The real risks of antidepressants

Selective serotonin reuptake inhibitors (SSRIs), which are among the most widely prescribed medications and generally considered safe, can’t be given a clean bill of health as no medical treatment is without risk.

A recent issue of the Harvard Mental Health Letter reviewed potential side effects of popular antidepressants. They included:

Physical symptoms. While some patients taking SSRIs develop insomnia, rashes, headaches, joint and muscle pain, stomach upset, nausea, or diarrhea, these problems are usually temporary, mild, or both.

Bleeding problems. A more serious potential problem is reduced blood clotting capacity that increases risk for stomach or uterine bleeding. If patients use SSRIs and NSAIDs (aspirin, ibuprofen, naproxen, COX-2 inhibitors) at the same time, the risk more than doubles, so these drugs must be combined with care.

Sexual effects. For many patients, SSRIs diminish sexual interest, desire, performance, satisfaction, or all four. Lowering the dose, switching antidepressants, or, for men, taking a drug like sildenafil can help.

Suicide. The risk that antidepressants will incite violent or self-destructive actions has become the subject of renewed controversy. One reason for concern is the increasing number of children and adolescents receiving antidepressant prescriptions. Compared with a placebo, all antidepressants, including SSRIs, appear to double the risk of suicidal thinking, from 1%–2% to 2%–4%, both in children and adults.

In view of these and other risks accompanying use of antidepressants, regular follow-up and close monitoring are critical. Patients should also let their prescribing clinicians know immediately should they start to feel worse or begin developing new symptoms, especially after changing the medication or the dose.

SOURCE: Harvard Mental Health Letter, May 2005.