Editor's Note: We are hearing from different folks that they are being required to quit their doctor prescribed medicine if it is narcotic based or addictive. Unless you have had depression you may not be aware of the side effects of altering your medicine. YOU NEED TO SEE YOUR FAMILY DOCTOR BEFORE YOU ALTER THE MEDICINE YOU ARE TAKING REGARDLESS OF WHETHER OR NOT IT IS NARCOTIC BASED OR CONSIDERED ADDICTIVE.

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Side effects of antidepressant medication

The types of drugs used in the treatment of depression are selective serotonin reuptake inhibitors (SSRIs), “atypical” antidepressants, and the older tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs). Side effects are common in all antidepressants and for many people, the side effects are serious enough to make them stop taking the medication.
Side effects of SSRIs (selective serotonin reuptake inhibitors)

The most widely prescribed antidepressants come from a class of medications known as selective serotonin reuptake inhibitors (SSRIs).
Common side effects of
SSRI antidepressants:

* Nausea
* Insomnia
* Anxiety
* Restlessness
* Decreased sex drive
* Dizziness
* Weight gain or loss
* Tremors
* Sweating
* Sleepiness
* Fatigue
* Dry mouth
* Diarrhea
* Constipation
* Headaches

The SSRIs include:

* Fluoxetine (Prozac)
* Fluvoxamine (Luvox)
* Sertraline (Zoloft)
* Paroxetine (Paxil)
* Escitalopram (Lexapro)
* Citalopram (Celexa)

The SSRIs act on a chemical in the brain called serotonin. Serotonin helps regulate mood, but it also plays a role in digestion, pain, sleep, mental clarity, and other bodily functions. As a result, the SSRI antidepressants cause a wide range of side effects.

Common side effects include sexual problems, drowsiness, sleep difficulties, and nausea. While some side effects go away after the first few weeks of drug treatment, others persist and may even get worse.

In adults over the age of 65, SSRIs pose an additional concern. Studies show that SSRI medications may increase the risk for falls, fractures, and bone loss in older adults. The SSRIs can also cause serious withdrawal symptoms if you stop taking them abruptly.

Antidepressant withdrawal

Once you’ve started taking antidepressants, stopping can be tough; many people have withdrawal symptoms that make it difficult to get off of the medication.

If you decide to stop taking antidepressants, it’s essential to taper off slowly. If you stop abruptly, you may experience a number of unpleasant withdrawal symptoms such as crying spells, extreme restlessness, dizziness, fatigue, and aches and pains. These withdrawal symptoms are known as antidepressant discontinuation syndrome. Antidepressant discontinuation syndrome is especially common when you stop taking Paxil or Zoloft. However, all medications for depression can cause withdrawal symptoms.
Antidepressant withdrawal symptoms

* Anxiety, agitation
* Depression, mood swings
* Flu-like symptoms
* Irritability and aggression
* Insomnia, nightmares
* Nausea and vomiting
* Dizziness, loss of coordination
* Stomach cramping and pain
* Electric shock sensations
* Tremor, muscle spasms

Depression and anxiety are also common symptoms when withdrawing from antidepressants. When depression is a withdrawal symptom, it’s often worse than the original depression that led to drug treatment in the first place. Unfortunately, many people mistake this withdrawal symptom for a return of their depressive illness and resume medication, creating a vicious circle.

In order to avoid antidepressant withdrawal symptoms, never stop your medication “cold turkey.” Instead, gradually taper your dose, allowing for at least 1-2 weeks between each dosage reduction. This tapering process may take up to several months, and should be monitored under a doctor's supervision.
Antidepressants and suicide risk

There is a danger that, in some people, antidepressant treatment will cause an increase, rather than a decrease, in depression. In fact, the U.S. Food and Drug Administration requires that all depression medications include a warning label about the increased risk of suicide in children and young adults. The suicide risk is particularly great during the first month to two months of treatment.

Anyone taking antidepressants should be closely watched for suicidal thoughts and behaviors. Monitoring is especially important if this is the person’s first time on depression medication or if the dose has recently been changed. Signs that medication is making things worse include anxiety, insomnia, hostility, and extreme agitation—particularly if the symptoms appear suddenly or rapidly deteriorate. If you spot the warning signs in yourself or a loved one, contact your doctor or therapist immediately.
Antidepressant warning signs

* Suicidal thoughts or attempts
* New or worse depression
* New or worse anxiety
* Aggression and anger
* Acting on dangerous impulses



* New or worse irritability
* Feeling agitated or restless
* Difficulty sleeping
* Extreme hyperactivity
* Other unusual changes in behavior

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If you use antidepressants

If you decide to take depression medication, it’s prudent to learn all you can about your prescription. The more you know about your antidepressant, the better equipped you’ll be to deal with side effects, avoid dangerous drug interactions, and minimize other safety concerns.

Some suggestions:

* See a psychiatrist, not a family physician. Your family physician might help you or your loved one first realize that you may need depression treatment. But although any medical doctor can prescribe medications, psychiatrists are doctors who specialize in mental health treatment. They are more likely to be familiar with the newest research on antidepressants and any safety concerns. Your health depends on your doctor's expertise, so it's important to choose the physician who is best qualified.
* Be patient. Finding the right drug and dosage is a trial and error process. It takes approximately 4 to 6 weeks for antidepressant medications to reach their full therapeutic effect. Many people try several medications before finding one that helps.
* Monitor side effects – Keep track of any physical and emotional changes you’re experiencing and talk to your doctor about them. Contact your doctor or therapist immediately if your depression gets worse or you experience an increase in suicidal thoughts.
* Don’t stop medication without talking to your doctor – Be sure to take your antidepressant according to the doctor's instructions. Don't skip or alter your dose, and don't stop taking your pills as soon as you begin to feel better. Stopping treatment prematurely is associated with high relapse rates. It can also cause serious withdrawal symptoms.
* Go to therapy – Medication can reduce the symptoms of depression, but it doesn’t treat the underlying problem. Psychotherapy can help you get to the root of your depression, change negative thinking patterns, and learn new ways of coping.

The new group of drugs was initially greeted with optimism by the medical profession, but gradually concerns arose; in particular, the risk of dependence became evident in the 1980s. Benzodiazepines have a unique history in that they were responsible for the largest ever class action lawsuit against drug manufacturers in the United Kingdom, involving 14,000 patients and 1,800 law firms that alleged the manufacturers knew of the dependence potential but intentionally withheld this information from doctors. At the same time, 117 general practitioners and 50 health authorities were sued by patients to recover damages for the harmful effects of dependence and withdrawal. This led some doctors to require a signed consent form from their patients and to recommend that all patients be adequately warned of the risks of dependence and withdrawal before starting treatment with benzodiazepines.[18] The court case against the drug manufacturers never reached a verdict; legal aid had been withdrawn and there were allegations that the consultant psychiatrists, the expert witnesses, had a conflict of interest. This litigation led to changes in the British law, making class action law suits more difficult.[19]

Although antidepressants with anxiolytic properties have been introduced, and there is increasing awareness of the adverse effects of benzodiazepines, prescriptions for short term anxiety relief drugs have not significantly dropped. For treatment of insomnia, benzodiazepines are now less popular than nonbenzodiazepines, which include zolpidem, zaleplon, eszopiclone, and ramelteon.[20] Nonbenzodiazepines are molecularly distinct, but nonetheless, they work on benzodiazepine receptors.[21]

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Seizures

Prolonged convulsive epileptic seizures are a medical emergency that can usually be dealt with effectively by administering fast-acting benzodiazepines, which are potent anticonvulsants. In a hospital environment, intravenous lorazepam and diazepam are first-line choices, with a preference for lorazepam due to its longer duration of action. In the community, intravenous administration is not practical and so rectal diazepam or (more recently) buccal midazolam are used, with a preference for midazolam as its administration is easier and more socially acceptable.[40][41]

When benzodiazepines were first introduced, they were enthusiastically adopted for treating all forms of epilepsy. However, drowsiness and tolerance become problems with continued use and none are now considered first-line choices for long-term epilepsy therapy.[42] Clobazam is widely used by specialist epilepsy clinics worldwide (but it is not available in the US) and clonazepam is popular in France.[42] In the UK, both clobazam and clonazepam are second-line choices for treating many forms of epilepsy.[43] Clobazam also has a useful role for very short-term seizure prophylaxis and in catamenial epilepsy.[42] Discontinuation after long term use in epilepsy requires additional caution because of the risks of rebound seizures. Therefore, the dose is slowly tapered over a period of up to six months or longer.[41]

Side effects
See also: Long-term effects of benzodiazepines and Paradoxical reaction#Benzodiazepines

The most common side effects of benzodiazepines are related to their sedating and muscle-relaxing action. They include drowsiness, dizziness and decreased alertness and concentration. Lack of coordination may result in ataxia, falls and injuries, particularly in the elderly.[55][56] Another result is impairment of driving skills and increased risk of road traffic accidents.[57][58] Decreased libido and erection problems are a common side effect. Depression and disinhibition may emerge. Hypotension and suppressed breathing may be encountered with intravenous use.[55][56] Less common side effects include nausea and changes in appetite, blurred vision, confusion, euphoria, depersonalization and nightmares. Cases of liver toxicity have been described but are very rare.[22]:183–189[59]
[edit] Paradoxical effects

Paradoxical reactions, such as aggression, violence, impulsivity, irritability and suicidal behavior sometimes occur. These reactions have been explained as consequences of disinhibition, that is loss of control over socially unacceptable behavior. Paradoxical reactions are rare in the general population, with an incidence rate below 1% and similar to placebo. [60] However, they occur with greater frequency in recreational abusers, individuals with borderline personality disorder, children and patients on high-dosage regimes.[61][62] In these groups, impulse control problems are perhaps the most important risk factor for disinhibition; learning disabilities and neurological disorders are also significant risks. Most reports of disinhibition involve high doses of high-potency benzodiazepines.[60] Paradoxical effects may only appear after chronic use of benzodiazepines.[63]
[edit] Cognitive effects

The short-term use of benzodiazepines adversely affects multiple areas of cognition; most notably, it interferes with the formation and consolidation of memories of new material and may induce complete anterograde amnesia.[55] However, researchers hold contrary opinions regarding the effects of long-term administration. One view is that many of the short-term effects continue into the long-term and may even worsen, and are not resolved after quitting benzodiazepines. Another view maintains that cognitive deficits in chronic benzodiazepine users occur only for a short period after the dose, or that the anxiety disorders is the cause of these deficits. While the definitive studies are lacking, the former view recently received support from a meta-analysis of 13 small studies.[64][65] This meta-analysis found that long-term use of benzodiazepines was associated with moderate to large adverse effects on all areas of cognition, with visuospatial memory being the most commonly detected impairment. Some of the other impairments reported were decreased IQ, visiomotor coordination, information processing, verbal learning and concentration. The authors of the meta-analysis[64] and a later reviewer[65] noted that the applicability of this meta-analysis is limited because the subjects were taken mostly from withdrawal clinics, the coexisting drug, alcohol use and psychiatric disorders were not defined, and several of the included studies conducted the cognitive measurements during the withdrawal period.

Benzodiazepines have a reputation with patients and doctors for causing a severe and traumatic withdrawal; however, this is in large part due to the withdrawal process being poorly managed. Over-rapid withdrawal from benzodiazepines increases the severity of the withdrawal syndrome and increases the failure rate. A slow and gradual withdrawal customised to the individual and, if indicated, psychological support is the most effective way of managing the withdrawal. Opinion as to the time needed to complete withdrawal ranges from four weeks to several years. A goal of less than six months has been suggested, but due to factors such as dosage and type of benzodiazepine, reasons for prescription, lifestyle, personality, environmental stresses and amount of available support, a year or more may be needed to withdraw. [22]:183–184 Withdrawal is best managed by transferring the physically-dependent patient to an equivalent dose of diazepam because it has the longest half-life of all of the benzodiazepines, is metabolised into long acting active metabolites and is available in low-potency tablets, which can be quartered for smaller doses.[74] A further benefit is that it is available in liquid form which allows for even smaller reductions. Chlordiazepoxide which also has a long half life and long acting active metabolites can be used as an alternative.[74][75] Nonbenzodiazepines are contraindicated during benzodiazepine withdrawal as they are cross tolerant with benzodiazepines and can induce dependence. Alcohol is also cross tolerant with benzodiazepines and more toxic and thus caution is needed to avoid replacing one dependence with another. Fluoroquinolone antibiotics if possible are best avoided during withdrawal; they displace benzodiazepines from their binding site and reduce GABA function and thus may aggravate withdrawal symptoms.[74] Antipsychotics are not recommended for benzodiazepine withdrawal (or other CNS depressant withdrawal states) especially clozapine, olanzapine or low potency phenothiazines eg chlorpromazine as they lower the seizure threshold and can worsen withdrawal effects; if used extreme caution is required.[76]

Withdrawal from long term benzodiazepines is benefitial for most individuals.[63] Withdrawal of benzodiazepines from long term users generally leads to improved physical and mental health particularly in the elderly; however, some long term users report continued benefit from taking benzodiazepines, but this may be the result of suppression of withdrawal effects.