Skip to main content
SpringerLink
Log in

The Safety of Antidepressants

  • Chapter
  • First Online:
Unhappiness, Sadness and 'Depression'

  • 1562 Accesses

Abstract

This chapter deals with how the greater molecular selectivity of selective serotonin reuptake inhibitors (SSRIs) in comparison with tricyclics caused a reduced incidence of adverse side effects . SSRIs were thus extensively prescribed, not only for depression but also for anxiety, obsessive compulsive disorders and eating disorders. This was done with large support from sponsoring pharmaceutical companies, who were happy to promote the safety of SSRIs and interested in replacing the benzodiazepines with recently expired patents and emphasised adverse effects . In spite of these efforts, a paradoxical increase in suicidal risk was ascertained for young patients, which led to warnings by the Food and Drug Administration and other regulatory agencies. Moreover, sexual dysfunctions in men and risks in pregnant and breast-feeding women were observed, accompanied by a serious abstinence syndrome labelled as “discontinuation”, providing an altogether less reassuring picture.

One of the first duties of the physician is to educate the masses not to take medicine.

William Osler

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ashton Keller, A., Hamer, R., & Rosen, R. C. (1997). Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: A large-scale retrospective study of 596 psychiatric outpatients. Journal of Sex and Marital Therapy, 23(3), 165–175.

    Article  Google Scholar 

  • Balon, R. (2006). SSRI-associated sexual dysfunction. American Journal of Psychiatry, 163(9), 1504–1509.

    Article  PubMed  Google Scholar 

  • Boyer, E. W., & Shannon, M. (2005). The serotonin syndrome. New England Journal of Medicine, 352(11), 1112–1120.

    Article  PubMed  Google Scholar 

  • Cusack, B., Nelson, A., & Richelson, E. (1994). Binding of antidepressants to human brain receptors: Focus on newer generation compounds. Psychopharmacology, 114(4), 559–565.

    Article  PubMed  Google Scholar 

  • DeVane, C. L. (2006). Antidepressant-drug interactions are potentially but rarely clinically significant. Neuropsychopharmacology, 31(8), 1594–1604.

    Article  PubMed  Google Scholar 

  • Fava, M., & Rankin, M. R. (2002). Sexual functioning and SSRIs. Journal of Clinical Psychiatry, 63(5), 13–16.

    PubMed  Google Scholar 

  • Field, T. (2010). Prenatal depression and selective serotonin reuptake inhibitors. International Journal of Neurosciences, 120(3), 163–167.

    Article  Google Scholar 

  • Freedman, R. (2003). Schizophrenia. New England Journal of Medicine, 349(18), 1738–1749.

    Article  PubMed  Google Scholar 

  • Friedman, R. A. (2014). Antidepressants’ black-box warning-10 years later. New England Journal of Medicine, 371(18), 1666–1668.

    Article  PubMed  Google Scholar 

  • Friedman, R. A., & Leon, A. C. (2007). Expanding the black box—depression, antidepressants, and the risk of suicide. New England Journal of Medicine, 356(23), 2343–2346.

    Article  PubMed  Google Scholar 

  • Gillman, P. K. (2007). Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. British Journal of Pharmacology, 151(6), 737–748.

    Article  PubMed  PubMed Central  Google Scholar 

  • Haddad, P. (1998). The SSRI discontinuation syndrome. Journal of Psychopharmacology, 12(3), 305–313.

    Article  PubMed  Google Scholar 

  • Hall, W. D. (2006). How have the SSRI antidepressants affected suicide risk? Lancet, 367(9527), 1959–1962.

    Article  PubMed  Google Scholar 

  • Hawton, K., Casañas, I., Comabella, C., Haw, C., & Saunders, K. (2013). Risk factors for suicide in individuals with depression: A systematic review. Journal of Affective Disorders, 147(1–3), 17–28.

    Google Scholar 

  • Healy, D., & Leonard, B. E. (1987). Monoamine transport in depression: kinetics and dynamics. Journal of Affective Disorders, 12(2), 91–103.

    Article  PubMed  Google Scholar 

  • Hemeryck, A., & Belpaire, F. M. (2002). Selective serotonin reuptake inhibitors and cytochrome P-450 mediated drug-drug interactions: An update. Current Drug Metabolism, 3(1), 13–37.

    Article  PubMed  Google Scholar 

  • Kennedy, S. H., & Rizvi, S. (2009). Sexual dysfunction, depression, and the impact of antidepressants. Journal of Clinical Psychopharmacology, 29(2), 157–164.

    Article  PubMed  Google Scholar 

  • Ludwig, J., & Marcotte, D. E. (2005). Anti-depressants, suicide, and drug regulation. Journal of Policy Analysis and Management, 24(2), 249–272.

    Article  PubMed  Google Scholar 

  • Mann, J. J. (2005). The medical management of depression. New England Journal of Medicine, 353(17), 1819–1834.

    Article  PubMed  Google Scholar 

  • Meyer, U. A. (2000). Pharmacogenetics and adverse drug reactions. Lancet, 356(9242), 1667–1671.

    Article  PubMed  Google Scholar 

  • Nielsen, M., Hansen, E. H., & Gøtzsche, P. C. (2012). What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin re-uptake inhibitors. Addiction, 107(5), 900–908.

    Article  PubMed  Google Scholar 

  • Prabhakar, D., & Balon, R. (2010). How do SSRIs cause sexual dysfunction. Current Psychiatry, 9(12), 30–35.

    Google Scholar 

  • Richelson, E., & Nelson, A. (1984). Antagonism by antidepressants of neurotransmitter receptors of normal human brain in vitro. Journal of Pharmacology and Experimental Therapeutics, 230(1), 94–102.

    PubMed  Google Scholar 

  • Serebruany, V. L. (2006). Selective serotonin reuptake inhibitors and increased bleeding risk: Are we missing something? American Journal of Medicine, 119(2), 113–116.

    Article  PubMed  Google Scholar 

  • Shulman, K. I., Herrmann, N., & Walker, S. E. (2013). Current place of monoamine oxidase inhibitors in the treatment of depression. CNS Drugs, 27(10), 789–797.

    Article  PubMed  Google Scholar 

  • Sie, S. D., Wennink, J. M., van Driel, J. J., te Winkel, A. G., Boer, K., Casteelen, G., & van Weissenbruch, M. M. (2012). Maternal use of SSRIs, SNRIs and NaSSAs: Practical recommendations during pregnancy and lactation. Archives of Disease in Childhood. Fetal and Neonatal Edition, 97(6), F472–F476.

    Google Scholar 

  • Stone, M. B. (2014). The FDA warning on antidepressants and suicidality-why the controversy? New England Journal of Medicine, 371(18), 1668–1671.

    Article  PubMed  Google Scholar 

  • Tatsumi, M., Groshan, K., Blakely, R. D., & Richelson, E. (1997). Pharmacological profile of antidepressants and related compounds at human monoamine transporters. European Journal of Pharmacology, 340(2–3), 249–258.

    Google Scholar 

  • Warner, C. H., Bobo, W., Warner, C., Reid, S., & Rachal, J. (2006). Antidepressant discontinuation syndrome. American Family Physician, 74(3), 449–456.

    Google Scholar 

  • Weinrieb, R. M., Auriacombe, M., Lynch, K. G., & Lewis, J. D. (2005). Selective serotonin re-uptake inhibitors and the risk of bleeding. Expert Opinion in Drug Safety, 4(2), 337–344.

    Google Scholar 

  • Whittington, C. J., Kendall, T., Fonagy, P., Cottrell, D., Cotgrove, A., & Boddington. E.  (2004). Selective serotonin reuptake inhibitors in childhood depression: Systematic review of published versus unpublished data. Lancet, 363(9418), 1341–1345.

    Google Scholar 

  • WHO. (2003). WHO Expert Committee on Drug Dependence: Thirty-third Report (Vol. 33). http://apps.who.int/iris/bitstream/10665/42655/1/WHO_TRS_915.pdf. Accessed 30 May, 2016.

  • Whooley, M. A., & Simon, G. E. (2000). Managing depression in medical outpatients. New England Journal of Medicine, 343(26), 1942–1950.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Trieste, Trieste, Italy

    Tullio Giraldi

Authors
  1. Tullio Giraldi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tullio Giraldi .

Rights and permissions

Reprints and permissions

Copyright information

© 2017 The Author(s)

About this chapter

Cite this chapter

Giraldi, T. (2017). The Safety of Antidepressants. In: Unhappiness, Sadness and 'Depression'. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-57657-2_11

Download citation

Publish with us

Policies and ethics

Search

Navigation