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30.07.2014

Pills for depression side effects, stop ringing of ears - PDF Review

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Although the most commonly used antidepressants (ie, selective serotonin reuptake inhibitors) have a lower incidence of side effects compared to the earlier antidepressants (ie, tricylic antidepressants), some less serious and a few potentially serious side effects are associated with the range of newer antidepressants and adjuvant agents used to augment the efficacy of antidepressants. This article focuses on the medications used in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Typically, SSRIs are the first agents used to treat depression in clinical practice due to their safety and low incidence of serious side effects.
When medications are combined, the potential for side effects can increase, and it can become difficult to differentiate which agent is responsible for the side effect(s). Medication side effects or adverse events can range from less serious annoyances to very serious, life-threatening situations (Table 2). It should be standard practice to educate or warn patients that antidepressants have potential sedative effects and could impair judgment, thinking, and motor skills, as well as their ability to drive, use machines, or perform tasks that require alertness, coordination, or physical dexterity.
Possible remedies include dose lowering or trying to schedule sexual activity before taking medication for the day. Clinicians may try stopping medication for only the day that sexual activity will occur (or lower the dose on that day, returning to regular higher dose the other days of the week (this may not work so well for antidepressants with half-lives >24 hours, such as fluoxetine).
Overall, SSRIs (except paroxetine) are thought to have no or only slight weight-inducing effects (although there are no doubt exceptions to this). Not all patients taking antidepressants experience SSRI discontinuation syndrome, but for those who do the syndrome often presents with flu-like symptoms such as headache, diarrhea, nausea, vomiting, chills, dizziness, fatigue, and insomnia. Estimates are that 3% to 10% of depressed individuals may be at risk for developing hypomania or mania when treated with antidepressants. Agitation, restlessness, and anxiety can result from the stimulating effect of some antidepressants. Patients with a history of panic disorder (Table 3) or anxiety who are being treated with antidepressants should have a gradual escalation in dosage to minimize these side effects, typically seen during the initial days of treatment with antidepressants. Serotonin syndrome can be mild (in which case it may not be detected) or dramatic and life threatening.21 An often-cited differential point for differentiating neuroleptic malignant syndrome (NMS) from serotonin syndrome involves abnormal reflexes, where there will be hyperreflexia and clonus in serotonin syndrome versus bradyreflexia in NMS.
Though antidepressants help alleviate the potentially impairing syndrome of depression, it is important to recognize their side effects to more effectively help maintain compliance. A lower concentration of serotonin in platelets increases the risk for stomach or uterine bleeding, which means an increased need for a blood transfusion during or after surgery. National collaborating centre for mental health commissioned by the national institute for health and care excellence leucht c, huhn m, leucht s (2012). The Project envisages the development of a common methodology for the preparation, storage, dissemination and evaluation of scientific literature in electronic format. The interface also provides access to the full text of articles via author index or subject index, or by a search form on article elements such as author names, words from title, subject, words from the full text and publication year.
Primary care physicians engaged in the modern practice of psychopharmacologic treatment of depression need to be aware of the range of side effects, from minor to more serious.


This was the largest and longest study on the effectiveness of treatments for depression and led to the best evidence-based treatment for depression to date.
Hence, the primary antidepressant should be introduced first and the adjuvant agent added at a later time to analyze the etiology of potential future side effects. The more side effects that a patient experiences, the less adherent patients are likely to be. Interventions for fatigue can also be beneficial for counteracting antidepressant-induced sedation. However, this intervention of stopping SSRIs before planned sexual acttivity can cause an SSRI discontinuation syndrome (especially for SSRIs with a shorter half-life).
Hence, with the SSRIs, it is prudent to carefully monitor patients’ weight, since the amelioration of depressive symptoms can be associated with improved appetite and weight gain. Thus, a dose-related effect of paroxetine during first-trimester exposure on cardiac malformations may exist. However, SSRI exposure during pregnancy does have metabolic and clinical consequences, albeit often subtle, for the neonate.
PCPs should also be aware that some symptoms in a patient treated with an SSRI might be an adverse event associated with high morbidity and even fatality, such as SIADH and serotonin syndrome, the latter of which can present with symptoms (eg, agitation, anxiety, twitching, confusion) interpreted as worsening depression. This article focuses on the more common side effects of antidepressants used in the modern treatment of depression. Whether serious or not, it is important to manage the side effects experienced by the patient.
Sometimes, the medication can be taken 1–2 hours before bedtime so that the side effect can be put to use by helping the patient fall sleep.
Anecdotally, this common side effect has been reduced by taking antidepressants with food or with an antacid (there are no studies to the authors’ knowledge supporting this intervention for nausea).
Another option is to switch to the liquid form of the medication so that patients can reduce their dosages more slowly to avoid discomfort when they discontinue an SSRI. There is a high rate of instances when bipolar depression is misdiagnosed as unipolar depression.5,6 The rate of antidepressant-induced hypomania in patients with major depressive disorder (MDD) is thought to correspond with the rate of misdiagnosis of bipolar depression as unipolar depression.
Clinicians should be alert for racing or impulsive thoughts along with high energy, as they may be signs of antidepressant-induced hypomania or mania. It has also been shown that the presence of agitation and anxiety in a patient with depression is a risk factor for suicide. This plan could include going to the nearest emergency room, calling suicide hot lines, encouraging family education about depression and suicide, providing Internet sites for patients with suicidal ideation,12,13 and ways to contact their mental healthcare workers if suicidal ideation emerges.
The impression that paroxetine is distinguished from other SSRIs in terms of a heightened association between its use during early pregnancy and infant cardiovascular defects, notably ventricular and atrium septum defects, emerged in a study of the Swedish Medical Birth Registry of 6,481 women who used SSRIs in early pregnancy between July 1, 1995 through the end of 2004.35 This study did not find any support for a postulated association of maternal use of SSRIs during pregnancy and craniostenosis or omphalocele.
A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report.


The DSM-IV and ICD-10 categories of recurrent [major] depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum. Efficacy of alprazolam in reducing fluoxetine-induced jitteriness in patients with major depression. Duloxetine: meta-analyses of suicidal behaviors and ideation in clinical trials for major depressive disorder. Emergence, persistence, and resolution of suicidal ideation during treatment of depression in old age. Effects of reboxetine on anxiety, agitation, and insomnia: results of a pooled evaluation of randomized clinical trials. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations.
However, augmentation with bupropion SR did have certain advantages, including a greater reduction in the number and severity of symptoms and fewer side effects.2 If the dosing strategies in Table 1 are adhered to, the incidence of adverse side effects should be diminished. If erectile dysfunction is an issue, agents such as sildenafil, vardenafil, tadalafil, or alprostadil (the latter given by injection into the side of the penis) may be considered.
Stimulation associated with antidepressants can be a negative side effect when taken at night, but a positive experience when taken in the morning, with the medication providing a needed energy boost. If available, a slow-release form of an antidepressant might lessen gastric upset and nausea, or the dosage might be decreased and the upward dose titration slowed.
Another option is for patients to switch from their shorter-acting SSRI to fluoxetine for the final discontinuation. An increased awareness of the side effects of the most current and commonly used antidepressants should improve the PCP’s confidence to treat the most common disabling illness in this country.
The overall risk of this depression medication side effect for children, teens, and adults is 2 to 4 percent. Deutsch is associate chief of staff for mental health in the Mental Health Service Line at the Department of Veterans Affairs Medical Center and professor in the Department of Psychiatry at Georgetown University School of Medicine.
Antidepressant medications are sometimes used to treat depression, major depression, and anxiety in conjunction with therapy. Because antidepressant medications are such big business for drug manufacturers, the pharmaceutical industry reacts slowly to research.



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