Depression Series (Part 3): What to Do with Those Antidepressant Side Effects? by Michael G. Rayel, MD

Tricyclic antidepressants (TCA e.g. amitriptyline) are notorious for causing dry mouth. Why? These drugs have distressing anticholinergic side effects. Avoid this type of drugs. If TCA is still considered, talk about the use of desipramine or nortriptyline. Compared to other TCAs, these two drugs have less anticholinergic effects.

Moreover, try ice chips. Frequent sips of water should also help. To avoid dental cavities, try sugarless candy or sugar-free gum.

Constipation

Like dry mouth, constipation is usually caused by TCAs. To prevent it from happening, drink enough water and eat high fiber foods such as vegetables and fruits. Consider stool softeners if the above interventions fail. If possible, avoid TCAs.

Nausea and vomiting

Patience is the key in dealing with these side effects. Frequently, patients develop tolerance within two weeks. Take the medication with food. If ineffective, talk to your doctor about possibly reducing the dose of your medication or trying antacid or bismuth salicylate (Pepto-Bismol)

Memory lapses

If given permission by your doctor, try to reduce the dose. Also, discuss with your physician about switching antidepressant (especially if dose reduction doesn’t alleviate your concern) and avoiding drugs with anticholinergic side effects.

Moreover, don’t mix the antidepressant with alcohol. The alcohol-drug interaction can only worsen the memory and cognitive functioning. While on psychotropic drugs, be careful driving and using mechanized equipment.

Dizziness

While still in bed, sit up for 30 seconds, then stand up for another 30 seconds while holding a rail, a table, or a chair before walking. Take the medication at bedtime. Some people use support hose with success.

Agitation or anxiety

Some people benefit from a brief use of benzodiazepine such as lorazepam. Breathing exercises and progressive muscle relaxation should also help.

In general, some side effects such as gastrointestinal upset and insomnia may resolve in a few days. Patience is the key. However, be on guard. When they occur, address them promptly. I’m not however suggesting that you should be your own doctor.

Collaborating with your doctor is an effective way to cope with mental illness and medication problems. Treatment options such as the need to switch or reduce medications should be discussed in an open and accepting manner.

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BIO:

Copyright © 2003. All rights reserved. Dr. Michael G. Rayel – author (First Aid to Mental Illness–Finalist, Reader’s Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Through the CARE approach, Dr. Rayel helps individuals recognize the early signs of mental illness and provide early intervention. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores

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