Clinically, patients with many different disorders require antidepressants, especially for depression, which requires a long period of standardized treatment under the guidance of a psychiatrist. However, after a diagnosis of depression, many patients are daunted by antidepressants: “I’ve heard that once you take the medication, you become drug dependent and can’t quit, so you must not start taking them!” “I have friends who are also depressed, and after taking antidepressants they are particularly uncomfortable and not well, so I was told not to take them!” “Antidepressants can make people fat!” “I can’t take antidepressants because I feel drowsy and my brain is not clear, and I have to work!” And so on and so forth, these kinds of concerns are common in real life. I will answer these questions for you and give you a better understanding of the side effects of antidepressants. 1, the basic understanding of the side effects of antidepressants (1) compared with the psychological and physical hazards of depression, taking antidepressants is clearly more beneficial than harmful Depression, if not treated promptly and effectively, will affect the patient’s work and quality of life, exacerbate the risk of suicide, and also increase the risk of developing chronic physical diseases such as cardiovascular disease. Antidepressants have been shown to be an effective treatment for depression, especially for moderate to severe depression, and are recommended as the first line of choice in various national guidelines for the treatment of depression. (2) Most of the side effects of antidepressants will be reduced with the prolongation of medication, and the side effects will be more obvious in the first 1-2 weeks after starting the medication. Since the onset of antidepressants is usually 2-4 weeks, the onset of action time is long, so patients may experience significant discomfort at the beginning of the medication, and may not experience the positive therapeutic effect of antidepressants. However, as long as the duration of medication is extended, the side effects will be reduced after the medication becomes effective. It is a pity to give up taking medication at the early stage, and it will artificially increase the probability of “refractory depression”. (3) There are many basic clinical approaches to deal with antidepressant side effects, such as gradually increasing the dose of the drug, taking the drug at bedtime, taking the drug after meals, etc. Doctors will give patients a small dose of the drug at the beginning, and then slowly increase the dose of the drug, which can improve the patient’s tolerance of side effects. For drugs that can cause fatigue and drowsiness, such as mirtazapine and paroxetine, the doctor will instruct the patient to take them before bedtime to reduce side effects and help the patient sleep. Also, taking the medication after meals can reduce the gastrointestinal side effects of the drug. (4) For unbearable side effects, you should communicate with your doctor in a timely manner and he or she will reduce the dose or change the type of medication. For example, side effects such as gastrointestinal discomfort should be tolerated by most patients; however, there are some side effects that patients may find intolerable, such as weight gain or drowsiness. If this happens, it is permissible to reduce the dose of the drug or switch to another antidepressant with a different mechanism of action under the guidance of the doctor. (5) Do not discontinue medication because of side effects, but always work with your doctor to develop the next treatment plan. Discontinuing medication without authorization will lead to relapse of depressive symptoms or induce “withdrawal syndrome”. These side effects do not last long and only occur in a small percentage of antidepressants. In fact, the more serious side effect of stopping medication without permission is that the patient lacks the protection of antidepressants and is more likely to have a relapse of the disease in the long run, just like if a diabetic patient stops taking diabetes medication, although there is no withdrawal reaction, the disease will relapse. (6) Need to be alert to rare but serious side effects Although the chance of antidepressants, especially new antidepressants, causing clinically serious adverse events is very small, if very serious side effects occur, such as suicidal tendency, chest pain, difficulty in breathing, swollen lips, and skin lesions, etc., immediate medical attention is needed. 2.Frequently asked questions and answers about antidepressant side effects (1) Can antidepressants lead to addiction or drug dependence? The new antidepressants used in clinical practice do not lead to dependence due to addiction. However, there are still some patients who may experience headache, dizziness, abnormal sensation, nausea, etc. after stopping antidepressants for a long time. This discomfort is not a “dependence” on antidepressants, but a “withdrawal reaction”. Because of the long-term use of drugs, the body has adapted to the drug, once the drug is stopped or the dosage is reduced excessively, this reaction will occur. Therefore, if you reduce the dosage or stop taking the medication because of the fear of “addiction”, it will aggravate the “withdrawal reaction”, which is not good for the treatment. (2) Can antidepressants cause fatigue and drowsiness? What about the decrease in work capacity? Some antidepressants such as mirtazapine, paroxetine, amitriptyline and other drugs have strong sedative effect, so it is easy to get sleepy after taking them, so you can take these drugs before bedtime or reduce the dose. If drowsiness still occurs, you can switch to drugs with less sedative effects such as bupropion, venlafaxine, sertraline, escitalopram, etc. For patients with excessive sleep or fatigue, the doctor may also combine modafinil to improve the patient’s condition. Although antidepressants may cause daytime sleepiness, untreated depression can more greatly affect work efficiency. (3) Can antidepressants make people fat? Some antidepressants can cause patients to gain weight because they increase appetite and affect metabolism. Since many patients have lost their appetite and lost weight during their previous depression, and gained weight after treatment, this is actually a therapeutic effect in a way. For patients who have weight concerns or are at risk for high weight, doctors may recommend that they be put on medications that have less impact on weight gain such as sertraline, bupropion. Medications such as mirtazapine, amitriptyline, and promethazine have more significant weight gain side effects and the doctor will consult with the patient before prescribing the medication to adjust the treatment plan. (4) I am worried that antidepressants will affect my sexual function, what should I do? Sexual dysfunction itself is a symptom of depression, and antidepressants, especially SSRIs, can also cause decreased libido, erectile dysfunction, delayed ejaculation, and so on. Once such problems occur, patients should overcome their shyness and communicate with their doctors, who can switch to drugs that have a mild effect on sexual function, such as bupropion, mirtazapine, nefazodone, etc. But the key to solving this problem is to treat depression thoroughly and promptly to get cured. (5) Is my condition worsening despite taking antidepressants? Because antidepressants take a long time to work, patients do not feel any improvement in symptoms in the early stage of taking them, and there are some side effects, which make patients think that their condition is “worsening”. Some antidepressants, such as fluoxetine and paroxetine, may have activating effects in the early stage of taking, which may manifest as anxiety and agitation symptoms. (6) Other common side effects of antidepressants are: dry mouth, constipation, diarrhea, nausea and other gastrointestinal adverse reactions, headache, dizziness, tremor, hypotension with postural changes, etc. These adverse reactions will generally be alleviated with the time of taking the medication, and very few patients discontinue taking the medication for this reason. Although there are some side effects, most of them will be reduced with the treatment time and can be effectively controlled by various methods. As a patient, if there are concerns about the side effects of the medication, you can communicate with your doctor before using the medication to understand the characteristics of the medication prescribed by your doctor, to understand the causes of the side effects of the medication, and to inform your doctor of your expectations of the treatment effect. For example, there are requirements for weight, the need for sufficient energy for daytime work, or the desire not to affect sexual function. During the course of treatment, patients should also give feedback to the doctor on both their symptom improvement and any discomfort they experience, and discuss further treatment options with the doctor. The doctor will start with a small dose according to the patient’s personal requirements and psychosomatic characteristics, adopt a scientific medication regimen, and promptly adjust the dose and type of medication according to the patient’s feedback during the medication process to ensure the efficacy of the medication while minimizing the side effects. In general, under the benign interaction between patients and doctors, the use of antidepressants is guided by scientific methods and principles, which is more beneficial than harmful for depressed patients.