Table 2.
Summary of costly (C) and beneficial (B) effects of antidepressant medications, with some estimate of their effect size or frequency.
| Effect | C/B | Estimated effect size/frequency | Reference |
|---|---|---|---|
| MOOD | |||
| Reduce depressive symptoms | ? | 1.8 HDRS points (not clinically significant) | Kirsch et al. (2008) |
| Relapse risk after discontinuation | – | 21.4% (unmedicated) | See text |
| C | 43.3% (SSRI) | See text | |
| C | 47.7% (SNRI) | See text | |
| C | 55.2% (TCA) | See text | |
| C | 61.8% (fluoxetine) | See text | |
| C | 75.1% (MAOI) | See text | |
| NEUROCOGNITIVE EFFECTS | |||
| Neuronal death | C | ? | See text |
| Anti-cancer effects | B | ? | See text |
| Neuronal dematuration | C | ? | Kobayashi et al. (2010) |
| Motor recovery after stroke | B | 9.7 Points improvement in Fugl-Meyer motor scale score | Chollet et al. (2011) |
| Neuronal structural damage | C | Detectable within 4 days of a clinically relevant dose | Kalia et al. (2000) |
| Mild cognitive impairment | C | 70% increased risk | Goveas et al. (2011) |
| Driving accidents | C | SSRIs: 16% increased risk | Gibson et al. (2009) |
| – | TCAs: no significant effect | Gibson et al. (2009) | |
| GASTROINTESTINAL EFFECTS | |||
| Diarrhea | C | 16.7% | Zimmerman et al. (2010) |
| Constipation | C | 22.4% | Zimmerman et al. (2010) |
| Upset stomach | C | 22.9% | Zimmerman et al. (2010) |
| Nausea | C | 17.5% | Zimmerman et al. (2010) |
| Abdominal pain | C | 13.8% | Zimmerman et al. (2010) |
| VASCULAR EVENTS | |||
| Gastrointestinal bleeding | C | 1.7 Adjusted odds ratio for SSRI alone | See Table 4 |
| Cardiac events | ? | SSRIs: mixed results | See text |
| Stroke | C | TCAs: increased risk | See text |
| Elderly women | C | ≈1.4 Events/1000 person-years | Smoller et al. (2009) |
| Elderly of both sexes (1 year risk, 65+ years old) | – | 2.23% (no antidepressant use) | Coupland et al. (2011) |
| – | 2.26% (TCAs) | Coupland et al. (2011) | |
| C | 2.61% (SSRIs) | Coupland et al. (2011) | |
| C | 3.04% (other antidepressants) | Coupland et al. (2011) | |
| REPRODUCTIVE FUNCTIONING | |||
| Sexual dysfunction | C | 25.8–80.3% | Serretti and Chiesa (2009) |
| DEVELOPMENT | |||
| Congenital malformities | C | 1.89 Adjusted odds ratio (paroxetine) | Cole et al. (2007) |
| ELECTROLYTE BALANCE | |||
| Hyponatremia | C | 0.5–32.0% frequency | Moret et al. (2009) |
| SUICIDAL BEHAVIOR | |||
| Elderly of both sexes (1 year risk, 65 + years old) | – | 0.25% (no antidepressant use) | Coupland et al. (2011) |
| C | 0.43% (TCAs) | Coupland et al. (2011) | |
| C | 0.55% (SSRIs) | Coupland et al. (2011) | |
| C | 1.30% (other antidepressants) | Coupland et al. (2011) | |
| OVERALL MORTALITY | |||
| Elderly men (not depressed) | C | 1.22 Adjusted hazard ratio | Almeida et al. (2010) |
| Elderly men (depressed) | C | 2.97 Adjusted hazard ratio | Almeida et al. (2010) |
| Elderly women | C | ≈5/1000 Person-years | Smoller et al. (2009) |
| Elderly of both sexes (1 year risk, 65+ years old) | C | 10.8/1000 Person-years (TCAs) | Coupland et al. (2011) |
| C | 35.7/1000 Person-years (SSRIs) | Coupland et al. (2011) | |
| C | 43.9/1000 Person-years (other antidepressants) | Coupland et al. (2011) | |