Antidepressants Side Effects Chart
Antidepressants offers relief to millions of individuals struggling with depression every year, but they can come with potential side effects that need to be carefully taken into account. Considering they variety and multitude of antidepressants available, it's important to carefully compare the different options.
As such, WhatMedicine presents our extensive chart that visualizes and compares the likelihood of various side effects based on different antidepressant medications.
It's not just an SSRI side effects chart, but it compares a wide variety of antidepressants from different pharmacological groups (SSRIs, SNRIs, atypical antidepressants, and others). The main supporting reference used to compile this chart is UpToDate, a trusted evidence-based clinical decision support resource.
Table of Contents
Antidepressants Side Effects Chart
The antidepressants side effects chart offers a concise yet comprehensive overview of the most common side effects associated with the most common antidepressants. Whether you are about to start a new antidepressant or are curious about potential alternatives, this chart may serve as an invaluable resource.
Antidepressant drugs are prescribed more than ever before and their use in medicine extends beyond psychiatric disorders such as depression and anxiety. They may be used to treat insomnia, premature ejaculation, neuropathic pain, premenstrual dysphoric disorder, and much more.
The chart categorizes the side effects based on their likelihood and compares them across different antidepressant drugs. This way, users can easily identify which side effects are more prevalent with specific medications, allowing for a more informed decision-making process.
Individual Variability
Antidepressants are widely prescribed for depressive disorders, but it's important to acknowledge that these medications can affect individuals in vastly different ways. Some users may experience minor side effects, while others may encounter more significant problems.
The antidepressant side effects chart lists the most frequent side effects from the most commonly prescribed medications for major depressive disorder.
Not all clinically important side effects are listed in this chart, even common side effects that may occur in most antidepressants, such as hyperhidrosis (excessive sweating), dry mouth, headaches, skin reactions, and more.
General Guidance, Not Individual Truth
By providing a comprehensive chart comparing different antidepressant side effects, we aim to empower individuals to understand the potential risks associated with their chosen medication.
Keep in mind that a number '4' in the chart doesn't equal guaranteed side effects in a particular individual from a certain drug, nor does a '0' exclude the possibility that a patient may experience the corresponding side effect.
Additionally, the whole topic surrounding side effects is complex and there is room for interpretation. For example, Escitalopram is listed as a '0' for drowsiness, however, one of the more commonly reported side effects is fatigue and somnolence.
Keep in mind that a number '4' in the chart doesn't equal guaranteed side effects in a particular individual from a certain drug, nor does a '0' exclude the possibility that a patient may experience the corresponding side effect.
Additionally, the whole topic surrounding side effects is complex and there is room for interpretation. For example, Escitalopram is listed as a '0' for drowsiness, however, one of the more commonly reported side effects is fatigue and somnolence.
Explanation of Side Effects
Below is a brief explanation of each side effect brought out in the chart above.
1. Sexual Dysfunction
Antidepressants can lead to sexual dysfunction, including reduced libido, difficulty achieving or maintaining erections (erectile dysfunction), and problems with orgasm in both men and women. This occurs due to the impact of certain antidepressants on neurotransmitters and hormones that regulate sexual function.
2. Gastrointestinal Discomfort
It's common to experience gastrointestinal side effects when starting antidepressants. These side effects include nausea, vomiting, diarrhea, and stomach pains. This side effect may arise from the effect of antidepressants on certain receptors in the gastrointestinal tract. Commonly, they subside after 1 to 2 weeks of taking the medication. Those with lactose intolerance should be aware of continuous stomach pains and flatulence, as many antidepressants contain lactose.
3. Weight Gain
Unfortunately, certain antidepressants are associated with weight gain, most likely due to their impact on appetite regulation. This side effect can be concerning, as it may contribute to further emotional distress for individuals already dealing with depressive symptoms. In a few cases, as with underweight patients, these can be a wanted side effect of the medication.
4. QTc Prolongation
QTc prolongation is a cardiac side effect where the interval between certain points in the heart's electrical cycle becomes extended. Some antidepressants can affect the heart's electrical activity, potentially leading to irregular heartbeats (arrhythmias). This is particularly important to keep in mind for individuals with preexisting heart conditions.
5. Hypotension
Hypotension, or low blood pressure, can occur as a side effect of certain antidepressants. This can lead to dizziness, lightheadedness, and even fainting when standing up quickly. It's recommended to monitor blood pressure regularly during the initial stages of taking a new medication. Some antidepressants may also cause high blood pressure, but these are not noted in this chart.
6. Insomnia
Insomnia is originally a Latin word, and it means difficulty falling asleep or staying asleep. Insomnia can be triggered or exacerbated by some antidepressants. Adjusting the timing of medication intake or using adjunctive sleep aids may help manage said side effects.
7. Drowsiness
Drowsiness or tiredness is a common side effect of many antidepressants, especially those that have a sedative effect on the central nervous system. In some cases, it can be considered a wanted side effect, as with individuals struggling with insomnia. That said, excessive drowsiness during the day can impair daily functioning and increase the risk of falls, especially in the elderly.
The Effects on Liver & Kidneys
Antidepressants, across the board, carry the rare risk of causing hepatotoxicity, particularly in elderly individuals and those taking multiple medications. The occurrence of liver damage is often unpredictable, with no consistent correlation to drug dosage.
As for the kidneys, Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are generally not recommended for individuals with kidney failure. However, among the more commonly prescribed antidepressants, several are considered safe for the kidneys.
Certain medications necessitate dose adjustments based on renal function, as is the case with Venlafaxine. In contrast, others, such as Paroxetine, can typically be administered at standard doses without the need for lowering the dosage.
Certain medications necessitate dose adjustments based on renal function, as is the case with Venlafaxine. In contrast, others, such as Paroxetine, can typically be administered at standard doses without the need for lowering the dosage.
Find An Antidepressant That May Suit You
Every patients road to finding an effective and tolerable antidepressant is unique, and the possibility to easily compare potential side effects can increase the overall treatment experience. In addition, not all antidepressants are equal.
The mechanism of action varies a lot between the aforementioned drugs. Understanding these pharmacological differences is important as it can explain why certain side effects may be more prevalent with certain medications.
Take our antidepressant quiz which consists of 20 questions. It may help you find a potentially suitable antidepressant for you, which you can further discuss with your psychiatrist.
Consult With Your Psychiatrist
Always consult a competent medical doctor, such as a psychiatrist, who can provide personalized guidance and address any concerns or specific considerations.
The listed side effects are not absolute guarantees, but it's important to be adequately informed about their existence. The chart only serves as a general guide based on available clinical data.
Clear communication between the prescribing healthcare provider and patient about potential side effects is the most important component in building rapport and increasing treatment adherence, as up to 33% of all patients chose to discontinue their prescribed antidepressant due to intolerable side effects.
Key Data & Clinical Pearls
The antidepressants side effects graph only provides general guidance on the risk of encountering different side effects (gastrointestinal discomfort, sexual dysfunction, weight gain, QTc prolongation, hypotension, insomnia, drowsiness). Below, we present key data for each antidepressant, including its brand name and other clinically significant side effects or information associated with the medication. Note that this is not an exhaustive list of side effects for each medication.
= SSRIs = SNRIs = TCAs = Other Antidepressants
Sertraline
Launch: 1991
Brand name: Zoloft
Mechanism of Action: It's a selective serotonin reuptake inhibitor (SSRI) that primarily works through increasing serotonin levels in the brain.
Mechanism of Action: It's a selective serotonin reuptake inhibitor (SSRI) that primarily works through increasing serotonin levels in the brain.
FDA Approvals: Approved for major depressive disorder (MDD), obsessive-compulsive disorder (OCD) in both adults and children over 6, panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD).
Off-Label Uses: Generalized anxiety disorder (GAD), binge eating disorder, bulimia nervosa, body dysmorphic disorder, premature ejaculation.
Clinical Pearl: Sertraline may increase the risk of bleeding. It's also related to a higher frequency of diarrhea compared to other SSRIs.
Paroxetine
Launch: 1992
Brand Name: Paxil
Mechanism of Action: An SSRI that selectively increases serotonin levels in the brain.
FDA Approvals: Approved for MDD, OCD, panic disorder, social anxiety disorder, and PMDD.
Off-Label Uses: Social anxiety disorder, separation anxiety, dysthymia, body dysmorphic disorder, postpartum depression, premature ejaculation, malignancy-related pruritus unresponsive to standard treatment.
Clinical Pearl: Prescribers should use Paroxetine cautiously in the elderly, as it has the highest anticholinergic effect out of all SSRIs.
Citalopram
Launch: 1998
Brand Name: Celexa
Mechanism of Action: An SSRI that selectively increases serotonin levels in the brain.
FDA Approvals: Approved for MDD.
Off-Label Uses: Non-FDA-approved uses include alcohol use disorder, coronary arteriosclerosis, OCD, panic disorder, postmenopausal flushing, and PMDD.
Clinical Pearl: The enantiomer of Citalopram, Escitalopram, has been shown to have a higher efficiency in treating depression, with less impact on QTc times.
Escitalopram
Launch: 2002
Brand Name: Lexapro
Mechanism of Action: An SSRI that primarily increases serotonin levels in the brain.
FDA Approvals: Approved for major depressive disorder (MDD) and generalized anxiety disorder (GAD).
Off-Label Uses: Social anxiety disorder, OCD, panic disorder, PTSD, PMDD, and vasomotor symptoms of menopause.
Clinical Pearl: Research suggests Escitalopram may provide quicker relief to depressive symptoms compared to other antidepressants.
Fluoxetine
Launch: 1987
Brand Name: Prozac.
Mechanism of Action: An SSRI that primarily increases serotonin levels in the brain.
FDA Approvals: Approved for MDD in both adults and children over 7 years old, OCD in both adults and children over 7 years old, panic disorder, bulimia nervosa, and PMDD.
Off-Label Uses: Social anxiety disorder, PTSD, borderline personality disorder, Raynaud phenomenon, and selective mutism.
Clinical Pearl: Fluoxetine has the longest half-life of any antidepressant, as such it requires a washout period of at least 4-7 days before starting any new SSRI.
Fluvoxamine
Launch: 1994
Brand Name: Luvox
Mechanism of Action: An SSRI that primarily increases serotonin levels in the brain.
FDA Approvals: OCD in adults and children over 8 years. In 2008 it was approved for social anxiety disorder.
Off-Label Uses: MDD, PTSD, panic disorder.
Clinical Pearl: Prescribing Fluvoxamine can prove challenging due to its extensive drug-to-drug interactions through inhibiting several CYP450 enzymes. Not only does it affect the concentration of other drugs, but it can increase the half life of caffeine from 4.9 to 56 hours.
Vortioxetine
Launch: 2013
Brand Name: Trintellix
Mechanism of Action: Often classified as an SSRI, even though it has a unique pharmacological profile and multimodal mechanism of action.
FDA Approvals: MDD.
Off-Label Uses: No information about off-label use.
Clinical Pearl: Vortioxetine may cause pruritus, which is suggested to be dose-related. Studies suggest it is not effective in treating adolescent depression.
Trazodone
Launch: 1981
Brand Name: Desyrel.
Mechanism of Action: An atypical antidepressant, which mainly works as a serotonin antagonist and reuptake inhibitor (SARI).
FDA Approvals: Trazodone is FDA-approved for MDD.
Off-Label Uses: While FDA-approved for depression, the drug is mainly prescribed off-label at low doses for insomnia, due to its sedative properties. Also used off-label for anxiety, substance abuse, and fibromyalgia.
Clinical Pearl: Trazodone may in rare cases cause priapism, a medical emergency where an erection lasts for more than four hours or longer. There have also been reported cases of palinopsia. A more common side effect that may cause someone to stop taking Trazodone is nasal congestion.
Bupropion
Launch: Originally first patented in 1974, FDA approved in 1985.
Brand Name: Wellbutrin, Zyban.
Mechanism of Action: It is a norepinephrine-dopamine reuptake inhibitor (NDRI) with a unique pharmacological mechanism.
FDA Approvals: Approved for MDD, smoking cessation, as well as seasonal affective disorder (SAD).
Off-Label Uses: Non-FDA-approved uses include sexual dysfunction, obesity, bipolar depression, and ADHD.
Clinical Pearl: Bupropion lowers the seizure threshold and is contraindicated in people with a history of seizures or in patients with any predisposition to seizures. Bupropion may also cause agitation, irritability, and nightmares.
Venlafaxine
Launch: 1993
Brand Name: Effexor
Mechanism of Action: Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that, as the name implies, increases the levels of serotonin and norepinephrine in the brain.
FDA Approvals: MDD, GAD, social anxiety disorder, and panic disorder.
Off-Label Uses: Occasionally used off-label for atypical pain syndromes, hot flashes, and migraine prevention. It may also be used in PTSD, OCD, and PMDD.
Clinical Pearl: Venlafaxine may cause a persistent increase in blood pressure and heart rate (a dose-related effect). Moreover, abrupt discontinuation involves a high risk of withdrawal syndrome.
Duloxetine
Launch: 2004
Brand Name: Cymbalta
Mechanism of Action: Duloxetine is another SNRI that increases serotonin and norepinephrine.
FDA Approvals: Approved for MDD, GAD, diabetic neuropathy, fibromyalgia, and chronic musculoskeletal pain.
Off-Label Uses: Non-FDA-approved uses include other atypical or chronic pain syndromes, as well as stress urinary incontinence.
Clinical Pearl: The drug may be particularly helpful in managing pain-related symptoms in addition to depression, which may explain its extensive use.
Mirtazapine
Launch:1996
Brand Name: Remeron
Mechanism of Action: It's an atypical antidepressant with noradrenergic and specific serotonergic properties (NaSSA).
FDA Approvals: Approved for major depressive disorder.
Off-Label Uses: Mirtazapine is often prescribed at low doses for insomnia due to its sedative effects. It is also used in appetite stimulation.
Clinical Pearl: Mirtazapine may in rare cases cause bone marrow suppression (thrombocytopenia, neutropenia). Additionally, Mirtazapine is associated with the highest incidence of weight gain out of all the modern antidepressants.
Agomelatine
Launch: 2009
Brand Name: Valdoxan.
Mechanism of Action: A melatonergic agonist and selective serotonin antagonist. Due to its unique mechanism of action, it's classified as an atypical antidepressant.
FDA Approvals: Agomelatine is not FDA-approved in the US.
Off-Label Uses: No information about off-label use.
Clinical Pearl: Agomelatine can be hepatotoxic, which is why it requires regular monitoring of liver values and the drug is contraindication in any liver impairment.
Amitriptyline
Launched: In 1961 with the brand name Elavil.
Mechanism of Action: It is a tricyclic antidepressant that affects the balance of certain neurotransmitters in the brain.
FDA Approvals: FDA-approved for the relief of symptoms in depression.
Off-Label Uses: Often used for migraine prevention and as an analgesic for chronic pain conditions.
Clinical Pearl: Amitriptyline can have significant cardiovascular side effects and can both increase QT time, heart rate, and impair effective contractility.
Source of Drug Information: StatsPearls, NCBI.
Please note that all antidepressant drugs may cause:
- Allergic reactions due to hypersensitivity to the particular drug used.
- Increased prevalence of suicidal ideations and suicidal behavior in children, adolescents, and young adults at the beginning of treatment.
- Increased risk of developing a manic or hypomanic episode during treatment.
Author: J. Martin, M.D.
Last updated: August 23, 2024
Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness seek immediate medical attention.
Last updated: August 23, 2024
Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness seek immediate medical attention.