Safety concerns

Here are some issues to consider before taking a cyclic antidepressant:

  • Antidepressants and pregnancy. Some antidepressants may harm your child if you take them during pregnancy or while you're breast-feeding. If you're taking an antidepressant and considering getting pregnant, talk to your doctor or mental health provider about the possible dangers. Don't stop taking your medication without contacting your doctor first.
  • Drug interactions. When taking an antidepressant, be sure to tell your doctor about any other medications or dietary supplements you're taking. Some antidepressants can cause dangerous reactions when combined with certain medications or herbal remedies.
  • Serotonin syndrome. Rarely, a cyclic antidepressant can cause dangerously high levels of serotonin. This is known as serotonin syndrome. It most often occurs when two medications that raise serotonin are combined. These include other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort. Signs and symptoms of serotonin syndrome include anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination and rapid heart rate. Seek immediate medical attention if you have any of these symptoms.
  • Safety and blood tests. High doses of tricyclic antidepressants can cause serious health problems. You may need periodic blood tests to check levels of a tricyclic antidepressant in your bloodstream, particularly if you're taking a high dose.
  • Chronic health conditions. Cyclic antidepressants can cause problems in people with certain health conditions. For example, if you have narrow-angle glaucoma, an enlarged prostate, heart problems, liver disease or a history of seizures, talk to your doctor about whether a tricyclic antidepressant is a safe choice for you.
  • Blood sugar and diabetes. Cyclic antidepressants may increase appetite, leading to weight gain — which can affect blood sugar levels, especially in people who have diabetes.
  • Drowsiness. Cyclic antidepressants can make you drowsy and may reduce your ability to drive or use machinery safely. Taking these medications at bedtime may help.

Suicide risk and antidepressants

Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Stopping treatment with cyclic antidepressants

Cyclic antidepressants aren't considered addictive, but sometimes physical dependence, which is different from addiction, can occur. So stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms. This is sometimes called discontinuation syndrome. Work with your doctor to gradually and safely decrease your dose.

Withdrawal-like signs and symptoms can include:

  • Nausea and vomiting
  • Sweating
  • Flu-like symptoms
  • Lethargy
  • Headache
  • Dizziness
  • Muscle cramping
  • Irregular or rapid heartbeat

Finding the right antidepressant

Each person may react differently to a particular antidepressant and may be more susceptible to certain side effects. Because of this, one antidepressant may work better for you than another, or your doctor may prescribe a combination.

When choosing an antidepressant, your doctor will take into account your symptoms, your health problems, other medications you take, what's worked for you in the past and what's worked for a close relative with depression.

Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of special blood tests may offer clues about how your body may respond to a particular antidepressant. The study of how genes affect a person's response to drugs is called pharmacogenomics. However, other variables besides genetics can affect your response to medication.

Typically, it may take several weeks or longer before an antidepressant is fully effective and for initial side effects to ease up. You may need to try several antidepressants before you find the right one, but hang in there. With patience, you and your doctor can find a medication that works well for you.

July 19, 2013 See more In-depth