotonin can lead to a preponderance of symptoms such as anxiety, restlessness, sweating, confusion and agitation.
Those who are pregnant, planning to become pregnant, or currently breastfeeding should discuss with their doctor any necessary changes to their medication and relevant side effects of antidepressants to decrease the risk of possible complications.
Vulnerable groups, such as those under 25 years of age, should employ caution when taking SSRIs. Younger populations are often monitored for an initial uptick in suicidal thoughts or other severe depressive behaviors after beginning a new medication regimen, or after their doctors alter the dosage. The FDA marks antidepressant prescriptions with black box warnings for this reason. Though severe antidepressant side effects often decrease over time — as these medications are primarily meant to treat these symptoms — it’s important to remain aware of the risk, especially in SSRI varieties with the highest rates of overall side effects, such as Paxil and Luvox.
Studies have not found antidepressants to be addictive, but many patients — up to 20% — see withdrawal-like effects immediately after SSRIs are discontinued. Known as discontinuation syndrome, antidepressant side effects such as insomnia, nausea, sensory disturbances, and flu-like symptoms occur when use of SSRIs is abruptly stopped. It’s imperative to discuss the safest way to wean off SSRIs properly to avoid this disruption or relapse. Luvox and other brands of fluvoxamine have been found to have the highest rate of discontinuation syndrome effects.
Transcranial magnetic therapy — known as TMS — stimulates the prefrontal cortex with the noninvasive use of magnets. Brief and painless sessions alter the activity in the mind to decrease the symptoms of MDD. The number of sessions required varies from person to person and can be easily customized for each unique patient.
As with all therapies, finding the right treatment for MDD requires striking a healthy balance between benefits and side effects. When antidepressants fail, TMS can be an effective solution.
Doctors have found that TMS carries a very low risk of temporary adverse reactions. As sessions continue, patients adjust to the therapy and report fewer reactions and less discomfort over time. Because of this, transcranial magnetic stimulation is often a great alternative for those looking to avoid the side effects of antidepressants.
In the majority of cases, TMS side effects are mild to moderate. Symptoms during and immediately after TMS sessions may include scalp discomfort and tingling, slight headache, and minor twitching or spasms in the surrounding face and head region. Any pain can usually be treated with over-the-counter medications like NSAIDs (e.g. Ibuprofen, Naproxin, Aspirin). TMS therapy can be easily adjusted or discontinued by a doctor in response to any concerns, without adverse consequences.
Over the past century, a range of therapies have been developed to treat major depressive disorder and related illnesses, but balancing adverse antidepressant side effects with their benefits often proves difficult. TMS provides a safe, non-invasive alternative to long-term medication and the related side effects of antidepressants.
The most common side effects of antidepressants are insomnia, blurred vision, dry mouth, fatigue, weight gain, nausea, GI distress and sexual dysfunction.
TMS stands for transcranial magnetic stimulation. It’s a treatment that uses magnets to stimulate the prefrontal cortex to promote brain cell activity to decrease depressive symptoms. It’s a drug free therapy with contraindications so limited that patients require no post-treatment monitoring and are able to drive home straight away.
The most common side effects of TMS are scalp discomfort and headache.
If you would like to stop or reduce the dosage of antidepressants you are taking, consult with your doctor. Your doctor will be able to help and guide you with a tapering schedule and discuss your ongoing treatment.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Active Recovery TMS website is solely at your own risk.