Table 2.
Gastrointestinal Adverse Effect Profiles of Common Antidepressants Based on Network Meta-Analysis
| Antidepressant Class | Specific Agents | Constipation Risk (vs Placebo) | Other GI Effects | Clinical Consideration for Comorbidity |
|---|---|---|---|---|
| TCAs | Amitriptyline, Clomipramine | Higher risk (OR > 2.5) | Dry mouth, dyspepsia | Avoid in comorbid constipation |
| NRI / NaSSA | Reboxetine, Mirtazapine | Moderate–higher (reboxetine) / lower (mirtazapine) | Dry mouth, weight gain | Mirtazapine preferred (~13% incidence, but post-hoc data) |
| SSRIs (higher risk) | Paroxetine, Fluoxetine | Moderate (~1.5–2.0) | Nausea, diarrhea (fluoxetine) | Use with caution; consider alternatives |
| SSRIs (lower risk) | Escitalopram, Sertraline | Lower–moderate (~1.2–1.5) | Diarrhea (sertraline) | Escitalopram may be better tolerated |
| SNRIs | Duloxetine, Venlafaxine | Moderate–higher (duloxetine) | Nausea, anorexia | Monitor GI effects |
| Atypical | Trazodone, Agomelatine | Lower (better tolerated) | Minimal | Potential alternative for selected patients |