Coping With Nausea While on Antidepressants

Gastrointestinal Side Effects Common With SSRI Drugs

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 of selective serotonin reuptake inhibitors (SSRIs) used to treat major depression and anxiety disorders. In some cases, nausea and vomiting can become so severe or persistent that a person has no other option but to stop treatment.

Tips for relieving nausea from antidepressants
Illustration by Brianna Gilmartin, Verywell

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 (GIT).

The situation is slightly different with SSRI antidepressants. This class of drug works by stimulating the production of serotonin, a neurotransmitter associated with mood, cognition, and appetite.

When serotonin levels increase under the influence of SSRIs, they stimulate serotonin receptors in the GIT as well as the brain. The combined stimulatory effect—on both the GIT and CNS—can trigger such side effects as nausea, vomiting, diarrhea, and the loss of appetite (anorexia).

Call your doctor if you experience persistent vomiting for more than 24 hours and have signs of moderate dehydration, or if vomiting and diarrhea are both present.

Antidepressant Withdrawal

Antidepressants can also cause nausea and vomiting when treatment is stopped too suddenly. Known as antidepressant 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.

While antidepressant withdrawal symptoms are less intense than those associated with benzodiazepines, they can 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 diarrhea, anxiety, fever, headaches, confusion, profuse sweating, tremors, dizziness, vivid dream, panic attacks, and even hallucinations.

People who have taken antidepressants for longer than six weeks are more likely to experience withdrawal unless the daily dose is gradually tapered.

Risk by Drug Type

Research issued by the U.S. Food and Drug Administration suggests that the risk of SSRI-associated nausea ranges from significant to high:

This shouldn't suggest that nausea and vomiting only occur with SSRIs. The symptoms are also common with other classes of antidepressants, albeit less commonly or profoundly.

Nausea and vomiting are less common with a class of antidepressant known as monoamine oxidase inhibitors (MAOIs). The only exception is with MAOIs are stopped too abruptly, triggering withdrawal.

Coping

In most cases, nausea and vomiting will develop soon after treatment is started and gradually resolve within one to two weeks once the body adapts to the medication. However, as many as 32 percent of people taking an SSRI will experience recurrent bouts 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 bedtime to sleep through the worst of the symptoms.
  • Eat smaller, more frequent meals.
  • Suck on sugarless, hard candy whenever you are nauseous
  • Take an antacid like Zantac (ranitidine) or bismuth subsalicylate like Pepto-Bismol.
  • Sip ginger tea or slightly flattened ginger ale.
  • As your doctor about a slow-release form of your antidepressant.
  • Ask your doctor to temporarily lower your dosage.

Your doctor can also prescribe anti-nausea medications such as Zofran (ondansetron).

While proton pump inhibitors like Prilosec (omeprazole) may help, they can sometimes increase the concentration of antidepressant in your blood and may require a dose adjustment to avoid new or worsening side effects.

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, such as Celexa (citalopram), Paxil (paroxetine), or Symbyax (fluoxetine/olanzapine).

Drug Tapering Strategies

To reduce the risk of withdrawal symptoms when stopping an antidepressant, speak with your doctor about the appropriate tapering 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. Examples include:

  • Paxil
    • Starting dose: 60 milligrams (mg)
    • 1st dose reduction: 40 mg
    • 2nd dose reduction: 30 mg
    • 3rd dose reduction: 20 mg
    • 4th dose reduction: 10 mg
  • Celexa
    • Starting dose: 40 mg
    • 1st dose reduction: 30 mg
    • 2nd dose reduction: 20 mg
    • 3rd dose reduction: 10 mg
  • Lexapro
    • Starting dose: 20 mg
    • 1st dose reduction: 15 mg
    • 2nd dose reduction: 10 mg
    • 3rd dose reduction: 5 mg
  • 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: 200 mg
    • 1st dose reduction: 150 mg
    • 2nd dose reduction: 100 mg
    • 3rd dose reduction: 75 mg
    • 4th dose reduction: 50 mg
  • Luvox
    • Starting dose: 250 mg
    • 1st dose reduction: 175 mg
    • 2nd dose reduction: 100 mg
    • 3rd dose reduction: 75 mg
    • 4th dose reduction: 50 mg

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 40 mg one day and 20 mg the next if a 30-mg pill is not available.)

Unless otherwise directed, never cut an antidepressant in half as this affects the speed in which it is absorbed and may trigger side effects. Call your doctor immediately if you experience any signs of withdrawal.

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