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The pharmacologic management of
SSRI-induced side effects: a survey of
psychiatrists.
Dording CM, Mischoulon D, Petersen
TJ, Kornbluh R, Gordon J, Nierenberg AA, Rosenbaum JE, Fava
M.
Depression Clinical and Research Group, Massachusetts
General Hospital, Boston, Massachusetts 02114, USA.
cdording@partners.org
Despite the superior side effect profile of
the newer antidepressants over the tricyclics and monoamine oxidase
inhibitors, all newer antidepressants are associated with a wide array
of side effects. Clinicians are constantly confronted with the challenge
of managing these side effects in the context of minimal research to
prove one management strategy is more effective than another. The
purpose of this study was to examine prescribing practices regarding the
management of SSRI-associated side effects in a sample of psychiatrists
attending a psychopharmacology review course. A total of 439 out of 800
clinicians (55%) attending a psychopharmacology review course responded
to our questionnaire that was given prior to beginning the review
course, though not all respondents answered all four items on the
questionnaire. Among these items were questions designed to assess
clinician preference for the management of SSRI-induced side effects. As
a treatment for SSRI-induced sexual dysfunction, 43% (143/330) chose
adding bupropion, while 36% (120/330) opted to switch agents as their
first choice; for SSRI-induced insomnia, 78% (264/326) chose adding
trazodone. Switching agents was the first choice of 61% (214/353) of
clinicians for managing SSRI-induced agitation, 93% (339/363) for
managing SSRI-associated weight gain. In an effort to manage most
SSRI-associated side effects (with the exception of sexual dysfunction
and insomnia), the majority of the clinicians responding to our survey
opted to switch agents rather than add a specific medication to the
existing SSRI. In our opinion, this practice may reflect the relative
lack of research studies on the role of adjunctive treatments in the
management of SSRI-induced side effects and/or the tendency to favor
monotherapy over polypharmacy.
PMID: 12585563 [PubMed - indexed
for MEDLINE]
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