Much attention has been paid to the effects of antidepressants, especially in children and adolescents. In 2004, the FDA requested a variety of antidepressant manufacturers to include “black box” warnings on the packaging of selected drugs due to a potential for worsening depression and suicidal tendencies. 1 On May 2, 2007, the FDA proposed that makers of all antidepressants update existing warnings to include the increased risk of suicidal thoughts and behavior in young adults ages 18 – 24 during initial treatment. 2
Potential for Suicidal Thoughts and Actions
The National Institute of Mental Health (NIMH) has indicated that antidepressant medications may increase suicidal thoughts in some children, teenagers or young adults, especially within the first few months of treatment or after changes in dosage. Depression and other serious mental illnesses are the most common causes of suicidal thoughts and actions.
People on antidepressants, their family members and friends should watch out for changes in mood, behavior, activities, thoughts or feelings, especially if severe. Be sure to keep all follow-up visits with healthcare providers, and call between visits if you are worried about symptoms.
Data has shown that adults older than 24 have demonstrated no increased risk in suicide and patients older than 65 have demonstrated a decrease in suicidal behavior. Furthermore, according to a 2007 study, the advantages offered by antidepressants of may offset any risks to adolescents and younger children. 3
As many as 1 in 10 people may take antidepressants on a regular basis, with frequency differing based on age, gender, cultural background and other demographic characteristics. 4
Antidepressants can have different effects on people based on various physical conditions, especially during pregnancy, infancy and childhood.
Various studies have shown that antidepressants may be connected to an increased chance of premature delivery, certain birth defects, and rare disorders such as pulmonary hypertension, which inhibits the flow of blood to a fetus’s lungs. Antidepressants should be used during pregnancy only if the potential benefit justifies any potential risk to the fetus. Women who become pregnant or intend to become pregnant while taking antidepressants should contact their doctor immediately. 5
A 2010 study of empirical papers showed that there is still not enough information to make conclusions about the long-term effects of breastfeeding while on antidepressants. Limited data implies “theoretical risks,” and the study’s authors cautioned that doctors and patients must compare the benefits of antidepressants to the mother against possible risks to the child. 6 Mothers who intend to breastfeed should notify their physicians immediately if they are taking antidepressants.
The FDA has approved fluoxetine (the generic name of Prozac) for use in treating children 8 years old and up with major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Currently there are no other approved drugs for treating depression in children, and further studies are required to understand how fluoxetine affects child and adolescent development and maturation. Parents, guardians and caregivers should monitor the height, weight and moods of children on fluoxetine and contact the child’s doctor if any extreme changes are observed.
Potential Side Effects of Antidepressants
Excessive amounts of serotonin in the brain can cause serotonin syndrome. Symptoms of the syndrome include agitation, hallucinations, coma or other changes in mental status, as well as physical side effects such as coordination problems, muscle twitching, sweating, nausea, and more.
Certain combinations of drugs can unfavorably affect serotonin levels. A class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) — such as Prozac, Paxil and Zoloft — block serotonin from being absorbed, and when taken with other drugs that either produce serotonin or impede its removal from the bloodstream (such as certain migraine medications), the patient may be left with too much serotonin in the body.
Serotonin syndrome can be a serious and even life-threatening condition if not treated properly. However, prompt treatment can help resolve symptoms quickly. When taking antidepressants along with other medications, always be sure to discuss possible side effects or interactions with your doctor. 7
A small number of people may have severe allergic reaction to certain antidepressants, such as fluoxetine (Prozac). Symptoms can include trouble breathing, swelling of the face, tongue, eyes or mouth, a rash, hives or blisters, fever, and joint pain. If you notice any signs of allergic reaction while taking antidepressants or other medications, contact your doctor or emergency medical professionals immediately.
A person’s risk of bleeding or bruising may increase while on antidepressants. Certain antidepressants (SSRIs) can double the risk of gastrointestinal bleeding and may increase bleeding during surgical procedures. 8 In addition, patients who take SSRIs along with aspirin or antiplatelet therapy may have an increased risk of bleeding, especially those who have experienced acute myocardial infarction (heart attack). 9 Contact your doctor if you experience abnormal bleeding or you wish to know more about how certain drugs will interact.
Although uncommon, seizures are another potentially adverse side effect of antidepressants. According to a review of case reports and clinical trials, the possibility of seizure is greater in people identified as having a predisposition, or who have previously had seizures. Increased dosages may also increase the likelihood of seizures. 10
Short-term studies have suggested that antidepressants may be associated with weight gains. However, a 2014 study found no evidence of significant weight gain over longer treatment periods. Additional studies are required to better understand how antidepressants may affect weight. 11
List of Antidepressants
Below is a full list of drugs that the FDA has indicated should include “black box” warning labels as of April 20, 2013. 12
- Anafranil (clomipramine)
- Asendin (amoxapine)
- Aventyl (nortriptyline)
- Celexa (citalopram hydrobromide)
- Cymbalta (duloxetine)
- Desyrel (trazodone HCl)
- Elavil (amitriptyline)
- Effexor (venlafaxine HCl)
- Emsam (selegiline)
- Etrafon (perphenazine/amitriptyline)
- fluvoxamine maleate
- Lexapro (escitalopram hydrobromide)
- Limbitrol (chlordiazepoxide/amitriptyline)
- Ludiomil (maprotiline)
- Marplan (isocarboxazid)
- Nardil (phenelzine sulfate)
- nefazodone HCl
- Norpramin (desipramine HCl)
- Pamelor (nortriptyline)
- Parnate (tranylcypromine sulfate)
- Paxil (paroxetine HCl)
- Pexeva (paroxetine mesylate)
- Prozac (fluoxetine HCl)
- Remeron (mirtazapine)
- Sarafem (fluoxetine HCl)
- Seroquel (quetiapine)
- Sinequan (doxepin)
- Surmontil (trimipramine)
- Symbyax (olanzapine/fluoxetine)
- Tofranil (imipramine)
- Tofranil-PM (imipramine pamoate)
- Triavil (perphenazine/amitriptyline)
- Vivactil (protriptyline)
- Wellbutrin (bupropion HCl)
- Zoloft (sertraline HCl)
- Zyban (bupropion HCl)
Seasonal Affective Disorder
Depression—even if it only occurs during certain times of the year—is a serious medical condition.
If your mood plummets as soon as we set the clocks back, if the thought of winter makes you want to curl up into a fetal ball and hide until the daffodils bloom, and if you start to feel lighter and happier once the days lengthen, then you might have a form of depression called seasonal affective disorder, or SAD.
About 5 percent of the US population experiences SAD (up to 10 percent in northern areas of the country) with symptoms present for about 40 percent of the year (think “winter”). The condition is far more common in women, particularly young women, affecting four times as many women as men. Even adolescents and older school-aged children can be affected. Researchers don’t know exactly why some of us tend towards depression as the days get shorter, but suspect several underlying biologic reasons related to circadian rhythms, light sensitivity, genetics, and the impact of all three on brain chemicals like serotonin.
Symptoms include a pattern of depression in the fall and winter, craving carbohydrates, increased appetite, weight gain, and the classic symptoms of depression, including changes in sleeping patterns, irritability, loss of interest in usual activities, and difficulty concentrating.
Perhaps the most effective treatment for SAD is also the simplest: light. You should sit about a foot away from a white, fluorescent light for 30 minutes every morning. You don’t have to look right into the light, but the light needs to reach your pupils, which it will even if you’re eating or reading. You should start to feel better in a week or two. Once you start feeling better, you can taper down your light use to 15 minutes a day, or only use it during the week. Just make sure you continue until spring.
Other options include antidepressants such as fluoxetine (Prozac), and cognitive behavior therapy. One study found that Prozac was just as effective as light therapy, but that people receiving light therapy felt better sooner and had fewer side effects. Other studies find no difference between light therapy and cognitive behavioral therapy, or between all three. So if you prefer to avoid medication or don’t the time, money, or access to a mental health professional for therapy, consider the light option.
You can find lights at retail stores and online. Check with your insurance company—some will cover the cost if your doctor prescribes it. Once you know you have SAD, you can take steps to prevent it next year. As soon as the days begin to get shorter—around early October—it’s time to turn on the light.
U.S. Food and Drug Administration. Worsening Depression and Suicidality in Patients Being Treated With Antidepressants. (Rev. Aug 7, 2009). Accessed July 30, 2013. ↩
U.S. Food and Drug Administration. FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressant Medications. (May 2, 2007). Accessed July 23, 2014. ↩
National Institute of Mental Health. Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers. Accessed July 23, 2014. ↩
Wehrwein, Peter. Astounding increase in antidepressant use by Americans. (Oct. 20, 2011). Accessed July 23, 2014. ↩
Anxiety and Depression Association of America. Pregnancy and Medication. Accessed July 23, 2014. ↩
Di Scalea, Teresa Lanzi and Katherine L. Wisner. Antidepressant Medication Use during Breastfeeding. (Sept. 2009). Accessed July 23, 2014. ↩
MedlinePlus. Serotonin syndrome. (July 8, 2012). Accessed July 24, 2014. ↩
Andrade et al. Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. (Dec. 2010). Accessed July 24, 2014. ↩
Labos, Christopher et al. Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. (Sept. 26, 2011). Accessed July 24, 2014. ↩
Rosenstein et al. Seizures associated with antidepressants: a review. (Aug. 1993). Accessed July 24, 2014. ↩
Blumenthal, Sarah R. et al. An Electronic Health Records Study of Long-Term Weight Gain Following Antidepressant Use. (June 4, 2014). Accessed July 24, 2014. ↩
U.S. Food and Drug Administration. FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressant Medications. (May 2, 2007; Updated April 10, 2013). Accessed July 24, 2014. ↩