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Medication side-effects; treating them

A.       Medication Side-Effects and their treatment

Section 58: Sexual Problems due to Antidepressants;  Various solutions.

Section 59: Weight gain due to Depression or its treatment.

Section 60: Perspiration due to antidepressants;  2 effective antidotes.

Section 61: Tremor, due to antidepressants or Lithium:  2 effective antidotes

Section 62: Dry mouth / thirst, due to antidepressants:  How to resolve this.

Section 63: Thirst while on Lithium.

Section 64: Eye problems due to antidepressants:  How to resolve them.

Section 64A:  Eye specialist tips for Blurring of Vision

Section 65: Blood pressure changes due to antidepressants.

Section 66: Dizziness / low blood pressure due to antidepressants:  treating the problem.

Section 67: Breast and gynaecological changes due to antidepressants.

Section 68: Bladder and bowel problems due to antidepressants:  How to deal with them.

Section 69: Difficulty sleeping due to Depression or its treatment.

Section 70: White blood cell and platelet changes due to medications.

 

SECTION 58

Sexual problems due to antidepressants; VARIOUS solutions

 

Approximately 50%! of people taking the modern generation of antidepressants, have sexual problems due to the medication. 

 

Many people with depressive illness notice a reduction in their sex drive, and they may even be revolted at the idea of sexual activity with their partner, having previously not had any such problem.  It is therefore very distressing for all involved to find that the treatment which has cured the depressive illness, after perhaps months of distress for the patient and their family, brings with it a new problem, particularly when the medication normally needs to be continued for many months after the symptoms of depression have cleared up.

 

The standard sexual problems associated with modern antidepressants include:-

1.   drastic reduction or total loss of general sexual awareness and interest;

2.   men have an inability to obtain an erection, or maintain it for any significant period of time;

3.   women find they cannot physically respond to sexual activity;

4.   ejaculation in men is impossible or extremely delayed;

5.   orgasm in women is impossible or extremely delayed, or minimised.

 

Regardless of the awareness in both partners of the role of medication in causing these problems, the inability to have the sexual relationship the couple previously had often causes distress, with the individuals involved blaming themselves.

 

Treatments

A number of treatments have been suggested over the past few years, but the harsh reality is that we currently do NOT have an effective treatment.  The possibilities suggested, all of which have only low levels of success are :-

1.     reduction in dosage of the antidepressant: theoretically, this should improve the problem, but the reality seems to be that very little improvement occurs with dosage reduction.  Furthermore, this technique brings with it the risk of return of the depressive symptoms.  Depressive illness is like cancer, and total and prolonged obliteration of symptoms is the ideal treatment; no-one would suggest a cancer patient reduces his or her chemotherapy for any reason, provided the patient can tolerate the therapy.

2.     “Drug holidays” : this refers to stopping the antidepressant for two or three days, in the hope that blood levels of the antidepressant will drop rapidly enough to allow normal sexual functioning to return.  Apart from the above risk of recurrence of depression, this technique is also somewhat of a catch 22 situation. Any antidepressant, whose levels can be dropped adequately within two or three days, runs the risk of precipitating a flu-like withdrawal syndrome!  Prozac has a half-life of one week (the time it takes to get half the drug out of your blood stream), and therefore you are not going to get any significant reduction in blood levels, any improvement in sexual side effects or any withdrawal symptoms as a general rule by stopping the medication for two or three days.  The other modern antidepressants have a half-life of one day approximately, and while you may get some improvement in sexual side effects by stopping the drug, there is a risk of unpleasant withdrawal reactions.

3.     PERIACTIN (Cyproheptadine) is an antihistamine medication widely available.  However, this medication usually needs to be taken every night, and / or in high doses to try to overcome the chemical blockage underlying the sexual problems.  Unfortunately, high doses of Cyproheptadine are very sedating in most people, with the tiredness lasting throughout the next day.  Furthermore, this medication causes significant appetite increase and weight gain.

4.     TOLVON  (Mianserin) is a derivative of the tricyclic antidepressants, and there is a small amount of research indicating that adding low doses of this medication to the modern antidepressants may help with the sexual side effects of the modern antidepressants.  However, Mianserin also causes weight gain and sedation.  Furthermore, the modern antidepressants have the effect of magnifying the serum levels of certain other medications, including Mianserin, so that your doctor needs to take certain precautions if attempting this manoeuvre.  Ideally, patients on a combination of modern antidepressants and Mianserin should have serum levels of Mianserin done on a regular basis, and also regular electroencephalograms (EEGs) to ensure that abnormally high levels of Mianserin in the blood stream do not occur, or bring with them the risk of an epileptic seizure.

5.     VIAGRA, CIALIS etc have been effective in many men in allowing them to have an erection while taking modern antidepressants, and there are isolated reports of some women finding the medication useful in improving sexual responsiveness or regaining the ability to have an orgasm, but many women find Viagra is ineffective.

6.     DEXAMPHETAMINE is a stimulant medication used in attention deficit disorder with hyperactivity in children, and rarely used in psychiatry as an energising agent.  There have been occasional reports of sexual improvement in patients taking Dexamphetamine in addition to the modern antidepressants.  However, it does appear this technique is not effective for the majority of people.

7.     Various HERBAL MEDICATIONS have been claimed to be effective, but again it seems it is only in a small minority of people that any benefit appears.

8.     CHANGE OF ANTIDEPRESSANT - In my experience, patients who experience sexual problems on any one of the SSRIs, or on Effexor, are likely to experience the same sexual problems with all other members of that group.  Accordingly, it is therefore sometimes necessary to change the antidepressant to either Moclobemide (not available in the USA), SERZONE ,  or one of the tricyclic antidepressants.  Sexual side effects are much less common using these antidepressants, but other side effects may appear (especially with the tricyclic antidepressants), and there is a significant risk that depressive illness which has responded to one antidepressant may not respond to any other antidepressant available.  Only trial and error will tell.

 

SEXUAL EFFECTS OF TRICYCLIC ANTIDEPRESSANTS - This older group of antidepressants does cause sexual problems in a small number of people.  Typically, the problem is not interference in sexual desire, but difficulty in having an erection, ejaculation or orgasm.  In many people with this problem, an occasional high dose of the medication BETHANECHOL (30-40 mgs) will allow normal sexual function an hour later, lasting for about four hours.

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 


SECTION 59

Weight gain due to depression or its treatment

 

In response to stressful situations, such as studying for exams, it is a frequent pattern that women are tempted to overeat, while men may be tempted to increase their intake of alcohol.  Obviously, this is not an inflexible rule. Overeating is not restricted to women, and increased alcohol intake is not restricted to men.

 

When depression and anxiety slowly creep up on an unsuspecting person, he or she may well find themselves indulging in comfort eating.  This may consist of frequent snacking, especially on high carbohydrate foods, or repeated binges of large amounts of foods.  Some people then induce vomiting, in an attempt to minimise the weight gain due to the food binges, and may well develop the illness known as ‘Bulimia Nervosa’.  In fact, many people with Bulimia Nervosa are significantly improved, and actually eat much less with associated weight loss, if they are prescribed one of the modern antidepressants (not the older tricyclics, for reasons described below). 

 

As depression becomes more severe, it is more usual for people to lose their appetite for food, and eventually to actually lose weight.  However, it is also recognised that a minority of people actually have marked increase in appetite due to depression.  This seems to particularly be the case in those susceptible to getting depression in winters, a condition known as ‘SAD’ (seasonal affective disorder). 

 

Weight gain due to antidepressants

This is a major problem with almost all currently available antidepressant agents, with a small number of exceptions.

 

The antidepressants available from the 1940s to the 1980s were fundamentally the group of chemicals known as tricyclics.  Tricyclic antidepressants are notorious for causing weight gain, especially the antidepressants which simultaneously calmed people down or helped them to sleep.  It is very common for people taking this group of antidepressants to gain one to two stone in weight (6 to 12 kilos)! 

 

The other old group of antidepressants, known as the irreversible MAO Inhibitors, also caused weight gain, but usually to a lesser degree.  However, people taking these medications have to be very careful about eating certain foodstuffs, such as cheese, or taking various other medications, especially cough and cold mixtures, to avoid having a blood vessel burst in their brain.

 

In the past ten years, a number of new antidepressants have appeared on the market.  The best known group are the SSRIs (selective serotonin re-uptake inhibitors), of which Prozac is the best known member. Other members of the SSRIs include Zoloft, Aropax, Cipramil and Luvox. However, while it was initially believed that patients taking these antidepressants did not gain weight, experience over the years has shown that about half the people taking these substances will gain weight, and have breast enlargement.  The same findings apply to the agent known as an SNRI (serotonin and noradrenaline/ norepinephrine re-uptake inhibitor), sold as the agent Efexor.

 

 

An antidepressant agent called Moclobemide (Aurorix, Mannerix) is available in some parts of the world (but not in the United States), and this agent appears to have very low rates of weight gain associated with its use.  This agent was designed to replace the old MAO Inhibitors, so that there is no need for caution with diet or other medications when taking this antidepressant.

 

How does weight gain occur?

Patients taking antidepressants describe two phenomena.  Firstly, patients describe an irresistible hunger, made worse very often by an inability to ever feel they have ever eaten enough.  The hunger typically manifests itself as a craving for sweet things, even in those who have previously disliked sweet foods.  Typically, a patient will be desperate to eat, eat much larger portions than before, and start to have desserts they would never previously have considered.  Often, this is followed by eating large amounts of chocolate.  Many patients describe this craving as irresistible.  For those who wish to actually gain weight, this is an easy way to do it, but for the majority of the population, this reaction is very distressing.

 

Secondly, patients describe how their weight increases even when they are extremely strict about their intake of calories / kilojoules.  It does seem that antidepressant medications change metabolic pathways within our bodies, so that fat is produced rather than the food simply being used as an immediately available source of energy for daily activities. 

 

It has also been suggested that people who have recovered from depression due to the benefits of antidepressants actually regain their appetites and enjoy food more.  While this reasoning appeals greatly to the manufacturers of antidepressants, in my experience this is an almost irrelevant part of the problem.

 

What can be done?

The best option, if at all possible, is to change to a different antidepressant, or reduce the dose of the antidepressant currently being prescribed.  However, this runs the risk that the benefits of having controlled the depressive illness would be lost, as we cannot guarantee that the next antidepressant will be as effective as the one currently being taken. 

 

Certain tricyclic antidepressants, such as Desipramine, Imipramine, and Nortriptyline, seem to cause less weight gain than the more sedating tricyclic agents.  Your doctor may wish to try the antidepressant   Moclobemide. 

 

The unusual anti-epilepsy agent topiramate (Topamax) and the antidiabetic agent metformin(Diabex) cause appetite reduction in some people.

 

The ordinary measures of weight control will help, although the battle will be more difficult due to the effects of antidepressants on your metabolism.  Keeping your calorie / kilojoule intake under control, drinking a lot of fluid, and exercising frequently will all help.  In some people, taking appetite suppressant medication helps, although there is concern about possible interaction between appetite suppressants and modern antidepressants, resulting in damage to the valves of the heart (which is the reason some appetite suppressants were withdrawn from the market world wide recently).  There is also concern about prescribing appetite suppressants for more than three months at a time, due to the risk of developing high blood pressure in the arteries between the heart and the lungs (pulmonary hypertension). 

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 


SECTION 60

Perspiration due to antidepressants; 2 effective antidotes

 

Modern antidepressants in particular, being Prozac and its cousins, and also Effexor, have a side effect in very many people of causing intense perspiration. For many people the situation is so bad that they have to change their night wear, or else they alternate from being intensely hot and perspiring to being very cold as the perspiration dries off during the night.  The problem is particularly bad in warm weather, and many people find the symptom socially very embarrassing.

 

Our sweat glands in our skin are ordered to produce sweating by nerve impulses, and these nerve impulses are accidentally activated as a side effect of the antidepressants.  While stopping perspiration completely runs the risk of causing our body to overheat, the following two antidotes, which need to be prescribed by your doctor, can safely reduce the perspiration, without endangering your temperature control from your body.

 

PROPANTHELINE (sold under the trade name PROBANTHINE in some countries) is a very effective agent in many people at stopping perspiration, regardless of its source.  The medication itself is quite a simple medication, and the only common side effect associated with this medication is dryness of the mouth.  The medication normally lasts a number of hours after taking the tablet, so that some people find they only need to take the medication at night, or only on hot nights.

 

CLONIDINE is another agent that is very effective in low doses in many people in stopping perspiration.  The medication is widely available under various brand names, as it has been used for many years to control high blood pressure, or to prevent migraine.  Because of its role in reducing blood pressure, this medication should be taken in low doses only, when being used to control perspiration.  Either you or your doctor should keep a check that your blood pressure does not become too low, as indicated by symptoms such as dizziness or feeling unusually weak and tired.

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 


SECTION 61

SHAKING / Tremor, due to antidepressants or Lithium: 2 effective antidotes

 

Shaking of the hands is a common side effect of antidepressants and of Lithium.  The problem is worsened in cases where people take both medications simultaneously.  Many people find the symptom socially embarrassing, and the tremor is actually worse when we are slightly nervous, such as mixing socially, especially when we feel people are watching us.

 

PROPANALOL (Inderal) is an effective agent at stopping tremor, regardless of the cause of the tremor.  This medication is normally used to lower blood pressure, or to slow your heart rate.  For most people taking Propanalol to stop tremor, low doses are usually effective, such as 10 mg three times per day. Some people need up to 40mg three times a day. Each dose lasts about 4 hours.  Some people take the medication only before they are going to be in a social situation.  The medication rarely causes any significant drop in blood pressure, if used in low dose.  People who are prone to Asthma will probably be advised not to take this medication, as it can interfere with breathing in such people.

 

PRIMIDONE (Mysoline) is an agent which very few doctors realise is actually dramatically effective in stopping tremor.  It is normally used to prevent convulsions, in people who are suffering from Epilepsy.  However, it is relatively rarely used, being an older agent.  Primidone needs to be taken at night only, and will stop tremor all the next day!  However, it is an intensely sedating agent, so you may find you have to take only a quarter of a tablet at night initially, until you see how much it affects you in terms of sleeping and tiredness the next day.

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 

 


SECTION 62

Dry mouth / thirst due to antidepressants: how to resolve this

 

The symptom of dry mouth (technically called Xerostomia) is a very common side effect of tricyclic antidepressants, and occurs in a minority of people taking Nefazodone and the SSRIs / Effexor group of antidepressants.

 

This symptom typically becomes more of a problem in social situations, when people are attempting to talk, and may or may not be slightly more anxious than usual.  Those who have to speak publicly find it a major nuisance. 

 

Apart from the irritation of having a continuously dry mouth, especially on waking in the morning, dry mouth significantly increases the risk of gum disease and tooth decay, as our mouth is normally protected to a large extent by the presence of normal amounts of saliva.  Accordingly, particularly good dental hygiene is very important while this problem persists.

 

Most people interpret the dry mouth sensation as being thirsty.  In fact, this is not the case, and drinking a lot of fluid really does not help the problem.  The mechanism that is occurring is that the antidepressants have blocked the messages which allow the normal flow of saliva to occur, and therefore your salivary glands are not producing saliva as needed.  This is one of the group of side effects of antidepressants known as an anticholinergic side effect, as the cholinergic system is the chemical pathway which controls various automatic functions of our body.  Other symptoms in this group of anticholinergic side effects include blurring of vision, dry eyes and constipation. 

 

INTENSELY BITTER DRINKS will briefly directly stimulate your salivary glands and cause them to produce saliva again, relieving the dry mouth sensation.  Bitter lemon drinks or confectionery may achieve this affect.  Squeezing lemon juice directly into water or soda water is a useful way of producing a bitter drink that will stimulate the salivary glands and temporarily reduce thirst.

 

BETHANECHOL is a simple antidote which will relieve the anticholinergic side effects of antidepressants in the majority of people.  This medication normally has no side effects itself, and needs to be taken in a dose of 10-20 mgs three times per day usually.  While the timing of the medication is not an issue for the majority of people, some people find Bethanechol works far better if taken on an empty stomach, and half an hour before any food is consumed.

 

CHEWING GUM   will increase salivary flow for some time, but it is important to use only sugarless gum in view of the absence of the protective effect of normal saliva.

 

ARTIFICIAL SALIVA SPRAYS will also be useful for short periods of time, and can be obtained in your pharmacy or drug store without a prescription.

 

In some cases, it may be possible for your doctor to change your tricyclic antidepressant to one with fewer anticholinergic side effects in most people, (eg Nortriptyline or Dothiepien), or consider Mianserin, a derivative of the tricyclic antidepressants with no anticholinergic side effects.  However, do keep in mind that a new antidepressant may not necessarily give you the same benefits as the one you are currently taking.

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 


SECTION 63

Thirst while ON LITHIUM

 

Unlike the problem with some antidepressants, if you are very thirsty due to taking Lithium, a different mechanism is taking place.  Lithium reduces the capacity of your kidney to retain fluid, so that it causes you to pass a lot of urine.  In an attempt to compensate for this excessive loss of fluid from your body, you become very thirsty.  The thirst on Lithium can become severe, so that people have to drink large amounts of fluid day and night, and perhaps carry fluid with them continuously throughout the day.

 

There is an unusual antidote for this problem with Lithium.  This involves taking a tablet which would make people not taking Lithium actually lose fluid!  Particular diuretics (tablets which cause fluid loss) have the reverse effect in people taking Lithium.  These diuretics are in the group of diuretics, known chemically as the “thiazide diuretics”.  Chlorthiazide is the best known member of this group.

 

It is calculated that Chlorthiazide will reduce fluid loss in people taking Lithium by twenty five per cent.  This markedly reduces the amount of urine you pass, and therefore the amount of fluid you need to drink to compensate.  You may have to experiment as to whether it suits you better to take the thiazide diuretic at night or in the morning, to give you the best control of day time thirst and night time disturbance.

 

However, you must also remember that losing less fluid also means you will lose less Lithium, and your blood levels of Lithium will increase if you take thiazide diuretics.  Accordingly, the usual practice is to reduce your Lithium dose when adding in thiazide diuretics.  Your doctor will keep a check on your Lithium levels until the correct mixture of Lithium and thiazide diuretic is established, and presumably will also keep an eye on your potassium levels, which may be lowered due to taking the diuretic.

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.


SECTION 64

Eye problems due to antidepressants: how to resolve them

 

Difficulty reading fine print, and dryness of the eyes, are almost inevitable in people taking the older tricyclic antidepressants, and also occur in a minority of people taking the newer antidepressants.  These are part of what are called the anticholinergic side effects of antidepressants, as these antidepressants interfere with the cholinergic transmission pathway in our body, which looks after many automatic functions such as the production of tears, the automatic adjustment of our eyes, and the production of saliva.

 

BETHANECHOL (UROCARB) is a simple antidote, which will relieve the anticholinergic side effects of antidepressants in the majority of people.  This medication normally has no side effects itself, and needs to be taken in a dose of 10-20 mgs three times per day usually.  While the timing of the medication is not an issue for the majority of people, some people find Bethanechol works far better if taken on an empty stomach, and half an hour before any food is consumed.

 

People with glaucoma (increased pressure inside the eye) or at risk of developing glaucoma (especially those in late middle age or older), need to be especially careful using these antidepressant agents.  Your eye specialist can check your eye pressure, and advise whether or not an increase in eye medication is necessary to compensate.

 

SIMPLE MAGNIFYING READING GLASSES will compensate for the blurring of vision and difficulty reading fine print in many cases.  These glasses can usually be bought in pharmacies or drug stores, and there is no need to have expensive prescription glasses made up simply to deal with this side effect of tricyclic antidepressants.

 

In some cases, it may be possible for your doctor to change your tricyclic antidepressant to one with fewer anticholinergic side effects in most people, (eg Nortriptyline or Dothiepien), or consider Mianserin, a derivative of the tricyclic antidepressants with no anticholinergic side effects.  However, do keep in mind that a new antidepressant may not necessarily give you the same benefits as the one you are currently taking.

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 


 

Section 64A:

 

Eye Specialist Tips for Blurring of Vision

 

As I have mentioned in another paper on this subject, blurring of vision is a common problem with antidepressants.  For some people, simple cheap magnifying glasses, bought over the counter, will resolve the problem.  Others may find it very beneficial to take the medication Urecholine (Urocarb) on prescription, and this medication will also help with other side effects of antidepressants, such as dry mouth and constipation.

 

An eye specialist has recently provided a further solution to the problem of blurring of vision in people taking antidepressants.  These medications not only cause dry mouth, but also dry eyes.  Adequate fluid in the eyes is necessary to see clearly, otherwise blurring of vision does occur.

 

Indeed, the problem is made worse when we have blurring of vision by our automatic instinct to stare more intensely at what we are reading or looking at, and deliberately blinking less. This actually reduces the ability of the eyes to spread tears and fluid within the eye, actually resulting in the situation that staring makes blurring of vision worse!

 

For many people therefore, it will be very useful to regularly apply ARTIFICIAL TEARS to their eyes, so that this contribution to blurring of vision is removed.

 

Other people will still have blurring of vision due to a different mechanism, being the problems with small muscles within the eye responding adequately, for whom Urecholine or glasses may help.  Urecholine should also help with the problem of dry eyes anyway.

 

 

 

 

 

 

This is medical information only, and is not to be taken as medical advice or treatment

 

 

 

 

 

 

 

 

 

 

 

SECTION 65

Blood pressure changes due to antidepressants

 

Low blood pressure

Most people have no change in their blood pressure while taking antidepressants. However, nearly all available antidepressants, especially tricyclic antidepressants, can cause lowering of your blood pressure, especially in warm weather, or after physical activity.

 

Typical symptoms of low blood pressure are feeling dizzy (especially when getting out of bed or getting out of a chair), feeling tired, or feeling very cold in warm weather.

 

This problem, and suggested solutions,  are described in detail in this information.

 

High blood pressure

High blood pressure can be induced in a minority of people taking the antidepressant Effexor.  This seems to be a problem in at least five per cent of people, and is more likely as the dose of Effexor is increased.  Hopefully, your doctor, or you yourself, will measure your blood pressure from time to time, to detect if this problem is occurring.

 

If the problem is significant, the usual approach would be to change to another antidepressant, rather than giving you extra medication to control your blood pressure.

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 

 

SECTION 66

Dizziness / low blood pressure due to antidepressants: treating the problem

 

This is a common side effect, occurring in a minority of people on all available antidepressants, especially in warm weather. 

 

When low blood pressure is beginning, you may feel dizzy, especially when you stand up from sitting, or get out of bed, or bend over and straighten.  This phenomenon is due to low blood pressure, so that the blood cannot get to your brain adequately quickly when you change position, and is technically described as postural hypotension.

 

When low blood pressure becomes worse, you may feel unusually tired and weak, and may feel strangely very cold in warm weather.

 

Of course, it is only by taking a proper reading of your blood pressure that it can be known for certain whether or not your blood pressure is significantly below what is normal for you. 

 

Treatment of low blood pressure:-

1.     Drinking a lot of fluid tends to increase the amount of fluid within your blood vessels and therefore raises your blood pressure.

2.   Salt will have a slight effect in raising your blood pressure.

3.   caffeine in drinks or in tablet form will slightly raise your blood pressure

4.   Raising the head of your bed, such as by putting blocks under the legs of the bed in which you sleep, drops your blood pressure while you are asleep.  Your body automatically tries to compensate, and the compensation will continue throughout the next day, so that your blood pressure next day will be slightly higher than it otherwise would be.

5.   Wearing tight stockings over your legs forces blood from the lower part of your legs back up into the general circulation and may help your blood pressure.  However, theoretically such stockings would have to be put on before you change from the horizontal position in bed, and would of course be very uncomfortable in warm weather.

 

 

PUMPING YOUR CALF MUSCLES - when standing, tightening and releasing your calf muscles in your lower leg repeatedly causes blood to be pumped back up into your body, raising your blood pressure.  When getting up from a chair, it is a good idea to do this a number of times before actually standing, and to then hang on to a solid object for about 30 seconds, while your blood pressure adjusts.  Before getting out of bed, it is wise to sit on the edge of the bed and carry out this manoeuvre for about 60 seconds, so that your blood pressure has time to adapt to the changes involved in lying down, sitting down, and then standing.

 

FLUDROCORTISONE - this medication, prescribed by your doctor, is a variety of steroid medication, which retains sodium in your body, thus raising your blood pressure.  Taking 0.1 mg tablets three times per day is very useful in some people in markedly raising their blood pressure.  A number of patients take this medication in warm weather, with the need for this medication disappearing in colder weather.  However, as this mechanism of retaining sodium to raise your blood pressure is actually at the expense of causing your body to lose potassium, it is necessary to take Potassium tablets at the same rate as you take Florinef tablets, to keep your potassium levels steady.  As very low levels of potassium make you feel weak, and could even cause your heart to stop if it was extremely low, your doctor should test your potassium levels from time to time while you are taking the combination of Fludrocortisone and Potassium.

 

DIZZINESS NOT DUE TO LOW BLOOD PRESSURE - a minority of people taking any of the currently available antidepressants will experience dizziness as a side effect.  If this side effect is severe, you will probably have to stop the antidepressant and try to restart at a lower dose, or try a different antidepressant.  In most people, side effects progressively get less as your body gets used to the medication, but this can take up to six weeks.

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 


SECTION 67

Breast and gynaecological changes due to antidepressants

 

Breast enlargement

Weight gain is a common problem with most antidepressants.  If a woman gains weight while taking antidepressants, some of the weight gain will also be deposited in her breasts, causing breast enlargement.

 

In recent years, research has indicated that at least forty per cent of women taking the modern antidepressants (SSRIs and Effexor) will have breast enlargement over a number of months.  In a number of these women, the changes occur due to weight gain, while in others the changes of breast enlargement occur despite their weight remaining stable.

 

Breast milk

In a small number of cases with antidepressants, and in a large number of cases in patients taking antipsychotic medications, the chemical pathways preventing breast milk production are blocked; as a result, the milk-producing glands in the breast are stimulated inappropriately.  This results in milk being produced in the breasts, and leaking out at times.

 

Vaginal bleeding

Vaginal bleeding can occur in women taking the SSRIs (Prozac, Zoloft, Aropax, Luvox, Cipramil, Effexor) especially when taking high doses of these antidepressants.

 

Vaginal lubrication

Vaginal lubrication can be reduced due to anticholinergic side effects of antidepressants, especially the older tricyclic antidepressants.  (Anticholinergic side effects are those resulting from interference with the cholinergic system, which looks after many automatic functions of our body.)  Furthermore, many of the modern antidepressants cause marked sexual problems, including an inability to respond normally sexually, with resultant reduction in vaginal lubrication.

 

Sexual problems due to antidepressants are described in detail in Section 58, together with suggested solutions to these problems.

 

Breast cancer

Breast cancer is more likely to recur in the presence of certain hormonal changes.  Accordingly, the manufacturers of a number of antidepressants, including Serzone (Nefazodone), caution against the use of their antidepressant in someone with a history of breast cancer, and perhaps also the same care would need to be taken with women with a strong family history of breast cancer.  However, little is known about this situation.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 


SECTION 68

Bladder and bowel problems due to antidepressants: how to deal with them

 

INCONTINENCE OF URINE, or the need to rush urgently to the toilet to avoid being incontinent, is a problem in a minority of people taking the modern antidepressants.

For these side-effects, the medication PROBANTHINE may help, although usually only in a minority of cases.  Probanthine needs to be taken 3 to 4 times a day, and may give you a dry mouth.

 

Constipation and difficulty passing urine are very common side effects from the tricyclic antidepressants.  Constipation also occurs in a minority of people taking the modern antidepressant agents, especially Nefazodone.  Diarrhoea is a common side effect of the other modern antidepressants available, being the SSRIs and Effexor. 

 

CONSTIPATION is a common side-effect of the older antidepressants, and occurs in a minority of those taking the newer drugs, often due to interference with nerve transmission in the cholinergic system.  There is an antidote to the range of anticholinergic symptoms.  BETHANECHOL  (UROCARB) is a simple antidote, which will relieve the anticholinergic side effects of tricyclic antidepressants in the majority of people.  This medication normally has no side effects itself, and needs to be taken in a dose of 10-20 mgs three times per day usually.  While the timing of the medication is not an issue for the majority of people, some people find Bethanechol works far better if taken on an empty stomach, and half an hour before any food is consumed.

 

Older people have to be cautious if the antidepressant they are taking causes constipation, due to the rare possibility they will go on to develop bowel obstruction.

 

Older men, especially with enlarge prostate glands, also have to be careful they do not develop a total inability to pass any urine as a complication of taking tricyclic antidepressants.

 

In some cases, it may be possible for your doctor to change your tricyclic antidepressant to one with fewer anticholinergic side effects in most people, (eg Nortriptyline or Dothiepien), or consider Mianserin, a derivative of the tricyclic antidepressants with no anticholinergic side effects.  However, do keep in mind that a new antidepressant may not necessarily give you the same benefits as the one you are currently taking.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

 


SECTION 69

DIFFICULTY SLEEPING DUE TO DEPRESSION OR ITS TREATMENT

 

Sleep disturbance due to depression:  It is very common for people to have occasional sleepless nights, or nights where they sleep badly, when worried about something.

 

In depressive illness, difficulty sleeping becomes almost a nightly problem.  The sleep disturbance may consist of problems falling asleep, so that the affected person lies awake for a long time, unable to sleep.

 

Waking up repeatedly during the night and lying awake for periods of time, is also a common problem in depressive illness.

 

Waking up very early in the morning, typically 2 or 3 hours before you normally need to wake up, is a classical phenomenon associated with more severe forms of depressive illness.  Typically, people often describe their depression and anxiety as at its worst at this time, as your biochemistry is at its lowest point, from the point of view of depression.  While the depression may improve slightly as the day goes on from this low point, it will never disappear completely in the case of depressive illness, until the illness has been treated or subsides over many months.

 

Some people with depression actually sleep excessively, describing it as a mixture of a desire to escape how terrible they feel when awake, and an irresistible urge to stay asleep.

 

Common to almost everybody with depression is the complaint of being continually exhausted, almost regardless of how many hours sleep they actually get.

 

Simple sleeping tablets may help the sleeping problem itself, but only antidepressants will eventually eradicate the underlying cause of the problem.  Some doctors like to use very-sedative antidepressants (such as Tryptanol, Serzone, Prothiaden) from the first day of treatment of depression, to ensure the patient gets enough sleep.  However, others doctors prefer to use less-sedative antidepressants which will be more easily tolerated by the patient in the long run when the depression has subsided, perhaps backed up by a short course of sleeping tablets while waiting for the antidepressants to solve the depressive illness and the associated sleep problems.  Severe sleep disturbance is not only very distressing to the person affected by it, but is also the time when suicidal ideas seem to become stronger, as the sufferer lies awake and alone, while everybody around them sleeps on, apparently regardless.  Accordingly, it is very important to take whatever medication is going to give sleep in this situation.

Sleep effects of various antidepressants

1.  Tricyclic antidepressants:  These antidepressants are typically very sedating, and indeed, the level of their sedating effect is generally matched by the level of weight gain they induce.  Tryptanol is the most sedative of the tricyclic antidepressants.  Prothiaden is perhaps moderately sedating.  Nortriptyline is minimally sedating in most people, although there will be some who are very sensitive to it.  Desipramine (Pertofran) and Chlorimipramine (Anafranil) produce a mixture of bodily tiredness and mental stimulation in many people, so that experimenting with taking them in the morning and throughout the day may be worthwhile, rather than taking the medication at night, and running the risk that the mental energising effect will wake you up. 

 

2.  Serzone:  This medication is very sedative, and typically has to be started in low doses, with the dose increased at weekly intervals.  For very anxious people, this can be a very good choice of medication, as it does not have the weight gain problems associated with most of the other antidepressants, and it does not have the sexual problems associated with the modern antidepressants in general.

 

3.  SSRI’s (Prozac, Paxil, Zoloft, Luvox, Cipramil etc) and Effexor:  These modern antidepressants are generally mentally energising.  Accordingly, most people who take them late in the day, or at night, will either have trouble going to sleep, or will wake up after a few hours sleep, with their mind very active.  Accordingly, in most cases, the medication is best taken first thing in the morning.

 

Because these modern antidepressants are so effective at wiping out depression and anxiety symptoms, it sometimes occurs that the patient becomes drowsy, despite not having changed their dose of medication.  (See Section 21, “Am I taking too much antidepressant?”).

 

4.  MAO Inhibitors:  These older antidepressants (Parnate, Nardil etc) and their more modern replacement (Aurorix, Mannerix – not available in USA) are typically energising mentally.  Accordingly, it is usually advised that they be taken morning and lunchtime, to avoid problems with sleeping.

 

A small number of people find they are made drowsy.  While this is often an individual reaction to these medications, in a number of cases, especially in warm weather, the drowsiness may be associated with a feeling of being very lethargic, or feeling cold in warm situations.  This suggests a blood pressure drop as a result of these medications (See Section 65).

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.


SECTION 70

White blood cell and platelet changes due to medications

 

White cells

The white blood cells in our blood stream are the cells we depend on to detect infection, and to fight it, as well as fighting a number of other illnesses. 

 

MIANSERIN (Tolvon) has a rare side effect of causing a marked drop in white blood cell numbers in a small number of people.  This can manifest itself in an unusually severe infection, or an infection that takes a long time to heal up.  If you develop an infection, and you are taking the antidepressant Mianserin, it is a useful precaution to have your doctor order a check on your white cell count.  This is a very simple and inexpensive laboratory test.  In infection, your white cell count should be raised, indicating your body is producing more white cells to fight the infection.  In rare cases, people on Mianserin will be found to have an abnormally low white cell count, and will have to stop the medication.

 

LITHIUM actually causes an increase in white cell numbers as a perfectly normal side effect of this medication.  There is no cause for concern, and it should be noted that this is a normal finding in people on Lithium.  Accordingly, if your doctor does find an increase in white cells (particularly white cells known as Neutrophils), you may have to remind him that you are taking Lithium, as doctors cannot be expected to remember every detail in the fine print medical literature.

 

CLOZAPINE (Clozaril) is a medication used to control severe psychotic symptoms, is dramatically effective in resistant cases, but has the possibility of causing potentially fatal bone marrow changes.  These changes can be detected before they become life threatening if the patient has regular white cell counts, as a reduction in white cell count is the first warning of the bone marrow changes beginning.  Any patient taking Clozapine must have regular white cell counts, and indeed in most countries in the world, doctors and pharmacists are forbidden to continue the supply of Clozapine to a patient, until the results of regular white cell counts are available.

 

Almost any medication used in psychiatry, and in many other branches of medicine, can occasionally cause concerning drops in white cell count, or in platelet count.

 

Platelets

Platelets are numerous tiny cells floating in our blood stream, which automatically close over the innumerable tiny leaks that develop in our blood vessels, and help in the clotting process, which stops us bleeding after an injury or a cut.  Some medications used in psychiatry, particularly anticonvulsants to stabilise mood swings, can cause a drop in platelet numbers.  The usual evidence of low platelets is very easy bruising, or the appearance of spontaneous bruises.  This may alert you to request a platelet count from your doctor to ensure that all is well.

 

This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.