Psychologically, agitation is the most dangerous side effect. It can be
like adding an anxiety disorder. People should be warned about agitation in
advance, and if it persists for more than four days, they should probably
try a different medication. There are plenty more to choose from. Agitation
seems most prevalent in the first-generation SSRIs, Prozac, Zoloft, and
Paxil, but it is totally unpredictable. It may occur with one and not the
others, though they’re chemically quite similar. Newer serotonergics have
been formulated to affect one serotonin pathway and block others so as
to be less agitating and to have less side effects in general, but sometimes
they’re also less generally effective. The effects of all antidepressant med-
ications vary more widely from person to person than from drug to drug.
SEDATION. SSRIs agitate some people and put others to sleep. Serotonin
pathways go almost everywhere in the brain, so you never know what
you’re going to get. Usually, serious sedation occurs for only a few days,
then abates. If it persists, the medication should probably be changed.
SEXUAL IMPAIRMENT. About half the people taking SSRIs and newer,
similar compounds experience sexual side effects. Lack of libido and
delayed orgasm are the most common. Some serotonin pathways go places
you’d rather not have them.
There is some speculation that adding BuSpar helps with this side
effect, but the most common tactic is switching to Wellbutrin, which is a
dopamine and norepinephrine reuptake inhibitor, and is chemically dif-
ferent from both tricyclics and SSRIs. It usually helps with the side effect,
but in my experience it doesn’t always work as well as an antidepressant.
WEIGHT GAIN. Virtually every seretonergic can cause weight gain if peo-
ple are on it long enough. Some, like Prozac, can cause an initial loss fol-
lowed by gain. Wellbutrin and Serzone are supposedly less likely to put
weight on, but the evidence is not conclusive. Wellbutrin also has its own
side effects, which are potentially more dangerous than those of the SSRIs.
It was taken off the market briefly because of the danger of seizures.
APATHY. SSRIs can cause people to move from feeling too much to feel-
ing nothing at all. This effect is particularly disturbing to artistic people,
who sometimes feel that antidepressants sap their creative energy.
162 ❧Explosions into Sadness