Side effects can occur with all medications, not just psychotropic medications. In depression, however, medications are taken for long stretches, and therefore, some side effects may not be tolerable because of the duration of treatment required. Side effects vary both inside a class of medications and between classes.
Typically, one class of medications shares similar unwanted effects; however, if one medicine inside a class causes a specific side effect (e.g., nausea), it's not necessarily the case that another medicine inside the same class may cause exactly the same side-effect.
Your doctor is going of these with you. Some side effects can be useful in certain situations. For example, in an individual who has insomnia, a more sedating antidepressant might be helpful when taken in the evening. In someone with a poor appetite, a medication by having an associated increase in appetite might be desired.
Instead of discontinuing a medicine if you find a suspected, bothersome side-effect, you should consult with your doctor first. Some side effects are transient or can be simply alleviated by another remedy. Stopping medications abruptly when any side effect occurs could cause a discontinuation syndrome, as well as may prematurely interrupt a potentially helpful treatment intervention.
If possible, it is advisable to stick to a treatment not less than a couple of days, as some perceived unwanted effects might be related to unrelated conditions (e.g., viral infection). Bear in mind that scientific studies that compare an energetic medication to some placebo (sugar pill) have reported "side effects" in the placebo group as well. If your suspected effect seems dangerous for any reason, it certainly is most prudent to stop the medication before you can consult with a doctor and when necessary receive an evaluation in an emergency setting.
The one major concern for many patients taking these medications for a long time is the fear that they are addicted to the medication. Addiction is a complicated and controversial issue that bears some explaining.
From a medical standpoint, addiction is understood to be pursuit of a substance in a way that the pursuit and employ of it consumes so much time and energy for the person towards the exclusion from the majority of, if not completely of, important activities in that person's life. Therefore, anything that gives pleasure causing one to pursue it with abandon is potentially addictive-from gambling to sex to drugs and all sorts of variations on those themes.
By that simple definition, no antidepressant has shown to be addictive, and incredibly few psychiatric medications show to be addictive as well. Many people do, however, become dependent on various prescription drugs, and this is where confusion reigns. Dependency is defined medically through the fact that physiologically measurable changes occur in the body after repeated administration of the drug.
The most obvious drug that people think about in relation to dependency includes the majority of the prescription pain medications that are called opiates. Everyone who takes these medications on a regular basis will end up dependent on them. The confusion between dependency and addiction stems from the fact that with dependency comes withdrawal once the drug is taken away abruptly from the body, be responsible for longing for the drug. Because a drug like an opiate can make one high, is usually pursued with abandon, and does cause dependency, people often mistake dependency for addiction.
Dependency and addiction might be linked depending on the drug. For example, most anticonvulsant medications, many antihypertensive medications, and all sorts of steroid medications cause dependency, but no one would ever consider these drugs addictive. In stark contrast, many hallucinogens and stimulants do not cause any measurable physiologic changes in the body that one could absolutely label dependency, and nevertheless, these are some of the most highly addictive substances recognized to humans. Where do antidepressants along with other psychiatric medications fit about this continuum?
Most antidepressants cause some level of physiologic dependency, especially the TCAs. Some mood stabilizers and antipsychotic medications (particularly the older ones) also cause some physiologic dependency. Any drug, whether prescription medicine or street drug, that causes dependency, must be tapered over time, or one risks developing withdrawal.
Three types of discontinuation syndromes may appear whenever you stop a medication that you have been taking regularly for any significant time period: withdrawal, rebound, and recurrence. Withdrawal occurs when a drug or medicine is abruptly stopped. It is accompanied by clear physiologically measurable changes, including vital sign changes, skin color and temperature changes, and psychological distress. For some drugs, for example benzodiazepines, this is often a lifethreatening emergency.
Because of this, one must always consult your physician when choosing to discontinue a medicine to see whether such a withdrawal could occur. Rebound occurs when the symptoms that one was receiving the medication become transiently worse compared to symptoms one had before treatment. This is a danger for just about any sleep medication from which rebound insomnia can be quite severe.
However, this is a transient effect and abates within days. Unfortunately, most people do not realize that rebound is anticipated and transient, and they immediately return on the sleeping medications. Rebound generally is not accompanied by any physiologic changes. Recurrence is simply the return of symptoms for which one originally received the medication. Recurrence is more delayed in the time line after stopping a medication than either withdrawal or rebound.
Typically, if one begins to experience symptoms as soon as a couple of days after stopping antidepressant medications, this actually represents rebound or minor withdrawal (no measurable physiologic changes) that is often known as the discontinuation syndrome.
Rarely are the symptoms caused by recurrence. It is generally smart to taper the medications. When the medications are appropriately tapered, any symptoms that return can properly be related to recurrence, and therefore, increasing the medication back to a therapeutic dose can be a wise choice. In summary, clearly, although these medications may cause various discontinuation syndromes, they aren't addictive.
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