For people living with myasthenia gravis (MG), taking care of mental health is just as important as managing physical symptoms. Depression and anxiety are more common in people with long-term conditions like myasthenia gravis. Left untreated, these mental health challenges can sometimes make MG symptoms worse. Stress is also linked to myasthenia gravis flare-ups (also called exacerbations), which can lead to increased muscle weakness.

If you’re thinking about taking an antidepressant, it’s important to know that some medications may affect MG symptoms. Research on antidepressant safety in people with myasthenia gravis is limited, and risks can differ from person to person.

Before starting any new medication, including an antidepressant, always talk to your myasthenia gravis specialist to make sure it’s the right choice for you.

🗳️ Do you live with myasthenia gravis and take an antidepressant?

Yes

No

Thanks! You've successfully submitted your vote.

Sign up to view the results!

Continue with Facebook

Continue with Google

Continue with Email

By joining, you accept our Terms of Use, and acknowledge our collection, sharing, and use of your data in accordance with our Health Data and Privacy policies.

Already a member? Log In

In this article, we’ll go over five antidepressants that may be considered for people with myasthenia gravis and medications that may need extra caution.

5 Antidepressants That May Be Considered With Myasthenia Gravis

No antidepressant has been proven to be the safest choice for everyone with myasthenia gravis. Much of the available evidence comes from case reports and drug-safety databases rather than clinical trials in people with myasthenia gravis.

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that helps increase levels of serotonin, a “feel-good” chemical in the brain. It’s commonly prescribed for depression and several anxiety-related conditions.

Muscle weakness is a listed side effect of fluoxetine, which may be a concern for people with myasthenia gravis. Research on fluoxetine’s safety in people with myasthenia gravis is limited. Small reports have described people with myasthenia gravis taking fluoxetine without worsening their MG symptoms, but more research is needed to understand its safety in this population.

A separate report described worsening weakness with fluoxetine in a person with congenital myasthenic syndrome, an inherited condition that is different from autoimmune myasthenia gravis.

Bupropion works differently than SSRIs. It affects norepinephrine and dopamine in the brain. It’s used to treat depression and help people quit smoking.

A drug safety analysis found a lower reporting signal for myasthenia gravis worsening with bupropion. A reporting signal reflects how often a side effect shows up in reports for one drug compared with reports for others. Because it’s based on reports rather than measured outcomes, a lower signal does not prove bupropion is safer for people with myasthenia gravis.

Bupropion can increase seizure risk. Myasthenia gravis itself is not a seizure disorder. Bupropion’s seizure precautions depend on the dose and other known seizure risk factors, not simply having myasthenia gravis.

Bupropion also has not been shown to treat MG-related fatigue.

Dextromethorphan/bupropion, approved for major depressive disorder in adults in 2022, has not been adequately studied in people with myasthenia gravis. Findings about bupropion alone should not be assumed to apply in this combination.

Sertraline is another SSRI that helps increase levels of serotonin in the brain. SSRIs like sertraline are often the first choice for people with depression because of their lower risk of side effects.

However, sertraline should not be described as specifically safer for myasthenia gravis. A 2021 drug safety analysis found a higher reporting signal for worsening myasthenia with sertraline. This does not prove sertraline caused the worsening, but it supports caution and monitoring.

Sertraline is also available in a liquid form, which can be helpful for people who have difficulty swallowing. New or worsening swallowing problems should always be reported to your healthcare team.

Citalopram is another SSRI that helps balance serotonin levels in the brain. It’s commonly prescribed for depression in adults.

Citalopram has been studied in a small group of people with myasthenia gravis and depression, but MG-specific safety research remains limited. A larger drug safety analysis found a higher reporting signal for worsening myasthenia with citalopram. This does not prove that citalopram causes myasthenia gravis worsening, but careful monitoring is appropriate.

Escitalopram is an SSRI that boosts serotonin levels to improve mood and reduce anxiety. It’s closely related to citalopram and is prescribed for major depressive disorder and generalized anxiety disorder.

A 2021 drug safety analysis found fewer MG-related reports than expected with escitalopram. However, this type of study can’t prove that escitalopram is safer or predict an individual person’s risk.

Other Psychiatric Medications That May Need Extra Caution With Myasthenia Gravis

Certain psychiatric medication may need extra caution in people with myasthenia gravis. This does not mean everyone with myasthenia gravis must avoid them. Doctors should weigh the risks and benefits for each person.

Certain Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) work by affecting multiple chemicals in the brain, which can lead to more side effects.

Some TCAs, like amitriptyline and imipramine, have stronger anticholinergic effects. This means they block some of the actions of acetylcholine, a chemical that helps the nervous system send messages. These effects can cause symptoms such as dry mouth, blurred vision, constipation, and trouble urinating.

Because of these effects, doctors may use extra caution when prescribing these medications to people with myasthenia gravis. There is also limited research on their safety specifically with myasthenia gravis.

Some TCAs are less likely to cause these side effects, such as desipramine and nortriptyline. However, this does not prove that they are safer for people with myasthenia gravis.

Lithium

Lithium is not an antidepressant. It is a mood stabilizer used mainly for bipolar disorder.

Lithium has been linked to new or worsening myasthenic symptoms in case reports and drug safety research. People with myasthenia gravis who take or are considering lithium should discuss this risk with their healthcare team.

Choosing an Antidepressant When You Have Myasthenia Gravis

Managing depression and anxiety is important for your overall health. However, current research does not prove that the five antidepressants above are generally safer for everyone with myasthenia gravis.

Drug safety reports can flag possible risks, but a higher-than-expected number of reports does not prove that a medication causes myasthenia gravis worsening. Likewise, fewer reports than expected does not prove that a medication is safe.

Finding the right antidepressant may take time and require trial and error. Because MG-specific evidence is limited, the best choice will depend on the individual. Close monitoring can help your healthcare team spot new or worsening weakness after treatment starts or changes.