Settle E C
West Virginia University School of Medicine, Charleston 25301, USA.
J Clin Psychiatry. 1998;59 Suppl 16:25-30; discussion 40-2.
Adverse effects associated with antidepressant drug therapy rarely cause significant morbidity or mortality. Nevertheless, the successful management of patients with depression requires recognition of potential adverse effects that have serious consequences, which include the discontinuation of otherwise effective therapy. The aim of this overview is to highlight the more common and potentially deleterious adverse effects of both older and newer classes of antidepressant drugs. Major adverse effects attributed to the tricyclic antidepressant drugs (TCAs) include conduction defects and lethal overdose. Most worrisome with the selective serotonin reuptake inhibitor drugs (SSRIs) is the serotonin syndrome. Although rare, this syndrome can be insidious and lethal. Recent trends toward the use of medication combinations and augmentation therapies significantly enhance the risk of serotonin syndrome. Cognitive impairment also may occur, especially with the TCAs. Apathy is occasionally a problem with SSRI therapy. The syndrome of inappropriate antidiuretic hormone (SIADH) has been reported with most antidepressant drugs but appears to be more common with serotonergic agents and in elderly patients. Although seizures are uncommon in patients receiving antidepressant therapy, the risk must be understood by both the patient and the clinician. Adverse effects related to sexual function are common, especially with TCAs, SSRIs, and venlafaxine. Sexual dysfunction often leads to noncompliance and self-discontinuation of therapy. Sleep disturbances are common in patients with depression, and recent data illustrate how crucial sleep regulation is to mood. Antidepressant drugs vary in their sleep effects. Although antidepressant drugs can cause a variety of adverse effects, these drugs save lives and their benefits far exceed their risks.
抗抑郁药物治疗相关的不良反应很少导致严重的发病或死亡。然而，成功治疗抑郁症患者需要认识到可能产生严重后果的潜在不良反应，其中包括停用原本有效的治疗方法。本综述的目的是强调新旧各类抗抑郁药物更常见且可能有害的不良反应。三环类抗抑郁药物（TCAs）的主要不良反应包括传导缺陷和致命性过量用药。选择性5-羟色胺再摄取抑制剂药物（SSRIs）最令人担忧的是5-羟色胺综合征。尽管这种综合征很罕见，但可能隐匿且致命。近期联合用药和增效治疗的趋势显著增加了5-羟色胺综合征的风险。认知障碍也可能发生，尤其是使用TCAs时。冷漠偶尔是SSRI治疗的一个问题。多数抗抑郁药物都曾报告过抗利尿激素分泌异常综合征（SIADH），但在使用5-羟色胺能药物的患者及老年患者中似乎更常见。尽管接受抗抑郁治疗的患者癫痫发作并不常见，但患者和临床医生都必须了解这一风险。与性功能相关的不良反应很常见，尤其是使用TCAs、SSRIs和文拉法辛时。性功能障碍常导致治疗依从性差和自行停药。睡眠障碍在抑郁症患者中很常见，近期数据表明睡眠调节对情绪有多关键。抗抑郁药物对睡眠的影响各不相同。尽管抗抑郁药物会引起多种不良反应，但这些药物能挽救生命，其益处远超过风险。
