antidepressant
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[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]
Epidemiology
- 1 in 7 reproductive age women on antidepressants
Indications
- depression
- depressive psychosis*
- seasonal affective disorder
- bipolar disorder, mania
- obsessive-compulsive disorder: only venlafaxine effective*[21]
- attention-deficit hyperactivity disorder[13]
- may mitigate effects of prenatal maternal anxiety on auditory sensory gating, a measure of attentional function[11]
- anorexia nervosa, bulimia nervosa obesity[13]
- post-traumatic stress disorder
- urticaria, pruritus, atopic dermatitis, lichen simplex chronicus
- neuralgia, diabetic neuropathy, chronic musculoskeletal pain, muscle spasm, neuropathic pain: only amitryptyline effective*[21]
- migraine prophylaxis, cluster headache
- cataplexy, narcolepsy, parkinsonism
- premenstrual syndrome, menopause, hot flash
- insomnia
- enuresis
- smoking cessation
- attention-deficit hyperhyperactivity disorder
- fibromyalgia
- panic disorder[13]: only escitalopram effective*[21]
- generalized anxiety disorder, social phobia[13]
* 25% of antidepressant prescriptions in Canada for off-label use 2006-2015[20]
* of the off-label uses, only 3 with strong evidence supporting use[21]
Contraindications
- treatment of back pain or knee osteoarthritis[28]
Adverse effects
- anxiety, agitation & restlessness with initiation of therapy
- suicide in adolescents ? (FDA warning)[3] adults?[5]
- antidpressant use down among young people & suicide attempts up after FDA warning[15]
- doubling of risk for suicidality & aggression in children & adolescents using antidepressants[17]
- adverse effects of specific agents (not all inclusive)
- increased risk of autism with maternal use during pregnancy[11]
- no association with osteoporosis or osteopenia[12]
- association with hip fracture questioned[27]
- cardiovascular risk low, but variable[19]
- associated with risk of dementia & Alzheimer's disease (RR=3.7 for SSRI, RR= 4.7 for SNRI, RR=3.3 for TCA, RR=4.9 for MAO inhibitor)[22]
- increased risk of psychiatric disorders in offspring[23]
- increased risk for type 2 diabetes in young people (RR=1.9)[24]
- withdrawal symptoms of dizziness & insomnia[25][31]
- weight gain[26]
- antidepressants may facilitate antibiotic resistance[30]
Management
- efficacy
- 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]
- deprescribing
- cognitive-behavioral therapy during antidepressant taper is as effective as continuing antidepressant[29]
* 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
More specific terms
- agomelatine (Valdoxan, Melitor, Thymanax)
- antidepressant combination
- esketamine (Spravato)
- gepirone (Exxua)
- monoamine oxidase [MAO] inhibitor
- second generation antidepressant
- tricyclic antidepressant (TCA)
- vortioxetine (Trintellix)
- zuranolone (Zurzuvae)
References
- ↑ Prescriber's Letter 11(5):26 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200503&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter: Comparison of Commonly Used Antidepressants Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200606&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 3.0 3.1 Prescriber's Letter 11(12): 2004 Suicidality in Children and Adolescents Being Treated With Antidepressant Medications Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=201212&pb=PRL (subscription needed) http://www.prescribersletter.com http://www.fda.gov/cder/drug/antidepres sants/SSRIPHA200410.htm http://www.psych.org/news_room/press_releases/04-55apaonfdablackboxwarning.pdf http://www.aacap.org/Announcements/antidepressants.htm
- ↑ 4.0 4.1 4.2 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: https://www.ncbi.nlm.nih.gov/pubmed/16172440
- ↑ 5.0 5.1 FDA Medwatch Public Health Advisory: Suicidality in Adults Being Treated with Antidepressant Medications http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#antidepressant
- ↑ Prescriber's Letter 15(4): 2008 Antidepressant Efficacy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240409&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 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: https://www.ncbi.nlm.nih.gov/pubmed/18303940
- ↑ Prescriber's Letter 15(5): 2008 Comparison of Commonly Used Antidepressants Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240509&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 9.0 9.1 9.2 9.3 9.4 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: https://www.ncbi.nlm.nih.gov/pubmed/19017591 (Correponding NGC guideline withdrawn Jan 2014)
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: https://www.ncbi.nlm.nih.gov/pubmed/19017592 - ↑ 10.0 10.1 10.2 10.3 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: https://www.ncbi.nlm.nih.gov/pubmed/19185342
- ↑ 11.0 11.1 11.2 Hunter SK et al. Antidepressants may mitigate the effects of prenatal maternal anxiety on infant auditory sensory gating. Am J Psychiatry 2012 Jun 1; 169:616 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22581104 <Internet> http://psychiatryonline.org/article.aspx?articleid=1148701&journalid=13
- ↑ 12.0 12.1 Diem SJ et al. Rates of bone loss among women initiating antidepressant medication use in midlife. J Clin Endocrinol Metab 2013 Sep 3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24001746
- ↑ 13.0 13.1 13.2 13.3 13.4 Deprecated Reference
- ↑ Prescriber's Letter 20(12): 2013 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=291206&pb=PRL Comparison of Antidepressants (subscription needed) http://www.prescribersletter.com
- ↑ 15.0 15.1 Lu CY et al Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi- experimental study. BMJ 2014;348:g3596 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24942789 <Internet> http://www.bmj.com/content/348/bmj.g3596
- ↑ Prescriber's Letter 21(7): 2014 Choosing and Switching Antidepressants. Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300721&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 17.0 17.1 Sharma T et al Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26819231 <Internet> http://www.bmj.com/content/352/bmj.i65
Moncrieff J Misrepresenting harms in antidepressant trials. BMJ 2016;352:i217 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26819231 <Internet> http://www.bmj.com/content/352/bmj.i217 - ↑ Dawson AL et al Antidepressant Prescription Claims Among Reproductive-Aged Women With Private Employer-Sponsored Insurance - United States 2008-2013 http://www.cdc.gov/mmwr/volumes/65/wr/mm6503a1.htm
- ↑ 19.0 19.1 Coupland C, Hill T, Morriss R et al Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database. BMJ 2016;352:i1350 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27005565 Free full text <Internet> http://www.bmj.com/content/352/bmj.i1350
- ↑ 20.0 20.1 Wong J et al Treatment Indications for Antidepressants Prescribed in Primary Care in Quebec, Canada, 2006-2015. JAMA. 2016;315(20):2230-2232 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27218634 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2524175
- ↑ 21.0 21.1 21.2 21.3 21.4 Wong J, Motulsky A, Abrahamowicz M et al. Off-label indications for antidepressants in primary care: Descriptive study of prescriptions from an indication based electronic prescribing system. BMJ 2017;356:j603 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28228380 Free PMC Article <Internet> http://www.bmj.com/content/356/bmj.j603
- ↑ 22.0 22.1 Then CK et al. Risk analysis of use of different classes of antidepressants on subsequent dementia: A nationwide cohort study in Taiwan. PLoS One 2017 Apr 6; 12:e0175187 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28384235 Free Article
- ↑ 23.0 23.1 Liu X, Agerbo E, Ingstrup KG et al Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study. BMJ 2017;358:j3668 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28877907 <Internet> http://www.bmj.com/content/358/bmj.j3668
Nordeng H, Lupattelli A, Wood M. Prenatal exposure to antidepressants and increased risk of psychiatric disorders. BMJ 2017;358:j3950 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28877910 <Internet> http://www.bmj.com/content/358/bmj.j3950 - ↑ 24.0 24.1 Burcu M, Zito JM, Safer DJ et al Association of Antidepressant Medications With Incident Type 2 Diabetes Among Medicaid-Insured Youths. JAMA Pediatr. Published online October 16, 2017 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29049533 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2656620
- ↑ 25.0 25.1 Orciari Herman A, Sadoughi S, Sofair A Millions of Americans Keep Taking Antidepressants for Years, Often Because of Severe Withdrawal Symptoms. David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Carey B, Gebeloff R. Many People Taking Antidepressants Discover They Cannot Quit. New York Times. April 7, 2018 https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html - ↑ 26.0 26.1 Gafoor R, Booth HP, Gulliford MC. Antidepressant utilisation and incidence of weight gain during 10 years' follow-up: population based cohort study. BMJ 2018;361:k1951 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29793997 Free PMC Article https://www.bmj.com/content/361/bmj.K1951
Serretti A, Porcelli S. Antidepressant induced weight gain. BMJ 2018 May 23; 361:k2151 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29792297 https://www.bmj.com/content/361/bmj.k2151 - ↑ 27.0 27.1 Brannstrom J, Lovheim H, Gustafson Y et al Association Between Antidepressant Drug Use and Hip Fracture in Older People Before and After Treatment Initiation. JAMA Psychiatry. Published online January 2, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30601883 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2719274
Iaboni A, Maust DT A Status Update on the Association Between Antidepressants and Fractures Breaking Up? JAMA Psychiatry. Published online January 2, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30601880 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2719272 - ↑ 28.0 28.1 Ferreira GE, McLachlan AJ, Lin CWC et al Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis. BMJ 2021;372:m4825 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33472813 Free article https://www.bmj.com/content/372/bmj.m4825
Underwood M, Tysall C. Antidepressants for musculoskeletal pain. BMJ 2021;372:n80 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33472842 https://www.bmj.com/content/372/bmj.n80 - ↑ 29.0 29.1 Breedvelt JJF et al. Continuation of antidepressants vs sequential psychological interventions to prevent relapse in depression. JAMA Psychiatry 2021 May 19; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34009273 PMCID: PMC8135055 (available on 2022-05-19) https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2780290
- ↑ 30.0 30.1 Drew L How antidepressants help bacteria resist antibiotics. A laboratory study unravels ways non-antibiotic drugs can contribute to drug resistance. Nature News. Jan 24, 2023 https://www.nature.com/articles/d41586-023-00186-y
- ↑ 31.0 31.1 Iacobucci G. Stopping antidepressants causes symptoms in one in six people, study estimates. BMJ. 2024 Jun 6;385:q1246. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38843886 No abstract available.