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 | ||
|
|
++ | 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.