Summary
[SIDE EFFECTS] The main differences among the newer antidepressants are side effects and drug interactions. See the Commentary for a drug-by-drug list of these key differences. [PCP's] This review comes from a group of primary care docs, which is important because most depression is treated by PCPs. [FOLLOW-UP] It emphasizes the need for follow-up 1-2 weeks after initial prescription, which is KEY to improving adherence and addressing new side effects.
Analysis
The article refers to the American College of Physicians' new "guideline" on the use of second-generation antidepressants, which refers to those with more specific mechanisms of action, meaning all the ones which have come out since Prozac's debut in 1988.
Side effects can occur within the first few days of starting these drugs, while the antidepressant effects may take several weeks. Thus, early follow-up visits help the physician to address these initial problems, through reassurance or changes in drug or dose. Also, early symptoms of increased anxiety or agitation or mania can sometimes lead to suicidal thoughts, so early follow-up is important for this reason, too.
The main way to minimize intolerable side effects is to pick the best drug for that particular person based on their symptoms, preferences, and other medications. Here is a list of second-generation antidepressants mentioned in the ACP guidelines, the name of the manufacturer, and the symptoms or history that would make one lean FOR (+symptom) or AGAINST (-symptom) using a specific drug in a specific person.
• bupropion/Wellbutrin (GlaxoSmithKline, generics): +fatigue, +hypersomnia, +sexual dysfunction, -seizures
• citalopram/Celexa (Forest, generics): +on multiple meds, +inexpensive
• duloxetine/Cymbalta (Lilly): +pain, -nausea, -wt loss
• escitalopram/Lexapro (Forest): +on multiple meds
• fluoxetine/Prozac/Serafem (Lilly, generics): +forget to take, -certain drug interactions
• fluvoxamine/Luvox: +OCD, -certain drug interactions, -fatigue
• mirtazapine/Remeron (Organon, generics): +nausea, +wt loss, +insomnia, -wt gain
• nefazodone/Serzone: +anxiety, +sexual dysfunction, -certain drug interactions
• paroxetine/Paxil/Pexeva (GlaxoSmithKline, generics): -certain drug interactions
• sertraline/Zoloft (Pfizer, generics): +on multiple meds, +cardiac disease
• trazadone/Desyrel: +insomnia, -male
• venlafaxine/Effexor (Wyeth, generics): +pain, -nausea, -hypertension
• desmethlyvenlafaxine/Pristiq (Wyeth): +no titration needed, -nausea, -hypertension
(Note: I wrote this analysis in Nov 2008, but it got stuck in drafts. It still is worthy of publishing.)
This author consults with leading institutions through GLG
Analyses are solely the work of the authors and have not been edited or endorsed by GLG.
