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Table 4: Antidepressant Drug Side Effects
Drug Anticholinergic Effects* Sedation Activation Postural Hypotension Hypertension Sexual Dysfunction†† Seizures§ Weight Gain Comments
Amitriptyline +++ ++++ + +++ ++ ++ ++++
Amoxapine +++ +++ ++ ++++ +++ Loxapine, an antipsychotic, is an active metabolite that accounts for reports of amoxapine-associated extrapyramidal effects, including movement disorders, tardive dyskinesia, and neuroleptic malignant syndrome
Bupropion +++ +++ Seizure risk is elevated at therapeutic doses, and the risk of seizures increases dramatically at doses >450 mg qd
Citalopram +++ + +
Desipramine ++ + ++ ++ ++ ++ ++ Quinidine-like effects that can prolong the QTc and lead to heart block
Doxepin +++ +++ +++ ++ ++ ++++ Quinidine-like effects that can prolong the QTc and lead to heart block
Duloxetine +++ ++ +++ + ++ Risk of medication-induced hypertension is dose related
Escitalopram ++ + +
Fluoxetine +++ +++ + +
Imipramine +++ +++ +++ ++ ++ +++ Quinidine-like effects that can prolong the QTc and lead to heart block
L-Deprenyl ++ Patients taking MAOIs must adhere to a low-tyramine diet and avoid medications that can result in life-threatening hypertensive crisis or serotonin syndrome
Doses ≤9 mg are much less likely than other MAOI drugs to cause harmful interactions with tyramine and drugs
Maprotiline +++ +++ ++ +++ +++ Quinidine-like effects that can prolong the QTc and lead to heart block
Mirtazapine ++++ +++ ++++
Nefazodone ++++ +++ ++ Risk of medication-induced hypertension is dose related
Nortriptyline ++ + ++ + +++ ++ ++ Quinidine-like effects that can prolong the QTc and lead to heart block

This is the TCA least likely to cause postural hypotension
Paroxetine + ++ ++ + +++ + ++ Minor withdrawal symptoms (flulike) can occur with sudden discontinuation
Phenelzine ++ ++ ++++ ++ ++++ Risk of medication-induced hypertension is dose related
Protriptyline ++++ +++ ++ ++ + Quinidine-like effects that can prolong the QTc and lead to heart block
Sertraline +++ +++ + +
Tranylcypromine +++ ++ Patients taking MAOIs must adhere to a low-tyramine diet and avoid a wide variety of medications that can result in life-threatening hypertensive crisis or serotonin syndrome
Trazodone ++++ +++ ++ +++ Associated with non–dose-related priapism
Trimipramine +++ +++ ++ +++ ++ ++ +++ Quinidine-like effects that can prolong the QTc and lead to heart block
Venlafaxine +++ +++ +++ + + Risk of medication-induced hypertension is dose related
Minor withdrawal symptoms (flulike) can occur with sudden discontinuation

*Clinical manifestations include dry mouth, blurred vision, mydriasis, tachycardia, constipation, and confusion.
Headache, tremor, restlessness.
††Impotence, delayed ejaculation, anorgasmia. Bupropion, mirtazapine, and nefazodone are the antidepressants least likely to cause sexual side effects.
§Nearly all antidepressants reduce seizure threshold. SSRIs, however, are unlikely to have a clinically significant effect on seizure threshold, even in overdose.
MAOI, monoamine oxidase inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.

 

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