Side Effects of Antidepressants and Alternative Treatments

Side effects of antidepressants?

Hello Doctor, my family member has been experiencing anxiety, restlessness, and panic, occasionally showing symptoms of depression and suicidal thoughts.
After consulting a psychiatrist, it was determined that there is an issue with autonomic nervous system dysregulation.
They were prescribed Lexapro as the primary treatment medication, but my family member is very sensitive to medications.
Previously, they had taken one pill each of two antidepressants, Cymbalta and Effexor, but had to stop due to severe side effects as advised by the doctor.
Recently, after taking one 50 mg dose of Lexapro (divided into two doses), they experienced severe flushing and nausea.
Upon reporting this to the doctor, it was suggested that my family member may not be suitable for SSRI medications.
Currently, they have stopped taking the medication.
I would like to ask the doctor: 1.
Since Lexapro was only taken for two days (totaling one pill), should there be any withdrawal symptoms? 2.
If multiple SSRIs have caused severe side effects, does this indicate that the patient is not suitable for SSRIs? 3.
If there is a high sensitivity to the side effects of antidepressants, would rTMS or CES therapy be more appropriate? 4.
I would like to know if the out-of-pocket rTMS or CES treatment at Taoyuan would have a long waiting period?

Niming, 20~29 year old female. Ask Date: 2023/10/20

Dr. Wu Enliang reply Psychiatry

1.
If someone has only taken Levodopa for two days (a total of one pill), should they expect withdrawal symptoms? A: No.
2.
If a patient experiences severe side effects from multiple SSRIs, does that indicate they are unsuitable for SSRIs? A: Yes.
3.
If a patient is very sensitive to the side effects of antidepressants, would rTMS or CES treatment be more appropriate? A: If financially feasible, it can be considered.
There are other types of antidepressants that may be worth trying.
4.
How long is the wait for self-paid rTMS or CES treatment at the clinic? A: You will be scheduled with Dr.
Wu Enliang very soon.

Reply Date: 2023/10/20

More Info

When dealing with the treatment of depression, particularly in individuals who are sensitive to medications, it is crucial to approach the situation with care and a thorough understanding of the available options. Your family member's experience with severe side effects from SSRIs (Selective Serotonin Reuptake Inhibitors) like Lexapro (Escitalopram) highlights the importance of personalized treatment plans in mental health care.

1. Withdrawal Symptoms: Since your family member has only taken Lexapro for a short period (two days), it is unlikely that they will experience withdrawal symptoms. Withdrawal symptoms typically occur after prolonged use of antidepressants, especially if the medication is stopped abruptly. However, it is always best to consult with the prescribing physician before making any changes to medication regimens.

2. Sensitivity to SSRIs: Experiencing significant side effects from multiple SSRIs may indicate that your family member is indeed sensitive to this class of medications. Each individual metabolizes drugs differently, and some may not tolerate SSRIs well. In such cases, it is essential to communicate these experiences with the healthcare provider, who can explore alternative treatment options that may be better suited to your family member's needs.

3. Alternative Treatments: Given the sensitivity to antidepressants, exploring non-pharmacological treatments such as rTMS (repetitive Transcranial Magnetic Stimulation) or CES (Cranial Electrotherapy Stimulation) may be beneficial. rTMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain and has been shown to be effective for treatment-resistant depression. CES involves the application of a small electrical current to the brain and is used to treat anxiety and depression. Both treatments have been found to have fewer side effects compared to traditional medications, making them suitable alternatives for individuals who cannot tolerate SSRIs.

4. Waiting Times for rTMS or CES: The availability and waiting times for rTMS or CES treatments can vary significantly based on location and the specific clinic's capacity. It is advisable to contact local mental health facilities or specialized clinics that offer these treatments to inquire about their schedules and any potential waiting lists. Some clinics may have immediate availability, while others may require a longer wait due to high demand.

In summary, it is essential to maintain open communication with healthcare providers regarding your family member's experiences with medications. If SSRIs are not a viable option, discussing alternative treatments like rTMS or CES could provide a pathway to managing their symptoms effectively. Additionally, ensuring that your family member feels supported throughout this process is crucial, as mental health treatment can often be a journey of trial and error. Always consult with a healthcare professional before making any changes to treatment plans, as they can provide tailored advice based on your family member's specific situation.

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