Advertisement

Medical Toxicology and Adverse Drug Experience

, Volume 2, Issue 6, pp 445–462 | Cite as

The Risk-Benefit Assessment of Antidepressant Drugs

  • J. A. Henry
  • A. J. Martin
Adverse Drug Experience Review

Summary

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.

Keywords

Amitriptyline Antidepressant Drug Trazodone Hamilton Depression Rate Scale Mianserin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Arnoff GM. Trazodone associated with priapism. Lancet 1: 856, 1984CrossRefGoogle Scholar
  2. Avery D, Winokur G. Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Archives of General Psychiatry 33: 1029, 1976PubMedCrossRefGoogle Scholar
  3. Baldwin RC, Jolley DJ. The prognosis of depression in old age. British Journal of Psychiatry 149: 574–583, 1986PubMedCrossRefGoogle Scholar
  4. Barnes TRE, Greenwood DT. Viloxazine and migraine. Lancet 2: 1368, 1979PubMedCrossRefGoogle Scholar
  5. Barraclough BM, Bunch J, Nelson B, Sainsbury P. 100 cases of suicide: clinical aspects. British Journal of Psychiatry 125: 355–373, 1974PubMedCrossRefGoogle Scholar
  6. 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
  7. Blackwell B. Antidepressant drugs. In Dukes MNG (Ed.) Side effects of drugs, Annual 9, pp. 19–26, Elsevier Science Publishers BV, 1985Google Scholar
  8. 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
  9. Burrows GD, Vohra J, Hunt D, et al. Cardiac effects of different tricyclic antidepressant drugs. British Journal of Psychiatry 129: 335–341, 1976PubMedCrossRefGoogle Scholar
  10. Cassidy SL, Henry JA. Fatal toxicity of antidepressant drugs in overdose. British Medical Journal, in press, 1987Google Scholar
  11. 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
  12. Coccaro EF, Siever LJ. Second generation antidepressants: a comparative review. Journal of Clinical Pharmacology 25: 241–260, 1985PubMedGoogle Scholar
  13. 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
  14. 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
  15. Craft AW. Circumstances surrounding deaths from accidental poisoning, 1974–1980. Archives of Disease in Childhood 58: 544–546, 1983PubMedCrossRefGoogle Scholar
  16. Crome P. Poisoning due to tricyclic antidepressant overdosage: clinical presentation and treatment. Medical Toxicology 1: 261–285, 1986PubMedGoogle Scholar
  17. Crome P, Ali P. Clinical features and management of self-poisoning with newer antidepressants. Medical Toxicology 1: 411–420, 1986PubMedGoogle Scholar
  18. Crome P, Newman B. Poisoning with maprotiline and mianserin. British Medical Journal 2: 260, 1977PubMedCrossRefGoogle Scholar
  19. Croog SH, Levine S, Testa MA, Brown B. The effects of anti-hypertensive therapy on the quality of life. New England Journal of Medicine 314: 1657–1664, 1986PubMedCrossRefGoogle Scholar
  20. CSM Update. Adverse reactions to antidepressants. British Medical Journal 291: 1638, 1985CrossRefGoogle Scholar
  21. CSM Update. Withdrawal of nomifensine. British Medical Journal 293: 41, 1986CrossRefGoogle Scholar
  22. Data Sheet 1986. Revised data sheet issued by Organon Laboratories in agreement with Committee on Safety of Medicines — May 1986Google Scholar
  23. Davies RK, Tucker DJ, Harrow M, Detre TP. Confusional episodes and antidepressant medication. American Journal of Psychiatry 128: 127, 1971Google Scholar
  24. Editorial. Product News — Welbutrin launch delayed. Scrip No. 1083 (March 10): 20, 1986Google Scholar
  25. Editorial. La courageuse décision de Pharmuka. Gazette Medicale 92: 27, 1985Google Scholar
  26. Evans DL, Davidson J, Raft D. Early and late side effects of phenelzine. Journal of Clinical Psychopharmacology 2: 208–210, 1982PubMedCrossRefGoogle Scholar
  27. Feldmann HS, Denber HCB. Long-term study of fluvoxamine: a new rapid-acting antidepressant. International Pharmacopsychiatry 17: 114–122, 1982PubMedGoogle Scholar
  28. 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
  29. Gerner RH. Present status of drug therapy of depression in late life. Journal of Affective Disorders (Suppl. 1): S23-S31, 1985Google Scholar
  30. 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
  31. Goldberg D. Identifying psychiatric illness among general medical patients. British Medical Journal 291: 161–162, 1985PubMedCrossRefGoogle Scholar
  32. Griffin N, Draper RJ, Webb MGT. Addiction to tranylcypromine. British Medical Journal 283: 346, 1981PubMedCrossRefGoogle Scholar
  33. Gruter W, Poldinger W. Maprotiline. Modern Problems in Pharmacopsychiatry 18: 17–48, 1982Google Scholar
  34. 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
  35. Guze SB, Robins E. Suicide among primary affective disorders. British Journal of Psychiatry 117: 437–438, 1970PubMedCrossRefGoogle Scholar
  36. Hamilton M. The assessment of anxiety states by rating. British Journal of Medical Psychology 32: 50–55, 1959PubMedCrossRefGoogle Scholar
  37. Hamilton M. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23: 46–62, 1960CrossRefGoogle Scholar
  38. Hamilton M. Comparative value of rating scales. British Journal of Clinical Pharmacology 3 (Suppl.): 58–60, 1976PubMedCrossRefGoogle Scholar
  39. Himmelhoch JM, Schechtman K, Auchenback R. The role of trazodone in the treatment of depressed cardiac patients. Psychopathology 17 (Suppl. 2): 51–63, 1984PubMedCrossRefGoogle Scholar
  40. Hollister LE. Current antidepressant drugs: their clinical use. Drugs 22: 129–152, 1981PubMedCrossRefGoogle Scholar
  41. Jabbari B, Bryan G, Mars LEE, Gunderson CH. Incidence of seizure with tricyclic and tetracyclic antidepressants. Archives of Neurology 42: 480–481, 1985PubMedCrossRefGoogle Scholar
  42. Janowsky D, Curtis G, Zisook S, et al. Ventricular arrhythmias possibly aggravated by trazodone. American Journal of Psychiatry 140: 796–797, 1983PubMedGoogle Scholar
  43. Knudsen K, Heath A. Effects of self poisoning with maprotiline. British Medical Journal 288: 601–603, 1984PubMedCrossRefGoogle Scholar
  44. Kronig MH, Roose SP, Walsh BT, et al. Blood pressure effects of phenelzine. Journal of Clinical Psychopharmacology 3: 307–308, 1983PubMedCrossRefGoogle Scholar
  45. Lewis JA. Postmarketing surveillance: how many patients? Trends in Pharmacological Sciences 2: 93–94, 1981CrossRefGoogle Scholar
  46. Litovitz TL, Troutman WG. Amoxapine overdose: seizures and fatalities. Journal of the American Medical Association 250: 1069–1071, 1983PubMedCrossRefGoogle Scholar
  47. Mendez MF, Cummings JL, Benson DF. Psychotropic drugs and epilepsy. Stress Medicine 2: 325–332, 1986CrossRefGoogle Scholar
  48. Moir DC, Crooks J, Cornwell WB, et al. Cardiotoxicity of amitriptyline. Lancet 2: 561–564, 1972PubMedCrossRefGoogle Scholar
  49. 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
  50. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134: 382–389, 1979PubMedCrossRefGoogle Scholar
  51. Morris JB, Beck AT. The efficacy of antidepressant drugs: a review of research (1958-1972). Archives of General Psychiatry 30: 667, 1974PubMedCrossRefGoogle Scholar
  52. Murphy E. General management of depression in late life. Journal of Affective Disorders (Suppl. 1): S7-S10, 1985Google Scholar
  53. Nilsson BS. Adverse reactions in connection with zimeldine treatment: a review. Acta Psychiatrica Scandinavica 308 (Suppl. 1): 115–119, 1983PubMedGoogle Scholar
  54. 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
  55. O’Sullivan K. Depression and its treatment in alcoholics: a review. Canadian Journal of Psychiatry 29: 379–384, 1984Google Scholar
  56. Overall JE. Efficacy of nomifensine in different depressive syndromes. Journal of Clinical Psychiatry 45 (4 Sec. 2): 85–88, 1984PubMedGoogle Scholar
  57. 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
  58. Peabody CA, Whiteford HA, Hollister LE. Antidepressants and the elderly. Journal of the American Geriatrics Society 34: 869–874, 1986PubMedGoogle Scholar
  59. Pentel PR, Benowitz NL. Tricyclic antidepressant poisoning: management of arrhythmias. Medical Toxicology 1: 101–121, 1986PubMedGoogle Scholar
  60. Prescott LF, Highley MS. Drugs prescribed for self poisoners. British Medical Journal 290: 1633–1636, 1985PubMedCrossRefGoogle Scholar
  61. 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
  62. 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
  63. Rickels K, Weise CC, Csanalosi I, et al. Clomipiamine and amitriptyline in depressed outpatients: a controlled study. Psychopharmacologia 34: 361–376, 1974PubMedCrossRefGoogle Scholar
  64. 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
  65. Scher M, Krieger JN, Juergens S. Trazodone and priapism. American Journal of Psychiatry 140: 1362–1363, 1983PubMedGoogle Scholar
  66. Skegg K, Skegg DCG, Richards SM. Incidence of self poisoning in patients prescribed psychotropic drugs. British Medical Journal 286: 841–848, 1983PubMedCrossRefGoogle Scholar
  67. Snaith RP, Taylor CM. Rating scales for depression and anxiety: a current perspective. British Journal of Clinical Pharmacology 19: 17S–20S, 1985PubMedCrossRefGoogle Scholar
  68. Tyrer P. Drug treatment of psychiatric patients in general practice. British Medical Journal 2: 1008–1010, 1978PubMedCrossRefGoogle Scholar
  69. 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
  70. Vlay SC, Friedling S. Trazodone exacerbation of VT. American Heart Journal 106: 604, 1983PubMedCrossRefGoogle Scholar
  71. Waite J, Grundy E, Arie T. A controlled trial of antidepressant medication in elderly in-patients. International Clinical Psychopharmacology 1: 113–126, 1986PubMedCrossRefGoogle Scholar
  72. Wedin GP, Oderda G, Klein-Schwartz W, Gorman R. Relative toxicity of cyclic antidepressants. Annals of Emergency Medicine 14: 797–804, 1986CrossRefGoogle Scholar
  73. Zung W, Magill M, Moore J, George D. Recognition and treatment of depression in family practice. Journal of Clinical Psychiatry 44: 3–6, 1983PubMedGoogle Scholar

Copyright information

© ADIS Press Limited 1987

Authors and Affiliations

  • J. A. Henry
    • 1
  • A. J. Martin
    • 1
  1. 1.National Poisons UnitGuys Hospital London and Duphar Laboratories LtdSouthamptonEngland

Personalised recommendations