Category: Antidepressants

Antidepressants

Antidepressants

Psychiatry

Antidepressants

What are antidepressants?

Antidepressants are a group of medications which are used to treat depression. They have been available in the market for many decades and new research has lead to more molecules coming to the market for treatment.

How do antidepressants work?

Antidepressants work on certain chemicals in the brain called neurotransmitters thereby helping people suffering from depression.

What are the types of antidepressants?

There are many anti depressants available in the market and they can broadly be divided into the following groups depending upon the chemical it works in the brain

  1. Serotonin specific reuptake inhibitors (SSRI) : fluoxetine, sertraline, citalopram, escitalopram, fluvoxamine and paroxetine
  2. Serotonin and nor adrenaline reuptake inhibitors ( SNRI ) : venlafaxin, des –venlafaxin, duloxetine, milnacipran
  3. Tricyclic antidepressants (TCA): Imipramine, amitryptlyine, doxepin
  4. Monoamine inhibitors:   used very infrequently
  5. Nor adrenalin and serotonin specific re uptake inhibitors  ( NASSA) : mirtazapine

What are the side effects of antidepressants?

The side effects of anti depressants depend upon the group of medication used.

Some of the common side effects are as follows

1. SSRI:  SSRI can cause nausea, vomiting, gastritis, diarrhea, increased sweating, headache, sleep disturbances and at times anxiety.  These side effects normally occur during the initial stages of treatment and most of them subside after a few days. Other side effects like sexual dysfunction and low sodium level can also occur. Contact your doctor if the side effects occur.

For a complete list of side effects consult your doctor, pharmacology books or the literature given along with the medication.

2. SNRI:  It can cause nausea, sleep disturbances, increased sweating, headache, sexual dysfunction and constipation.  Blood pressure can be elevated at higher doses and hence blood pressure must be checked regularly ( venlafaxin)

For a complete list of side effects consult your doctor, pharmacology books or the literature given along with the medication.

3. Tricyclic antidepressants:  Some of the side effects caused by tricyclic anti depressants  are sedation, dry mouth, constipation, blurred vision and a drop in blood pressure .( postural hypotension ) .  

For a complete list of side effects consult your doctor, pharmacology books or the literature given along with the medication.

4. NASSA:  some of the side effects caused by mirtazapine are sedation, increased appetite, weight gain, and headache. 

For a complete list of side effects consult your doctor, pharmacology books or the literature given along with the medication.

POINT TO NOTE:  All medications given in allopathy have side effects it does not mean you will certainly get the side effects. Always the side effect profile should be weighed with the therapeutic benefit.  Most side effects can be treated and are not long lasting.  

How long does the antidepressant take to start working?

Earlier it was commonly believed that antidepressant starts to work after about 2 weeks. However new research shows that the antidepressant effect can start much earlier and even within one week.

How long should a person take antidepressants?

An untreated episode of depression normally lasts for 8-12 months. Hence antidepressants are normally continued for 6 months after you feel better and then gradually stopped.

Are antidepressants addictive?

Anti depressant drugs do not cause addictions like how nicotine, sleeping tablets and alcohol cause. You will not have to go on increasing the dosage to get the desired effect and once the medication has been stopped you will not having craving for the medications.

Some of the antidepressants can cause withdrawal symptoms if stopped abruptly and hence it must be gradually reduced and stopped.

How should I take antidepressants?

Anti depressants is usually started on a low dosage and gradually increased to the optimum dosage depending upon the response the patient has. It is usually increased once in two weeks and hence you should see the psychiatrist once in two weeks for an assessment until you stabilize. DO NOT INCREASE THE DOSAGE BY YOURSELF WITHOUT THE CONSULTATION OF THE DOCTOR.

If you get any side effects it will wear off after a few days, persist with the medication and consult your psychiatrist about the side effects.

Antidepressant should be taken everyday otherwise it will not work.

It is advisable not to drink alcohol along with the antidepressant.

When you are unwell it is advisable for some responsible person to administer the medication. Once you have shown significant improvement you can take over the responsibility of taking your medications. 

Keep them out of reach from children.

Overdose of anti depressant can be dangerous consult your doctor immediately.

Can I drive when on anti depressants?

Some of the anti depressants can be sedative and make you drowsy and hence it is advisable not to drive when you are drowsy. 

Will my depression come back?

For some people depression can come back and hence will have to take medications for a longer period of time.  Such people who get multiple episodes suffer from recurrent depressive disorder and other medication like lithium will be added to their antidepressant.  In addition to medications talk therapy like cognitive behaviour therapy will help patients.

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The Antidepressant Moclobemide

The Antidepressant Moclobemide

Psychiatry

The Antidepressant Moclobemide

PATIENT INFORMATION ON THE ANTIDEPRESSANT MOCLOBEMIDE

The name of your medication is moclobemide. It belongs to a class of antidepressants called RIMA (Reversible Inhibitor of Monoamine Oxidize-A).

Use

Moclobemide is primarily used in the treatment of major depressive disorders and depression associated with Manic Depressive Illness (Bipolar Disorder). It has also been approved in the management of chronic dysthymia. Though not approved for these indications, moclobomide has also been found effective for seasonal affective disorder and social phobia.

How quickly will the drug start working?

Moclobemide begins to improve sleep and appetite and to increase energy within about one week; however, feelings of depression may take from 4-6 weeks to improve. Because antidepressants take time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor. Improvement in symptoms of seasonal affective disorder and social phobia also occur gradually. 

When should I take this medication?

Moclobemide is usually prescribed to be taken twice daily , morning and evening. Take this drug after meals to minimize side effects. If a meal is missed, the drug should still be taken, but a large meal should not be eaten for at least 1 hour.

How long should you take this medication?

Following the first episode of depression it is recommended that antidepressants be continued for a minimum of 1 year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms of depression; if none occur, the drug can gradually be stopped. For individuals who have had several episode of depression, antidepressant medication should be continued indefinitely. Long-term treatment is generally recommended for social phobia; while cyclical therapy may be effective for seasonal affective disorder.

Side effects 

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Energizing/agitated feeling-Some individuals may fell nervous or have difficulty sleeping for a few days after starting this medication . Report this to your doctor; he/she may advise you to take the medication in the morning and afternoon (rather than the evening).
  • Headache-This can be managed by taking analgesics (e. g., aspirin, acetaminophen) as required. If the headache persists or is “troubling” contact your doctor.
  • Dizziness-Get up from a lying or sitting position slowly; dangle your legs over the edge of the bed for a few minutes before getting up. Sit or lie down if dizziness persists or if you feel faint,-then call the doctor.
  • Nausea or heartburn—if this happens, take the medication with food.
  • Sweating—You may sweat more than usual; frequent showering, used of deodorants and talcum powder may help.
  • Rare side effects you should report your doctor IMMEDIATELY include:
  • Persistent, throbbing headache
  • Soreness of the mouth, gums, or throat
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Yellow tinge in the eyes or to the skin; dark-colored urine
  • Severe agitation or restlessness
  • Switch in mood to an unusual state of happiness, excitement, irritability, or a marked disturbance in sleep

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

Treatment with moclobemide does Not require special diet restrictions as with other MAOI’s. However, you should avoid eating excessive amounts of aged, overripe cheeses or yeast extracts. If a hypertensive reaction should occur, the symptoms usually come on suddenly, so be alert for these signs:

  • Severe, throbbing headache which starts at the back of the head and radiates forward. Often the headache is accompanied by nausea and vomiting
  • Neck stiffness
  • Heart palpitations, fast heart beat, chest pain
  • Sweating , cold and clammy skin
  • Enlarged (dilated)pupils of the eyes
  • Sudden unexplained nose bleeds 

If a combination of these symptoms dose occur, contact your doctor IMMEDIATELY ; if you are unable to do so, go to the Emergency Department of your nearest hospital.

Moclobemide should always be taken after meals to avoid any food-related side effects(e. g., headaches).

What should you do if you forget to take a dose of your medication?

If you take your total dose of antidepressant in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because antidepressant drugs can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the -counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking an antidepressant drug.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. Do not stop your drug suddenly as this may result in withdrawal symptoms such as muscle aches, chills, tingling in your hands or feet, nausea, vomiting, and dizziness.
  3. Report any changes in mood or behavior to your physician.
  4. This drug may interact with medication prescribed by your dentist, so let him/ her know the name of the drug you are taking.
  5. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse.

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The Antidepressant Bupropion

The Antidepressant Bupropion

Psychiatry

Patient Information On The Antidepresant Bupropion

PATIENT INFORMATION ON THE ANTIDEPRESANT BUPROPION

The name of your medication is Bupropion. It belongs to a class of antidepressants called Selective Dopamine Reuptake Inhibitors (SDRI).

Use

Bupropion is primarily used in the treatment of major depressive disorders and depression associated with Manic Depressive Illness (Bipolar Disorder ). It has also been approved in the management of smoking cessation.

Though not approved for this indication, bupropion has also been found useful in children with Attention Deficit Hyperactivity Disorder.

How quickly will the drug start working?

Bupropion is prescribed twice a day, morning and evening. It begins to improve sleep and appetite and to increase energy within about one week; however, feelings of depression may take from 4-6 weeks to improve. Because antidepressants take time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor. Improvement in smoking cessation/ withdrawal also occurs over a period of 6 weeks.

How long should you take this medication?

Following the first episode of depression it is recommended that antidepressants be continued for a minimum of one year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms of depression; if none occur, the drug can gradually be stopped.

For individuals; who have had several episodes of depression, antidepressant medication should be continued indefinitely.

Use of bupropion for smoking cessation is recommended as a one-time treatment for a period of 6 weeks.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Energizing/ agitated feeling—Some individuals may feel nervous or have difficulty sleeping for a few days after starting this medication. Report this to your doctor; he/she may advise you to take the medication in the morning.
  • Vivid dreams or nightmares—This can occur at the start of treatment.
  • Headache– This can be managed by taking analgesics (e.g.,paracetamol, aspirin, acetaminophen) as required. If the headache persists or is “ troubling” contact your doctor.
  • Muscle tremor, twitching—Speak to your doctor as this may require an adjustment in your dosage.
  • Nausea or heartburn—if this happens, take the medication with food.
  • Loss of appetite.
  • Dry mouth—Sour candy and sugarless gum help increase saliva in your mouth; try to avoid sweet, calorie-laden beverages. Drink water and brush your teeth regularly.
  • Sweating—You may sweat more than usual; frequent showering, use of deodorants and talcum powder may help.
  • Blood pressure—A slight increase in blood pressure can occur with this drug. If you are taking medication for high blood pressure, tell doctor, as this medication may have to be adjusted.

Rare side effects you should report your doctor IMMEDIATELY include:

  • Persistent, troubling headache
  • Seizures; these usually occur with high doses
  • Soreness of the mouth, gums, or throat
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Yellow tinge in the eyes or to the skin; dark-colored urine
  • Tingling in the hands and feet, severe muscle twitching
  • Severe agitation or restlessness
  • Switch in mood to an unusual state of happiness, excitement, irritability, or a marked disturbance in sleep

Let your doctor know as soon possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you forget to take the morning dose of antidepressant by more than 4 hours, skip the missed dose and continue with your schedule for the evening dose. DO NOT DOUBLE THE DOSE as seizures may occur.

Interactions with other medication

Because antidepressant drugs can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking an antidepressant drug.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. Do not stop your drug suddenly as this may result in withdrawal symptoms such as muscle aches, chills, tingling in your hands or feet, nausea, vomiting, and dizziness.
  3. Report any changes in mood or behavior to your physician.
  4. This drug may interact with medication prescribed by your dentist, so let him/her know the name of the drug you are taking.
  5. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse.

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Antagonist/Reuptake Inhibitor (SARI)

Antagonist/Reuptake Inhibitor (SARI)

Psychiatry

Antagonist/Reuptake Inhibitor (SARI)

PATIENT INFORMATION ON SEROTONIN-2 ANTAGONIST/REUPTAKE INHIBITOR (SARI) 

ANTIDEPRESSANTS

The name of your medication is nefazodone / trazodone

Use

SARI antidepressants are used in the treatment of Major Depressive Disorder and depression associated with Manic Depressive Illness (Bipolar Disorder). These drugs have also been found effective in several other disorders including dysthymia, premenstrual dysphoria or depression and impulsive behavior, though they are currently not approved for these indications.

How quickly will the drug start working?

Antidepressants begin to improve sleep and appetite and to increase energy within about one week; however, feelings of depression may take from 4-6 weeks to improve. Because antidepressants take time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor. Improvement in symptoms of premenstrual dysphoria or impulsive behavior also occur gradually. 

How long should you take this medication?

Following the first episode of depression it is recommended that antidepressants be continued for a minimum of one year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms of depression; if none occur, the drug can gradually be stopped. For individuals who have had several episodes of depression, antidepressant medication should be continued indefinitely.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed . If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Drowsiness and lethargy— this problem goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Energizing/agitated feeling-Some individuals may feel nervous or have difficulty sleeping for a few days after starting this medication.
  • Headache-This tends to be temporary and can be managed by taking analgesics (paracetamol, aspirin, acetaminophen) when required.
  • Muscle tremor, twitching-Speak to your doctor as this may require an adjustment in your dosage.
  • Changes in sex drive or sexual performance-Though rare, should this problem occur, discuss it with your doctor.
  • Dry mouth-Sour candy and sugarless gum help increase saliva in your mouth; try to avoid sweet, calorie-laden beverages. Drink water and brush your teeth regularly.
  • Loss of appetite.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Soreness of the mouth, gums, or throat
  • Skin rash or itching, swelling of the face
  • Any unusual bruising or bleeding
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Yellow tinge in the eyes or to the skin; dark-colored urine
  • Tingling in the hands and feet, severe muscle twitching
  • Severe agitation or restlessness
  • Switch in mood to an unusual state of happiness, excitement, irritability , or a marked disturbance in sleep

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of antidepressant in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because SARI antidepressant drugs can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking an antidepressant drug.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. Take your drug with meals or with water, milk , orange or apple juice; avoid grapefruit juice as it may interfere with the effect of the drug.
  3. This drug may impair the mental and physical abilities required for driving a car or operating machinery. Avoid these activities if you feel drowsy or slowed down.
  4. This drug may increase the effects of alcohol, making you more sleepy, dizzy and lightheaded.
  5. Do not stop your drug suddenly as this may result in withdrawal symptoms such as muscle aches, aches, chills, tingling in your hands or feet, nausea, vomiting, and dizziness.
  6. Report any changes in mood or behavior to your physician.
  7. This drug may interact with medication prescribed by your dentist, so let him/ her know the name of the drug you are taking.
  8. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse.

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Cyclic Antidepressants

Cyclic Antidepressants

Psychiatry

Cyclic Antidepressants

PATIENT INFORMATION ON CYCLIC ANTIDEPRESSANTS

The name of your medication is amitriptyline, imipramine,clomipramine etc.

Use

Cyclic antidepressants are primarily used in the treatment of major depressive disorders and depression associated with Manic Depressive Illness (Bipolar Disorder).

Certain drugs in this class have also been found effective in several other disorders including obsessive compulsive disorder, panic disorder, bulimia, management of chronic pain conditions (e. g., migraines) and enuresis in children.

How quickly will the drug start working?

Antidepressants begin to improve sleep and appetite and to increase energy within about one week; however, feelings of depression may take from 4 to 6 weeks to improve. Because antidepressants take time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor.

Improvement in symptoms of obsessive compulsive disorder, panic disorder and bulimia, pain management and enuresis also occur gradually.

How long should you take this medication?

Following the first episode of depression it is recommended that antidepressants be continued for a minimum of one year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms of depression; if none had several episodes of depression, antidepressant medication should be continued indefinitely.

For individuals who have had several episodes of depression, antidepressant medication should be continued indefinitely.

Long-term treatment is generally recommended for obsessive compulsive disorder, panic disorder, bulimia, pain management and enuresis.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Drowsiness and lethargy-This problem goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Energizing/agitated feeling-Some individuals may feel nervous or have difficulty sleeping for a few days after starting this medication. Report this to your doctor; he/she may advise you to take the medication in the morning.
  • Blurred vision-This usually occurs at the start of treatment and tends to be temporary. Reading under a bright light or at a distance may help; a magnifying glass can be of temporary use. If the problem continues, advise your doctor.
  • Dry mouth-Sour candy and sugarless gum help increase saliva in your mouth; try to avoid sweet, calorie-laden beverages. Drink water and brush your teeth regularly.
  • Constipation-Increase bulk foods in your diet(e.g., salads, bran) and drink plenty of fluids. Some individuals find a bulk laxative (e.g., isapgul) or a stool softener helps regulate their bowels. If these remedies are not effective, consult your doctor or pharmacist.
  • Headache-This tends to be temporary and can be managed by taking analgesics ( Paracetamol, aspirin, acetaminophen) when required.
  • Nausea or heartburn-If this happens, take the medication with food. 
  • Dizziness- Get up from a lying or sitting position slowly; dangle your legs over the edge of the bed for a few minutes before getting up. Sit or lie down if dizziness persists or if you feel faint, then contact your doctor.
  • Sweating You may sweat more than usual; frequent showering, use of deodorants and talcum powder may help.
  • Muscle tremor, twitching- Speak to your doctor as this may require an adjustment in your dosage.
  • Changes in sex drive or sexual performance-Discuss this with your doctor.
  • Nightmares- Can is managed by changing the dosing schedule.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Soreness of the mouth, gums, or throat
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Yellow tinge in the eyes or to the skin; dark-colored urine
  • Inability’ to pass urine (more than 24 hours)
  • Inability to have a bowel movement (more than 2-3 days)
  • Tingling in the hands and feet, severe muscle twitching
  • Severe agitation or restlessness
  • Switch in mood to an unusual state of happiness, excitement, irritability, or a marked disturbance in sleep

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of antidepressant in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because antidepressant drugs can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking an antidepressant drug.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. Take your drug with meals or with water, milk orange or apple juice; avoid grapefruit juice as it may interfere with the effect of the drug.
  3. This drug may impair the mental and physical abilities required for driving a car or operating machinery. Avoid these activities if you feel drowsy or slowed down.
  4. This drug may increase the effects of alcohol, making you more sleepy, dizzy and lightheaded.
  5. Avoid exposure to extreme heat and humidity since this drug may affect your body’s ability to regulate temperature.
  6. Do not stop your drug suddenly as this may result in withdrawal symptoms such as muscle aches, chills, tingling in your hands or feet, nausea, vomiting, and dizziness.
  7. Report any changes in mood or behavior to your physician.
  8. This drug may interact with medication prescribed by your dentist, so let him/her know the name of the drug you are taking.
  9. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children. 

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse.

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The Antidepressant Venlafaxine

The Antidepressant Venlafaxine

Psychiatry

The Antidepressant Venlafaxine

PATIENT INFORMATION ON THE ANTIDEPRESSANT VENLAFAXINE

The name of your medication is venlafaxine. It belongs to a class of antidepressants called Selective Serotonin and Nor epinephrine Reuptake Inhibitors (SNRI).

Use

Venlafaxine is primarily used in the treatment of major depressive disorders and depression associated with Manic Depressive Illness (Bipolar Disorder ).

Though not approved for these indications, venlafaxine has also been found effective in several other disorders including obsessive compulsive disorder, panic disorder, social phobia, and in children with Attention Deficit Hyperactivity Disorder. 

How quickly will the drug start working?

Venlafaxine begins to improve sleep and appetite and to increase energy within about one week; however, feelings of depression may take from 4 to 6 weeks to improve. Because antidepressants take time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor.

Improvement in symptoms of obsessive compulsive disorder, panic disorder and social phobia also occur gradually over several weeks.

How long should you take this medication?

Following the first episode of depression it is recommended that antidepressants be continued for a minimum of one year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms of depression; if none occur, the drug can gradually be stopped. For individuals who have had several episodes of depression, antidepressant medication should be continued indefinitely. Long-term treatment is generally recommended for obsessive compulsive disorder, panic disorder, and social phobia.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Energizing/ agitated feeling—Some individuals may feel nervous or have difficulty sleeping for a few days after starting this medication. Report this to your doctor; he/ she may advise you to take the medications in the morning.
  • Headache—This can be managed by taking analgesics (e.g.,paracetamol, aspirin, acetaminophen) as required . If the headache persists or is “troubling” contact your doctor.
  • Nausea or heartburn—If this happens, take the medication with food.
  • Dry mouth—Sour candy and sugarless gum help increase saliva in your mouth; try to avoid sweet, calorie- laden beverages. Drink water and brush your teeth regularly.
  • Constipation—Increase bulk foods in your diet (e.g., salads, bran) and drink plenty of fluids. Some individuals find a bulk laxative (e . g., isapgul) or a stool softener helps regulate their bowels. If these remedies are not effective, consult your doctor or pharmacist.
  • Sweating—You may sweat more than usual; frequent showering, use of deodorants and talcum powder may help.
  • Blood pressure—A slight increase in blood pressure can occur with this drug . If you are taking medication for high blood pressure, tell your doctor, as this medication may have to be adjusted.
  • Changes in sex drive or sexual performance- – Discuss this with your doctor.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Persistent, troubling headache
  • Soreness of the mouth , gums, or throat
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Yellow tinge in the eyes or to the skin; dark-colored urine
  • Tingling in the hands and feet, severe muscle twitching
  • Severe agitation or restlessness
  • Switch in mood to an unusual state of happiness, excitement, irritability, or a marked disturbance in sleep

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of antidepressant in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed does when you remember, then continue with your regular schedule.

Interactions with other medication

Because antidepressant drugs can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking an antidepressant drug.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. This drug may impair the mental and physical abilities required for driving a car or operating machinery. Avoid these activities if you feel drowsy or slowed down.
  3. This drug may increase the effects of alcohol, making you more sleepy, dizzy and lightheaded.
  4. Do not stop your drug suddenly as this may result in withdrawal symptoms such as muscle aches, chills , tingling in your hands or feet, nausea, vomiting, and dizziness.
  5. Report any changes in mood or behavior to your physician
  6. This drug may interact with medication prescribed by your dentist, so let him/her know the name of the drug you are taking.
  7. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse.

Medical Specialists

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