Are there any antidepressants that do not cause side effects?

Question

Hello doctor,

My 25-year-old sister has been struggling with depression since her miscarriage eight months ago, and I do not know how to help her anymore. She was 16 weeks pregnant when she lost the baby and has not been the same since.

Her OB referred her to a psychiatrist who started Sertraline 100 mg daily, but she says it makes her feel numb and kills her sex drive completely, which is causing problems in her marriage.

Tried switching to Bupropion, but gave her severe anxiety and panic attacks. She is sleeping 12 to 14 hours a day and has stopped showing up to her teaching job, now on medical leave. Gained 30 pounds from not eating right and staying in bed all day. Her thyroid was checked, and TSH is normal at 2.4.

Started therapy, but only went to three sessions before quitting. The depression is so bad that she talks about not wanting to be here anymore, which terrifies our whole family. Her husband is losing patience and threatens to leave if she does not get better. Tried exercise, meditation apps, light therapy box, but nothing helps.

The psychiatrist mentioned ECT, but she is scared of memory loss. She wants to try getting pregnant again, but doctors say depression needs to be controlled first. Are there other antidepressants that do not cause weight gain and sexual side effects?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I am deeply concerned about your worries. Management plane-

You should consult a consultant psychiatrist.
A consultant in psychotherapy.
Start taking tablet Cipralex 10 mg, one tablet morning and night for three months.
Immediate Concern- safety first: You mentioned she talks about not wanting to be here anymore. That is an emergency red flag.

Please make sure:

She is not left alone when expressing suicidal thoughts.
Remove access to medications, sharps, or weapons.
If she expresses intent, has a plan, or becomes withdrawn or unreachable → take her to the nearest emergency department or call local emergency services immediately.
After a miscarriage, hormonal and emotional changes can trigger major depressive disorder, often complicated by grief and guilt.

Key points:

She is showing biological symptoms: hypersomnia, weight gain, and low motivation.
She has already tried two antidepressants (Sertraline and Bupropion) with limited success.
This qualifies as treatment-resistant depression, meaning she likely needs a comprehensive plan, not just medication.

Medication options that may suit her better-

Her psychiatrist can consider several alternatives depending on her symptoms, side-effect tolerance, and future pregnancy plans.

Medication pros and cons:

Escitalopram or Citalopram (SSRI) is often better tolerated than Sertraline; fewer sexual side effects at lower doses. May still cause some libido decrease.
Vortioxetine (Trintellix) is a newer antidepressant; it tends to preserve sexual function and cause less weight gain. Can cause mild nausea initially; expensive; limited data in pregnancy, but considered low risk.
Mirtazapine improves sleep and appetite (useful if insomnia or weight loss); minimal sexual dysfunction. It can cause weight gain, not ideal for her current situation.
Agomelatine (Valdoxan) works on melatonin receptors; restores sleep rhythm, with minimal sexual effects. Requires liver monitoring every few months.
Low-dose SSRI Bupropion combo is sometimes used together to balance sexual side effects and anxiety. It must be carefully adjusted by a psychiatrist.
SNRIs (Venlafaxine, Duloxetine) may help with energy, focus, and anxiety. Can cause increased sweating or blood pressure; mild sexual side effects are possible.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.