Antidepressants (cont.)

The risk of gastrointestinal bleeding may be increased when SSRIs are combined with nonsteroidal antiinflammatory drugs (NSAIDs).

SSRIs may increase the effect of warfarin (Coumadin), leading to excessive bleeding. Therefore, warfarin therapy should be monitored more frequently in patients who are also taking SSRIs.

SSRIs cause headaches and dose-related nausea, vomiting, and diarrhea that improve with continued treatment.

Insomnia, restlessness, and agitation-which decrease over time-also are associated with SSRIs. Insomnia can be treated with low dose (50-100 mg) trazodone (Desyrel) at bedtime and agitation may be managed by reducing the SSRI dose or treating with anti-anxiety drugs.

SSRIs also are associated with sexual dysfunction. Symptoms of sexual dysfunction may be treated with sildenafil (Viagra), yohimbine (Pausinystalia yohimbe), amantadine (Symmetrel), cyproheptadine, or neostigmine (Prostigmin).

Over time, weight loss or weight gain has been associated with SSRIs. Patients may experience weight loss initially but quickly regain weight.

What are examples of SSRIs?

What are serotonin norepinephrine reuptake inhibitors (SNRIs)?

SNRIs are the newest class of antidepressants. SNRIs work by increasing the levels of serotonin and norepinephrine in the brain. Drug interactions and side effects associated with SNRIs are similar to those seen with SSRIs.

SNRIs may increase blood pressure, especially at high doses. High blood pressure caused by SNRIs may be managed by reducing the dose of the SNRI.

What are examples of SNRIs?

Conclusion

Depression is a serious condition that often can be effectively treated with available therapies. Many antidepressants have been developed over the years. The newer classes of antidepressants are better tolerated and associated with fewer drug interactions than the older class of antidepressants. Side effects and drug interactions are barriers to successful treatment. Some side effects of antidepressants resolve with continued use while other side effects can be managed by dose reduction or adding other therapies. Appropriate management of side effects and avoidance of drugs that may interact with antidepressants may improve the success of antidepressant therapy.

Reference: FDA Prescribing Information


Last Editorial Review: 5/31/2013



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