Antidepressant side effects and adverse reactions

Abstract

AbstractA drug's side effects and adverse reactions can be assigned to one of eight general categories: direct toxicity, toxicity of metabolites, pharmacologic side effects, hypersensitivity reactions, drug interactions, idiosyncratic reactions, over‐action, and exacerbation of secondary disease. The side effects of and adverse reactions to antidepressants are considered according to this scheme.The use of some antidepressants has been associated with cardiotoxicity, marrow toxicity, and hepatotoxicity. These effects may be more common among tricyclic antidepressants, compared with the selective serotonin reuptake inhibitors.Pharmacologic side effects are predictable on the basis of known specific reuptake inhibition and receptor blockade. Anticholinergic and antihistaminic effects, commonly associated with the tricyclic antidepressants, are most likely to impair quality of life. Serotonergic effects, particularly nausea, are the most troublesome effects of selective serotonin reuptake inhibitors.Hypersensitivity reactions have been reported rarely following the use of most antidepressants. Drug interactions with antidepressants are many and varied, and the potential for their occurrence may be a determinant of antidepressant choice. Idiosyncratic reactions are very rare, unpredictable, and often catastrophic, and may lead to withdrawal of a drug from clinical use. “Over‐action” may occur with antidepressants, leading to the precipitation of hypomania or mania. Additionally, antidepressants may exacerbate secondary disease. Convulsions have been more frequently reported following the use of classical antidepressants, as well as the newer compounds, maprotiline and bupropion. Depression 2:138–144 (1994/1995). © 1995 Wiley‐Liss, Inc.