Treating depression related to lupus can be a balancing act. About 35 percent of people with systemic lupus erythematosus (SLE) — the most common type of lupus — experience depression. If you’re thinking about taking an antidepressant, it’s important to know which lupus medications you’re already taking.

Hydroxychloroquine (Plaquenil) is a medication used to treat lupus and other rheumatic diseases. This antimalarial drug can help relieve pain and inflammation and prevent flares. People living with lupus usually take hydroxychloroquine long term.

If you’re experiencing depression, you might need an antidepressant in addition to your lupus medications. Here are four facts to keep in mind about taking antidepressants with hydroxychloroquine.

1. Effects of Antidepressants Can Worsen Lupus Symptoms

People living with lupus typically have multiple chronic symptoms. Antidepressants can sometimes worsen certain symptoms, such as dry eyes or mouth. This effect is especially important to consider in those with Sjögren’s disease, which causes dry eyes and dry mouth. Sjögren’s disease commonly occurs along with other autoimmune conditions, like lupus and rheumatoid arthritis.

Though rare, antidepressants may worsen feelings of depression and suicidal thoughts. This is more common in early treatment with antidepressants, during a dose change, or in people younger than 25.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

Common side effects of hydroxychloroquine include diarrhea, stomach pain, and nausea.

2. Some Antidepressants Interact With Hydroxychloroquine

A drug interaction refers to a change in how a drug affects the body when taken with another drug. This reaction may increase or decrease the drug’s effects or lead to additional side effects.

Hydroxychloroquine can interact with antidepressants. Three common types of antidepressants include:

• Serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Brisdelle, Paxil, and Paxil CR), and sertraline (Zoloft)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Drizalma Sprinkle) and venlafaxine (Effexor)
• Bupropion (Aplenzin, Wellbutrin SR, and Wellbutrin XL)

Antidepressants work to affect chemicals in the brain that impact mood.

Taking certain antidepressants with hydroxychloroquine may increase how much hydroxychloroquine stays in the blood, causing the drug to have a greater effect or raising the risk of toxicity (side effects).

Arrhythmia Concerns

Hydroxychloroquine may increase the risk of arrhythmia (abnormal heart rhythm). The arrhythmia caused by hydroxychloroquine is called QT prolongation. QT interval is the time your heart’s electrical system takes to contract and then reset for the next beat. QT prolongation means this process is taking longer than normal, which can lead to a life-threatening rapid heartbeat.

Some antidepressants — including escitalopram, fluoxetine, sertraline, and venlafaxine — can affect heart rhythm. Taking them with hydroxychloroquine may raise this risk. Although it’s rare, it’s important to be aware of this possibility.

A recent study confirmed a moderate level of QT prolongation with hydroxychloroquine. However, the findings didn’t show that taking other drugs that can also affect the QT interval, such as antidepressants, made the problem worse.

3. Certain Factors Affect Drug Interactions

Certain factors may increase a person’s risk of drug interactions, including:

• Age
• Number of drugs being taken
• Specific medications being used
• The way medications are taken (timing, with or without food, etc.)
• A history of drug interactions
• High medication doses
• Other health conditions

Older people who take several medications and have multiple medical conditions are at the highest risk of a drug interaction. These risk factors increase the likelihood that a person’s body will have difficulty breaking down medications, leading to a greater risk of side effects.

The type of medication taken can also affect the risk of drug interactions. For example, hydroxychloroquine may interact with diabetes medications (including insulin and glipizide) and seizure medications (including carbamazepine and phenytoin).

To reduce the chance of drug interaction, it’s important to take medications as recommended by a healthcare professional — specifically a rheumatologist, in the case of lupus treatment. It’s important to talk with your healthcare team about nonprescription drugs and supplements too. It’s possible to have a drug interaction with an over-the-counter medication or supplement.

4. Always Discuss Medication Issues With a Healthcare Provider

Anytime you have medication concerns, you should seek medical advice from your rheumatologist.

If you want to stop taking an antidepressant, talk with your doctor first. They can help you lower the dose slowly and safely. Stopping suddenly can lead to discontinuation syndrome, which may cause side effects such as nausea, dizziness, lethargy (very low energy), and fever.

This rule also applies to lupus treatments. Don’t stop taking hydroxychloroquine or any lupus drugs suddenly. If you or a loved one is thinking of changing lupus medications, talk first with your rheumatologist.

Connect With Others Who Understand

On MyLupusTeam, people share their experiences with lupus, get advice, and find support from others who understand.

Do you take antidepressants and hydroxychloroquine? Let others know in the comments below.