What Antidepressants Cause Nausea and How to Manage It

Nausea is a common side effect of antidepressants, affecting 17% to 26% of patients [1.2.1]. Understanding what antidepressants cause nausea is the first step toward managing this symptom and adhering to your treatment plan.

Quick Summary

Many antidepressants, especially SSRIs and SNRIs, can cause nausea. This is due to increased serotonin activity in the gut. Management includes dietary changes, medication timing, and consulting a doctor.

Key Points

• Serotonin Surge: Antidepressants, especially SSRIs and SNRIs, cause nausea by increasing serotonin levels, which stimulates receptors in the gut [1.3.2].

• High-Risk Medications: Venlafaxine (Effexor XR) and Vortioxetine (Trintellix) are among the antidepressants with a higher incidence of nausea [1.5.7, 1.7.7].

• Temporary Side Effect: For most people, nausea is a temporary side effect that begins shortly after starting treatment and resolves within a few weeks [1.6.2].

• Management is Key: Simple strategies like taking medication with food, eating smaller meals, and taking the dose at bedtime can help manage nausea [1.4.1, 1.4.3].

• Consult a Doctor: Never stop your medication abruptly. If nausea is severe or persistent, consult your doctor about dose adjustments or switching medications [1.4.7].

• Lower-Risk Options: Some antidepressants, like bupropion (Wellbutrin), are associated with a lower risk of causing nausea compared to SSRIs [1.5.7].

• Duration Varies: While nausea often subsides in 1-2 weeks, for up to 32% of people, it can persist for three months [1.6.2].

The Link Between Antidepressants and Nausea

Nausea is one of the most frequently reported side effects when starting an antidepressant medication [1.6.1]. For many, it's a temporary inconvenience, but for others, it can be severe enough to consider stopping treatment [1.3.2]. The sensation of nausea is often most pronounced during the first few weeks of starting a new medication or after a dose increase [1.6.1, 1.5.1]. While it typically resolves as the body adapts, some research indicates that up to 32% of individuals may experience gastrointestinal issues, including nausea, for as long as three months [1.6.2].

Why Do Antidepressants Trigger Nausea?

The primary reason many antidepressants cause nausea is linked to the neurotransmitter serotonin [1.3.2]. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) work by increasing the levels of serotonin in the brain to improve mood. However, about 90% of the body's serotonin is actually found in the gastrointestinal (GI) tract, where it helps regulate digestion [1.6.4].

When you take an antidepressant that boosts serotonin, it doesn't just affect your brain. It also stimulates the 5-HT3 receptors in your gut [1.3.3]. This sudden increase in serotonin activity in the digestive system can lead to common side effects like nausea, vomiting, and diarrhea [1.3.2, 1.3.6]. This effect is not due to the medication being toxic to the stomach but rather its systemic impact on the central nervous system and the GI tract [1.3.2].

Antidepressant Classes and Their Nausea Potential

While many antidepressants can cause nausea, the likelihood varies between different classes and even individual drugs within the same class [1.5.5, 1.5.7].

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the most commonly prescribed antidepressants and are frequently cited as a top cause of nausea [1.3.2].

• Fluvoxamine, Sertraline (Zoloft), and Paroxetine (Paxil): Studies suggest fluvoxamine is associated with a high frequency of GI disturbances [1.3.3]. Sertraline and paroxetine are also known to cause nausea [1.2.6].
• Escitalopram (Lexapro): While generally considered well-tolerated, clinical studies found up to 18% of people taking Lexapro experienced nausea [1.6.4]. Another study noted nausea in about 9-11% of users [1.2.7].
• Fluoxetine (Prozac): Nausea is a common side effect, especially when first starting the medication [1.6.6].

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs also have a notable incidence of nausea, sometimes higher than SSRIs [1.5.4].

• Venlafaxine (Effexor XR): Has been found to have a higher incidence of nausea than many SSRIs [1.5.7].
• Duloxetine (Cymbalta): The incidence of nausea with duloxetine is generally comparable to that of SSRIs like paroxetine and fluoxetine [1.2.3].
• Desvenlafaxine (Pristiq): Nausea is a common side effect that usually improves after a few weeks [1.6.3].

Other Antidepressants

• Tricyclic Antidepressants (TCAs): This older class of antidepressants can also cause nausea, among other side effects like drowsiness and dry mouth [1.5.6]. However, they are generally associated with less nausea compared to SSRIs but more constipation [1.5.3].
• Monoamine Oxidase Inhibitors (MAOIs): Another older class, MAOIs also list nausea as a potential side effect [1.5.6].
• Atypical Antidepressants: Medications like Bupropion (Wellbutrin) are less likely to cause nausea compared to SSRIs [1.5.7]. Mirtazapine (Remeron) may also have a lower rate of nausea and can sometimes be used to counteract it due to its 5-HT3 receptor antagonist properties [1.2.1].
• Vortioxetine (Trintellix): Nausea is a very common side effect of Vortioxetine, with some studies showing an incidence rate of 20% or higher [1.7.1, 1.7.7].

Comparison of Common Antidepressants and Nausea

Medication Class	Generic Name (Brand Name)	Relative Nausea Risk	Note
SNRI	Venlafaxine (Effexor XR)	High	Incidence may be higher than SSRIs [1.5.7].
Atypical	Vortioxetine (Trintellix)	High	Reported in up to 1 in 3 patients [1.7.7].
SSRI	Sertraline (Zoloft)	Moderate to High	One of the most common side effects [1.2.6].
SSRI	Paroxetine (Paxil)	Moderate	Controlled-release formulations may reduce nausea [1.2.1].
SSRI	Escitalopram (Lexapro)	Moderate	Affects up to 18% of users [1.6.4].
SNRI	Duloxetine (Cymbalta)	Moderate	Similar rates to fluoxetine and paroxetine [1.2.3].
SSRI	Fluoxetine (Prozac)	Moderate	A common initial side effect [1.6.6].
Atypical	Bupropion (Wellbutrin)	Low	Associated with lower rates of nausea than SSRIs [1.5.7].

Strategies for Managing Antidepressant-Induced Nausea

Fortunately, there are several effective ways to manage this side effect. It is crucial not to stop taking your medication abruptly without consulting your doctor, as this can lead to withdrawal symptoms [1.4.7].

Simple and Effective Home Remedies

1. Take with Food: Unless directed otherwise, taking your antidepressant with a small amount of food, like crackers or toast, can significantly reduce stomach irritation [1.2.1, 1.4.3].
2. Adjust Meal Habits: Eat smaller, more frequent meals throughout the day instead of three large ones to avoid overwhelming your stomach [1.4.1].
3. Stay Hydrated: Sip on cool water, unsweetened juice, or ginger ale throughout the day [1.4.2].
4. Try Ginger or Peppermint: Ginger-containing foods, beverages, or teas have been shown to help some patients. Sucking on sugar-free hard candy or peppermint can also provide relief [1.2.1, 1.4.6].
5. Change Medication Timing: If your doctor approves, taking your dose at bedtime may allow you to sleep through the worst of the nausea [1.4.1].

Medical and Professional Guidance

• Talk to Your Doctor: If nausea persists, speak with your healthcare provider. They can offer several solutions.
• Dose Adjustment: Your doctor might suggest temporarily lowering the dose or starting with a lower dose and increasing it more slowly [1.4.6].
• Slow-Release Formulations: For some medications like paroxetine and venlafaxine, a controlled-release version may reduce nausea [1.2.1].
• Anti-Nausea Medication: In some cases, a doctor might prescribe an anti-nausea medication (antiemetic) like ondansetron (Zofran) for short-term relief [1.4.5].
• Switching Medications: If the nausea is intolerable, your doctor may switch you to a different antidepressant with a lower risk of this side effect, such as bupropion [1.4.5, 1.5.7].

Conclusion

While many people who take antidepressants will experience nausea, it is often a manageable and temporary side effect. The initial discomfort is typically caused by the medication's effect on serotonin receptors in the gut and usually subsides within a few weeks as the body adjusts [1.6.1, 1.6.2]. By using simple strategies like taking medication with food, adjusting meal times, and staying hydrated, most individuals can mitigate this side effect. If nausea continues to be a problem, it is essential to collaborate with a healthcare provider to explore options such as dose adjustments, slow-release formulas, or switching to a different medication. Open communication with your doctor is key to finding a treatment that effectively manages your depression with minimal side effects.

For more in-depth information on managing antidepressant side effects, you can visit the Mayo Clinic [1.4.3].

Frequently Asked Questions

Which class of antidepressants is most likely to cause nausea?

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are the classes most likely to cause nausea because they increase serotonin activity in the gut [1.5.1, 1.5.5].

How long does nausea from antidepressants typically last?

Nausea from antidepressants usually begins soon after starting the medication and often resolves within one to two weeks as your body adapts. However, in some cases, it can last for up to three months [1.6.2].

Will taking my antidepressant with food help with nausea?

Yes, taking your antidepressant with a small amount of food, like crackers or toast, can help reduce stomach irritation and is a commonly recommended strategy for managing nausea [1.4.3].

Is venlafaxine (Effexor XR) known for causing bad nausea?

Yes, studies have shown that venlafaxine, an SNRI, has a higher incidence of nausea compared to many SSRIs [1.5.7].

Are there any antidepressants that don't cause nausea?

While most antidepressants carry some risk of nausea, medications like bupropion (Wellbutrin) are associated with a significantly lower rate of nausea compared to SSRIs and SNRIs [1.5.7].

What can I do if the nausea from my antidepressant is unbearable?

If the nausea is severe, you should contact your doctor immediately. Do not stop the medication on your own. Your doctor may adjust your dose, prescribe an anti-nausea medication, or switch you to a different antidepressant [1.4.5, 1.4.7].

Why do antidepressants cause nausea?

They increase levels of the neurotransmitter serotonin. While this helps mood in the brain, most of the body's serotonin is in the gastrointestinal tract, and the sudden increase stimulates gut receptors, leading to nausea [1.3.2, 1.6.4].