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Managing Risks and Side Effects of Antidepressant Medications

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Caring for Patients with Depression in Primary Care

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Abstract

All antidepressant medications carry some risk of adverse or unintended effects. Suicidal ideation in particular can emerge after starting any antidepressant medication, although this risk is most pronounced in patients who are less than 25 years old. The risk of emergent suicidal ideation should not discourage treatment in most cases, however, because the overall risk of suicide death is still lower with treatment compared to without it. Other common risks—including physical discomforts, sexual side effects, effects on weight and/or sleep, paradoxical responses, and medical risks—may be more or less relevant to individual patients based on their needs and preferences, but they should still be considered and discussed candidly at the outset of treatment.

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References

  1. Ghaemi SN. Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression. Bipolar Disord. 2008;10:957–68.

    Article  PubMed  Google Scholar 

  2. McGirr A, Vöhringer PA, Ghaemi SN, et al. Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabilizer or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomized placebo-controlled trials. Lancet. Psychiatry. 2016;3:1138–46.

    PubMed  Google Scholar 

  3. Benvenuti A, Rucci P, Miniati M, et al. Treatment-emergent mania/hypomania in unipolar patients. Bipolar Disord. 2008;10:726–32.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Brent DA. Antidepressants and suicidality. Psychiatr Clin North Am. 2016;39:503–12.

    Article  PubMed  Google Scholar 

  5. Katz LY, Kozyrskyj AL, Prior JH, et al. Effect of regulatory warnings on antidepressant prescription rates, use of health services and outcomes among children, adolescents and young adults. CMAJ. 2008;178:1005–11.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Libby AM, Orton HD, Valuck RJ. Persisting decline in depression treatment after FDA warnings. Arch Gen Psychiatry. 2009;66:633–9.

    Article  PubMed  Google Scholar 

  7. Food and Drug Administration. Revisions to product labeling. https://www.fda.gov/media/77404/download. Accessed 5/12/21 10:04am.

  8. Stübner S, Grohmann R, Greil W, et al. Suicidal ideation and suicidal behavior as rare adverse events of antidepressant medication: current report from the AMSP multicenter drug safety surveillance project. Int J Neuropsychopharmacol. 2018;21:814–21.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gartlehner G, Hansen RA, Morgan LC, et al. Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Ann Intern Med. 2011;155:772–85.

    Article  PubMed  Google Scholar 

  10. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed; 2010.

    Google Scholar 

  11. Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol. 2007;151:737–48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Wang RZ, Vashistha V, Kaur S, Houchens NW. Serotonin syndrome: preventing, recognizing, and treating it. Cleve Clin J Med. 2016;83:810–7.

    Article  PubMed  Google Scholar 

  13. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352:1112–20.

    Article  CAS  PubMed  Google Scholar 

  14. Orlova Y, Rizzoli P, Loder E. Association of coprescription of triptan antimigraine drugs and selective serotonin reuptake inhibitor or selective norepinephrine reuptake inhibitor antidepressants with serotonin syndrome. JAMA Neurol. 2018;75:566–72.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Roose SP, Rutherford BR. Selective serotonin reuptake inhibitors and operative bleeding risk: a review of the literature. J Clin Psychopharmacol. 2016;36:704–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Beach SR, Kostis WJ, Celano CM, et al. Meta-analysis of selective serotonin reuptake inhibitor-associated QTc prolongation. J Clin Psychiatry. 2014;75:e441-9.

    Article  PubMed  Google Scholar 

  17. Hasnain M, Vieweg WVR. QTc interval prolongation and torsade de pointes associated with second-generation antipsychotics and antidepressants: a comprehensive review. CNS Drugs. 2014;28:887–920.

    Article  CAS  PubMed  Google Scholar 

  18. Tellone V, Rosignoli MT, Picollo R, et al. Effect of 3 single doses of trazodone on QTc interval in health subjects. J Clin Pharmacol. 2020;60:1483–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Gurkan S, Liu F, Chain A, Gutstein DE. A study to assess the proarrhythmic potential of mirtazapine using concentration-QTc (C-QTc) analysis. Clin Pharmacol Drug Dev. 2019;8:449–58.

    Article  CAS  PubMed  Google Scholar 

  20. Jasiak NM, Bostwick JR. Risk of QT/QTc prolongation among newer non-SSRI antidepressants. Ann Pharmacother. 2013;48:1620–8.

    Article  CAS  Google Scholar 

  21. Castro VM, Clements CC, Murphy SN, et al. QTc interval and antidepressant use: a cross-sectional study of electronic health records. BMJ. 2013;346:f288.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Food and Drug Administration. FDA Drug Safety Communication: revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-revised-recommendations-celexa-citalopram-hydrobromide-related. Revised 12/15/17. Accessed 5/16/21 at 12:21pm.

  23. Leth-Møller KB, Hansen AH, Torstensson M, et al. Antidepressants and the risk of hyponatremia: a Danish register-based population study. BMJ Open. 2016;6:e011200.

    Article  PubMed  PubMed Central  Google Scholar 

  24. De Picker L, Van Den Eede F, Dumont G, et al. Antidepressants and the risk of hyponatremia: a class-by-class review of literature. Psychosomatics. 2014;55:536–47.

    Article  PubMed  Google Scholar 

  25. Carvalho AF, Sharma MS, Brunoni AR, et al. The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: a critical review of the literature. Psychother Psychosom. 2016;85:270–88.

    Article  PubMed  Google Scholar 

  26. Voican CS, Corruble E, Naveau S, Perlemuter G. Antidepressant-induced liver injury: a review for clinicians. Am J Psychiatry. 2014;171:404–15.

    Article  PubMed  Google Scholar 

  27. Lohman MC, Fairchild AJ, Merchant AT. Antidepressant use partially mediates the association between depression and risk of falls and fall injuries among older adults. J Gerontol A Biol Sci Med Sci. 2020:glaa253.

    Google Scholar 

  28. Power C, Duffy R, Mahon J, et al. Bones of contention: a comprehensive literature review of non-SSRI antidepressant use and bone health. J Geriatr Psychiatry Neurol. 2020;33:340–52.

    Article  PubMed  Google Scholar 

  29. Dwoskin LP, Rauhut AS, King-Pospisil KA, Bardo MT. Review of the pharmacology and clinical profile of bupropion, an antidepressant and tobacco use cessation agent. CNS Drug Rev. 2006;12:178–207.

    Article  PubMed  Google Scholar 

  30. Kanner AM. Most antidepressant drugs are safe for patients with epilepsy at therapeutic doses: a review of the evidence. Epilepsy Behav. 2016;61:282–6.

    Article  PubMed  Google Scholar 

  31. Segraves RT, Balon R. Antidepressant-induced sexual dysfunction in men. Pharmacol Biochem Behav. 2014;121:132–7.

    Article  CAS  PubMed  Google Scholar 

  32. Demyttenaere K, Jaspers L. Bupropion and SSRI-induced side effects. J Psychopharmacol. 2008;22:792–804.

    Article  CAS  PubMed  Google Scholar 

  33. Lorenz T, Rullo J, Faubion S. Antidepressant-induced female sexual dysfunction. Mayo Clin Proc. 2016;91:1280–6.

    Article  CAS  PubMed  Google Scholar 

  34. Koesters M, Ostuzzi G, Guaiana G, et al. Vortioxetine for depression in adults. Cochrane Database Syst Rev. 2017;7:CD011520.

    PubMed  Google Scholar 

  35. Stuivenga M, Giltay EJ, Cools O, et al. Evaluation of vilazodone for the treatment of depressive and anxiety disorders. Expert Opin Pharmacother. 2019;20:251–60.

    Article  CAS  PubMed  Google Scholar 

  36. Freeman MP, Fava M, Dirks B, et al. Improvement of sexual functioning during treatment of MDD with adjunctive pimavanserin: a secondary analysis. Depress Anxiety. 2020;37:485–95.

    Article  CAS  PubMed  Google Scholar 

  37. Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI sexual dysfunction: a literature review. Sex Med Rev. 2018;6:29–34.

    Article  PubMed  Google Scholar 

  38. Sampson SM. Treating depression with selective serotonin reuptake inhibitors: a practical approach. Mayo Clin Proc. 2001;76:739–44.

    Article  CAS  PubMed  Google Scholar 

  39. Watanabe N, Omori IM, Nakagawa A, et al. Mirtazapine versus other antidepressive agents for depression. Cochrane Database Syst Rev. 2011:CD006528.

    Google Scholar 

  40. Cangemi DJ, Kuo B. Practical perspectives in the treatment of nausea and vomiting. J Clin Gastroenterol. 2019;53:170–8.

    Article  PubMed  Google Scholar 

  41. Gafoor R, Booth HP, Gulliford MC. Antidepressant utilization and incidence of weight gain during 10 years’ follow-up: population based cohort study. BMJ. 2018;351:k1951.

    Article  Google Scholar 

  42. Alonso-Pedrero L, Bes-Rastrollo M, Marti A. Effects of antidepressant and antipsychotic use on weight gain: a systematic review. Obes Rev. 2019;20:1680–90.

    Article  PubMed  Google Scholar 

  43. Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol. 2005;20:533–59.

    Article  CAS  PubMed  Google Scholar 

  44. Harada Y, Sakamoto K, Ishigooka J. Incidence and predictors of activation syndrome induced by antidepressants. Depress Anxiety. 2008;25:1014–9.

    Article  CAS  PubMed  Google Scholar 

  45. Bussing R, Reid AM, McNamara JPH, et al. A pilot study of actigraphy as an objective measure of SSRI activation symptoms: results from a randomized placebo controlled psychopharmacological treatment study. Psychiatry Res. 2015;225:440–5.

    Article  PubMed  Google Scholar 

  46. Telang S, Walton C, Olten B, Bloch MH. Meta-analysis: second generation antidepressants and headache. J Affect Disord. 2018;236:60–8.

    Article  CAS  PubMed  Google Scholar 

  47. Jackson JL, Mancuso JM, Nickoloff S, et al. Tricyclic and tetracyclic antidepressants for the prevention of frequent episodic or chronic tension type headache in adults: a systematic review and meta-analysis. J Gen Intern Med. 2017;32:1351–8.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Hensch T, Blume A, Böttger D, et al. Yawning in depression: worth looking into. Pharmacopsychiatry. 2015;48:118–20.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA

    David S. Kroll

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Kroll, D.S. (2022). Managing Risks and Side Effects of Antidepressant Medications. In: Caring for Patients with Depression in Primary Care. Springer, Cham. https://doi.org/10.1007/978-3-031-08495-9_4

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  • DOI: https://doi.org/10.1007/978-3-031-08495-9_4

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  • Print ISBN: 978-3-031-08494-2

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