“Why do antidepressants cause anxiety?”
I am a 38 year old female. I want to know why do antidepressants cause anxiety?
3 Answers
PsychiatristPsychiatrist
Most antidepressants actually decrease anxiety symptoms.
Why do antidepressants cause anxiety?
I find this site to have very knowledgeable readers, so I don't want to give a simple answer because I believe you seek more. The answer is complex. First, many antidepressants are actually approved to treat anxiety in addition to depression; in many ways, the term "antidepressant" is misnomer for some molecules. With this in mind, there are some antidepressants that are very activating and the experience of this activation often feels like anxiety. This is especially true if there isn't a "protective" agent already on board to soften the activation.
For medication naive patients, bupropion is one such agent. However, I wouldn't necessarily not use this medication because of this. If this is the correct medication, there are strategies to mitigate or minimize the possibility of anxiety being a side effect and these can be deployed. The most basic one is telling your patient this might happen and proceeding with low-dose on-boarding and using the appropriate formulation (for example immediate vs. intermediate or long-acting release formulation). Layering of medications or perhaps an alternate first line medication might be an option for someone with a chief complaint of anxiety and depression. It all depends on the clinical situation.
On the other hand, there are some other antidepressants classes for which anxiety is not typically an anticipated side effect. However, these agents may have other side effects that would need to be considered in the treatment to see if they are an appropriate first line agent.
Anxiety can also occur because of uncommon or unusual side effects that are not the primary action of the anti-depressants and often are easily be managed by providing specific information to your health care provider about the specific symptoms you are experiencing.
Anxiety also can be experienced in the context of unanticipated drug-drug interactions. It is for this reason I maintain a very close contact with my patients when initiating any new medication and carefully review all their current medications and ask they reach out to me if they have any concerns what-so-ever and being available to receive their calls.
Unusual gene expression causing metabolism of medication to be different than expected resulting in excessively high or low levels of medications can produce unanticipated responses to medication.
My approach to your question and treating patient in general is as follows: Understanding the various agents and each of their side effect profiles; the chief complaint of my patient and all aspects of their chief complaint; their co-morbid medical problems and the underlying psychodynamic issues and psychology of their life. Then carefully choosing the right agent or agents in conjunction and discussion with my patient and putting together a treatment plan. Providing a truly informed consent, still with the possibility there may be an unanticipated side effect and being available to my patient to help manage the side effect as part of a collaborative team with my patient and any other providers involved.
I wish you the best of luck and thank you for your question.
Sincerely,
Renee S. Kohanski, M.D.
I find this site to have very knowledgeable readers, so I don't want to give a simple answer because I believe you seek more. The answer is complex. First, many antidepressants are actually approved to treat anxiety in addition to depression; in many ways, the term "antidepressant" is misnomer for some molecules. With this in mind, there are some antidepressants that are very activating and the experience of this activation often feels like anxiety. This is especially true if there isn't a "protective" agent already on board to soften the activation.
For medication naive patients, bupropion is one such agent. However, I wouldn't necessarily not use this medication because of this. If this is the correct medication, there are strategies to mitigate or minimize the possibility of anxiety being a side effect and these can be deployed. The most basic one is telling your patient this might happen and proceeding with low-dose on-boarding and using the appropriate formulation (for example immediate vs. intermediate or long-acting release formulation). Layering of medications or perhaps an alternate first line medication might be an option for someone with a chief complaint of anxiety and depression. It all depends on the clinical situation.
On the other hand, there are some other antidepressants classes for which anxiety is not typically an anticipated side effect. However, these agents may have other side effects that would need to be considered in the treatment to see if they are an appropriate first line agent.
Anxiety can also occur because of uncommon or unusual side effects that are not the primary action of the anti-depressants and often are easily be managed by providing specific information to your health care provider about the specific symptoms you are experiencing.
Anxiety also can be experienced in the context of unanticipated drug-drug interactions. It is for this reason I maintain a very close contact with my patients when initiating any new medication and carefully review all their current medications and ask they reach out to me if they have any concerns what-so-ever and being available to receive their calls.
Unusual gene expression causing metabolism of medication to be different than expected resulting in excessively high or low levels of medications can produce unanticipated responses to medication.
My approach to your question and treating patient in general is as follows: Understanding the various agents and each of their side effect profiles; the chief complaint of my patient and all aspects of their chief complaint; their co-morbid medical problems and the underlying psychodynamic issues and psychology of their life. Then carefully choosing the right agent or agents in conjunction and discussion with my patient and putting together a treatment plan. Providing a truly informed consent, still with the possibility there may be an unanticipated side effect and being available to my patient to help manage the side effect as part of a collaborative team with my patient and any other providers involved.
I wish you the best of luck and thank you for your question.
Sincerely,
Renee S. Kohanski, M.D.
I don't believe antidepressants cause anxiety. Anxiety frequently coexists with depression. External circumstances can also cause anxiety.
