Management of Side Effects of Antidepressant Medications

Side effects of antidepressants are common, distressing, and impairing. They have a substantial effect on nonadherence to antidepressants, which is very common. Greater attention to learning about various strategies for preventing, reducing, and managing side effects may have a significant effect in improving the outcomes of treatment with antidepressants. Attention needs to be paid to both common, “nuisance” side effects and the uncommon or rare “medically serious” side effects. This chapter provides examples of both categories. While nuisance side effects may seem unimportant, in fact, they have a considerable impact on nonadherence. On the other hand, while medically serious side effects may be seen as uncommon or even rare, they can lead to serious consequences. In particular, clinicians who often treat patients who are at high risk of such medically serious side effects need to be thoroughly familiar with them. Clinicians who prescribe antidepressant medications are urged to have a menu of options for the management of side effects, ranging from simple, benign interventions to more active interventions that may carry risks of their own. The latter are often needed in situations where continuing that particular antidepressant, or type of antidepressant, is essential and stopping or changing it is not a reasonable option. In such situations, risk/benefit considerations require that the side effect be actively treated to allow the patient to stay on the medication. This chapter provides many examples of both simple and more active interventions for a variety of potential side effects of antidepressants.