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06.03.2015

Side effects of drugs for depression, tinnitus more causes_risk_factors - For You

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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. Prevention of serotonin syndrome with the avoidance of drug interactions that might cause it should be the mainstay of treating serotonin syndrome. Though antidepressants help alleviate the potentially impairing syndrome of depression, it is important to recognize their side effects to more effectively help maintain compliance.
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Transcranial Magnetic Stimulation (TMS) is the only FDA approved, drug-free and pain free alternative treatment for major depressive disorder, indicated for patients who previously failed to get adequate relief with anti-depressants, or experienced adverse side effects. If you are a patient suffering from depression who has not had satisfactory results from standard antidepressant medication, NeuroStar TMS Therapy may be able to help. 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. Many studies of SSRIs show prevalences of headache to be greater in the placebo group than in the active drug groups.
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. While many patients have successful remission with anti-depressants, many also experience adverse side effects, such as sedation, weight gain, and drug interactions. This novel alternative depression treatment is not a drug, so it does not circulate throughout the body and does not have the side effects that are associated with drug therapy. These events are transient; they occur during the TMS treatment course and do not occur for most patients after the first week of treatment. 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. Patients who are suffering with chronic pain, are at a higher risk for also having depression as a co-morbidity often related isolation, limited function, and decrease quality of life as a consequence of chronic pain.
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.
They typically respond to analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), or to an ice pack on the headache area. 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.
RA PAIN Services is very excited to introduce the most innovative treatment for depression, which is called Transcranial Magnetic Stimulation. 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.



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