Minimizing and managing antidepressant side effects
Department of Psychiatry, University of Cincinnati College of Medicine OH 45267-0559.The Journal of Clinical Psychiatry (Impact Factor: 5.5). 02/1995; 56 Suppl 2:49-55.
Side effects often complicate the use of antidepressants for treatment of patients with major depression. Aggressive minimization and management of antidepressant side effects may relieve discomfort and distress, improve quality of life, enable clinicians to use appropriate medications at therapeutic doses, improve compliance, and thus enhance overall outcome. In this article we present recommendations for the management of side effects associated with antidepressant medications. Specifically, strategies are provided for the management of anticholinergic, cardiovascular, sedative, and activating side effects. Strategies for the management of antidepressant-associated insomnia, hypomania and mania, sexual dysfunction, appetite stimulation and weight gain, cognitive impairment, and parathesias are also discussed.
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ABSTRACT: Behavioural disinhibition implies the loss of restraint over some form of social behaviour. Such disinhibition can be drug induced and, on rare occasions, lead to extreme acts of aggression or violence. Examples of behavioural disinhibition are often considered paradoxical and rare reactions to drugs, but they may in fact be a more severe behavioural manifestation of a general effect that the drug has on emotions and behaviour. However, the incidence of drug-induced behavioural disinhibition varies considerably and cannot be estimated accurately, as accounts stem mainly from case reports rather than from controlled clinical trials. Adverse effects of drugs are rarely, if ever, the sole focus of clinical studies, although they are now monitored more rigorously in controlled trials. There are numerous anecdotal case reports in the literature of behavioural disinhibition occurring during administration of benzodiazepines, and recent controlled trials have addressed this issue. The incidence varies with the population studied, but tends to be higher in patients with pre-existing poor impulse control. Alcohol (ethanol) potentiates the disinhibiting effect of benzodiazepines. Aberrant forms of disinhibited behaviour may be accompanied by memory loss. Disinhibition has also been reported after treatment with tricyclic antidepressants, and reports are now appearing that describe disinhibition in patients who have been treated with selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors. These include incidents of akathisia, suicidal urges, agitation, hyperactivity and mania. They are more prevalent in children and those with learning disabilities. Disinhibition is rare with antipsychotics and non-benzodiazepine anticonvulsants but some isolated case reports contain descriptions of such reactions with newer compounds. The most important drug variable in drug-induced behavioural disinhibition is dosage, although mode of administration is also important. Discontinuation of the drug is usually expected to resolve behavioural reactions, but in certain cases drug withdrawal may precipitate a reaction. In order to minimise drug-induced behavioural disinhibition, it is essential to always use the minimum dosage necessary, to increase the dosage gradually and to monitor the effects carefully. Multiple drug use should be avoided whenever possible.
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ABSTRACT: Psychiatry Women's Health Program has contributed to and helped develop guidelines for delivery of care in the psychiatric aspects of the menopausal transition and depression. Gwendoyn Puryear Keita, PhD, is executive director, Public Interest Directorate, American Psychological Association, Washington, D.C., where she previously served as director, Women's Programs Office, for 18 years. She has written extensively and made numerous presentations on women's issues, particularly women's health and women and depression, as well as on topics related to work, stress, and health. She convened 3 conferences on psychosocial and behavioral factors in women's health. Keita was instrumental in developing the new field of occupational health psychology, convened 6 international conferences on occupational stress and health, and coauthored several books and journal articles on the subject, including Work and Well-Being: An Agenda for the 1990s (1992), Job Stress in a Changing Workforce: Investigating Gender, Diversity, and Family Issues (1994), and Job Stress Interventions (1995). Keita has presented before Congress on depression, violence, and other issues. Sam D. Toney, MD, is founder, vice chairman, and chief medical officer, Health Integrated, Tampa, Florida. Toney, a board-certified psychiatrist, founded Health Integrated in 1996 in response to the growing need for the development of integrated managed care systems. Toney's experience includes developing and managing multiple outpatient mental health centers and partial hospitalization programs in Florida. He also served as national medical director for 1 of the 10 largest managed behavioral health care organizations in the nation, providing capitated behavioral health care management to health maintenance organizations around the country. Toney subse quently assisted in developing multispecialty integrated practice associations and primary care networks throughout the country, precipitating the conceptualization and development of initiatives to integrate medical and behavioral health care management. Among these initiatives was 1 of the nation's first comprehensive and integrated depression disease management programs. Toney is licensed to practice medicine in 14 states and is board certified in psychiatry as well as in utilization review and quality assurance.
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