Antidepressant

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• QWhat are the side effects of SSNRIs in people with multiple sclerosis (MS)?

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  A Multiple Sclerosis Foundation answered

  Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) include Effexor (venlafaxine) and Cymbalta (duloxetine). Data suggests that these products may be more effective in treating multiple sclerosis (MS)-related severe depression and depression resistant to other medications than the selective serotonin reuptake inhibitors (SSRI) antidepressants and tricyclic antidepressants.

  The most common adverse effects associated with SSNRIs include changes in appetite, weight and sleep; drowsiness, dizziness, fatigue, headache, nausea and vomiting, and sexual dysfunction. Generally, sexual dysfunction is milder with the SSNRIs compared to the SSRIs.

• QWhat is the dosage for Cymbalta and what are its side effects?

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  A Discovery Health answered

  The recommended daily dose for Cymbalta is 60 mg one time a day. Some individuals experience intense nausea in which case the dosage may be divided into two smaller doses of 30 mg each, taken twice a day. Cymbalta is taken in the form of a capsule and may be ingested with or without food.
  The most common side effect of Cymbalta is nausea. This nausea usually subsides in one to three weeks. Additional side effects may include constipation, decreased appetite, difficulty urinating or increased urination, dizziness, drowsiness, dry mouth, heartburn, insomnia and sweating. Men, and women to a lesser extent, using Cymbalta may experience sexual dysfunction.
  Cymbalta may increase thoughts of suicide, as with many antidepressants, when the drug is first started, especially in young adults. When beginning to take Cymbalta, indidividuals should alert a medical professional right away if significant changes in mood or behavior are experienced, particularly thoughts of suicide.
  Inform your doctor of any other medications you are currently taking. For example, if you are on taking any medication containing MAOIs or thioridazine, do not take Cymbalta. If you suffer from glaucoma, you should look for alternate medications since Cymbalta may worsen this condition.
  Some of the more serious side effects of Cymbalta that signal that the drug is adversely effectly your liver include yellow skin or eyes, pain in the upper belly area, or dark urine.
  When you stop taking Cymbalta, you may experience nausea, headache and dizziness.
• QWhat should I know about antidepressants before I take them?

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  A Dr. John Preston, PsyD , Psychology, answered

  There are many different types of antidepressants on the market. If you decide to use prescription medication, it’s important that you work with your medical provider to find the right medication, or combination of medications, and the right dosage for yourself. Report any symptoms or troubling side effects in detail to your medical provider, and be aware that most antidepressants can take between two to six weeks to work. Also bear in mind that about 25% of those who ultimately have a good response to antidepressants require eight to ten weeks of treatment before their symptoms go away. If you don’t immediately feel better, be sure that you’ve given the medication enough time to have an effect. It’s also important to never stop taking your medications suddenly, as this may cause withdrawal symptoms or trigger the return of a depressive episode.

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• QDo serotonin reuptake inhibitors interact with any other medications?

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  A Univ. of Nev. School of Medicine, Family Medicine answered

  Serotonin reuptake inhibitors interact with many other medications. Most of the interactions are minor.  To be safe, people should discuss all medications, both over the counter and prescribed, including herbal supplements, birth control and vitamins, with a pharmacist.
• QDo serotonin reuptake inhibitors have any side effects?

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  A Univ. of Nev. School of Medicine, Family Medicine answered

  Specific side effects of selective serotonin reuptake inhibitors (SSRIs) depend on which SSRI is being taken. Overall SSRIs are usually started at a low dose and then slowly increased over days or weeks to let the body adjust to the medicine. Later, to stop the medication a similar step by step reduction of the dose is done over time to avoid uncomfortable side effects known as SSRI discontinuation syndrome.
• QWhat are side effects of antidepressants?

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  A Dr. John Preston, PsyD , Psychology, answered

  Side effects of antidepressants include the following:
  
  Common side effects: These include nausea and heartburn; energized or anxious feelings (this typically subsides within one to two weeks); headaches; sedation (primarily with Remeron and Desyrel); difficulty falling asleep (often subsides in a few weeks); muscle tremor; rash; and sexual dysfunction. Note that depression itself can significantly reduce sex drive, and not all forms of sexual dysfunction among depressed people are caused by antidepressants. Occasionally antidepressants may decrease sex drive, but the most common sexual side effect is inorgasmia, or difficulty achieving an orgasm despite adequate arousal. Drug-induced inorgasmia can occur in 25 to 30 percent of people treated with antidepressants (sexual side effects are very rare with Wellbutrin). Antidepressants do not cause erectile dysfunction (i.e., impotency). Weight gain is another side effect common with antidepressants, especially with Remeron and Paxil (with other antidepressants, weight gain can occur in up to 10 percent of people, but the weight gain typically does not occur until the person has been taking the drug longer than six months).
  
  Rare side effects: Rare, potentially serious side effects of antidepressants include soreness of mouth, throat, or gums; severe rash; seizures; unusual bruising or bleeding; severe nausea, vomiting, and flu-like symptoms; severe agitation or restlessness; a yellow tinge to skin or eyes; dark-colored urine; a rapid shift into mania or hypomania; and racing thoughts. If these effects occur, contact your doctor immediately.

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• QHow do antidepressant medications affect weight?

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  A Dr. Jack Merendino, MD , Endocrinology Diabetes & Metabolism, answered on behalf of The Best Life

  This depends mostly on what medication is being used, but it also varies a great deal from one person to another. The most common class of antidepressant medications used in the United States are the selective serotonin reuptake inhibitors (SSRIs), including fluoextine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro). Some of these, notably paroxetine, are well-known to cause weight gain. The others are more variable, and any physician who prescribes these medications, including myself, has seen people gain or lose weight on each of these drugs.
  One commonly employed antidepressant medication, buproprion (Wellbutrin) tends to cause weight loss in users more often than weight gain.  It is frequently used as an adjunct or “add-on” to the SSRI antidepressants because its properties are complementary in many respects. Buproprion itself is not approved by the FDA for weight loss, but there are ongoing trials of buproprion in combination with other medications that may lead to new options for weight management in the future. Buproprion is also the medication in Zyban, a prescription drug to assist with smoking cessation. 
  Although not strictly antidepressant medications, certain drugs known as “atypical antipsychotics” are often used as part of the medication regimen for those with severe depression. These include olanzepine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel) and aripiprazole (Abilify) among others. These medications are often very effective but tend to cause weight gain in many people. 
• QHow can nortriptyline help me quit smoking?

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  A Dr. Vincent T DeVita Jr , Oncology, answered

  Nortriptyline is an older anti-depressant drug. When used in groups of smokers, it has been found to double their chances of success in quitting smoking. It is started 10 to 28 days before you stop smoking to allow it to reach a stable level in the body.
  Some people have side effects like fast heart rate, blurred vision, trouble urinating, dry mouth, constipation, weight gain or loss, and low blood pressure when they stand up. The drug can impair your ability to drive or operate machinery, and there are certain drugs that cannot be used along with it.
  Be sure your doctor and pharmacist know exactly what you are taking before you start this medicine. Also be sure you know how to take it and how to taper it down when you are ready to stop. The dose of nortriptyline must be slowly lowered, since the drug cannot be stopped suddenly without the possibility of serious effects. The drug must be used with caution in people with heart disease.

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• QWhat medications or supplements interact with amitriptyline?

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  A Dr. Darria Gillespie, MD , Emergency Medicine, answered

  If you are taking a 5-HT3 antagonist, an antipsychotic, lithium, metaxalone, methylphenidate, metoclopramide, mirabegron, orphenadrine, tedizolid, or a drug that prolongs the QTc interval, amitriptyline can lead to serious side effects and should be avoided.
  
  If you are taking abiraterone, an anticholinergic bronchodilator, azelastine nasal spray, cisapride, dronedarone, eluxadoline, iobenguane I-123, linezolid, panobinostat, paraldehyde, a selective serotonin reuptake inhibitor, a serotonin and norepinephrine reuptake inhibitor, or thalidomide, amitriptyline can lead to side effects and should be avoided.
  
  If you are taking an anticholinergic drug or rufinamide, amitriptyline may not be a good option for you.
  
  If you are taking tramadol, amitriptyline can lead to serious side effects. Other opioids may also not be good options for you. 
  
  If you are taking potassium chloride in solid form, amitriptyline can lead to side effects and should be avoided.
  
  If you are taking an MAO inhibitor, amitriptyline can lead to serious side effects.
   
  If you take amitriptyline, you should avoid St. John's wort and kava kava.
  
  This answer was adapted from Sharecare's award-winning AskMD app. Start a consultation now to find out what's causing your symptoms, learn how to manage a condition, or find a doctor.
• QWhat are the side effects of amitriptyline?

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  A Dr. Darria Gillespie, MD , Emergency Medicine, answered

  Side effects may include drowsiness, agitation, dry mouth, blurred vision, urinary problems, constipation, low blood pressure, abnormal heart rate, and changes in blood sugar. Sexual problems have also been reported. Some people have had thoughts of suicide. Amitriptyline can make it dangerous to drive or to operate machinery. 
  
  This answer was adapted from Sharecare's award-winning AskMD app. Start a consultation now to find out what's causing your symptoms, learn how to manage a condition, or find a doctor.