Antidepressants Side Effects Chart

Seems to be missing the entire MAOI class (moclobemide, selegiline, phenelzine, tranylcypromine, isocarboxazid), and most tricyclics (clomipramine, imipramine, nortriptyline)

Needs a column for "makes you feel like you are Being John Malkoviching as you linger behind your own eyes and watch another version of yourself interact with the world while being confused about who is actually controlling your vessel", and put Bupropion at a 12.
- That... explains a lot about a few months of my life
  
  That shit is trippy as fuck to me, and not in a good way. More of a Twilight Zone sorta way.
  I took Bupropion exactly once, and that day happened to coincide with the day of a first date. There was not a second date. I'd say something to her, but it wasn't me, it was the "me" who was standing about three feet in front of me. I swear to Cotton Eyed Joe I could see the back of my own fucking head.
- I have never been diagnosed with anything and never consumed any antidepressant or other psychopharmaceutical, but I get what you are describing like a lot, especially lately but since practically forever, at least since I was 12.
  I practically often feel like the 2 taxi drivers in the Hudsucker Proxy (as I identify 2 internal voices) describing, in a detached way, whatever I do, including me typing on the keyboard right now (with one of them making fun of the fact that I still haven't got the confidence to never look at the keys while typing).
  Are we talking here about something that would hinder me functioning socially and professionally or does what I described count towards something I should take care of?
  
  Yeah, that would be something to see a professional about, I think.

Had a doctor tell me I should never feel the antidepressant. Should be a background thing. Thought that was good advice.
Setraline leveled me the fuck out.
- It's kinda funny how much medicines' effects can vary from person to person, I tried sertraline and had absolutely no difference, whereas my mother and my sister take it and it works for them
- May I ask, what do you mean it leveled you out?
  
  Anger flare ups stemming from depression. Took cognitive behavioral therapy for a time until I could learn the coping skills. Still take the setraline.
  Have noticed when I wheen off/am off it am more prone to those flare ups. They don't happen outright, I just notice them more prominently.

Where is a living wage? That shit really helped me.

I suffer from persistent depressive disorder with occasional major depressive episodes (aka "double depression"). These are just some notes in case anyone can relate. I also just find this kind of thing interesting...
Bupropion (300mg qd for ~1-1.5 yrs): I felt no difference at all in my energy/interest levels, but also no noticeable negative effects.
Diazepam (5-10mg prn): Barely perceptible effect at 5mg but felt slightly intoxicated at 10mg. Sometimes helpful to break out of dissociation during double-depressive episodes.
Duloxetine (60-90mg qd for ~9 months): I felt no noticeable positive effects - only anorgasmia, insomnia, and restless leg syndrome the night of dosage adjustments.
Escitalopram (10mg qd for 3-4 months): made me feel nauseous for ~30s every day without fail, and made me feel completely grey - no positive or negative feelings whatsoever.
Trazedone (25mg prn): Effective for me as a sleep aid; no experience with chronic use as an antidepressant.

Pretty strange considering fluoxetine makes me sleep waayyy too much

An off label use for Trazadone is as a sleep aid. At doses under 150 mg it doesn't really work as an antidepressant but will make you drowsy. I've been prescribed it before as the first step before Ambien
- Amitriptyline as well, started taking it for peripheral neuropathy. Ended up on a higher dose because it's a heavy sedative. Take it before bed, and I'm out. I was taking Zopiclone before, to help me sleep but don't need it now. Also it failed as an antidepressant but works wonders for antianxiety.
- I thought it's use as an antidepressant was completely discontinued because of that.
  
  ¯(ツ)/¯
  I'm not a doctor, just need help sleeping sometimes
- We have it for our dog. We got it first when she was spayed and needed to chill out in order to not rip stitches and now we have it to give before stressful situations (guests, vet, etc). It definitely makes her more tired, but she will still fight through it to be crazy.

I'm glad Buproprion has few side effects from this chart.
However, for those considering it, here's some missing side effects:
Can increase libido. (A lot.)
Can reduce weight. (A lot.)
Can reduce your appetite/eating. (A lot.)
I'm not saying these are pros or cons. Each person should assess how these side effects will affect their own situation.

There's no section for "brain zaps".

If y'all have had really bad side-effects look into pharmacogenomic testing, it can help rule out bad medicines before you try them
I had one done a while ago and it marked a ton of medicines that I had already tried, (and had bad effects from) and a bunch I hadn't tried yet. Since then, I've had much fewer bad experiences
- I also had testing for psychiatric medication-gene interaction, and can recommend it as worth it (and am in the US)

I did a bit of searching but I don't really understand what QTc prolongation is. Can anyone help me understand?
- During your heart’s electrical conduction there are different phases. You have the contraction of the atria. The little pumps above the ventricle (main pumps) whose role is to help fill up the ventricles. The contraction of the ventricles. The main pumping part of your heart that pumps the blood to both your body and your lungs. And the repolarisation of both the atria and the ventricles. Basically the heart muscle reseting for another beat.
  The atria contract first and repolarise first. On an ECG (heart trace) the atrial contraction corresponds to the P-wave. The little wave at the front. The atrial repolarisation occurs during ventricular contraction so you can see it on the ecg. When the ventricular contraction occurs you see the sharp up and down squiggles on the ECG. This is the QRS complex. Following ventricular contraction there is ventricular repolarisation. This occurs after the QRS complex and looks like a really big P-wave. This is the T-wave.
  QTc prolongation is when the T wave takes a long time to occur after the QRS complex. When it gets too bad it is dangerous because the electrical energy that occurs in the T wave can set off another contraction of the heart. This contraction occurs outside of the normal pattern of the heart and the heart does not pump effectively leading to something called torsades de pointe which can develop into ventricular fibrillation leading to cardiac arrest (your heart not really pumping any blood).
  Here is a labeled picture of an ECG ignore the u-wave its not really relevant and does not always occur.
  Here is a picture of the heart showing the location of the atria and ventricular Heart
  
  Thank you, that's really helpful
- https://en.m.wikipedia.org/wiki/QT_interval
  The QT interval is a measurement made on an electrocardiogram used to assess some of the electrical properties of the heart. (...) An abnormally long or abnormally short QT interval is associated with an increased risk of developing abnormal heart rhythms and sudden cardiac death.
  QTc stands for QT corrected for heart rate, the medication that increases QTc will increase the risk of certain dangerous heart conditions.
  
  Thank you 😊

Can confirm, bupropion causes insomnia.
I sometimes have to take nighttime benadryl to help me sleep.
- Been on it consistently for over a decade now and have always been funky with sleep. I started back in undergrad when the pressure of life left me spiralling out of control, and have since always thought I was just a weird sleeper.
  I have insomnia semi often, usually anxiety-induced, but I've never thought that it could be the bupropion directly.
  Very curious, and good to know.

Tried a bunch of them, none really worked except for Venlafaxine. Had sexual dysfunktion which was an unacceptable side effect for me so I also quit them. This sucks.
- I'm on Venlafaxine and the sexual dysfunction side effect does subside over time (months), at least that was my experience.
  
  Had the same side effect with Citalopram, Sertraline and one or two others I tried, but I can't remember. Basically that was the only effect I noticed until I tried Venlafaxine. All this happened in about 9 months because antidepressants usually need some time to properly get in/out the system. So maybe I'm just very sensitive in that regard.
- Venlafaxine almost killed me which is fun :^)
  
  Same here. Wasn't funny at all.
- Hey twinsies!

So I have never had depression but I am aware that Sertraline is probably the most common. Is there some higher rate of effectiveness it has over the less alternatives with less side effects? Is it just that it's cheaper?
- The issue with mental health and medications is that different root causes can create different symptoms in different people, and different medications have different effects in different people. The understanding of what those root causes even are is very limited, let alone trying to figure out what the root causes are in a specific person.
  We know that certain medications have certain effects on symptoms, generally speaking, but identifying which one, at which dose, suits that specific person with a collection of reported symptoms that look like depression or anxiety or whatever, often in combination, is trial and error.
  Of course, in the US, where healthcare is "fuck you, I got mine," cost does also play a role. Shouldn't, but does. Another thing to take into account is what other medications you're taking, and whether they interact poorly with one another.
  Sertraline is the generic for Zoloft, and it's been FDA-approved since 1991. That's a good long time, and if you're going to prescribe an SSRI, it makes sense to give more weight to something that has a long history, for the sake of both effectiveness and side effects.
- There's some conventional thinking that it's slightly more "activating" and has fewer side effects than the other cheap SRIs, escitalopram being still under patent.
- Research, and more anecdotal than I can count, including a number of my own, shows psilicybin (I use ground magic mushrooms) at slightly-less-than ‘feel high’ doses 4 days a week (aka micro or threshold dose) equals, or surpasses efficacy of any of that list.
  No side effects.
  Shit works, and you don’t have to “get high” and lose your moral compass, etc.
  If you abuse psilicybin, it just stops working. You really can’t get addicted to it at all. Also there is NO ‘lethal dose’. You can’t die from it.
  Fuck Rx!
  
  I would but it's illegal here and in the same category as heroin or coke for some idiotic reason.
  
  In general I feel the same about an occasional dose of ketamine. Any time I feel a general malaise, ketamine blasts all the cobwebs out and gives me a new lease of life for quite a long time.

So... If you wanted to reduce population growth, you would make everyone depressed?
Seems like its working.

I tried many of those with no success, until tried Duloxetine and the response was optimal. Each persons has different reactions.

Man, I wish we had these charts for all classes of medicines.

My wife tried fluoxetine (Prozac), and it really impacted her libido and weight gain. She was also very drowsy, but that’s not listed. She’s now on bupropion (Wellbutrin) and is just living her best life. We were late 20’s when she started taking it so the libido impact is super important to us. The biggest thing she says about Wellbutrin is that it can cause a little irritability with alcohol, and she’s glad she didn’t start that at the same time as adderall since it’s kinda the same.

Yeah Mirtazapine fucked me up in the weight department
- Same here. Soon as I stopped, the weight stopped!

Now I know y I dont have that much of a Craving for Sex anymore. Thought I just got old.
- Can you orgasm? Anorgasmia is a common effect.
  
  Yes I Can. Otherwise I guess id just never have Sex

Antidepressants get such a bad rep, they're truly amazing

Bupropion is interesting here. I’ve been on and off since I was literally a child. Last go-round I was on Effexor, Wellbutrin, and Adderall. Gained 40 lbs but I’m still not sure if that was the medication or I was on the medication because of life stress and it was the life stress. Would love to see more of these charts, I think it’s really well laid out and easy to read and compare.

i take agomelatine and have tried SSRIs and i will never go back after agomelatine.

Escitalopram and Trazodone here. Out like a light on the latter. Only way I can function.

Is this chart actually used in prescribing patients? I find that concerning. I have abnormal metabolism on several of my CYP enzymes, plus I have other medications that are ligands of them as well.
For instance, there are people who have multiple gene copies of rapid metabolizing enzymes. They may not get any side effects, but may also not get any benefit.
An intermediate metabolizer may get a better response at lower doses and not have to worry about side effects at all.
Compared with someone who has two inactive copies of the primary metabolic enzyme, they may end up with significant side effects and no benefit at low doses.
The only way to know your metabolism is genetic testing. (Which they have studies for, and some insurances cover).

Duloxetine made me really tired. Fatigue to the deepest level. I tried for two months but did not ease, had to switch back to sertraline. Any anecdotes of similar? Anyone find a good one? Was trying to get off sertraline due to weight gain slowly over a long time.

- Sorry mate.
  Writing like this.
  Doesn't make you look.
  More knowledgeable.
  This is a very complex topic that affects people's entire lives, please don't continue to make the mistake of thinking this is as black and white as "just take shrooms".
  
  Like my life?
  Struggling with depression, throwing out all my meds. Starting with microdosing and feeling improvement inside of a week?
  Continuing for 4 years like this.
  Advising others. 4 success stories. 0 ‘fails’.
  Speaking to nurses, Docs…
  2 science degrees.
  Ya, I’m good with my knowledge and experience.
- “the results we see are in a research setting and require quite a lot of preparation and structured support from trained clinicians and therapists, and people should not attempt to try it on their own.”
  https://www.hopkinsmedicine.org/news/newsroom/news-releases/2022/02/psilocybin-treatment-for-major-depression-effective-for-up-to-a-year-for-most-patients-study-shows
  
  That’s MACRO dosing. Different strategy and yes. More prep. Need guidance.
  Micro dosing is utterly non-invasive and also works very well. Safe as can be.
  If you are already taking an Rx though, don’t do psilicybin.