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Oral Antidepressants
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Depression
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Depression is a mental health condition that causes persistent depressed mood and a loss of interest in daily activities. Individuals experiencing depression often find it difficult to maintain a positive outlook on the future or derive pleasure from activities they normally enjoyed. Depression can affect individuals of any age, gender, or background.
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Other common symptoms of depression include:
- impaired concentration
- excessive feelings of guilt or worthlessness
- hopelessness about the future
- suicidal thoughts
- persistent fatigue or low energy
- loss of appetite, often resulting in significant weight loss
- insomnia
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In general, options for treating depression include psychotherapy, antidepressant medication, or a combination of both. For severe cases or when standard treatments have not helped, doctors may consider other specialized options.
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Oral Antidepressants* |
Antidepressants are medicines that can be used to treat the symptoms of depression. They function primarily by regulating the levels of certain neurotransmitters in the brain, such as serotonin, noradrenaline and dopamine, which play a fundamental role in regulating mood and emotion.
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All registered antidepressants in Hong Kong are classified as prescription-only medicines and
must be administered strictly under a doctor’s instruction and close medical supervision.
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Oral antidepressants are generally classified into the following main categories*:
- Tricyclic Antidepressants (TCAs) (e.g. amitriptyline, clomipramine, imipramine, nortriptyline)
- Monoamine Oxidase Inhibitors (MAOIs) including Reversible Inhibitors of Monoamine Oxidase Type A (RIMAs) (e.g. moclobemide)
- Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g. fluoxetine, paroxetine, sertraline, citalopram, escitalopram)
- Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs) (e.g. duloxetine, venlafaxine, desvenlafaxine, milnacipran)
- Atypical Antidepressants (e.g. agomelatine, bupropion, mirtazapine)
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Common Side Effects of Oral Antidepressants |
Antidepressants*
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Common side effects*
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| 1. | Tricyclic Antidepressants (TCAs) |
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- Dizziness
- Drowsiness
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention
- Headache
- Palpitations
- Tremor
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| 2. | Monoamine Oxidase Inhibitors (MAOIs) including Reversible Inhibitors of Monoamine Oxidase Type A (RIMAs) |
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- Dizziness
- Hypotension
- Gastrointestinal disturbance
- Headache
- Sleep disorder
- Dry mouth
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| 3. | Selective Serotonin Reuptake Inhibitors (SSRIs) |
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- Nausea and vomiting
- Gastrointestinal discomfort
- Diarrhoea
- Constipation
- Weight changes
- Headache
- Dry mouth
- Sexual dysfunction
- Sleep disorder
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| 4. | Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs) |
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- Nausea and vomiting
- Diarrhoea
- Constipation
- Decreased appetite and weight changes
- Dry mouth
- Sexual dysfunction
- Hot flush
- Palpitations
- Insomnia
- Headache
- Postpartum haemorrhage
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| 5. | Atypical Antidepressants |
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For Agomelatine:
- Abdominal pain
- Constipation
- Diarrhoea
- Dizziness
- Headache
- Nausea
- Abnormal liver function test results
For Bupropion:
- Abdominal pain
- Headache
- Insomnia
- Dry mouth
- Taste disturbance
- Tremor
- Anxiety
- Dizziness
For Mirtazapine:
- Appetite increased
- Weight gain
- Back pain
- Constipation
- Diarrhoea
- Dizziness
- Drowsiness
- Dry mouth
- Headache
- Nausea and vomiting
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General Advice for Taking Antidepressants*
- Strictly follow your doctor’s instructions: Always take your medicine exactly as prescribed.
- Avoid alcohol: Do not drink alcohol while taking antidepressants.
- Stay safe if you feel dizzy: Antidepressants can cause drowsiness, dizziness, or blurry vision, especially when you first start taking them. If you feel this way, do not drive or operate heavy machinery.
- Never mix antidepressants on your own: Do not take two different types of antidepressants at the same time unless your doctor explicitly tells you to.
- Don't stop suddenly: Keep taking your medication even if you feel better. Never stop taking your antidepressants without talking to your doctor first. Stopping antidepressants suddenly can cause withdrawal symptoms and increase the risk of relapse. To reduce these risks, doses should be reduced gradually under the guidance and supervision of a doctor.
- Oral antidepressants may take several weeks to begin showing a noticeable therapeutic effect. Patients may experience worsening or changes in depressive symptoms, agitation or suicidal ideation during the early treatment phase and at times of dosage adjustment. Patients, family members or caregivers should be vigilant for the emergence of any new, sudden or significantly worsening of the patient’s mood, thoughts or behavioural changes, and should inform healthcare professionals as soon as possible if such symptoms are present. Emergency medical assistance should be sought immediately if the patient develops suicidal ideation, has a suicidal plan, attempts suicide, or is at immediate risk of harming themselves or others.
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Communication with Your Doctor*
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- Get professional guidance: Always talk to a doctor to get an accurate diagnosis and find the right treatment plan for you.
- Share everything you take: Tell your doctor about all other medicines you are taking, including over-the-counter drugs, vitamins, and herbal supplements. Also, share your full health history. Some medicines can interact with antidepressants, and certain health conditions require extra precautions.
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- Mention pregnancy or breastfeeding: Let your doctor know right away if you are pregnant, planning to get pregnant, or currently breastfeeding.
- Reach out immediately if you need help: If you ever have thoughts of harming or killing yourself while taking antidepressants, please contact your doctor or go to an emergency room immediately.
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Oral antidepressants should be kept in a cool dry place. Do not refrigerate unless specified. Always keep medications out of reach and sight of children to prevent accidental ingestion.
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* This information may not cover all possible side effects, precautions, or medical advice. Always consult your healthcare professional for guidance.
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Acknowledgement: The Drug Office would like to thank the Surveillance and Epidemiology Branch (SEB) and the Professional Development and Quality Assurance Service (PD&QA) for their valuable contribution to the preparation of this article.
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