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Long-term side effects of
newer-generation antidepressants: SSRIS, venlafaxine, nefazodone,
bupropion, and mirtazapine.
Masand PS, Gupta
S.
Department of Psychiatry, Duke University Medical Center,
Durham, North Carolina 27710, USA. masan001@mc.duke.edu
Anecdotal
reports have suggested that the long-term use of selective serotonin
reuptake inhibitors (SSRIs) may be associated with significant weight
gain, sexual dysfunction, drug interactions, and discontinuation
symptoms. Are these effects inevitable or can they be managed
effectively with the appropriate interventions? In reviewing published,
controlled clinical trials, it has been noted that many depressed
patients experience weight gain during remission with or without
treatment. Most antidepressants appear to produce a 3- to 4-kg weight
gain after 6-12 months of therapy, which may be managed with nutritional
counseling and exercise. The exception is mirtazapine, which appears to
be associated with significant weight gain early in therapy.
Antidepressant-induced sexual dysfunction is also common but may be
managed with the addition of an antidote or substitution. Drug
interactions are most common with fluvoxamine, nefazodone, and
fluoxetine because these agents are more likely to affect the metabolism
of commonly prescribed medications. It may be possible to prevent
discontinuation symptoms with a cross taper to another antidepressant or
by slowly tapering the antidepressant.
Publication Types:
PMID: 12585567 [PubMed - indexed for
MEDLINE]
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