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Antidepressant Adverse Effects
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Antidepressant Adverse Effects
See Also
Antidepressant
Serotonin Syndrome
Antidepressant Withdrawal
Adverse Effects
Least Tolerated Agents (early discontinuation)
Most:
Tricyclic Antidepressant
s,
SNRI
Least:
SSRI
,
Bupropion
Adverse Effects
Anticholinergic Symptoms
Most:
Tricyclic Antidepressant
s (Tertiary amines)
Least:
SSRI
,
Bupropion
,
SARI
,
MAO inhibitor
s
Adverse Effects
Weight gain (Histamine H1 receptor blockade)
Most:
Tricyclic Antidepressant
s,
Remeron
,
Paxil
Least:
Bupropion
,
Prozac
Adverse Effects
Orthostatic Hypotension
(alpha 1 receptor blockade)
Most:
Tricyclic Antidepressant
s (Tertiary amines)
Least:
Bupropion
,
SSRI
Adverse Effects
Bleeding Risk (
Drug Interaction
)
SSRI
and
SNRI
agents increase risk of bleeding events when combined with
Anticoagulant
s and antiplatelet agents
Drug Interaction
s occur primarily with
Warfarin
SSRI
use may as much as double the risk of
Abnormal Bleeding
(esp.
Gastrointestinal Bleeding
)
Avoid combining with
NSAID
s 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
Anticoagulant
s 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]
Adverse Effects
Cardiac Arrhythmia
(Type 1A
Antiarrhythmic
effect)
Most:
Tricyclic Antidepressant
s (Tertiary amines)
Least:
Bupropion
,
SSRI
Although
QT Prolongation
has been seen with
Citalopram
and
Escitalopram
Adverse Effects
Gastrointestinal effects (
Serotonin
reuptake blockade)
Most adverse effects
Nausea
or
Vomiting
:
Effexor
Constipation
:
Paxil
Diarrhea
:
Zoloft
Minimal:
Prozac
,
MAO inhibitor
s,
Trazodone
None:
Tricyclic Antidepressant
s,
Bupropion
Adverse Effects
Sedation (Histamine H1 receptor blockade)
Most:
Tricyclic Antidepressant
s,
Serzone
,
Trazodone
Moderate:
Remeron
,
Paxil
,
Nardil
None:
Bupropion
,
Effexor
,
Prozac
Adverse Effects
Agitation
or
Insomnia
Most:
Bupropion
,
Prozac
,
Sertraline
Least:
Tricyclic Antidepressant
s,
Effexor
,
Trazodone
,
Paxil
Adverse Effects
Increased
Seizure
risk (Lower
Seizure
threshold)
Most:
Bupropion
, Anafranil,
Tricyclic Antidepressant
Least:
SSRI
,
MAO inhibitor
,
SARI
,
Effexor
Adverse Effects
Sexual Dysfunction
(
Serotonin
reuptake blockade)
See
Antidepressant Induced Sexual Dysfunction
Most:
SSRI
(esp.
Paroxetine
,
Escitalopram
),
Tricyclic Antidepressant
s,
MAO inhibitor
Least:
Bupropion
,
Nefazodone
Adverse Effects
Miscellaneous
Hyponatremia
Selective Serotonin Reuptake Inhibitor
s or
SSRI
(OR 3.3)
References
Bhatia (1997) Am Fam Physician 55(5):1683-94 [PubMed]
Hansen (2005) Ann Intern Med 143:415-26 [PubMed]
Kovich (2015) Am Fam Physician 92(2): 94-100 [PubMed]
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