Coping With Nausea While on Antidepressants

Nausea and vomiting are two of the more common side effects of antidepressants, and it may take some time to get over these symptoms when first starting treatment.

In fact, nausea is often cited as the number one side effect ofselective serotonin reuptake inhibitors (SSRIs)used to treat major depression andanxiety disorders。 In some cases, nausea and vomiting can become so severe or persistent that a person has no other option but to stop treatment.

Causes

Nausea and vomiting are common side effects of many drugs. These symptoms are more often due to the effect a drug has on the central nervous system (CNS) rather than any toxic effect it has on the stomach or gastrointestinal tract (GI tract).

The situation is slightly different with SSRI antidepressants. This class of drug works by stimulating the effects ofserotonin, aneurotransmitterassociated with mood, cognition, and appetite.

When serotonin levels increase under the influence of SSRIs, they stimulate serotonin receptors in the GI tract as well as the brain. The combined stimulatory effect—on both the GI tract and CNS—can trigger such side effects as:

• Diarrhea
• Loss of appetite (anorexia)
• Nausea
• Vomiting

Antidepressant Withdrawal

Antidepressants can also cause nausea and vomiting when treatment is stopped too suddenly. Known asantidepressant discontinuation syndrome(or simply antidepressant withdrawal), the condition can cause an array of symptoms if the body is suddenly deprived of the drug. Gastrointestinal symptoms are among the most common and potentially severe.

Antidepressant withdrawal symptoms can sometimes persist for several weeks and even lead to rebound depression (in which depressive symptoms return, sometimes worse than before).

In addition to nausea and vomiting, antidepressant withdrawal can cause the following:

• Anxiety
• Confusion
• Diarrhea
• Dizziness
• Fever
• Hallucinations
• Headaches
• Panic attacks
• Profuse sweating
• Tremors
• Vivid dreams

Risk by Drug Type

Nausea and vomiting doesn't only occur with SSRIs. The symptoms are also common with other classes of antidepressants, albeit less commonly or profoundly, including:

• Selective norepinephrine-dopamine reuptake inhibitors (SNDRIs) such as Wellbutrin (Buproprion)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants (TCAs)

Nausea and vomiting are less common with a class of antidepressants known asmonoamine oxidase inhibitors (MAOIs)。

Minimizing Antidepressant Nausea

在大多数情况下,恶心和呕吐将开发on after treatment is started and gradually resolve within one to two weeks once the body adapts to the medication. However, according to some research, as many as 32% of people taking an SSRI will continue to experience GI symptoms for up to three months.

Fortunately, there are things you can do to minimize these symptoms:

• Take your medication with food, unless you are told otherwise.
• Take your antidepressant at bedtimeto sleep through the worst of the symptoms.
• Eat smaller meals, more frequently.
• Suck on sugarless, hard candywhenever you are nauseous.
• Take an antacidlike Pepcid (famotidine) or Tums.
• Sip ginger teaor slightly flattened ginger ale.
• Ask your doctor about a slow-release form of your antidepressant, or whether you need to temporarily lower your dosage.
• Talk to your doctor about anti-nausea medication, such as Zofran (ondansetron).

If your nausea or vomiting becomes intolerable, your doctor may have no other choice but to change treatment to another antidepressant with a lower nausea risk.

Drug Tapering Strategies

To reduce the risk of withdrawal symptoms when stopping an antidepressant, speak with your doctor about the appropriatetapering strategy。Going "cold turkey" is never advised and may end up triggering the very symptoms you were being treated for.

As a general rule, the longer you've been on antidepressants, the longer and slower the tapering period will be. Some people can be tapered off in a matter of weeks; others may take months.

Most doctors will reduce the daily dosage in three to four stages, maybe more if you've been on a drug for a long time. The following are some examples of tapering schedules by medication.

Paxil

• Starting dose: 60 milligrams (mg)
• 1st dose reduction: 40mg
• 2nd dose reduction: 30mg
• 3rd dose reduction: 20mg
• 4th dose reduction: 10mg

Celexa

• Starting dose: 40mg
• 1st dose reduction: 30mg
• 2nd dose reduction: 20mg
• 3rd dose reduction: 10mg

Lexapro

• Starting dose: 20mg
• 1st dose reduction: 15mg
• 2nd dose reduction: 10mg
• 3rd dose reduction: 5mg

Prozac

• Starting dose: 60 mg
• 1st dose reduction: 40 mg
• 2nd dose reduction: 30 mg
• 3rd dose reduction: 20 mg
• 4th dose reduction: 10 mg

Zoloft

• Starting dose: 200mg
• 1st dose reduction: 150mg
• 2nd dose reduction: 100 mg
• 3rd dose reduction: 75mg
• 4th dose reduction: 50mg

Tapering should always be done under the supervision of a doctor. In some cases, tapering may require altering doses if an interim dose is not available. (For example, you may need to take 40mg one day and 20mg the next if a 30mg pill is not available.)