Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Neuroscience Campus Amsterdam, VU University, Amsterdam, the Netherlands.
Eur Neuropsychopharmacol. 2013 Nov;23(11):1443-51. doi: 10.1016/j.euroneuro.2013.05.001. Epub 2013 May 30.
Side effects of antidepressants are usually underreported in clinical trials and large scale naturalistic studies are restricted to six months of use. We examined the prevalence and nature of patient-perceived side effects and their determinants during long-term antidepressant use in a naturalistic setting. Subjects, aged 19 to 67 years, in the Netherlands Study of Depression and Anxiety were recruited from primary care and specialized mental health care covered 927 cases of single antidepressant use. In 64% of cases, on average, 2.9 side effects were reported. The number of side effects was higher when subjects had higher depression severity (OR=1.28; p=0.002), three or more psychiatric diagnoses (OR=1.97; p=0.02), higher dose (OR=1.44; p=0.006) and was lower when subjects were older (OR=0.83; p=0.02) and had longer duration of use (OR=0.94; p=0.04). Tricyclic antidepressants were associated with more side effects (OR=2.52; p=0.003) and, particularly, more anticholinergic effects, like dry mouth and constipation, as compared to selective serotonin reuptake inhibitors. Venlafaxine showed more profuse sweating (OR=1.79; p=0.007), whereas mirtazapine showed more weight gain and less sexual dysfunction (OR=0.36; p=0.03), as compared to selective serotonin reuptake inhibitors. Weight gain was associated with female gender (OR=1.76; p=0.004) and duration of use (OR=1.06; p=0.03). We show that antidepressant side effect, known from short-term studies, persist during long-term use and are associated with depression severity and antidepressant dose. A novel finding was that venlafaxine is associated with more profuse sweating and that weight gain appeared more specific in female users. Clinicians should be aware that, during long-term antidepressant use, side effects are common and persistent.
抗抑郁药的副作用在临床试验中通常报告不足，而大型自然主义研究仅限于使用六个月。我们在自然环境中检查了长期使用抗抑郁药期间患者感知到的副作用的普遍性和性质及其决定因素。研究对象年龄在 19 至 67 岁之间，来自初级保健和专门的精神保健，涵盖了 927 例单一抗抑郁药的使用情况。平均而言，在 64％的情况下报告了 2.9 种副作用。当患者的抑郁严重程度较高（OR=1.28；p=0.002），有三个或更多精神科诊断（OR=1.97；p=0.02），剂量较高（OR=1.44；p=0.006）时，副作用的数量更高，而当患者年龄较大（OR=0.83；p=0.02）和使用时间较长（OR=0.94；p=0.04）时，副作用的数量较低。与选择性 5-羟色胺再摄取抑制剂相比，三环类抗抑郁药与更多的副作用相关（OR=2.52；p=0.003），特别是口干和便秘等抗胆碱能作用。与选择性 5-羟色胺再摄取抑制剂相比，文拉法辛表现出更多的多汗（OR=1.79；p=0.007），而米氮平表现出更多的体重增加和较少的性功能障碍（OR=0.36；p=0.03）。体重增加与女性（OR=1.76；p=0.004）和使用时间（OR=1.06；p=0.03）有关。我们表明，从短期研究中已知的抗抑郁药副作用在长期使用期间仍然存在，并且与抑郁严重程度和抗抑郁药剂量有关。一个新的发现是文拉法辛与更多的多汗有关，而体重增加在女性使用者中更为明显。临床医生应意识到，在长期使用抗抑郁药期间，副作用很常见且持续存在。
