Depression medication — what side effects are overlooked in the doctor’s office?

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 individualised approach (e.g. considering other causes, reducing the dose, adding medication to treat the adverse 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: Stopping antidepressants can be challenging due to the high rate of discontinuation symptoms. Patients with antidepressant discontinuation syndrome (ADS) commonly experience insomnia, flu-like symptoms, mood disturbances, dizziness, and paresthesias, but a broad array of adverse effects is possible.

Results: Symptoms can last from days to months, and different symptoms last for different lengths of time. Patient education, identifying patients most at risk of developing symptoms, and gradually tapering or cross-tapering antidepressants are important steps in reducing the risk of ADS and addressing patients’ concerns about it. Tapering should take place over weeks to months. Discontinuation symptoms should be managed by restarting the previous antidepressant dose and then tapering even more slowly, with additional treatment of symptoms as needed.

Aim of the study: Although safer than tricyclic antidepressants and monoamine oxidase inhibitors, the newer antidepressants may be associated with certain medically serious adverse effects, of which cardiovascular adverse effects, seizures, abnormal bleeding, hyponatremia, and agranulocytosis are discussed in this review.

Results: Although safer than tricyclic antidepressants and monoamine oxidase inhibitors, the newer antidepressants may be associated with certain medically serious adverse effects, of which cardiovascular adverse effects, seizures, abnormal bleeding, hyponatremia, and agranulocytosis are discussed in this review. Data regarding the incidence and risk factors are summarized, and strategies for reducing the risk of these adverse effects and managing them are suggested. Identifying risk factors, choosing an appropriate antidepressant, and, when possible, careful monitoring may substantially reduce the incidence of these adverse effects and the associated morbidity.

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.