Side effects of antidepressants during long-term use in a naturalistic setting

Abstract

Side effects of antidepressants are usually underreported in clinical trials and large scale naturalistic studies are restricted to six months of use. We examined the prevalence and nature of patient-perceived side effects and their determinants during long-term antidepressant use in a naturalistic setting. Subjects, aged 19 to 67 years, in the Netherlands Study of Depression and Anxiety were recruited from primary care and specialized mental health care covered 927 cases of single antidepressant use. In 64% of cases, on average, 2.9 side effects were reported. The number of side effects was higher when subjects had higher depression severity (OR=1.28; p=0.002), three or more psychiatric diagnoses (OR=1.97; p=0.02), higher dose (OR=1.44; p=0.006) and was lower when subjects were older (OR=0.83; p=0.02) and had longer duration of use (OR=0.94; p=0.04). Tricyclic antidepressants were associated with more side effects (OR=2.52; p=0.003) and, particularly, more anticholinergic effects, like dry mouth and constipation, as compared to selective serotonin reuptake inhibitors. Venlafaxine showed more profuse sweating (OR=1.79; p=0.007), whereas mirtazapine showed more weight gain and less sexual dysfunction (OR=0.36; p=0.03), as compared to selective serotonin reuptake inhibitors. Weight gain was associated with female gender (OR=1.76; p=0.004) and duration of use (OR=1.06; p=0.03). We show that antidepressant side effect, known from short-term studies, persist during long-term use and are associated with depression severity and antidepressant dose. A novel finding was that venlafaxine is associated with more profuse sweating and that weight gain appeared more specific in female users. Clinicians should be aware that, during long-term antidepressant use, side effects are common and persistent.

Antidepressant-like effect of zinc is dependent on signaling pathways implicated in BDNF modulation

“…Although there are several classes of antidepressants, the use of these drugs is associated with several side effects (Bet et al, 2013), a delay in symptom remission (Nemeroff and Owens, 2002) and a large number of partial responses or lack of responses (Ruhe et al, 2011). These factors underscore the need to investigate alternative treatments or prevention strategies for depression.…”

Long-term antidepressant use: a qualitative study on perspectives of patients and GPs in primary care

“…Further, most patients in this study had relapsed previously, which could be a reason for continuation. However, discussing their use of antidepressants may be helpful, as these patients can experience side effects 16 and diminished functionality. 26 Furthermore, the four interviewers had limited clinical experience and may have missed cues for further questioning.…”

“…8,12,14 Patients need tailored treatment plans based on these guidelines. Unnecessary continuation of antidepressants may result in long-term side effects 16 and substantial healthcare costs. 17,18 Comparatively little is known about the motivations of patients to continue or discontinue antidepressants.…”

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“…Side effects of SNRIs are greater than for SSRIs and bupropion and include muscle spasms/twitching, profuse sweating and dizziness [125,126]. Controlled trials assessing the use of venlafaxine for the treatment of depression have noted excessive weight gain and sexual dysfunction [127].…”