Wang Sheng-Min, Han Changsu, Bahk Won-Myoung, Lee Soo-Jung, Patkar Ashwin A, Masand Prakash S, Pae Chi-Un
Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.
International Health Care Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Chonnam Med J. 2018 May;54(2):101-112. doi: 10.4068/cmj.2018.54.2.101. Epub 2018 May 25.
Randomized trials have shown that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have better safety profiles than classical tricyclic antidepressants (TCAs). However, an increasing number of studies, including meta-analyses, naturalistic studies, and longer-term studies suggested that SSRIs and SNRIs are no less safe than TCAs. We focused on comparing the common side effects of TCAs with those of newer generation antidepressants including SSRIs, SNRIs, mirtazapine, and bupropion. The main purpose was to investigate safety profile differences among drug classes rather than the individual antidepressants, so studies containing comparison data on drug groups were prioritized. In terms of safety after overdose, the common belief on newer generation antidepressants having fewer side effects than TCAs appears to be true. TCAs were also associated with higher drop-out rates, lower tolerability, and higher cardiac side-effects. However, evidence regarding side effects including dry mouth, gastrointestinal side effects, hepatotoxicity, seizure, and weight has been inconsistent, some studies demonstrated the superiority of SSRIs and SNRIs over TCAs, while others found the opposite. Some other side effects such as sexual dysfunction, bleeding, and hyponatremia were more prominent with either SSRIs or SNRIs.
随机试验表明，选择性5-羟色胺再摄取抑制剂（SSRIs）和5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）比传统三环类抗抑郁药（TCAs）具有更好的安全性。然而，越来越多的研究，包括荟萃分析、自然主义研究和长期研究表明，SSRIs和SNRIs的安全性并不亚于TCAs。我们着重比较了TCAs与新一代抗抑郁药（包括SSRIs、SNRIs、米氮平和安非他酮）的常见副作用。主要目的是研究不同药物类别之间的安全性差异，而非个别抗抑郁药，因此优先选取包含药物组比较数据的研究。就过量用药后的安全性而言，新一代抗抑郁药副作用比TCAs少这一普遍看法似乎是正确的。TCAs还与更高的停药率、更低的耐受性以及更高的心脏副作用相关。然而，关于口干、胃肠道副作用、肝毒性、癫痫发作和体重等副作用的证据并不一致，一些研究表明SSRIs和SNRIs优于TCAs，而另一些研究则得出相反结论。其他一些副作用，如性功能障碍、出血和低钠血症，在SSRIs或SNRIs中更为突出。
