Comparative Tolerability Profiles of the Newer versus Older Antidepressants

Abstract

Although the standard tricyclic antidepressants (TCAs) are generally effective in the treatment of depression, they can cause several troublesome adverse effects. Chief among these are their anticholinergic actions, which range from annoying dryness of the mouth and constipation to potentially dangerous urinary retention and confusion or delirium in the ill and elderly. Cardiovascular effects of TCAs include orthostatic hypotension, tachycardia and cardiac conduction slowing. Many TCAs are sedating and promote weight gain. Also problematic is the potential lethality of TCAs in overdose. The continual introduction of a host of new antidepressants over the past 15 years has provided an opportunity to improve the benefit-risk ratio for many patients by reducing medication-related toxicity. Selective serotonin reuptake inhibitors (SSRIs) and amfebutamone (bupropion), among others, are examples of effective antidepressants free of tricyclic-like anticholinergic, cardiovascular, sedating and appetite/weight-increasing effects. However, the new-generation drugs also present adverse effects of their own, including gastrointestinal distress, agitation and drug-drug interactions in the case of the SSRIs, and the risk of seizures or psychosis in amfebutamone recipients. Monoamine oxidase (MAO) inhibitors have also been refined; reversible inhibitors of MAO-type A afford protection against the usually feared hypertensive reaction to indirect sympathomimetic substances. The availability of new-generation antidepressants thus increases the likelihood of clinical response with a reduction in unwanted toxicity.

Fluoxetine and Fluvoxamine Combined with Individual Cognitive-Behaviour Therapy in Binge Eating Disorder: A One-Year Follow-Up Study

“…Several studies have shown that different antidepressants are effective in reducing binge eating in eating-disordered patients [14, 17]; however, most antidepressant drugs induce weight gain [32, 33]and are therefore inadequate for the treatment of patients with BED. On the other hand, some serotonin reuptake inhibitors with antidepressant activity are in the short term weight-neutral [34]or capable of inducing weight loss in obese patients during the first months of treatment [35]. In the present study, the weight loss obtained with CBT, CBT-FLX and CBT-FLV treatments was not significantly different, although there was a trend toward a greater reduction of BMI in patients treated with CBT + FLX or FLV.…”

Protective Effect of Mirtazapine on Indomethacin-Induced Ulcer in Rats and Its Relationship with Oxidant and Antioxidant Parameters

“…In the literature it has been reported that the combined usage of SSRI drugs and NSAIDs cause gastrointestinal bleeding [38]. 5-HT 2 and 5-HT 3 receptors of serotonin are responsible for these side effects [39,40]. SSRI drugs cause extracelluar serotonin to increase and the nonselective stimulation of 5-HT 2 and 5-HT 3 receptors [41].…”

Severe bradycardia following fluoxetine administration: A case report in a young HIV‐1 infected woman

“…These adverse effects are principally constituted by gastrointestinal disturbances, including nausea and/or vomiting, diarrhoea and less commonly constipation (Rudorfer et al, 1994).…”