When it comes to taking medication as directed, Americans have a shaky track record.
Among patients with depression, for example, up to 60 percent do not follow their medication plan, according to a review in PLoS One. A common reason for medication nonadherence, or the technical term for not taking medication as directed: adverse side effects.
For people with depression or anxiety, medication nonadherence can result in worsening symptoms. "You really have to take your antidepressants every single day for them to be effective,” says Melissa Frontino, PharmD, a clinical pharmacist. “Side effects should be addressed so they don’t further discourage a patient from taking a medication.”
Thankfully, side effects from antidepressants aren’t inevitable. Here, learn how to lessen or avoid them so you can better manage depression or anxiety.
Understanding Side Effect Terms
Side effects are any unwanted or unexpected reaction to the drug that is known by the Food and Drug Administration (FDA), the federal agency that oversees drug regulation and labeling.
How these adverse events are described can give you pause. It’s the reason you should read the Medication Guide that accompanies medications. It outlines common, possible, and serious adverse events related to certain drugs and drug classes. It can help you and your providers determine what you can do to prevent certain adverse reactions.
Common side effects are usually minor problems and may go away with use as your body adjusts to the medication. Occasionally, common side effects can interfere with quality of life and daily living.
For instance, selective serotonin reuptake inhibitors (SSRIs) are often the first-line drug therapy for major depressive disorder. Common side effects include:
- Dry mouth
- Weight gain or loss
- Skin rashes
- Joint or muscle pain
- Decreased sexual desire or sexual dysfunction
Adverse effects include serious complications discovered while bringing the drug to market or that have been reported since. Black box warnings, so-called because they are highlighted within a black box on the medication label, are used to alert patients to the most severe adverse events. These may be life-threatening, cause significant bodily damage, increase the risk of hospitalization, or result in birth defects if the drug is taken while pregnant.
In 2004, the FDA ruled that all antidepressants be labeled with a black box warning that the drugs increase the risk of suicidal thoughts or behavior in children, adolescents, and young adults. The FDA also requires labeling on many medications to include pharmacogenetic biomarker information due to specific actionable gene-drug associations.
How to Lessen Side Effects from Medicine
Age, gender, health, other drugs or supplements you take, and other factors can affect whether you’ll experience medication side effects. Your doctor and pharmacist can often recommend tips to manage common side effects.
“If a medication is causing drowsiness, we can move it to bedtime,” says Dr. Frontino. “If it causes stomach upset, we may be able to have them take it with food. It really depends on the medication they’re taking and what they’re experiencing.”
If you’re experiencing or worried about experiencing side effects, let your clinician or pharmacist know. They can often help you figure out a management strategy.
How Pharmacogenetics Can Help
If side effects continue despite management tactics, Dr. Frontino recommends pharmacogenetic (PGx) testing. Knowing how medications might interact with your genetic makeup can help clinians make a smarter, personalized treatment plan for you.
Some clinicians may recommend PGx testing when starting treatment so they have more information to guide them.
Genomind® Professional PGx Express™ looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:
- Which medications will likely be the most effective
- Which medications may have side effects
- How you metabolize medications for personalized dosing guidance
“Anyone can experience any side effect. If they are getting a lot of them, or they become unbearable, that’s where the genomics comes in, and we can say, ‘You’re going to be more prone to getting these side effects if you’re on this class of medication,’” says Dr. Frontino. “Or maybe we can switch you over to another class that makes you less prone to side effects.”
Side effects are often the result of how quickly you metabolize medications, says Roy Perlis, MD, MSc, director of the Center for Experimental Drugs and Diagnostics at Massachusetts General Hospital and a Genomind Scientific Advisory Board member.
“Some people may break down medications less efficiently. For those people, if you give them a standard dose, they are actually going to have more side effects on average because it’s like they’re taking twice as much,” explains Dr. Perlis. Others may metabolize drugs too quickly, requiring a higher dose to receive any benefits.
“What we struggle with isn’t just picking the right medicine, but having picked the right medicine, what’s the best dose to get better without having lots of side effects,” Dr. Perlis continues. “Understanding how someone breaks the drug down can help us select appropriate therapy.”
What to Ask Your Clinician or Pharmacist
Talk openly to your clinician or pharmacist about your medication treatment plan so they can address questions about antidepressant side effects, and you’ll know what to expect. Getting medication counseling has been shown to improve medication adherence.
Ask your clinician or pharmacist these questions about your antidepressant or any mental health medication:
- How often and when should I take it?
- What’s the most common side effect you see in patients?
- How long do common side effects usually last?
- What if I can’t manage the side effects? Is it safe to just stop taking the drug?
- Does it matter if I take my medication with or without food?
- Are there certain foods I should avoid taking with it?
- Will taking it with food help reduce possible gastrointestinal side effects, such as nausea?
- Does it matter what time of day I take my antidepressant?
- Will taking it at night reduce possible side effects of drowsiness or fatigue?
- What should I do if I experience serious symptoms I think are related to the medication?
- Can you go over the FDA Medication Guide with me?
- Is there anything else I need to know that can help me manage the common side effects of this drug?
Communicate as Needed
It’s important to keep communicating with your clinician or pharmacist throughout your treatment. Side effects don’t just happen when you start a new drug. Adverse reactions can be experienced when you stop taking a medication that you’ve taken for a while, when you add new medications, or when your antidepressant dose increases or decreases.
“Some side effects you may start seeing quickly. Depending on the efficacy of the medication, it may take between four, six, eight weeks after taking your medication for other side effects to appear,” says Dr. Frontino. “Ideally, we don’t want anyone to experience side effects.”
Does Your Medication Work for You?
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