Antidepressant

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Contents 1 More Specific Terms 2 Indications 3 Adverse-effects 4 Management 5 More General Terms 6 References

More Specific Terms

• antidepressant combination
• monoamine oxidase [MAO] inhibitor
• second generation antidepressant
• tricyclic antidepressant (TCA)

Indications

• depression

Adverse-effects

• anxiety, agitation & restlessness with initiation of therapy
• suicide in adolescents? [2,4] adults? [5]
• adverse effects of specific agents (not all inclusive)

• venlafaxine: nausea & vomiting
• sertraline: diarrhea
• mirtazapine: weight gain
• trazodone: somnolence
• paroxetine & venlafaxine: withdrawal
• paroxetine: sexual dysfunction bupropion (less sexual dysfunction)
• SSRIs: suicide attempts
  

• drug adverse effects of antidepressants

Management

• efficacy

• response rate for all antidepressants is 60-70%, with placebo response rate of ~ 30%
• benefits of antidepressants fall below accepted criteria for clinical significance [7]

• selection of antidepressant:

• no major differences in response among SSRIs or SSRIs & atypical antidepressants* [4,9]
• major difference in antidepressants is adverse effects* [4,9]
• select agent based on adverse-effect profiles, cost, & patient preferences [9]
• regular assessment for response & adverse effects, starting 1 to 2 weeks after initiating therapy
• modification of treatment if response is inadequate at 6 to 8 weeks
• continuation of treatment for 4-9 months after a satisfactory response (longer for patients with prior episode of major depression) [9]
  

• * escitalopram, mirtazapine, sertraline, & venlafaxine are the most efficacious [10]
• * escitalopram & sertraline have the 'best possible balance between efficacy & acceptability' [10]
• * sertraline is less expensive [10]

More General Terms

• psychotropic agent

References

1. Prescriber's Letter 11(5):26 2004 Detail-Document#: [1] (subscription needed) [2]
2. Prescriber's Letter: Comparison of Commonly Used Antidepressants Detail-Document#: [3] (subscription needed) [4]
3. Prescriber's Letter 11(12): 2004 Suicidality in Children and Adolescents Being Treated With Antidepressant Medications Detail-Document#: [5] (subscription needed) [6] sants/SSRIPHA200410.htm [7] [8]
4. Hansen RA, Gartlehner G, Lohr KN, Gaynes BN, Carey TS. Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder. Ann Intern Med. 2005 Sep 20;143(6):415-26. Review. PMID: [9]
5. FDA Medwatch Public Health Advisory: Suicidality in Adults Being Treated with Antidepressant Medications [10]
6. Prescriber's Letter 15(4): 2008 Antidepressant Efficacy Detail-Document#: [11] (subscription needed) [12]
7. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008 Feb;5(2):e45. PMID: [13]
8. Prescriber's Letter 15(5): 2008 Comparison of Commonly Used Antidepressants Detail-Document#: [14] (subscription needed) [15]
9. Qaseem A et al. Using second-generation antidepressants to treat depressive disorders: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2008 Nov 18; 149:725. PMID: &dopt=Abstract
   - Gartlehner G et al. Comparative benefits and harms of second-generation antidepressants: Background paper for the American College of Physicians. Ann Intern Med 2008 Nov 18; 149:734. PMID: [16]
10. Cipriani A et al, Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis Lancet 29 January 2009 doi:10.1016/S0140-6736(09)60046-5 PMID: [17]

antidepressant