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The Safety of Antidepressants

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Summary

In this article, a distinction is proposed between safe and less safe antidepressants. The safety of 18 antidepressants is discussed in relation to 3 principal issues: the safety of the drug in the event of an overdose; the seriousness of its side effects; and the existence of dangerous interactions. On the basis of present information, it can be said with reasonable confidence that fluoxetine, fluvoxamine and paroxetine are safe antidepressants, and with some reservation (mainly because of hypnosedation) the same can be said of mianserin and trazodone.

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References

  • Bancroft JHJ, Skrimshire AM, Sinkin S. The reasons people give for taking overdoses. British Journal of Psychiatry 128: 538–548, 1976

    Article  PubMed  CAS  Google Scholar 

  • Benfield P, Ward A. Fluvoxamine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs 32: 313–334, 1986

    Article  PubMed  CAS  Google Scholar 

  • Bernard PG, Levin MS. Maprotiline induced seizures. Southern Medical Journal 79: 1179–1181, 1986

    Article  PubMed  CAS  Google Scholar 

  • Branconnier RJ, Cole JO, Ghazvinian S, Rosenthal S. Treating the depressed elderly patient: the comparative behavioural pharmacology of mianserine and amitriptyline. Advances in Biochemical Psychopharmacology 32: 195–212, 1982

    PubMed  CAS  Google Scholar 

  • Burrows G, Norman T, Dennerstein L, et al. Antidepressant therapy: benefits and risks in perspective. Acta Psychiatrica Scandinavica 72: S435–S447, 1985

    Article  Google Scholar 

  • Claghorn JL, Schroeder J, Goldstein BJ. Comparison of the electrocardiographic effect of dothiepin and amitriptyline. Journal of Clinical Psychiatry 45: 291–293, 1984

    PubMed  CAS  Google Scholar 

  • Coccaro EF, Siever LJ. Second generation antidepressants: a comparative review. Journal of Clinical Pharmacology 25: 241–260, 1985

    PubMed  CAS  Google Scholar 

  • Comprehensive monograph Prozac. Dista Indianapolis, 1988

  • Dechant KL, Clissold SP. Paroxetine: A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depressive illness. Drugs 41: 225–253, 1991

    Article  PubMed  CAS  Google Scholar 

  • Dukes MNG, Beeley L. Side effects of drugs. Elsevier Annual 12, Chapter 12, Amsterdam, 1988

    Google Scholar 

  • Edwards JC, Glen-Bott M. Mianserine and convulsive seizures. British Journal of Clinical Pharmacology 15: 299s–311s, 1983

    Article  PubMed  Google Scholar 

  • Edwards JG. Antidepressants and seizures: epidemiological and clinical aspects. In Trimble MR (Ed.) The psychopharmacology of epilepsy, pp. 119–139, Wiley, Chichester, 1985

    Google Scholar 

  • Feighner JP. A comparative trial of fluoxetine and amitriptyline in patients with major depressive disorder. Journal of Clinical Psychiatry 46: 369–372, 1985

    PubMed  CAS  Google Scholar 

  • Gerner R, Estabrook W, Steuer J, et al. Treatment of geriatric depression with trazodone, imipramine and placebo: a double-blind study. Journal of Clinical Psychiatry 41: 216–220, 1980

    PubMed  CAS  Google Scholar 

  • Glassman AH, Bigger JT, Giardina EV, et al. Clinical characteristics of imipramine induced orthostatic hypotension. Lancet 1: 468–472, 1979

    Article  PubMed  CAS  Google Scholar 

  • Glassman AH, Roose SP. Cardiovascular effects of tricyclic antidepressants. Psychiatry Ann 27: 340–344, 1987

    Google Scholar 

  • Goodman-Gilman, et al. (Eds) The pharmacological basis of therapeutics, VIII Ed., p. 412, Pergamon Press, New York, 1990

    Google Scholar 

  • Guze SB, Robins E. Suicide and primary affective disorders. British Journal of Psychiatry 117: 437–438, 1970

    Article  PubMed  CAS  Google Scholar 

  • Harsch HH, Holt RE. Use of antidepressants in attempted suicide. Hospital and Community Psychiatry 39: 990–992, 1988

    PubMed  CAS  Google Scholar 

  • Hayes PE, Kristoff CA. Adverse reactions to five new antidepressants. Clinical Pharmacy 5: 472–480, 1986

    Google Scholar 

  • Henry JA. A fatal toxicity index for antidepressant poisoning. Acta Psychiatrica Scandinavica 80: 37–45, 1989

    Article  Google Scholar 

  • Hindmarch I. A pharmacological profile of fluoxetine and other antidepressants on aspects of skilled performance and car handling ability. British Journal of Psychiatry 153 (Suppl. 3): 99–104, 1988

    Google Scholar 

  • Hindmarch I. A double-blind, placebo-controlled investigation of the effects on psychomotor performance of paroxetine and amitriptyline with or without alcohol in adult subjects. Lecture at the 17th CINP Congress, Kyoto, September, 1990

  • Hindmarch I. Behavioural toxicity of antidepressants with particular reference to paroxetine. Lecture at the 5th World Congress of Biological Psychiatry, Florence, June 9–14, 1991

  • Hulten BA. TCA poisoning treated in the intensive care unit. Pharmacopsychiatry 23: 14–16, 1990

    Article  PubMed  Google Scholar 

  • Inman WH. Blood disorders and suicide in patients taking mianserin or amitriptyline. Lancet 2: 90–92, 1988

    Article  PubMed  CAS  Google Scholar 

  • Jabbari B, Bryan GE, Mars LEE, et al. Incidence of seizures with tricyclic and tetracyclic antidepressants. Archives of Neurology 42: 480–481, 1985

    Article  PubMed  CAS  Google Scholar 

  • Kristofferson A, Nilsson BS. Zimelidine: febrile reactions and peripheral neuropathy. In Kammüller ME, Bloksma N, Seinen W (Eds) Autoimmunity and Toxicology, Elsevier, Amsterdam, 1989

    Google Scholar 

  • Leonard BE. Toxicity of antidepressants. Lancet 2: 1105, 1986

    Article  PubMed  CAS  Google Scholar 

  • Linkowski P, Maetelaerd V, Mendlewicz J. Suicidal behaviour in major depressive illness. Acta Psychiatrica Scandinavica 72: 233–238, 1985

    Article  PubMed  CAS  Google Scholar 

  • Montgomery SA, Pinder RM. Do some antidepressants promote suicide? Psychopharmacology 92: 265–266, 1987

    Article  PubMed  CAS  Google Scholar 

  • Pichot P, Dreyfus JF, Pull C. A double-blind multicentre trial comparing mianserin with imipramine. British Journal of Psychopharmacology 5: 87s–90s, 1978

    Google Scholar 

  • Pinder RM. The benefits and risks of antidepressant drugs. Human Psychopharmacology 3: 73–86, 1988

    Article  Google Scholar 

  • Pinder RM, Blum A, Stulemeijer SM, et al. A double-blind multicenter trial comparing the efficacy and side-effects of mianserine and clomipramine in depressed inpatients and outpatients. Current Medical Research and Opinion 6 (Suppl. 7): 115–127, 1980

    Article  Google Scholar 

  • Prager G, Cimander K, Wagner W, et al. The cardiotropic effect of antidepressants. Advances in Pharmacotherapy 2: 133–150, 1986

    Google Scholar 

  • Preskorn SH, Jerkovich GS. Central nervous system toxicity of tricyclic antidepressants: phenomenology, course, risk factors, and the role of therapeutic drug monitoring. Journal of Clinical Psychopharmacology 10: 88–95, 1990

    Article  PubMed  CAS  Google Scholar 

  • Richens A, Nawishi S, Trimble M. Antidepressant drugs, convulsions and epilepsy. British Journal of Clinical Pharmacology 15: 295s–298s, 1983

    Article  PubMed  Google Scholar 

  • Robinson DS. Adverse reactions, toxicities, and drug interactions of newer antidepressants: anticholinergic, sedative and other side-effects. Psychopharmacology Bulletin 20: 280–290, 1984

    PubMed  CAS  Google Scholar 

  • Roos JC, Sharp DJ. Antidepressant drugs and cardiovascular effects. A comparison of fluvoxamine and the tricyclic antidepressant drugs. In Burrows et al. (Eds) Biological psychiatry: recent studies, John Libbey, London, 1984

    Google Scholar 

  • Roose SP, Glassman AH, Giardina EGV, et al. Tricyclic antidepressants in depressed patients with cardiac conduction disease. Archives of General Psychiatry 44: 273–275, 1987

    Article  PubMed  CAS  Google Scholar 

  • Shaw CA, Sullivan JT, Kadlec KE, Kaplan HL, Naranjo CA, et al. Ethanol interactions with serotonin uptake selective and non-selective antidepressants: fluoxetine and amitriptyline. Human Psychopharmacology 4: 113–120, 1989

    Article  CAS  Google Scholar 

  • Stallone F, Dunner DL, Ahean J, et al. Statistical prediction of suicide in depressives. Comprehensive Psychiatry 21: 381–387, 1982

    Article  Google Scholar 

  • Stark P, Hardison CD. A review of multicenter controlled studiers of fluoxetine vs imipramine and placebo in outpatients with major depressive disorder. Journal of Clinical Psychiatry 46: 53–58, 1985

    PubMed  CAS  Google Scholar 

  • Syssain EC, Schatzberg AF, Woods BT, et al. Maprotiline treatment in depression. Archives of General Psychiatry 43: 86–90, 1986

    Article  Google Scholar 

  • Teicher MH, Glod C, Cole JO. The emergence of intense suicidal preoccupation during fluoxetine treatment. American Journal of Psychiatry 147: 207–210, 1990

    PubMed  CAS  Google Scholar 

  • Tesar GE, Rosenbaum JF, Biederman J, et al. Orthostatic hypotension and antidepressant pharmacotherapy. Psychopharmacology Bulletin 23: 182–186, 1987

    PubMed  CAS  Google Scholar 

  • Warrington SJ, Padgham C, Lader M. The cardiovascular effects of antidepressants. In Psychological Medicine, monograph Suppl. 16, Cambridge University Press, 1989

    Google Scholar 

  • Worm K, Steentoft A. Fatal poisoning by cyclic antidepressants. Pharmacopsychiatry 23: 9–13, 1990

    Article  PubMed  Google Scholar 

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de Jonghe, F., Swinkels, J.A. The Safety of Antidepressants. Drugs 43 (Suppl 2), 40–47 (1992). https://doi.org/10.2165/00003495-199200432-00007

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