Interactions of Antidepressants

Antidepressants Can Affect Other Medications You May Be Taking

Antidepressants can have an effect on many other medicines. If you’re going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John’s wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant. When taken together, some medicines can cause serious problems.

Taking an MAOI antidepressant at the same time as any other antidepressants or certain over-the-counter medicines for colds and flu can cause a dangerous reaction. Your doctor will tell you what foods and alcoholic beverages you should avoid while you are taking an MAOI. You should not take an MAOI unless you clearly understand what medications and foods to avoid. If you are taking a MAOI and your doctor wants you to start taking one of the other antidepressants, he or she will have you stop taking the MAOI for a while before you start the new medicine. This gives the MAOI time to clear out of your body.

Another risk of antidepressants is serotonin syndrome, a drug reaction resulting from the over-stimulation of serotonin receptors. This can occur when an antidepressant is taken either with another antidepressant, with certain recreational and other drugs (see below), or more rarely, even when one antidepressant is taken alone. Symptoms include hyperactivity, mental confusion, agitation, shivering, sweating, fever, lack of coordination, seizure, and diarrhoea.

To minimise the risk of serotonin syndrome, there must be a ‘washout’ period of at least two weeks when switching from one antidepressant drug to another.

Drugs that may induce serotonin syndrome when taken with antidepressants (not a complete list)

  • ecstasy
  • cocaine
  • lithium
  • St John’s wort (Hypericum) – herbal antidepressant
  • diethylproprion – an amphetamine
  • dextromethorphan – found in many cough suppressants
  • Buspar (buspirone) – for anxiety
  • Selgene, Eldepryl (selegiline) – for Parkinson’s Disease
  • anti-epileptics – Tegretol, Carbium, Teril (carbamazepine)
  • analgesics – pethidine, Fortral (pentazocine), Tramal (tramadol), fentanyl
  • anti-migraine drugs – Naramig (naratriptan), Imigran (sumatriptan), Zomig (zolmitriptan)
  • appetite suppressants – phentermine and fenfluramine
  • tryptophan – an amino acid

Which Antidepressant Drug Is Best For Me?

Because the neurotransmitters involved in the control of moods are also involved in other processes, such as sleep, eating, and pain, drugs that affect these neurotransmitters can be used for more than just treating depression. Headache, eating disorders, bed-wetting, and other problems are now being treated with antidepressants.

All antidepressant drugs are effective, but certain types work best for certain kinds of depression. For example, people who are depressed and agitated do best when they take an antidepressant drug that also calms them down. People who are depressed and withdrawn may benefit more from an antidepressant drug that has a stimulating effect.

Antidepressants Are Not A Magic Bullet

While antidepressant drugs help people feel better, they cannot solve problems in people’s lives. Some mental health professionals worry that people who could benefit from psychotherapy rely instead on antidepressant drugs for a “quick fix.” Others point out that the drugs work gradually and do not produce instant happiness. The best approach is often a combination of counseling and medicine, but the correct treatment for a specific patient depends on many factors. The decision of how to treat depression or other conditions that may respond to antidepressant drugs should be made carefully and will be different for different people.