Can Antidepressants Cause Anxiety?
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Nancy Schimelpfening
Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.
Medically reviewed by Steven Gans, MD on November 18, 2015
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Steven Gans, MD
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Activation Syndrome
Anxiety Increases
While antidepressants can be used to treat anxiety, it is also a possible side effect of these medications. This can be confusing, especially if you're being successfully being treated for depression but begin feeling anxious at the same time. There are a number of possible reasons for this, though it is best to discuss your concerns with your doctor.
The Link Between Antidepressants and Anxiety
Antidepressants are often used to treat anxiety disorders, especially generalized anxiety and panic disorders, as well as depression. For some people, depression and an anxiety disorder can co-exist.
For instance, one study found that around 67 percent of people with a depressive disorder also have an anxiety disorder.
When two conditions are present at the same time, this is known as comorbidity. It is not uncommon and researchers continue to look into how antidepressants can help both types of conditions, including the link between the disorders and the neurotransmitter serotonin.
Antidepressants and Activation Syndrome
Occasionally, antidepressants may also create feelings of anxiety and jitteriness as a side effect. This effect, sometimes known as activation syndrome, usually occurs in the early days of treatment. In one study, 31 percent of people who had not taken antidepressants before experienced activation syndrome.
A systematic review of multiple studies took this a step further. In it, researchers compared rates of jitteriness/anxiety syndrome among different types of antidepressants. The results varied greatly, with anywhere from 4 to 65 percent of people newly prescribed antidepressants experiencing this side effect.
Generally, the side effect is mild and temporary, dissipating as a person adjusts to the new medication. Activation syndrome can also potentially include such symptoms as agitation, insomnia, irritability, aggressiveness, impulsiveness, and restlessness.
Antidepressants and Suicidal Thoughts
In addition, there is a complex relationship between symptoms such as hypomania or mania. This may worsen depression or suicidal thoughts—another rare side effect of antidepressant treatment—and the presence of activation syndrome.
Children, teens, and young adults are most prone to developing the more problematic side effects of worsening depression and suicidal thoughts. In 2007, the U.S. Food and Drug Administration (FDA) updated the black box warning required on all antidepressants. The new information includes the added risk for developing suicidal thoughts and urges during the early stages of treatment.
The FDA further recommends that any child, teen, or young adult who is beginning treatment with an antidepressant be carefully observed for any signs of unusual behavioral changes, worsening depression or suicidality. Help should be sought immediately if any of these do occur.
What You Can Do If an Antidepressant Is Increasing Your Anxiety
If you do feel like an antidepressant is increasing your anxiety, speak with your doctor about it. There are a number of different approaches they can take to counteract this side effect. For instance, they may lower your dose, switch you to a different medication, or prescribe another medication to counteract it.
It is not advised to stop taking your antidepressant without first consulting your doctor. Stopping your medication too quickly can create its own set problems, including symptoms such as muscle aches, fatigue, upset stomach, and dizziness. You also run the risk that your depression may return or become worse.
When you begin taking a new antidepressant, it may take some time for your body to adjust.
Everyone is different, which is why it's important to communicate with your doctor about any side effects that you experience, including increased anxiety. Most importantly, if you experience suicidal thoughts, seek medical help right away.
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Lamers F, et al. Comorbidity Patterns of anxiety and depressive disorders in a large cohort study: The Netherlands study of depression and anxiety (NESDA). J Clin Psychiat. 2011;72(3):341–8. doi:10.4088/JCP.10m06176blu
Harada T, et al. Incidence and predictors of activation syndrome induced by antidepressants. Depress Anxiety. 2008;25(12):1014–9. doi:10.1002/da.20438
Sinclair L, et al. Antidepressant-induced jitteriness/anxiety syndrome: Systematic review. Brit J Psychiat. 2009;194:483-490. doi:10.1192/bjp.bp.107.048371
Brent DA. Antidepressants and suicidality. Psychiatr Clin North Am. 2016;39(3):503-12. doi:10.1016/j.psc.2016.04.002
Albert PR, Vahid-Ansari F, Luckhart C. Serotonin-Prefrontal Cortical Circuitry in Anxiety and Depression Phenotypes: Pivotal Role of Pre- and Post-Synaptic 5-HT1a Receptor Expression. Frontiers in Behavioral Neuroscience. 2014;8:199. doi: 10.3389/fnbeh.2014.00199.
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