Overview of antidepressant adverse effects
This topic is intended to aid antidepressant choice by describing the likelihood of individual antidepressants to cause common adverse effects such as weight gain, sexual difficulties, central nervous system adverse effects, anticholinergic effects and gastrointestinal distress. See #ptg8-c68-s1__tptg8-c68-tbl2 for the relative frequency of these adverse effects. Antidepressants can also cause significant adverse effects such as serotonin toxicity, cardiac conduction disorders, suicidality, increased bleeding risk and hyponatraemia. Consult a source of drug information for comprehensive information on antidepressant adverse effects.
When choosing an antidepressant:
- engage in shared decision making with the patient. Discuss the adverse effect profile of individual antidepressants, and how the effects are monitored, prevented and addressed, and identify adverse effects that are not acceptable to the patient
- consider the potential for an antidepressant to cause adverse effects in the context of the patient’s comorbidities (eg weight gain, sexual difficulties, anticholinergic effects, cardiac conduction disorders)
- consider the adverse effect profile of other drugs the patient is taking; for example, avoid combining a selective serotonin reuptake inhibitor (SSRI) with other drugs associated with serotonin toxicity.
If a patient experiences an antidepressant adverse effect, consider whether it could be relieved by:
- adjusting the dose (eg slowing uptitration if the patient experiences initial adverse effects such as nausea, restlessness or agitation)
- adjusting the regimen (eg switching to morning dosing if the patient is experiencing insomnia with night-time dosing)
- addressing drug interactions (eg stopping interacting drugs)
- symptomatic management for adverse effects such as:
If the adverse effect cannot be addressed with the above measures, or is severe or unacceptable, it may be necessary to switch to another antidepressant.