Cold Medicine Interactions With Antidepressants and Bipolar Medication

Woman with a cold blowing her nose in bed
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If you wake up with a scratchy tickle in your throat or a runny nose, you might start by checking your medicine cabinet or heading to the pharmacy for your go-to cold and flu remedy.

Many of the products that treat cold symptoms are available over-the-counter (which means you can get them without a prescription from your doctor). While these products can be safe and effective, they can also interact with other kinds of medicine.

Prescription medications that treat mental health conditions such as depression, anxiety, or bipolar disorder are among the most common types of drugs that can interact with common cold medicines. Here's what you need to know about using OTC cold and flu remedies if you take antidepressants.

What Are Medication Interactions?

When doctors and pharmacists talk about medication interactions, they are referring to the way one drug can affect another. Knowing how different drugs interact is not just important to your safety but it also matters in terms of making sure that your medications work the way they were intended.

Even if an interaction is not dangerous, it can still cause problems (like when one drug makes another less effective). On the other hand, certain medications are sometimes combined on purpose because they work well together or have a positive effect on one another.

Drug interactions can be pharmacokinetic or pharmacodynamic.

A pharmacokinetic interaction means that when two medications are taken together, the interaction can change how one (or both) work. For example, taking certain medications at the same time might affect how the body absorbs, uses, or eliminates one (or both) drugs. When different medications are taken together, it might increase or decrease how much of the medicine is in your body.

Pharmacodynamic interactions occur when medicines directly affect each other. For example, taking more than one medication that causes sedation will make the effect more intense (potentiate). Pharmacodynamic interactions also occur when a drug is taken with a substance like alcohol.

If you are taking medications to treat depression, anxiety, or another mental health condition, they can interact with many other types of medicine—even those that you can get over-the-counter, like cold, cough, and flu remedies.

Certain ingredients in cold medicine can change how antidepressants work, including making them less effective. They can also exacerbate side effects or cause new side effects.

Cold Medicine and Antidepressants

There are several classes of drugs that are used to treat psychiatric conditions, including antidepressants, antipsychotics, tranquilizers, and anticonvulsants.

Many medications have the potential to interact poorly (even dangerously) with the common active ingredients in OTC cold medications.

Cold and flu remedies that are available over-the-counter often contain ingredients like pseudoephedrine (decongestant), diphenhydramine (antihistamine), dextromethorphan (cough suppressant), or guaifenesin (expectorant).

These substances can interact with prescription medications used to treat depression and other mental health conditions and have the potential to be serious.

The following are just a few common examples of medications that can interact with over-the-counter cold remedies. It is not an exhaustive list.

If you are taking any prescription medication, always check with your doctor or pharmacist before you take any over-the-counter medication or supplement.

Antipsychotics, Tranquilizers, and Sedatives

Some OTC cold remedies have ingredients that can make you feel sleepy. If you have a bad cough that's been keeping you awake at night, that can be helpful. However, certain antipsychotics and tranquilizers also have sedative effects. If you take these drugs with cough medicine, some decongestants, or an antihistamine, the sedating effect can be intensified.

Antidepressants and DXM

The list of major medication interactions between antidepressants and dextromethorphan (DXM), a common ingredient in cough medicine, is extensive.

It is especially important that you do not use any medicine with dextromethorphan if you take a selective serotonin reuptake inhibitor (SSRI) such as Prozac (fluoxetine), Zoloft (sertraline), or Lexapro (escitalopram). The combination can cause a serious interaction called serotonin syndrome.

Like other antidepressants, monoamine oxidase inhibitors (MAOIs) can also interact with other medications, remedies, or supplements you might be taking—they can even interact with food.

If you take an MAOI, you should not take cold, flu, or cough medicine that contains a decongestant (such as phenylephrine and pseudoephedrine) or dextromethorphan. Nasal decongestant sprays are also not safe to use if you are taking an MAOI.

Antidepressants and NSAIDs

Cold and flu preparations sometimes include a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen or acetaminophen as a pain reliever or fever reducer. NSAIDs can increase your risk of gastrointestinal (GI) bleeding.

If the antidepressant you take is a selective serotonin reuptake inhibitor (SSRI), you should avoid NSAIDs. Research has shown that taking SSRIs and NSAIDs together can further increase the risk of GI bleeding.

A 2015 study found that people who took SSRIs and NSAIDs (naproxen and aspirin, in addition to ibuprofen) together also appeared to be at an increased risk for bleeding in the brain (intracranial hemorrhage) in the month after they took the combination.

What to Do When You Get Sick

If you find yourself down and out with a bad cold or seasonal flu, there are some things you'll want to keep in mind as you're trying to get better.

Keep Taking Your Medications

Unless your doctor tells you to discontinue, you should never stop taking a medication that has been prescribed for you—including antidepressants or other drugs used to treat a mental health condition.

Many of the drugs that are used to treat depression and other mental illnesses can cause withdrawal symptoms if they are stopped abruptly. Stopping your medication without consulting your doctor can also lead to relapse or the worsening of symptoms related to your mental health condition.

The symptoms of stopping your medication can be severe—even life-threatening. For example, if a person who is taking a selective serotonin reuptake inhibitor (SSRI) to treat depression needs or wants to stop taking the medication, they will usually need to slowly taper their dose to reduce the risk of SSRI discontinuation syndrome.

Another reason to continue taking your medication even if you don't feel well is to help ensure that you don't make yourself feel worse. If you take an antidepressant to manage depression, stopping it could cause your depression symptoms to come back. You would not want this to happen in the best of times, let alone when you are already not feeling well.

Take Care of Your Mind and Body

When you're sick, you need to take care of your mind as well as your body. When your reserves are diminished because you are trying to heal from a physical illness or infection, your mental health might also feel a little sensitive.

If you are not sure whether it's safe to use a cold or flu remedy, don't hesitate to call your doctor or even your local pharmacist. They can review any prescription medications that you are taking and recommend a safe (and effective) treatment for your cold symptoms.

When you're sick, there are also things you can do to help yourself get better that are non-pharmaceutical. While they might seem obvious, it's easy to forget to take good care of yourself when you are healthy—let alone when you're not feeling well.

Eat and Drink Well

When you're feeling sick, you might not have much of an appetite or even feel sick to your stomach. Sticking to nutritious, simple, easy-to-digest foods will help keep your strength up without making your symptoms worse (there's a reason your Grandma's chicken soup has such a good reputation!).

You also need to drink plenty of fluids. Water is usually the most effective way to replenish, but there are a couple of exceptions:

  • If you have symptoms like vomiting or diarrhea (which can make you more likely to become dehydrated), you might want to try sipping a low-sugar sports drink to replenish electrolytes.
  • When you have a sore throat, hot tea with honey can be soothing as well as hydrating.
  • You don't want to drink it, but gargling with salt water might also help reduce the pain of a sore throat.

Take a Sick Day

Though you might feel stressed out at the thought of missing work or going back to bed for the day, one of the best things that you can do when you are sick is get plenty of rest.

Taking it easy (even having a nap) can help ease your symptoms (especially if you have a cough that's keeping you up all night) and gives your body with the rest that it needs to heal.

Resting up on the couch or in bed can also help prevent you from feeling (or getting) sicker. When your immune system is trying to fight off an illness, you're likely to feel extra tired and you're also more vulnerable to other infections.

Staying home when you're sick isn't just about your health. Avoiding close contact with people when you are not feeling well also helps to prevent the bacteria, virus, or whatever infectious pathogen is making you ill from spreading to others.

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