The British Journal of Psychiatry (2009) 195: 202-210. doi: 10.1192/bjp.bp.108.061960
© 2009 The Royal College of Psychiatrists
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Adverse reactions to antidepressants

Rudolf Uher, PhD, MRCPsych and Anne Farmer, MD, FRCPsych

Institute of Psychiatry, King’s College London, UK

Neven Henigsberg, MD

Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia

Marcella Rietschel, MD

Central Institute of Mental Health, Division of Genetic Epidemiology in Psychiatry, Mannheim, Germany

Ole Mors, PhD

Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark

Wolfgang Maier, MD

Department of Psychiatry, University of Bonn, Germany

Dejan Kozel

Institute of Public Health, Ljubljana, Slovenia

Joanna Hauser, MD

Laboratory of Psychiatric Genetics, Poznan University of Medical Sciences, Poland

Daniel Souery, PhD

Université Libre de Bruxelles, Erasme Academic Hospital, Department of Psychiatry, Brussels, Belgium

Anna Placentino, PsyD

Biological Psychiatry Unit and Dual Diagnosis ward IRCCS, Centro San Giovanni di Dio, FBF, Brescia, Italy

Jana Strohmaier, MD

Central Institute of Mental Health, Division of Genetic Epidemiology in Psychiatry, Mannheim, Germany

Nader Perroud, MD

Institute of Psychiatry, King’s College London

Astrid Zobel, MD

Department of Psychiatry, University of Bonn, Germany

Aleksandra Rajewska-Rager, MD PhD

Laboratory of Psychiatric Genetics, Poznan University of Medical Sciences, Poland

Moica Z. Dernovsek

Educational and Research Institute Ozara, Ljubljana, Slovenia

Erik Roj Larsen, MD PhD

Mood Disorders Research Unit, Aarhus University Hospital, Risskov, Denmark

Petra Kalember, MD

Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia

Caterina Giovannini, PsyD

Biological Psychiatry Unit and Dual Diagnosis ward IRCCS, Centro San Giovanni di Dio, FBF, Brescia, Italy

Mara Barreto, MD

Université Libre de Bruxelles, Erasme Academic Hospital, Department of Psychiatry, Brussels, Belgium

Peter McGuffin, PhD, FRCP, FRCPsych and Katherine J. Aitchison, MRCPsych, PhD

Institute of Psychiatry, King’s College London, UK

Correspondence: Rudolf Uher, P080 SGDP, Institute of Psychiatry, 16 De Crespigny Park, London SE5 8AF, UK. Email: r.uher{at}iop.kcl.ac.uk

Declaration of interest

N.H. participated in clinical trials sponsored by pharmaceutical companies, including GlaxoSmithKline and Lundbeck. A.F., P.M. and K.J.A have received consultancy fees and honoraria for participating in expert panels from pharmaceutical companies, including Lundbeck and GlaxoSmithKline.

Funding

The GENDEP study was funded by a European Commission Framework 6 grant, EC Contract Ref.: LSHB-CT-2003-503428. Lundbeck provided both nortriptyline and escitalopram free of charge for the GENDEP study. GlaxoSmithKline and the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King’s College London and South London and Maudsley NHS Foundation Trust (funded by the National Institute for Health Research, Department of Health, UK) contributed by funding an add-on project in the London centre. The funders had no role in the design and conduct of the study, in data collection, analysis, interpretation or writing the report.

Background

Adverse drug reactions are important determinants of non-adherence to antidepressant treatment, but their assessment is complicated by overlap with depressive symptoms and lack of reliable self-report measures.

Aims

To evaluate a simple self-report measure and describe adverse reactions to antidepressants in a large sample.

Method

The newly developed self-report Antidepressant Side-Effect Checklist and the psychiatrist-rated UKU Side Effect Rating Scale were repeatedly administered to 811 adult participants with depression in a part-randomised multicentre open-label study comparing escitalopram and nortriptyline.

Results

There was good agreement between self-report and psychiatrists’ ratings. Most complaints listed as adverse reactions in people with depression were more common when they were medication-free rather than during their treatment with antidepressants. Dry mouth (74%), constipation (33%) and weight gain (15%) were associated with nortriptyline treatment. Diarrhoea (9%), insomnia (36%) and yawning (16%) were more common during treatment with escitalopram. Problems with urination and drowsiness predicted discontinuation of nortriptyline. Diarrhoea and decreased appetite predicted discontinuation of escitalopram.

Conclusions

Adverse reactions to antidepressants can be reliably assessed by self-report. Attention to specific adverse reactions may improve adherence to antidepressant treatment.


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