Mental Health Book


Antidepressant Adverse Effects

Aka: Antidepressant Adverse Effects
  1. See Also
    1. Antidepressant
    2. Serotonin Syndrome
    3. Antidepressant Withdrawal
  2. Adverse Effects: Least Tolerated Agents (early discontinuation)
    1. Most: Tricyclic Antidepressants, SNRI
    2. Least: SSRI, Bupropion
  3. Adverse Effects: Anticholinergic Symptoms
    1. Most: Tricyclic Antidepressants (Tertiary amines)
    2. Least: SSRI, Bupropion, SARI, MAO inhibitors
  4. Adverse Effects: Weight gain (Histamine H1 receptor blockade)
    1. Most: Tricyclic Antidepressants, Remeron, Paxil
    2. Least: Bupropion, Prozac
  5. Adverse Effects: Orthostatic Hypotension (alpha 1 receptor blockade)
    1. Most: Tricyclic Antidepressants (Tertiary amines)
    2. Least: Bupropion, SSRI
  6. 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]
  7. 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
  8. 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
  9. Adverse Effects: Sedation (Histamine H1 receptor blockade)
    1. Most: Tricyclic Antidepressants, Serzone, Trazodone
    2. Moderate: Remeron, Paxil, Nardil
    3. None: Bupropion, Effexor, Prozac
  10. Adverse Effects: Agitation or Insomnia
    1. Most: Bupropion, Prozac, Sertraline
    2. Least: Tricyclic Antidepressants, Effexor, Trazodone, Paxil
  11. Adverse Effects: Increased Seizure risk (Lower Seizure threshold)
    1. Most: Bupropion, Anafranil, Tricyclic Antidepressant
    2. Least: SSRI, MAO inhibitor, SARI, Effexor
  12. 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
  13. Adverse Effects: Miscellaneous
    1. Hyponatremia
      1. Selective Serotonin Reuptake Inhibitors or SSRI (OR 3.3)
  14. 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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