, Volume 43, Supplement 2, pp 40–47 | Cite as

The Safety of Antidepressants

  • F. de Jonghe
  • J. A. Swinkels


In this article, a distinction is proposed between safe and less safe antidepressants. The safety of 18 antidepressants is discussed in relation to 3 principal issues: the safety of the drug in the event of an overdose; the seriousness of its side effects; and the existence of dangerous interactions. On the basis of present information, it can be said with reasonable confidence that fluoxetine, fluvoxamine and paroxetine are safe antidepressants, and with some reservation (mainly because of hypnosedation) the same can be said of mianserin and trazodone.


Fluoxetine Paroxetine Imipramine Amitriptyline Orthostatic Hypotension 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Bancroft JHJ, Skrimshire AM, Sinkin S. The reasons people give for taking overdoses. British Journal of Psychiatry 128: 538–548, 1976PubMedCrossRefGoogle Scholar
  2. Benfield P, Ward A. Fluvoxamine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs 32: 313–334, 1986PubMedCrossRefGoogle Scholar
  3. Bernard PG, Levin MS. Maprotiline induced seizures. Southern Medical Journal 79: 1179–1181, 1986PubMedCrossRefGoogle Scholar
  4. Branconnier RJ, Cole JO, Ghazvinian S, Rosenthal S. Treating the depressed elderly patient: the comparative behavioural pharmacology of mianserine and amitriptyline. Advances in Biochemical Psychopharmacology 32: 195–212, 1982PubMedGoogle Scholar
  5. Burrows G, Norman T, Dennerstein L, et al. Antidepressant therapy: benefits and risks in perspective. Acta Psychiatrica Scandinavica 72: S435–S447, 1985CrossRefGoogle Scholar
  6. Claghorn JL, Schroeder J, Goldstein BJ. Comparison of the electrocardiographic effect of dothiepin and amitriptyline. Journal of Clinical Psychiatry 45: 291–293, 1984PubMedGoogle Scholar
  7. Coccaro EF, Siever LJ. Second generation antidepressants: a comparative review. Journal of Clinical Pharmacology 25: 241–260, 1985PubMedGoogle Scholar
  8. Comprehensive monograph Prozac. Dista Indianapolis, 1988Google Scholar
  9. Dechant KL, Clissold SP. Paroxetine: A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depressive illness. Drugs 41: 225–253, 1991PubMedCrossRefGoogle Scholar
  10. Dukes MNG, Beeley L. Side effects of drugs. Elsevier Annual 12, Chapter 12, Amsterdam, 1988Google Scholar
  11. Edwards JC, Glen-Bott M. Mianserine and convulsive seizures. British Journal of Clinical Pharmacology 15: 299s–311s, 1983PubMedCrossRefGoogle Scholar
  12. Edwards JG. Antidepressants and seizures: epidemiological and clinical aspects. In Trimble MR (Ed.) The psychopharmacology of epilepsy, pp. 119–139, Wiley, Chichester, 1985Google Scholar
  13. Feighner JP. A comparative trial of fluoxetine and amitriptyline in patients with major depressive disorder. Journal of Clinical Psychiatry 46: 369–372, 1985PubMedGoogle Scholar
  14. Gerner R, Estabrook W, Steuer J, et al. Treatment of geriatric depression with trazodone, imipramine and placebo: a double-blind study. Journal of Clinical Psychiatry 41: 216–220, 1980PubMedGoogle Scholar
  15. Glassman AH, Bigger JT, Giardina EV, et al. Clinical characteristics of imipramine induced orthostatic hypotension. Lancet 1: 468–472, 1979PubMedCrossRefGoogle Scholar
  16. Glassman AH, Roose SP. Cardiovascular effects of tricyclic antidepressants. Psychiatry Ann 27: 340–344, 1987Google Scholar
  17. Goodman-Gilman, et al. (Eds) The pharmacological basis of therapeutics, VIII Ed., p. 412, Pergamon Press, New York, 1990Google Scholar
  18. Guze SB, Robins E. Suicide and primary affective disorders. British Journal of Psychiatry 117: 437–438, 1970PubMedCrossRefGoogle Scholar
  19. Harsch HH, Holt RE. Use of antidepressants in attempted suicide. Hospital and Community Psychiatry 39: 990–992, 1988PubMedGoogle Scholar
  20. Hayes PE, Kristoff CA. Adverse reactions to five new antidepressants. Clinical Pharmacy 5: 472–480, 1986Google Scholar
  21. Henry JA. A fatal toxicity index for antidepressant poisoning. Acta Psychiatrica Scandinavica 80: 37–45, 1989CrossRefGoogle Scholar
  22. Hindmarch I. A pharmacological profile of fluoxetine and other antidepressants on aspects of skilled performance and car handling ability. British Journal of Psychiatry 153 (Suppl. 3): 99–104, 1988Google Scholar
  23. Hindmarch I. A double-blind, placebo-controlled investigation of the effects on psychomotor performance of paroxetine and amitriptyline with or without alcohol in adult subjects. Lecture at the 17th CINP Congress, Kyoto, September, 1990Google Scholar
  24. Hindmarch I. Behavioural toxicity of antidepressants with particular reference to paroxetine. Lecture at the 5th World Congress of Biological Psychiatry, Florence, June 9–14, 1991Google Scholar
  25. Hulten BA. TCA poisoning treated in the intensive care unit. Pharmacopsychiatry 23: 14–16, 1990PubMedCrossRefGoogle Scholar
  26. Inman WH. Blood disorders and suicide in patients taking mianserin or amitriptyline. Lancet 2: 90–92, 1988PubMedCrossRefGoogle Scholar
  27. Jabbari B, Bryan GE, Mars LEE, et al. Incidence of seizures with tricyclic and tetracyclic antidepressants. Archives of Neurology 42: 480–481, 1985PubMedCrossRefGoogle Scholar
  28. Kristofferson A, Nilsson BS. Zimelidine: febrile reactions and peripheral neuropathy. In Kammüller ME, Bloksma N, Seinen W (Eds) Autoimmunity and Toxicology, Elsevier, Amsterdam, 1989Google Scholar
  29. Leonard BE. Toxicity of antidepressants. Lancet 2: 1105, 1986PubMedCrossRefGoogle Scholar
  30. Linkowski P, Maetelaerd V, Mendlewicz J. Suicidal behaviour in major depressive illness. Acta Psychiatrica Scandinavica 72: 233–238, 1985PubMedCrossRefGoogle Scholar
  31. Montgomery SA, Pinder RM. Do some antidepressants promote suicide? Psychopharmacology 92: 265–266, 1987PubMedCrossRefGoogle Scholar
  32. Pichot P, Dreyfus JF, Pull C. A double-blind multicentre trial comparing mianserin with imipramine. British Journal of Psychopharmacology 5: 87s–90s, 1978Google Scholar
  33. Pinder RM. The benefits and risks of antidepressant drugs. Human Psychopharmacology 3: 73–86, 1988CrossRefGoogle Scholar
  34. Pinder RM, Blum A, Stulemeijer SM, et al. A double-blind multicenter trial comparing the efficacy and side-effects of mianserine and clomipramine in depressed inpatients and outpatients. Current Medical Research and Opinion 6 (Suppl. 7): 115–127, 1980CrossRefGoogle Scholar
  35. Prager G, Cimander K, Wagner W, et al. The cardiotropic effect of antidepressants. Advances in Pharmacotherapy 2: 133–150, 1986Google Scholar
  36. Preskorn SH, Jerkovich GS. Central nervous system toxicity of tricyclic antidepressants: phenomenology, course, risk factors, and the role of therapeutic drug monitoring. Journal of Clinical Psychopharmacology 10: 88–95, 1990PubMedCrossRefGoogle Scholar
  37. Richens A, Nawishi S, Trimble M. Antidepressant drugs, convulsions and epilepsy. British Journal of Clinical Pharmacology 15: 295s–298s, 1983PubMedCrossRefGoogle Scholar
  38. Robinson DS. Adverse reactions, toxicities, and drug interactions of newer antidepressants: anticholinergic, sedative and other side-effects. Psychopharmacology Bulletin 20: 280–290, 1984PubMedGoogle Scholar
  39. Roos JC, Sharp DJ. Antidepressant drugs and cardiovascular effects. A comparison of fluvoxamine and the tricyclic antidepressant drugs. In Burrows et al. (Eds) Biological psychiatry: recent studies, John Libbey, London, 1984Google Scholar
  40. Roose SP, Glassman AH, Giardina EGV, et al. Tricyclic antidepressants in depressed patients with cardiac conduction disease. Archives of General Psychiatry 44: 273–275, 1987PubMedCrossRefGoogle Scholar
  41. Shaw CA, Sullivan JT, Kadlec KE, Kaplan HL, Naranjo CA, et al. Ethanol interactions with serotonin uptake selective and non-selective antidepressants: fluoxetine and amitriptyline. Human Psychopharmacology 4: 113–120, 1989CrossRefGoogle Scholar
  42. Stallone F, Dunner DL, Ahean J, et al. Statistical prediction of suicide in depressives. Comprehensive Psychiatry 21: 381–387, 1982CrossRefGoogle Scholar
  43. Stark P, Hardison CD. A review of multicenter controlled studiers of fluoxetine vs imipramine and placebo in outpatients with major depressive disorder. Journal of Clinical Psychiatry 46: 53–58, 1985PubMedGoogle Scholar
  44. Syssain EC, Schatzberg AF, Woods BT, et al. Maprotiline treatment in depression. Archives of General Psychiatry 43: 86–90, 1986CrossRefGoogle Scholar
  45. Teicher MH, Glod C, Cole JO. The emergence of intense suicidal preoccupation during fluoxetine treatment. American Journal of Psychiatry 147: 207–210, 1990PubMedGoogle Scholar
  46. Tesar GE, Rosenbaum JF, Biederman J, et al. Orthostatic hypotension and antidepressant pharmacotherapy. Psychopharmacology Bulletin 23: 182–186, 1987PubMedGoogle Scholar
  47. Warrington SJ, Padgham C, Lader M. The cardiovascular effects of antidepressants. In Psychological Medicine, monograph Suppl. 16, Cambridge University Press, 1989Google Scholar
  48. Worm K, Steentoft A. Fatal poisoning by cyclic antidepressants. Pharmacopsychiatry 23: 9–13, 1990PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1992

Authors and Affiliations

  • F. de Jonghe
    • 1
  • J. A. Swinkels
    • 2
  1. 1.Department of PsychiatryUniversity of Amsterdam, Academic Medical Centre, and Social Psychiatric Services CentreAmsterdamThe Netherlands
  2. 2.Outpatient Psychiatry ClinicAcademic Medical CentreAmsterdamThe Netherlands

Personalised recommendations