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What are the risks of antidepressants?

Antidepressants can have rare but serious side effects. It’s important to understand these risks before taking antidepressants and to contact your psychiatric provider immediately if you experience any of these serious side effects while taking antidepressants.

The FDA has issued a black box warning for SSRIs and similar medications. These medications may increase suicidal thoughts or behavior, particularly in people aged 24 or younger. Watch out for worsening mood, behavior, or suicidal thoughts, especially during the first few months of treatment. Seek help right away if you experience any of these changes. If you are ever in crisis, dial 988 or visit your nearest emergency department. You can also text ‘HOME’ to 741-741 to connect immediately with a free and confidential counselor.

Serotonin Syndrome is a rare but life-threatening condition where there is too much serotonin active in the brain. Symptoms include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. Do not take MAOIs, TCAs, St. John’s Wort, amphetamines, sumatriptan, or linezolid with SSRIs. See a Primary Care Provider right away if you experience any of these symptoms while taking your medication.

The risk of gastrointestinal bleeding may be increased when SSRIs are combined with non-steroidal anti-inflammatory drugs (NSAIDs). Common NSAIDs include aspirin, ibuprofen (Advil), naproxen (Aleve), and celecoxib (Celebrex).

Depressive symptoms can occasionally be the first manifestation of the up-and-down cycle between depression and mania in bipolar disorder. If you experience symptoms of mania, such as feeling so good or so hyper that people think you are not acting like your normal self, that you don’t need to sleep very much, or that thoughts race through your head and you can’t slow your mind down, you should talk to your Provider immediately.

SSRIs may be associated with an increased risk of birth defects. If you are pregnant, planning to get pregnant, or breastfeeding, consult your Provider about weighing the risks and benefits of taking antidepressants.

Some antidepressants may impair your ability to perform tasks requiring judgment or motor and cognitive skills. Exercise caution and refrain from dangerous activities, especially when starting your medication.

Hyponatremia (low levels of sodium in the blood) may occur as a result of treatment. Symptoms include mental changes, headache, nausea and vomiting, muscle spasms, and seizures. See a Provider right away if you experience any of these symptoms while taking your medication.

Taking SSRIs can cause mild pupillary dilation, which in susceptible individuals, can lead to an episode of angle closure glaucoma. Patients may wish to be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure (e.g., iridectomy), if they are susceptible.


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