Psychiatric Medication Side Effects

What are the major side effects of psychiatric medication?

1. Weight Gain

2. Sexual Problems

3. Restlessness, Hyperness, Irritability

4. Tiredness, drowsiness, clouded thinking, memory problems

Which medications are the most common causes of each of these side effects?

(The medications below are listed in relative frequency to cause these side effects from highest to lowest)

1. Weight Gain - Zyprexa, Seroquel, Risperdal, Depakote, lithium, mirtazapine, Paxil, Luvox, Prozac, Zoloft, Celexa, Lexapro, Effexor, Cymbalta, Abilify, Geodon, Wellbutrin, Lamictal.

2. Sexual Problems - SSRI (Prozac, Zoloft, Luvox, Celexa, Paxil, Lexapro), Risperdal, Zyprexa, Seroquel, Mirtazapine, Effexor, Cymbalta, Geodon, Abilify, Strattera, Lamictal, Wellbutrin.

3. Restlessness, Hyperness, irritability - Geodon, Abilify, Risperdal, Zyprexa, Seroquel, SSRI (Prozac, Zoloft, Luvox, Celexa, Paxil, Lexapro), Wellbutrin, Effexor, Cymbalta.

4. Tiredness, drowsiness, clouded thinking, memory problems - lithium, Depakote, Seroquel, Zyprexa, Risperdal, Abilify, Geodon, Klonopin, Xanax, Paxil, Luvox, Celexa, Prozac, Zoloft, Lexapro, Remeron, Effexor, Wellbutrin, Cymbalta, Neurontin, Lamictal.

What can be done to get rid of these side effects?

First you need to communicate to your psychiatrist. We have a checklist that our patients are asked to review before every session so that they remember to draw attention to these side effects.

Options include reducing or stopping the suspected medicine, switching to another medicine in the same class or in another class of medications, or giving an antidote, i.e., another medication that may reduce or alleviate the side effect.

What are the pros and cons of each option?

If the medication is reduced or stopped, the condition for which the medication is given may worsen or return. However, sometimes the condition has remitted or improved so that the medication is no longer needed or a lower dose will reduce the side effect and the condition may remain in remission. Example: depression often remits in nine months with or without medication and may need no more medication after nine months of treatment.

Switching to a sister medicine in the same class may get rid of the side effects and the other sister medicine may keep the illness from returning. Example: changing from Paxil to Lexapro, which has a lower risk of weight gain, may solve the problem, and may help the anxiety or depression disorder just as much as Paxil, as they are both in the SSRI class of serotonin neurotransmitter enhancers. Sometimes the sister medicine has the same side effect or even worse, it may not work as well, or have other side effects. Switching to another class of medicines is more likely to get rid of the side effects. Sexual side effects occur in about 50% of patients on SSRI's; (Prozac, Zoloft, Luvox, Celexa, Paxil, Lexapro). Example: recovered depression patients often get significantly reduced risks of sexual side effects if switched to Cymbalta (Cymbalta is in a different class called SNRI's) and often do not go back into depression.

Adding an antidote medicine may stop the side effects and preserve the benefits of the initial medication that gave a good response. Sometimes adding Wellbutrin to Lexapro may largely reduce the sexual side effects of Lexapro.

What are some more examples of antidotes for specific side effects?

1. Weight gain - Adding Topomax, Zonegran, or Wellbutrin may reduce carbohydrate cravings and make it easier to lose weight, especially if you use in combination with prudent dieting and exercise. Switching from Zyprexa, Risperdal or Seroquel to Geodon or Abilify usually stops carbohydrate cravings and weight gain in patients who are taking these medications for mood stabilizing. If you are taking Zyprexa, Risperdal, or Seroquel for anxiety or sleep, Geodon or Abilify may help the anxiety but not your insomnia. The insomnia may require another medicine to help with sleep such as Trazadone, Ambien, Rozerem, Lunesta, Gabapentin, Keppra, buspirone, or others.

2. Sexual side effects - Male sexual side effects (difficulty in achieving or maintaining erections) or female side effects (lessened arousal that includes lack of vaginal lubrication or reduced genital sensation) often have the same neurochemical side effect dysfunction in the different sexes. These symptoms or difficulty in achieving orgasm in either men or women may be responsive to Viagra, Levitra, and/or Cialis. Wellbutrin may also be helpful with these symptoms. Wellbutrin may also be helpful for reduced sexual drive and desire.

3. Restlessness, especially of the legs, is an often undetected side effect of the following mood-stabilizing dopamine blocking medications:  Geodon, Abilify, Risperdal, Zyprexa, and Seroquel. Patients often report they feel like they have the "heebie jeebies" or "ants in the pants". The medical name of this condition is akithisia. It would usually stop in an hour after beginning propanolol or nadolol.

Hyperness may be the same thing as the restlessness described above or it may be a mild manic-like symptom triggered by any of the antidepressants. If this occurs, the diagnosis of a mild form of bipolar disorder needs to be investigated with your psychiatrist. The most likely solution would be to stop the antidepressant and start a mood stabilizer, particularly considering a bipolar antidepressant such as Lamictal, lithium, Miropex, or others.

Irritability may be caused by antidepressants as described for hyperness. To treat it is described above. However, irritability may also be a presentation of akithisia described two paragraphs above. The treatment approach is the same for it.

Irritability may also be present if a person has a bipolar "high" (hypomania). If the high is resolved by a mood stabilizer, the person may then swing into a depressive cycle and become irritable from the depression.

4. Tiredness and drowsiness may be caused by literally all the psychiatric medications sometimes. Strategies to relieve tiredness and drowsiness: start with low doses aiming to undershoot, i.e., going to low and having a dose that is not beneficial rather than overshooting and over-sedating patients with the first dose size. If the medicine has a tendency to cause sedation, start it at bedtime. If the patient has some hangover sedation after awakening the next morning, it does not go away in a couple of days, and it is too low of dose to be beneficial, change to another medicine in that class--such as changing from Paxil to Lexapro; or change classes such as Prozac to Cymbalta.

Occasionally medicine is very effective but tiredness or drowsiness will remain a problem. Adding Provigil, Wellbutrin, or Ritalin may offset this side effect. Sometimes the tiredness or drowsiness is symptomatic of an emerging depression in a patient who has been treated effectively for bipolar hypomania or anxiety. In this case, starting a bipolar antidepressant for a bipolar patient or an antidepressant for the anxious patient may be the solution.

Clouded thinking (reduced cognition or slowing thinking) or reduced memory are frequently missed side effects of medicine. The mildest degrees are only subjectively experienced by the patient and not evident to the psychiatrist. Therefore, you have to tell us if you are noticing these symptoms in yourself and help us finger the offending agent. If you can identify that it started soon after a particular medicine was started or the dose was increased, we can then confirm if this is a known common risk for this suspected medicine.

What can be done for clouded thinking or reduced memory?

These symptoms do not usually go away by just waiting for the patient to get used to it. Reducing the dose or changing the medicine is usually the only solution. Literally, any of the medications can cause it. However, lithium and Wellbutrin are the most common medicines to cause these symptoms. There are multiple medicine alternatives to Lithium and Wellbutrin, if reducing the dose does not resolve the side effects or the reduction causes worsening of the condition that these medicines are treating.

These are just some of the examples of some of the side effects and solutions that Dr. Darvin Hege tries everyday. Dr. Hege is sensitive to concerns about side effects, persists in pursuing options, and ultimately helps find relief for your conditions on comfortable medicine. This is a challenging and gratifying endeavor. Call today if you seek a better solution to your emotional pain or discomfort.

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Darvin Hege MD, PC
2150 Peachford Road, Suite P
Atlanta, GA 30338-6521
770-458-0007
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