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.
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 (GI tract). The situation is slightly different with SSRI antidepressants. This class of drug works by stimulating the effects 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 GI tract as well as the brain. The combined stimulatory effect—on both the GI tract and CNS—can trigger such side effects as:
DiarrheaLoss of appetite (anorexia)NauseaVomiting
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. Antidepressant withdrawal symptoms can sometimes 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 the following:
Anxiety Confusion Diarrhea Dizziness Fever Hallucinations Headaches Panic attacks Profuse sweating Tremors Vivid dreams
Risk by Drug Type
Nausea and vomiting doesn’t only occur with SSRIs. The symptoms are also common with other classes of antidepressants, albeit less commonly or profoundly, including:
Selective norepinephrine-dopamine reuptake inhibitors (SNDRIs) such as Wellbutrin (Buproprion) Serotonin-norepinephrine reuptake inhibitors (SNRIs) Tricyclic antidepressants (TCAs)
Nausea and vomiting are less common with a class of antidepressants known as monoamine oxidase inhibitors (MAOIs).
Minimizing Antidepressant Nausea
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, according to some research, as many as 32% of people taking an SSRI will continue to experience GI symptoms 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 meals, more frequently.Suck on sugarless, hard candy whenever you are nauseous.Take an antacid like Pepcid (famotidine) or Tums.Sip ginger tea or slightly flattened ginger ale.Ask your doctor about a slow-release form of your antidepressant, or whether you need to temporarily lower your dosage.Talk to your doctor about anti-nausea medication, such as Zofran (ondansetron).
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.
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. The following are some examples of tapering schedules by medication.
Paxil
Starting dose: 60 milligrams (mg)1st dose reduction: 40mg2nd dose reduction: 30mg3rd dose reduction: 20mg4th dose reduction: 10mg
Celexa
Starting dose: 40mg1st dose reduction: 30mg2nd dose reduction: 20mg3rd dose reduction: 10mg
Lexapro
Starting dose: 20mg1st dose reduction: 15mg2nd dose reduction: 10mg3rd dose reduction: 5mg
Prozac
Starting dose: 60 mg1st dose reduction: 40 mg2nd dose reduction: 30 mg3rd dose reduction: 20 mg4th dose reduction: 10 mg
Zoloft
Starting dose: 200mg1st dose reduction: 150mg2nd dose reduction: 100 mg3rd dose reduction: 75mg4th dose reduction: 50mg
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 40mg one day and 20mg the next if a 30mg pill is not available.)
