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NeuroPsychopharmacotherapy pp 1–38Cite as

Antidepressants: Indications, Contraindications, Interactions, and Side Effects

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Abstract

Antidepressants are among the most largely prescribed medications worldwide. They are the mainstay of depression treatment but are used for other conditions too. As of today, over 40 medications are available. The history of new antidepressant development reflects an endeavor to reduce side effects while preserving efficacy. In this perspective, newer agents have largely replaced monoamine oxidase inhibitors and tricyclic antidepressants on the ground of higher tolerability and similar efficacy. Considerations of safety, tolerability, comorbidities, and possible drug interactions rather than efficacy generally guide antidepressant choice. Personalized antidepressant choice should be implemented by matching each patient’s symptom profile with the pharmacodynamic/pharmacokinetic profile of available antidepressants. However, the use of clinical criteria to guide drug choice does not prevent the occurrence of appreciable side effects, poor treatment adherence, and insufficient response in a relevant proportion of patients. The need of slow dose titration and the delayed development of the full antidepressant action represent further issues. Several approaches can address these issues and improve the outcomes of antidepressant treatment. These include the use of genetic variants modulating antidepressant metabolism to guide drug choice and dosing, as recommended by available guidelines. The validation of further genetic and nongenetic biomarkers is expected in the next future. However, such strategies merely capitalize on currently available medications which act on substantially similar pathways and do not reflect the heterogeneity in depression pathogenesis. The development of antidepressants with new mechanisms may involve the modulation of endocrinological and immunological pathways, as well as non-monoaminergic neurotransmission and metabolic regulation.

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Abbreviations

5-HT:

Serotonin

ACT:

Anatomical Therapeutic Chemical

ADHH:

Attention deficit hyperactivity disorder

AIJ:

Antidepressant-induced jitteriness

BD:

Bipolar disorder

BDI:

Type I bipolar disorder

BDII:

Type II bipolar disorder

BN:

Bulimia nervosa

DILI:

Drug-induced liver injury

EMA:

European Medicines Agency

EPS:

Extrapyramidal symptoms

FDA:

Food and Drug Administration

ISBD:

International Society for Bipolar Disorders

KOR:

K-opioid receptor

MAO:

Monoamine oxidase

MAOIs:

Monoamine oxidase inhibitors

MDD:

Major depressive disorder

NbN:

Neuroscience-based Nomenclature

NE:

Norepinephrine

NMDA:

N-methyl-D-aspartate

OCD:

Obsessive-compulsive disorder

PTSD:

Post-traumatic stress disorder

RCTs:

Randomized clinical trials

REM:

Rapid eye movement

SMD:

Standardized mean difference

SNRIs:

Serotonin and noradrenaline reuptake inhibitors

SSRIs:

Selective serotonin reuptake inhibitors

TCAs:

Tricyclic antidepressants

TRD:

Treatment-resistant depression

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Authors and Affiliations

  1. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Filippo Corponi & Alessandro Serretti

  2. Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Chiara Fabbri

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  1. Filippo Corponi
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  2. Chiara Fabbri
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Correspondence to Alessandro Serretti .

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Editors and Affiliations

  1. Dept Psychiatry , Psychosomatics & Psychotherapy, University of Würzburg, Medical School Clinical Neurochemistry, Würzburg, Germany

    Peter Riederer

  2. Inst für Psychologische Medizin, Haag, Bayern, Germany

    Gerd Laux

  3. Department of Psychiatry, University of Toronto Department of Psychiatry, Toronto, ON, Canada

    Benoit Mulsant

  4. Center Translational Res Neurol Diseases, Dalian Med Uni Shanghai Inst Health Sc Center Translational Res Neurol Diseases, Dalian, China

    Weidong Le

  5. Fujita Health University School Medicine, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

Section Editor information

  1. Inst für Psychologische Medizin, Haag, Germany

    Gerd Laux

  2. Department of Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany

    Hans-Jürgen Möller

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Corponi, F., Fabbri, C., Serretti, A. (2020). Antidepressants: Indications, Contraindications, Interactions, and Side Effects. In: Riederer, P., Laux, G., Mulsant, B., Le, W., Nagatsu, T. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-56015-1_29-1

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  • DOI: https://doi.org/10.1007/978-3-319-56015-1_29-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56015-1

  • Online ISBN: 978-3-319-56015-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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