The pharmacologic management of SSRI-induced side effects: a survey of psychiatrists

Ann Clin Psychiatry. 2002 Sep;14(3):143-7. doi: 10.1023/a:1021137118956.

Abstract

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.

MeSH terms

  • Akathisia, Drug-Induced / drug therapy*
  • Akathisia, Drug-Induced / etiology
  • Antidepressive Agents, Second-Generation / adverse effects*
  • Antidepressive Agents, Second-Generation / therapeutic use
  • Bupropion / therapeutic use
  • Critical Pathways*
  • Data Collection
  • Depressive Disorder / drug therapy*
  • Drug Therapy, Combination
  • Female
  • Hospitals, General
  • Humans
  • Male
  • Massachusetts
  • Selective Serotonin Reuptake Inhibitors / adverse effects*
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Sexual Dysfunction, Physiological / chemically induced*
  • Sexual Dysfunction, Physiological / drug therapy
  • Sleep Initiation and Maintenance Disorders / chemically induced*
  • Sleep Initiation and Maintenance Disorders / drug therapy
  • Trazodone / therapeutic use
  • Weight Gain / drug effects*

Substances

  • Antidepressive Agents, Second-Generation
  • Serotonin Uptake Inhibitors
  • Bupropion
  • Trazodone