Join the Discussion I recently was put on Effexor XR by my doctor... I have noticed that if I do not eat for a while I get very nauseous and start to have tremors. The tremors were so bad once that I dropped an entire plate of food. In addition to these symptoms, my body seems to really slow down and I have a hard time talking. I start to stutter and can't think straight. I also get dizzy and sometimes I have a headache. Last night was the worst episode. I became unbelievably nauseous and actually had a vomit reflex (nothing came up). In each of these cases, as soon as I ate something I felt much better. Effexor side-effects?

Related Resources • Sexual dysfunction from antidepressants • Psych Medications • Antidepressants

Psychotherapy and medications are the two most common forms of treatment for mental health problems.  Many depressed patients are not initially referred to a mental health professional; instead they take antidepressant medications prescribed by their primary care physician.  A significant percentage of patients taking antidepressants stop taking their medications before their doctor recommends stopping. 

Why do people stop taking antidepressants?  Many of the older tricyclic antidepressants such as imipramine are known to cause side-effects such as drowsiness and dry mouth.  As many as 1/3 of patients on these medications quit taking them because of these symptoms.  When the newer selective serotonin reuptake inhibitors (SSRIs) were introduces they produced fewer initial side-effects, and studies found that fewer patients quit taking these medications. 

As SSRIs became more popular it became clear that they had sexual side-effects that were not as frequently reported in early studies.  Among the sexual side effects associated with SSRIs are delayed ejaculation, absent or delayed orgasm, and decreased sexual desire and/or arousal.  A 2001 study found that 37% of patients on these medications had sexual side effects.  Some patient may be choosing to be depressed and sexual rather than experience these side effects.

Other patients quit taking antidepressants soon after they start working.  When the depression lifts they no longer feel like they need the medication, despite the fact that most physicians recommend that they continue on the medication for at least several months after they show effectiveness against depression. 

A 2003 study found that adherence reminders help patients stick with their medication routine.  Lauren Hoffman and her colleagues tracked adherence in a large study of 9,564 patients.  The researchers checked prescription refill records for each patient and looked for gaps in their medication routine.   When a patient appeared to have missed more than 10 days of medications the researchers sent a letter to the patient's doctor identifying the patient, along with a letter to the non-adherent patient reminding them how and when to take their medication.  The researchers found a significantly higher adherence rate among the mailing group patients after three and six months' of medication. The study is published in the January 2003 issue of the American Journal of Managed Care. 

Hoffman and her colleagues found that adherence rates differed among patients depending on what type of antidepressant drug they were taking. Like earlier studies patients taking SSRIs were more apt to stick with their medication than patients taking the older tricyclic antidepressants. 

• If you are taking an antidepressant you should continue to take it even after your depression has lifted.
   
• Tell your doctor about any side effects you have from the medication.
   
• While antidepressants are not addictive, it may be necessary to taper off your medication when it is time to stop.  Be sure to follow your doctor's recommendations.