The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature
The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature
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DOI：
10.1159/000447034
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发表时间：
2016-01-01
影响因子：
22.8
通讯作者：
Fava, Giovanni A.
中科院分区：
文献类型：
--
作者：
Carvalho, Andre F.;Sharma, Manu S.;Fava, Giovanni A.
新一代抗抑郁药（AD）被广泛用作治疗重度抑郁症的一线药物，被认为比三环类药物更安全。在这篇评论中，我们评估了选择性5-羟色胺再摄取抑制剂、5-羟色胺去甲肾上腺素再摄取抑制剂、安非他酮、米氮平、曲唑酮、阿戈美拉汀、维拉唑酮、左旋米那普仑和沃替西汀的不良事件、耐受性和安全性的文献。一些副作用是短暂的，可能会在治疗开始后几周内消失，但潜在的严重不良事件可能会持续或随后发生。它们包括胃肠道症状（恶心、腹泻、胃出血、消化不良）、肝毒性、体重增加和代谢异常、心血管紊乱（心率、QT间期延长、高血压、体位性低血压）、泌尿生殖系统症状（尿潴留、失禁）、性功能障碍、低钠血症、骨质疏松症和骨折风险、出血、中枢神经系统紊乱（癫痫发作阈值降低、锥体外系副作用、认知障碍）、出汗、睡眠障碍、情感障碍（冷漠、转换、反常效应）、眼科表现（青光眼、白内障）和高泌乳素血症。有时，这些不良事件可能在停药后持续存在，产生医源性合并症。其他值得关注的领域包括自杀、过量用药的安全性、停药综合征、妊娠和母乳喂养期间的风险以及恶性肿瘤的风险。因此，合理选择AD应考虑潜在的获益和风险、对治疗方案的反应可能性和对不良事件的易感性。本审查的结果应提醒医生在个体基础上仔细审查AD处方的适当性，并考虑替代治疗（如果可用）。(C)2016 S. Karger AG，巴塞尔
Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of fractures, bleeding, central nervous system disturbances (lowering of seizure threshold, extrapyramidal side effects, cognitive disturbances), sweating, sleep disturbances, affective disturbances (apathy, switches, paradoxical effects), ophthalmic manifestations (glaucoma, cataract) and hyperprolactinemia. At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available. (C) 2016 S. Karger AG, Basel