Safety issues

Atypical antidepressants are safe for most people. However, in some circumstances they can cause problems. For example:

• Bupropion should not be used by people who have a seizure disorder or an eating disorder such as bulimia or anorexia.
• Esketamine can cause serious side effects and must be administered by a psychiatrist or a primary care doctor in close communication with a psychiatrist who has expertise in administering this medication.
• Mirtazapine has been associated with an increase in cholesterol. Mirtazapine is also associated with weight gain.
• Nefazodone has been linked to liver failure in some people — don't take it if you already have liver problems.
• Trazodone has been associated with rare cases of priapism — a persistent, usually painful erection not associated with sexual arousal. In rare cases, trazodone has been linked to heart rhythm problems (cardiac arrhythmias), so if you have heart disease, ask your doctor whether this medication is safe for you.
• Vilazodone and vortioxetine may increase the risk of bleeding, especially in people taking other medications that increase the risk of bleeding.

For antidepressants that cause sleepiness, be careful about doing activities that require you to be alert, such as driving a car, until you know how the medication will affect you.

Other issues to discuss with your doctor before you take an atypical antidepressant include:

• Antidepressants and pregnancy. Talk to your doctor about the risks and benefits of using specific antidepressants. Some antidepressants may harm your baby if you take them during pregnancy or while you're breast-feeding. If you're taking an antidepressant and you're considering getting pregnant, talk to your doctor or mental health professional about the possible risks. Don't stop taking your medication without contacting your doctor first, as stopping might pose risks for you.
• Drug interactions. When taking an antidepressant, be sure to tell your doctor about any other prescription or over-the-counter medications, herbs or other supplements you're taking. Some antidepressants can cause dangerous reactions when combined with certain medications or herbal supplements.
• Serotonin syndrome. Rarely, an antidepressant can cause high levels of serotonin to accumulate in your body. Serotonin syndrome most often occurs when two medications that raise the level of serotonin are combined. These include other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort.
  • Symptoms of serotonin syndrome include anxiety, agitation, sweating, high fever, confusion, tremors, restlessness, lack of coordination, blood pressure changes and a rapid heart rate.
  • Seek immediate medical attention if you have any of these symptoms.