Antidepressant drugs in common use are reviewed in terms of their risks and benefits. A simple classification divides these into tricyclic antidepressants, monoamine oxidase inhibitors and second generation antidepressants.
Risks may arise from the correct use of an antidepressant, from its incorrect or inappropriate use, or due to its failure to reverse the depression. The greatest risk is to leave the depression untreated. Risks due to adverse drug effects are generally predictable but in some cases are unexpected and have led to the withdrawal of the drug from the market.
Assessing the benefits of antidepressant drugs is more difficult. Rating scales can be used in this context and the fact that the majority of antidepressant drugs have a similar degree of efficacy serves to emphasise the importance of making a risk-benefit assessment of each drug. This has been presented for the more widely used drugs. Safety in overdose is a particularly important benefit.
The ideal antidepressant should specifically reverse depressive illness without toxic effects. Although no drug at present measures up to this it is clear that antidepressants should be prescribed, as their benefits outweigh their risks.
Amitriptyline Antidepressant Drug Trazodone Hamilton Depression Rate Scale Mianserin
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Barraclough BM, Bunch J, Nelson B, Sainsbury P. 100 cases of suicide: clinical aspects. British Journal of Psychiatry 125: 355–373, 1974PubMedCrossRefGoogle Scholar
Blackwell B. Antidepressant drugs. In Dukes MNG (Ed.) Meyler’s side effects of drugs, 10th ed., pp. 25–61, Elsevier Science Publishers BV, 1984Google Scholar
Blackwell B. Antidepressant drugs. In Dukes MNG (Ed.) Side effects of drugs, Annual 9, pp. 19–26, Elsevier Science Publishers BV, 1985Google Scholar
Burgess CD, Montgomery S, Wadsworth J, Turner P. Cardiovascular effects of mianserin, zimeldine, nomifensine, in depressed patients. Postgraduate Medical Journal 55: 704–708, 1979PubMedCrossRefGoogle Scholar
Burrows GD, Vohra J, Hunt D, et al. Cardiac effects of different tricyclic antidepressant drugs. British Journal of Psychiatry 129: 335–341, 1976PubMedCrossRefGoogle Scholar
Cassidy SL, Henry JA. Fatal toxicity of antidepressant drugs in overdose. British Medical Journal, in press, 1987Google Scholar
Charney DS, Heninger GR, Sternberg DE, Landis H. Abrupt discontinuation of tricyclic antidepressant drugs: evidence for noradrenergic hyperactivity. British Journal of Psychiatry 141: 377–386, 1982PubMedCrossRefGoogle Scholar
Coccaro EF, Siever LJ. Second generation antidepressants: a comparative review. Journal of Clinical Pharmacology 25: 241–260, 1985PubMedGoogle Scholar
Costa D, Mogos I, Toma T. Efficacy and safety of mianserin in treatment of depression of women with cancer. Acta Psychiatrica Scandinavica 72 (Suppl. 320): 85–92, 1985CrossRefGoogle Scholar
Coull DC, Crooks J, Dingwall-Fordyce I, Scott AM, Weir RD. Amitriptyline and cardiac disease: risks of sudden death identified by monitoring system. Lancet 2: 590–591, 1970PubMedCrossRefGoogle Scholar
Craft AW. Circumstances surrounding deaths from accidental poisoning, 1974–1980. Archives of Disease in Childhood 58: 544–546, 1983PubMedCrossRefGoogle Scholar
Crome P. Poisoning due to tricyclic antidepressant overdosage: clinical presentation and treatment. Medical Toxicology 1: 261–285, 1986PubMedGoogle Scholar
Crome P, Ali P. Clinical features and management of self-poisoning with newer antidepressants. Medical Toxicology 1: 411–420, 1986PubMedGoogle Scholar
Editorial. La courageuse décision de Pharmuka. Gazette Medicale 92: 27, 1985Google Scholar
Evans DL, Davidson J, Raft D. Early and late side effects of phenelzine. Journal of Clinical Psychopharmacology 2: 208–210, 1982PubMedCrossRefGoogle Scholar
Feldmann HS, Denber HCB. Long-term study of fluvoxamine: a new rapid-acting antidepressant. International Pharmacopsychiatry 17: 114–122, 1982PubMedGoogle Scholar
Georgotas A, McCue RE, Hapworth W, et al. Comparative efficacy and safety of MAOIs v TCAs in treating depression in the elderly. Biological Psychiatry 21: 1155–1166, 1986PubMedCrossRefGoogle Scholar
Gerner RH. Present status of drug therapy of depression in late life. Journal of Affective Disorders (Suppl. 1): S23-S31, 1985Google Scholar
Gerner R, Eastbrook W, Steuer J, Jarvik L. Treatment of geriatric depression with trazodone, imipramine and placebo: a double-blind study. Journal of Clinical Psychiatry 41: 216–220, 1980PubMedGoogle Scholar
Goldberg D. Identifying psychiatric illness among general medical patients. British Medical Journal 291: 161–162, 1985PubMedCrossRefGoogle Scholar
Gruter W, Poldinger W. Maprotiline. Modern Problems in Pharmacopsychiatry 18: 17–48, 1982Google Scholar
Guy W(Ed.). CGI Clinical Global Impressions. ECDEU assessment manual for psychopharmacology (DHEW Publication no. 76338), pp. 218–222, Department of Health, Education and Welfare, Washington, D.C., 1976Google Scholar
Moir DC, Dingwall-Fordyce I, Weir RD. Medicines evaluation and monitoring group: a follow-up study of cardiac patients receiving amitriptyline. European Journal of Clinical Pharmacology 6: 98–101, 1973PubMedCrossRefGoogle Scholar
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134: 382–389, 1979PubMedCrossRefGoogle Scholar
Morris JB, Beck AT. The efficacy of antidepressant drugs: a review of research (1958-1972). Archives of General Psychiatry 30: 667, 1974PubMedCrossRefGoogle Scholar
Murphy E. General management of depression in late life. Journal of Affective Disorders (Suppl. 1): S7-S10, 1985Google Scholar
Nilsson BS. Adverse reactions in connection with zimeldine treatment: a review. Acta Psychiatrica Scandinavica 308 (Suppl. 1): 115–119, 1983PubMedGoogle Scholar
Ofsti E. Citalopram — a specific 5-HT reuptake inhibitor — as an antidepressant drug: a phase II multicentre trial. Progressive Neuro-Psychopharmacology and Biological Psychiatry 6: 327–335, 1982CrossRefGoogle Scholar
O’Sullivan K. Depression and its treatment in alcoholics: a review. Canadian Journal of Psychiatry 29: 379–384, 1984Google Scholar
Overall JE. Efficacy of nomifensine in different depressive syndromes. Journal of Clinical Psychiatry 45 (4 Sec. 2): 85–88, 1984PubMedGoogle Scholar
Paykel ES, Mueller PS, De La Vesgne PM. Amitriptyline, weight gain and carbohydrate craving: a side-effect. British Journal of Psychiatry 123: 501–507, 1973PubMedCrossRefGoogle Scholar
Peabody CA, Whiteford HA, Hollister LE. Antidepressants and the elderly. Journal of the American Geriatrics Society 34: 869–874, 1986PubMedGoogle Scholar
Pentel PR, Benowitz NL. Tricyclic antidepressant poisoning: management of arrhythmias. Medical Toxicology 1: 101–121, 1986PubMedGoogle Scholar
Pugh R, Bell J, Cooper AJ, Dunstan S, Greedharry D, et al. Does lofepramine have fewer side effects than amitriptyline: results of a comparative trial. Journal of Affective Disorders 4: 355–363, 1982PubMedCrossRefGoogle Scholar
Rabkin JG, Quitkin FM, McGrath P, et al. Adverse reactions to monoamine oxidase inhibitors, part II: treatment correlates and clinical management. Journal of Clinical Psychopharmacology 5: 1–9, 1985CrossRefGoogle Scholar
Rickels K, Weise CC, Csanalosi I, et al. Clomipiamine and amitriptyline in depressed outpatients: a controlled study. Psychopharmacologia 34: 361–376, 1974PubMedCrossRefGoogle Scholar
Roos JC. Cardiac effects of antidepressant drugs: a comparison of the tricyclic antidepressants and fluvoxamine. British Journal of Clinical Pharmacology 15: 439S–445S, 1983PubMedCrossRefGoogle Scholar
Scher M, Krieger JN, Juergens S. Trazodone and priapism. American Journal of Psychiatry 140: 1362–1363, 1983PubMedGoogle Scholar
Skegg K, Skegg DCG, Richards SM. Incidence of self poisoning in patients prescribed psychotropic drugs. British Medical Journal 286: 841–848, 1983PubMedCrossRefGoogle Scholar
Snaith RP, Taylor CM. Rating scales for depression and anxiety: a current perspective. British Journal of Clinical Pharmacology 19: 17S–20S, 1985PubMedCrossRefGoogle Scholar
Veith RC, Raskind M, Caldwell JH, et al. Cardiovascular effects of tricyclic antidepressants in depressed patients with chronic heart disease. New England Journal of Medicine 306: 954–959, 1982PubMedCrossRefGoogle Scholar