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drug adverse effects of antidepressants

Adverse effects: 1) anxiety, agitation & restlessness with initiation of therapy 2) flu-like symptoms, anxiety, tremor, & other symptoms after abrupt discontinuation a) taper over 4 weeks or longer for paroxetine, venlafaxine [1] b) fluoxetine may be exception because of long 1/2life 3) long-term use, especially at higher doses may increase risk of diabetes mellitus type-2 [2] a) paroxetine, fluvoxamine, venlafaxine, & amitriptyline increase risk b) fluoxetine, citalopram, sertraline do NOT appear to increase risk c) increased risk for type 2 diabetes in young people - current use of SSRI or SNRI (RR=1.9) [20] 4) may trigger manic attack in patients with a) bipolar affective disorder b) schizoaffective disorder 5) increase in all-cause mortality in post-menopausal women [3] 6) exacerbation of prostatism (LUTS) 7) autism, ADHD - use during pregnancy may be associated with increased risk of autism [5,18] - no association of 1st trimester antidepressant use & autism or ADHD in offspring [16] 8) no association with osteoporosis or osteopenia [6] - association with hip fracture questioned [23] 9) no increased risk of 1st trimester antidepressant use & congenital heart defects [7] 10) increased risk of suicide in young people ? (FDA warning) [8,11] - antidpressant use down among young people & suicide attempts up after FDA warning [9] - antidepressants increase, rather than decrease, risk of suicidal behavior in younger patients [10] - doubling of risk for suicidality & aggression in children & adolescents using antidepressants [13] 11) cardiovascular risk low, but variable [14] 12) associated with risk of dementia & Alzheimer's disease (RR=3.7 for SSRI, RR= 4.7 for SNRI, RR=3.3 for TCA, RR=4.9 for MAO inhibitor) [17] 13) increased risk for hospitalization with hyponatremia in the 1st month after starting elderly on 2nd generation antidepressant (SSRI, venlafaxine, duloxetine, mirtazapine) [15] 14) increased risk of psychiatric disorders in offspring [19] - 8% if mom did not use antidepressant - 12% if mom used antidepressant before but not during pregnancy - 14% if mom used antidepressant both before & during pregnancy - 15% if mom started antidepressant during pregnancy 15) withdrawal symptoms of dizziness & insomnia [21] 16) weight gain [22] 17) antidepressants may facilitate antibiotic resistance [4]

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DRUGS: antidepressant FORM: drug adverse effects antidepressant

References

  1. Prescriber's Letter 15(12): 2008 Common Oral Medications that May Need Tapering Detail-Document#: 241208 (subscription needed) http://www.prescribersletter.com
  2. Andersohn F et al. Long-term use of antidepressants for depressive disorders and the risk of diabetes mellitus. Am J Psychiatry 2009 Apr 1; PMID: 19339356 http://dx.doi.org/10.1176/appi.ajp.2008.08071065
  3. Smoller JW et al Antidepressant Use and Risk of Incident Cardiovascular Morbidity and Mortality Among Postmenopausal Women in the Women's Health Initiative Study Arch Intern Med. 2009;169(22):2128-2139. PMID: 20008698 http://archinte.ama-assn.org/cgi/content/short/169/22/2128
  4. Wuerstle MC, Van Den Edden SK, Poon T, et al. Contribution of common medications to lower urinary tract symptoms in men. Arch Intern Med 2011; 171(18):1680-1682 PMID: 21987200
  5. Rai D et al Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study BMJ 2013;346:f2059 PMID: 23604083 http://www.bmj.com/content/346/bmj.f2059
  6. Diem SJ et al. Rates of bone loss among women initiating antidepressant medication use in midlife. J Clin Endocrinol Metab 2013 Sep 3 PMID: 24001746
  7. Huybrechts KF et al Antidepressant Use in Pregnancy and the Risk of Cardiac Defects. N Engl J Med 2014; 370:2397-2407June 19, 2014 PMID: 24941178 http://www.nejm.org/doi/full/10.1056/NEJMoa1312828
  8. Prescriber's Letter 11(12): 2004 Suicidality in Children and Adolescents Being Treated With Antidepressant Medications Detail-Document#: 201212 (subscription needed) http://www.prescribersletter.com http://www.fda.gov/cder/drug/antidepres sants/SSRIPHA200410.htm http://www.psych.org/news_room/press_releases/04-55apaonfdablackboxwarning.pdf http://www.aacap.org/Announcements/antidepressants.htm
  9. Lu CY et al Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi- experimental study. BMJ 2014;348:g3596 PMID: 24942789 http://www.bmj.com/content/348/bmj.g3596
  10. Moore TJ. Antidepressants increase, rather than decrease, risk of suicidal behaviours in younger patients. BMJ. 2014 Oct 9;349:g5626. PMID: 25300283
  11. Friedman RA Antidepressants' Black-Box Warning - 10 years later. N Engl J Med 2014; 371:1666-1668. October 30, 2014 PMID: 25354101 http://www.nejm.org/doi/full/10.1056/NEJMp1408480
  12. Stone MB Perspective. The FDA Warning on Antidepressants and Suicidality - Why the Controversy? N Engl J Med 2014; 371:1668-1671October 30, 2014 PMID: 25354102 http://www.nejm.org/doi/full/10.1056/NEJMp1411138
  13. Sharma T et al Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65 PMID: 26819231 http://www.bmj.com/content/352/bmj.i65 - Moncrieff J Misrepresenting harms in antidepressant trials. BMJ 2016;352:i217 PMID: 26819231 http://www.bmj.com/content/352/bmj.i217
  14. Coupland C, Hill T, Morriss R et al Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database. BMJ 2016;352:i1350 PMID: 27005565 Free full text http://www.bmj.com/content/352/bmj.i1350
  15. Gandhi S, Shariff SZ, Al-Jaishi A et al. Second-generation antidepressants and hyponatremia risk: A population-based cohort study of older adults. Am J Kidney Dis 2017 Jan; 69:87. PMID: 2777347 http://www.ajkd.org/article/S0272-6386(16)30480-2/abstract
  16. Mezzacappa A, Lasica PA, Gianfagna F et al Risk for Autism Spectrum Disorders According to Period of Prenatal Antidepressant ExposureA Systematic Review and Meta-analysis. JAMA Pediatr. Published online April 17, 2017. PMID: 28418571 http://jamanetwork.com/journals/jamapediatrics/article-abstract/2616362 - Sujan AC, Rickert ME, Oberg AS et al Associations of Maternal Antidepressant Use During the First Trimester of Pregnancy With Preterm Birth, Small for Gestational Age, Autism Spectrum Disorder, and Attention-Deficit/Hyperactivity Disorder in Offspring. JAMA. 2017 Apr 18;317(15):1553-1562. PMID: 28418479 http://jamanetwork.com/journals/jama/article-abstract/2618619 - Brown HK, Ray JG, Wilton AS, Lunsky Y, Gomes T, Vigod SN. Association Between Serotonergic Antidepressant Use During Pregnancy and Autism Spectrum Disorder in Children. JAMA. 2017 Apr 18;317(15):1544-1552. PMID: 28418480 - Oberlander TF, Zwaigenbaum L. Disentangling Maternal Depression and Antidepressant Use During Pregnancy as Risks for Autism in Children. JAMA. 2017 Apr 18;317(15):1533-1534. No abstract available. PMID: 28418464
  17. Then CK et al. Risk analysis of use of different classes of antidepressants on subsequent dementia: A nationwide cohort study in Taiwan. PLoS One 2017 Apr 6; 12:e0175187 PMID: 28384235 Free Article
  18. Rai D et al Antidepressants during pregnancy and autism in offspring: population based cohort study BMJ 2017;358:j2811 PMID: 28724519 http://www.bmj.com/content/358/bmj.j2811
  19. Liu X, Agerbo E, Ingstrup KG et al Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study. BMJ 2017;358:j3668 PMID: 28877907 http://www.bmj.com/content/358/bmj.j3668 - Nordeng H, Lupattelli A, Wood M. Prenatal exposure to antidepressants and increased risk of psychiatric disorders. BMJ 2017;358:j3950 PMID: 28877910 http://www.bmj.com/content/358/bmj.j3950
  20. Burcu M, Zito JM, Safer DJ et al Association of Antidepressant Medications With Incident Type 2 Diabetes Among Medicaid-Insured Youths. JAMA Pediatr. Published online October 16, 2017 PMID: 29049533 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2656620
  21. Orciari Herman A, Sadoughi S, Sofair A Millions of Americans Keep Taking Antidepressants for Years, Often Because of Severe Withdrawal Symptoms. David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Carey B, Gebeloff R. Many People Taking Antidepressants Discover They Cannot Quit. New York Times. April 7, 2018 https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html
  22. Gafoor R, Booth HP, Gulliford MC. Antidepressant utilisation and incidence of weight gain during 10 years' follow-up: population based cohort study. BMJ 2018;361:k1951 PMID: 29793997 Free full text https://www.bmj.com/content/361/bmj.K1951
  23. Brannstrom J, Lovheim H, Gustafson Y et al Association Between Antidepressant Drug Use and Hip Fracture in Older People Before and After Treatment Initiation. JAMA Psychiatry. Published online January 2, 2019 PMID: 30601883 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2719274 - Iaboni A, Maust DT A Status Update on the Association Between Antidepressants and Fractures Breaking Up? JAMA Psychiatry. Published online January 2, 2019 PMID: 30601880 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2719272
  24. Drew L How antidepressants help bacteria resist antibiotics. A laboratory study unravels ways non-antibiotic drugs can contribute to drug resistance. Nature News. Jan 24, 2023 https://www.nature.com/articles/d41586-023-00186-y