Discontinuing or Switching Selective Serotonin-Reuptake Inhibitors

2002 ◽  
Vol 36 (4) ◽  
pp. 578-584 ◽  
Author(s):  
Scott A Bull ◽  
Enid M Hunkeler ◽  
Janelle Y Lee ◽  
Clayton R Rowland ◽  
Todd E Williamson ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Adverse Effects ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Early Discontinuation ◽  
Telephone Surveys ◽  
Recurrent Case ◽  
Frequent Reason

OBJECTIVE: To describe reasons for discontinuing or switching selective serotonin-reuptake inhibitors (SSRIs) at 3 and 6 months after starting treatment, and to identify information provided to patients that may help prevent premature discontinuation of medication. METHODS: Telephone surveys were conducted at 3 and 6 months after patients (n = 672) were started on an SSRI for a new or recurrent case of depression. RESULTS: Significantly more patients discontinued or switched their SSRI because of an adverse effect within the first 3 months of starting (43%) compared with the second 3 months (27%; p = 0.023). The adverse effect most frequently reported as the reason for early discontinuation or switching was drowsiness/fatigue (10.2%), followed by anxiety, headache, and nausea — All at just over 5%. The odds ratio for discontinuation was 61% less in patients who recalled being told to take the medication for at least 6 months compared with those who did not (OR 0.39; p < 0.001). Patients who recalled being informed of potential adverse effects increased their reported incidence of mild to moderate adverse effects by 55% (OR 1.55; p < 0.05) without affecting rates of premature discontinuation (OR 1.06; p = 0.77). CONCLUSIONS: Adverse effects are the most frequent reason for discontinuing or switching SSRIs within the first 3 months of treatment. Patients are more likely to continue taking their antidepressant if they fully understand how long to take the medication. Informing patients of potential adverse effects does not appear to prevent premature discontinuation, but may increase the patient's awareness and reporting of mild to moderate adverse effects.

Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment

2019 ◽  
Vol 33 (11) ◽  
pp. 1340-1351 ◽  
Author(s):  
Laiana A Quagliato ◽  
Fiammetta Cosci ◽  
Richard I Shader ◽  
Edward K Silberman ◽  
Vladan Starcevic ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Risk Factor ◽  
Panic Disorder ◽  
Adverse Effects ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Meta Analysis ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Short Term

Background:Benzodiazepines (BZs) and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacologic treatment of panic disorder (PD). However, treatment guidelines favor SSRIs over BZs based on the belief that BZs are associated with more adverse effects than SSRIs. This belief, however, is currently supported only by opinion and anecdotes.Aim:The aim of this review and meta-analysis was to determine if there truly is evidence that BZs cause more adverse effects than SSRIs in acute PD treatment.Methods:We systematically searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and clinical trials register databases. Short randomized clinical trials of a minimum of four weeks and a maximum of 12 weeks that studied SSRIs or BZs compared to placebo in acute PD treatment were included in a meta-analysis. The primary outcome was all-cause adverse event rate in participants who received SSRIs, BZs, or placebo.Results:Overall, the meta-analysis showed that SSRIs cause more adverse events than BZs in short-term PD treatment. Specifically, SSRI treatment was a risk factor for diaphoresis, fatigue, nausea, diarrhea, and insomnia, whereas BZ treatment was a risk factor for memory problems, constipation, and dry mouth. Both classes of drugs were associated with somnolence. SSRIs were associated with abnormal ejaculation, while BZs were associated with libido reduction. BZs were protective against tachycardia, diaphoresis, fatigue, and insomnia.Conclusion:Randomized, blinded studies comparing SSRIs and BZs for the short-term treatment of PD should be performed. Clinical guidelines based on incontrovertible evidence are needed.

Female Sexual Side Effects Associated with Selective Serotonin Reuptake Inhibitors: A Descriptive Clinical Study of 33 Patients

1995 ◽  
Vol 25 (3) ◽  
pp. 239-248 ◽  
Author(s):  
Winston W. Shen ◽  
Jeffrey H. Hsu
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Adverse Effects ◽  
Serotonin Reuptake ◽  
Female Sexual Dysfunction ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Spontaneous Remission ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Sexual Side Effects

Objective: After the advent of selective serotonin reuptake inhibitors on the U.S. market in 1988, American psychiatrists have been faced with more choices of antidepressants for the treatment of depression. The prescribing of SSRIs has been increasing in popularity because they are easily titrated by the physicians and tolerated by patients. However, the SSRI use is frequently associated with female sexual dysfunction. The aim of this study was to describe these SSRI-associated female sexual side effects. Methods: In a retrospective series, clinic records of 110 female SSRI-treated outpatients were reviewed for loss of or decreased libido, orgasmic disturbances (anorgasmia or delayed orgasm), as well as clinical management patterns to alleviate sexual side effects. Results: Twenty-one fluoxetine-, nine paroxetine-, and five sertraline-treated cases with female sexual inhibition were identified. The fates of SSRI-associated sexual adverse effects and clinical managements of restoring these side effects were described. Conclusions: With some limitations in interpreting the data, the findings of this study suggest that SSRI-associated female sexual dysfunction occurs at a higher rate than we previously thought, equal potentials in implicating female sexual side effects among three SSRIs, and the absence or the low incidence of female sexual adverse effects from bupropion, and that these side effects can be managed by waiting for a spontaneous remission, dosage reduction of SSRIs, substitution with bupropion and other antidepressants, or the use of an antidote.

Selective Serotonin Reuptake Inhibitors and Trazodone for Treatment of Depression, Psychosis, and Behavioral Symptoms in Patients With Dementia

2000 ◽  
Vol 12 (S1) ◽  
pp. 245-251 ◽  
Author(s):  
David L. Sultzer
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Adverse Effects ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Behavioral Symptoms ◽  
Selective Serotonin ◽  
Clinical Aspects ◽  
Treatment Of Depression

Depression, psychosis, agitation, and aggression are fundamental clinical aspects of Alzheimer's disease (AD) and other dementia syndromes. Although behavioral, environmental, and pharmacologic interventions often help ameliorate these symptoms, the efficacy of specific interventions is uncertain, and adverse effects of medications are common.

scholarly journals Sexual adverse effects with new antidepressants

1998 ◽  
Vol 22 (7) ◽  
pp. 438-441 ◽  
Author(s):  
Shameem Mir ◽  
David Taylor
Keyword(s):  
Adverse Effect ◽  
Sexual Dysfunction ◽  
Adverse Effects ◽  
Monoamine Oxidase ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Case Reports ◽  
Depressive Illness ◽  
Serotonin Reuptake Inhibitors ◽  
Psychotropic Agents

Sexual dysfunction is a widely recognised adverse effect of many psychotropic agents. Older antidepressants such as monoamine oxidase inhibitors and tricycles, particularly clomipramine, are known to engender sexual adverse effects. In depression, this problem is exacerbated by the occurrence of impotence and lowered libido as part of depressive illness itself. We examined evidence relating to more recently introduced antidepressants: selective serotonin reuptake inhibitors, moclobemide, venlafaxine, nefazodone, mirtazapine and reboxetine. We reviewed published trials and case reports collated from searches of Medline, PsychLit and Micromedex from 1985 to December 1997, and contacted manufacturers of new antidepressants and requested information from them.

scholarly journals Which is the safest antidepressant to use in epilepsy?

1995 ◽  
Vol 19 (6) ◽  
pp. 355-356 ◽  
Author(s):  
Denise Duncan ◽  
David Taylor
Keyword(s):  
Adverse Effect ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Seizure Threshold

Seizures are a serious adverse effect of many antidepressants: most, if not all, tricyclics (TCAs) lower the seizure threshold, some atypicals (e.g. maprotiline) are known to cause convulsions and seizures have been reported to occur with all selective serotonin reuptake inhibitors (SSRIs). Opinions vary on which is the safest antidepressant to use in epilepsy.

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