Antidepressant Adverse Effects

Aka: Antidepressant Adverse Effects

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II. Adverse Effects: Least Tolerated Agents (early discontinuation)

  1. Most: Tricyclic Antidepressants, SNRI
  2. Least: SSRI, Bupropion

III. Adverse Effects: Anticholinergic Symptoms

  1. Most: Tricyclic Antidepressants (Tertiary amines)
  2. Least: SSRI, Bupropion, SARI, MAO inhibitors

IV. Adverse Effects: Weight gain (Histamine H1 receptor blockade)

  1. Most: Tricyclic Antidepressants, Remeron, Paxil
  2. Least: Bupropion, Prozac

V. Adverse Effects: Orthostatic Hypotension (alpha 1 receptor blockade)

  1. Most: Tricyclic Antidepressants (Tertiary amines)
  2. Least: Bupropion, SSRI

VI. Adverse Effects: Bleeding Risk (Drug Interaction)

  1. SSRI and SNRI agents increase risk of bleeding events when combined with Anticoagulants and antiplatelet agents
    1. Drug Interactions occur primarily with Warfarin
    2. SSRI use may as much as double the risk of Abnormal Bleeding (esp. Gastrointestinal Bleeding)
      1. Avoid combining with NSAIDs and other risk factors for Gastrointestinal Bleeding
    3. One additional patient on Warfarin for Atrial Fibrillation with SNRI or SSRI will have have a major bleeding event
      1. However, also affect other Anticoagulants such as Pradaxa and antiplatelet agents
  2. Most: Fluoxetine, Flovoxamine (especially with Warfarin), Paroxetine, Sertraline
  3. Least: Mirtazapine, Bupropion
  4. References
    1. (2014) Presc Lett 21(11): 65
    2. Sansone (2009) Psychiatry 6(7): 24–29 [PubMed]

VII. Adverse Effects: Cardiac Arrhythmia (Type 1A Antiarrhythmic effect)

  1. Most: Tricyclic Antidepressants (Tertiary amines)
  2. Least: Bupropion, SSRI
    1. Although QT Prolongation has been seen with Citalopram and Escitalopram

VIII. Adverse Effects: Gastrointestinal effects (Serotonin reuptake blockade)

  1. Most adverse effects
    1. Nausea or Vomiting: Effexor
    2. Constipation: Paxil
    3. Diarrhea: Zoloft
  2. Minimal: Prozac, MAO inhibitors, Trazodone
  3. None: Tricyclic Antidepressants, Bupropion

IX. Adverse Effects: Sedation (Histamine H1 receptor blockade)

  1. Most: Tricyclic Antidepressants, Serzone, Trazodone
  2. Moderate: Remeron, Paxil, Nardil
  3. None: Bupropion, Effexor, Prozac

X. Adverse Effects: Agitation or Insomnia

  1. Most: Bupropion, Prozac, Sertraline
  2. Least: Tricyclic Antidepressants, Effexor, Trazodone, Paxil

XI. Adverse Effects: Increased Seizure risk (Lower Seizure threshold)

  1. Most: Bupropion, Anafranil, Tricyclic Antidepressant
  2. Least: SSRI, MAO inhibitor, SARI, Effexor

XII. Adverse Effects: Sexual Dysfunction (Serotonin reuptake blockade)

  1. See Antidepressant Induced Sexual Dysfunction
  2. Most: SSRI (esp. Paroxetine, Escitalopram), Tricyclic Antidepressants, MAO inhibitor
  3. Least: Bupropion, Nefazodone

XIII. Adverse Effects: Miscellaneous

  1. Hyponatremia
    1. Selective Serotonin Reuptake Inhibitors or SSRI (OR 3.3)

XIV. References

  1. Bhatia (1997) Am Fam Physician 55(5):1683-94 [PubMed]
  2. Hansen (2005) Ann Intern Med 143:415-26 [PubMed]
  3. Kovich (2015) Am Fam Physician 92(2): 94-100 [PubMed]

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