II. Adverse Effects: Least Tolerated Agents (early discontinuation)
- Most: Tricyclic Antidepressants, SNRI
- Least: SSRI, Bupropion
III. Adverse Effects: Anticholinergic Symptoms
- Most: Tricyclic Antidepressants (Tertiary amines)
- Least: SSRI, Bupropion, SARI, MAO Inhibitors
IV. Adverse Effects: Weight gain (Histamine H1 receptor blockade)
- Most: Tricyclic Antidepressants, Remeron, Paxil
- Least: Bupropion, Prozac
V. Adverse Effects: Orthostatic Hypotension (alpha 1 receptor blockade)
- Most: Tricyclic Antidepressants (Tertiary amines)
- Least: Bupropion, SSRI
VI. Adverse Effects: Bleeding Risk (Drug Interaction)
-
SSRI and SNRI agents increase risk of bleeding events when combined with Anticoagulants and antiplatelet agents
- Drug Interactions occur primarily with Warfarin
- SSRI use may as much as double the risk of Abnormal Bleeding (esp. Gastrointestinal Bleeding)
- Avoid combining with NSAIDs and other risk factors for Gastrointestinal Bleeding
- One additional patient on Warfarin for Atrial Fibrillation with SNRI or SSRI will have have a major bleeding event
- However, also affect other Anticoagulants such as Pradaxa and antiplatelet agents
- Most: Fluoxetine, Flovoxamine (especially with Warfarin), Paroxetine, Sertraline
- Least: Mirtazapine, Bupropion
- References
- (2014) Presc Lett 21(11): 65
- Sansone (2009) Psychiatry 6(7): 24–29 [PubMed]
VII. Adverse Effects: Cardiac Arrhythmia (Type 1A Antiarrhythmic effect)
- Most: Tricyclic Antidepressants (Tertiary amines)
- Least: Bupropion, SSRI
- Although QT Prolongation has been seen with Citalopram and Escitalopram
VIII. Adverse Effects: Gastrointestinal effects (Serotonin reuptake blockade)
- Most adverse effects
- Minimal: Prozac, MAO Inhibitors, Trazodone
- None: Tricyclic Antidepressants, Bupropion
IX. Adverse Effects: Sedation (Histamine H1 receptor blockade)
X. Adverse Effects: Agitation or Insomnia
- Most: Bupropion, Prozac, Sertraline
- Least: Tricyclic Antidepressants, Effexor, Trazodone, Paxil
XI. Adverse Effects: Increased Seizure risk (Lower Seizure threshold)
- Most: Bupropion, Anafranil, Tricyclic Antidepressant
- Least: SSRI, MAO Inhibitor, SARI, Effexor
XII. Adverse Effects: Sexual Dysfunction (Serotonin reuptake blockade)
- See Antidepressant Induced Sexual Dysfunction
- Most: SSRI (esp. Paroxetine, Escitalopram), Tricyclic Antidepressants, MAO Inhibitor
- Least: Bupropion, Nefazodone
XIII. Adverse Effects: Miscellaneous
-
Hyponatremia
- Selective Serotonin Reuptake Inhibitors or SSRI (OR 3.3)