Antidepressants — what do doctors and herbalists say about their side effects and stopping them?

Aim of the study: Sexual dysfunction is a frequent, potentially distressing, adverse effect of antidepressants and a leading cause of medication non-adherence. Sexual function should be actively assessed at baseline, at regular intervals during treatment, and after treatment cessation.

Results: Trials comparing the risk of sexual dysfunction with individual antidepressants are inadequate, but it is reasonable to conclude that the risk is greatest with selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs), lower with tricyclic antidepressants (except clomipramine) and mirtazapine, and lowest with moclobemide, agomelatine, reboxetine, and bupropion. Managing antidepressant-induced sexual dysfunction requires an individual approach (for example, considering other causes, reducing the dose, adding medication to treat the side effect, or switching to a different antidepressant). Post-SSRI sexual dysfunction has recently been identified as a potential, although rare, adverse effect of SSRIs and SNRIs.

Aim of the study: The prevalence of depression and the use of antidepressant medications have risen steadily in the United States over the past three decades. Antidepressants are the most commonly prescribed medications for U.S.

Results: There is an increased risk of relapse or recurrence of depressive symptoms when an antidepressant is discontinued, compared with continued use. Gradually tapering the dosage while concurrently providing cognitive behavior therapy can decrease this risk. High-quality evidence on antidepressant use in pregnancy is lacking. Depression and use of antidepressants are both associated with preterm birth.

Aim of the study: Antidepressant drugs are prescribed to patients with depressive, anxiety disorders, and other conditions. Evidence about antidepressant discontinuation syndrome (ADS) and related outcomes is sparse, although potentially burdensome in some patients.

Results: Integrated care combining medication and psychotherapy may minimize the unpleasant effects that can occur during discontinuation. In addition, patient-tailored interventions and education should be part of the discontinuation strategy. Future research must rely on broadly accepted definitions for ADS and related phenomena such as antidepressant withdrawal and shed further light on the underlying neurobiology. It is also important to distinguish ADS-related phenomena from a relapse of depression and to use a neuroscience-based nomenclature rather than one based on drug class.

Aim of the study: Gastrointestinal side effects (SEs) are frequently observed in patients with major depressive disorder (MDD) while taking antidepressants and may lead to treatment discontinuation. The aim of this meta-analysis is to provide quantitative measures on short-term rates of gastrointestinal SEs in MDD patients treated with second-generation antidepressants.

Results: All the considered antidepressants showed higher rates of gastrointestinal SEs than placebo. Escitalopram and sertraline were shown to be the least tolerated antidepressants on the gastrointestinal tract, being associated with all the considered SEs with the exception of constipation and increased appetite, while mirtazapine was shown to be the antidepressant with fewer side effects on the gut, being only associated with increased appetite. In conclusion, commonly used antidepressants showed different profiles of gastrointestinal SEs, possibly related to their mechanisms of action. The specific tolerability profile of each compound should be considered by clinicians when prescribing antidepressants in order to improve adherence to treatment and increase positive outcomes in patients with MDD.

Aim of the study: Discontinuation symptoms are recognised with tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs) and miscellaneous antidepressants. A wide variety of symptoms have been described, differing somewhat between antidepressant classes, and several symptom clusters or discontinuation syndromes appear to exist.

Results: Neonatal discontinuation symptoms can follow maternal use of antidepressants during pregnancy and possibly breast feeding. The patient and doctor must take this into consideration when making prescribing decisions. Discontinuation symptoms have received little systematic study with the result that most of the recommendations made here are based on anecdotal data or expert opinion. Research is needed to provide a firm evidence base for future recommendations.

Aim of the study: Antidepressant discontinuation syndrome occurs in approximately 20 percent of patients after abrupt discontinuation of an antidepressant medication that was taken for at least six weeks. Typical symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal.

Results: Antidepressant discontinuation syndrome is more likely with a longer duration of treatment and a shorter half-life of the treatment drug. A high index of suspicion should be maintained for the emergence of discontinuation symptoms, which should prompt close questioning regarding accidental or purposeful self-discontinuation of medication. Before antidepressants are prescribed, patient education should include warnings about the potential problems associated with abrupt discontinuation. Education about this common and likely underrecognized clinical phenomenon will help prevent future episodes and minimize the risk of misdiagnosis.

Aim of the study: Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents.

Results: At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available.

Aim of the study: In older adults, the prescription of antidepressants is common and often extends over several years. This population is particularly vulnerable to adverse drug effects due to age-related physiological changes and the risk of drug-drug interactions associated with polypharmacy.

Results: In older adults, the prescription of antidepressants is common and often extends over several years. This population is particularly vulnerable to adverse drug effects due to age-related physiological changes and the risk of drug-drug interactions associated with polypharmacy. When treatment is no longer indicated, discontinuation should be considered in a gradual and carefully coordinated manner, with attention to the potential emergence of withdrawal symptoms. A clinical approach centered on regular reassessment and shared decision-making with the patient supports the optimal use of antidepressants in this population.

Aim of the study: Selective serotonin reuptake inhibitors (SSRIs) are widely used as first-line treatments for major depressive disorder (MDD) and anxiety disorders, with common adverse effects, including sexual dysfunction, anxiety, insomnia, and appetite changes, although seizures have also been reported, particularly in the presence of risk factors such as older age, family history of epilepsy, neurological comorbidities, and high antidepressant dosages.

Results: The second case is a woman with generalized anxiety disorder (GAD) who developed two generalized tonic-clonic seizures temporally related to paroxetine use. In both cases, extensive investigations, including laboratory tests, electroencephalogram (EEG), CT, and MRI, yielded normal results, suggesting a potential drug-associated etiology. Both patients were subsequently switched to the atypical antidepressant agomelatine, which was followed by a complete cessation of seizures and marked improvement in mood and anxiety symptoms. These observations underscore the need to consider seizures as a potential adverse event of SSRIs and suggest that agomelatine could be considered an alternative pharmacological option for patients at risk of antidepressant-associated seizures.

Aim of the study: Background/Objectives: Antidepressant treatment response is highly variable, and CYP2D6 metabolizer phenotype has been proposed as a contributor to this variability. It was examined whether CYP2D6 metabolizer phenotype is associated with real-world antidepressant treatment outcomes in a large population-based cohort.

Results: No significant association was observed for fluoxetine. Associations with switching were limited, and no significant associations were detected for side effects. Conclusions: CYP2D6 variation appears to primarily influence early antidepressant discontinuation within the first 30 days of treatment, particularly for paroxetine, venlafaxine, and mirtazapine, rather than treatment switching or side effects. These findings provide observational support relevant to drug-specific gene interactions and suggest a role for CYP2D6-guided prescribing in clinical practice, notably in the first 30 days of antidepressant treatment.