How to cope when your joy pills are killjoys.
Vivid nightmares and frequent bouts of sexual dysfunction were not what Robert had in mind when he began taking antidepressants a year ago. The drug helped his depression, but disrupted his life with troublesome side effects.
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"I was afraid to go to sleep because the nightmares were so real," says Robert. And although he was not in a serious relationship at the time, he worried that his sexual dysfunction would pose problems for a new partner.
After switching antidepressant drugs several times, he found one that worked for him without the side effects. "There was definitely an improvement on all fronts. It was worth it to hang in there," says Robert.
Patients frequently abandon antidepressant therapy because of side effects ranging from sexual dysfunction to flatulence, according to psychiatrist Bernard Vittone, director of the Washington, D.C.-based National Center for the Treatment of Phobias, Anxiety and Depression.
But Vittone says there can be a big payoff to perseverance. "If one antidepressant doesn't work, you should try another because when you find the right treatment, it's great. The patient's life is transformed."
Sexual dysfunction is the most commonly reported side effect of depression treatment. It affects about 20 percent of men and 3 percent of women. Patients report reduced sexual desire, inability to become aroused and trouble achieving orgasm.
Vittone, who prescribed antidepressants for about 1,500 patients last year, says the most common male sexual problems include delayed orgasm, inability to have an orgasm and erectile problems. Women experience the inability to lubricate or become aroused.
People who are depressed or anxious often will at first tolerate sexual dysfunction, but as they begin to feel better, the problems become intolerable.
"When you tell people about these side effects at the start of therapy, they say, 'I don't care. I want to feel better.' At the beginning all they can focus on is the pain they are in and they just want to get well fast," says Vittone. "Once they feel better, they scream about the sexual side effects."
Vittone suggests talking to your doctor about decreasing or skipping doses on certain days of the week for relief from the sexual side effects. Other antidepressants such as Wellbutrin, Remeron or Serzone can reverse sexual side effects. Low-dose Ritalin, Viagra or Buspar, an anti-anxiety drug, can also be effective.
Some of the other common side effects of antidepressants include drowsiness, insomnia, dizziness, dry mouth, excessive sweating, nausea and teeth grinding.
Doctors suggest various methods to reduce these side effects, which may be temporary in some cases.
- To ease drowsiness, Vittone recommends taking your medication at night.
- If insomnia is a problem, take the medication in the morning.
- Dizziness and dry mouth often occur early in treatment while your body adjusts to the medication.
- Severe, excessive sweating is often temporary.
- To combat nausea take the medication with food. Stomach upset tends to improve over time.
- Jaw clenching, headaches, teeth grinding and broken teeth have been reported after starting on Zoloft, Paxil or Prozac. Talk with your doctor about adding an anti-anxiety drug.
"I try to give the lowest possible dose to patients if there are side effects and hope that the patient can maintain the same level of improvement," says Dr. Douglas Anderson, a psychiatrist in San Francisco. "There is always a risk in switching medication that you won't have the same robust response," he says.
Antidepressant therapy should produce some improvement in four to six weeks. If you don't improve, talk with your doctor about switching to another drug.
Patients need to realize that making a full recovery from depression will take inner strength and persistence, says Lydia Lewis, executive director of the National Depressive and Manic-Depressive Association. "You have to have the courage to try until you find the drug, or the combination of drugs, that works for you."