Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors
Abstract
Peretti S, Judge R, Hindmarch I. Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors. Acta Psychiatr Scand 2000: 101: 17–25. © Munksgaard 2000. Objective: An important consideration in the choice of an antidepressant is its safety and tolerability. Method: We present a review of literature, clinical trials and meta‐analyses regarding the safety and tolerability of the tricyclic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs) in depressed patients. Results: The SSRIs have a very favourable side‐effect profile compared to the TCAs and are associated with fewer treatment discontinuations. Unlike the TCAs, they do not cause anticholinergic, hypotensive or sedating reactions, and are not associated with impaired cognitive function. Their most common side‐effects (nausea, vomiting, nervousness, insomnia, headache and sexual dysfunction) are usually mild and typically disappear as treatment continues. The SSRTs also exhibit lower toxicity and lower lethality when taken in an overdose situation. Although the safety profiles of the principal SSRTs appear to be comparable, there is some data showing important differences in the severity and frequency of specific adverse events. Conclusion: The SSRTs have a more favourable safety profile than the TCAs in both acute and long‐term treatment of major depression.
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The deleterious effect on executive function might be explained at least in part by the anticholinergic effects of some tricyclic antidepressants.
“This deleterious effect might be explained at least in part by the anticholinergic effects of some TCAs [82].”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [82]
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- Authors
- Peretti, S., Judge, R., & Hindmarch, I.
- Affiliations
- Eli Lilly (United States) (US)
- University of Surrey (GB)
- Corresponding author
- Judge, R.
- ORCID
- Judge, R.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2000-09
- Volume
- 101
- Issue
- S403
- Pages
- 17-25
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2082298277
- Cited by
- 236
- References
- 64
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 5 · 2023: 7 · 2022: 8 · 2021: 5 · 2020: 11 · 2019: 9 · 2018: 10 · 2017: 8 · 2016: 17 · 2015: 9 · 2014: 6 · 2013: 13 · 2012: 10
- FWCI
- 4.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- tricyclic antidepressants, selective serotonin reuptake inhibitors, antidepressant safety, drug tolerability, adverse drug reactions, major depressive disorder, anticholinergic effects, overdose toxicity, sexual dysfunction, treatment discontinuation, cognitive function
- MeSH terms
- Antidepressive Agents, Tricyclic, Clinical Trials as Topic, Cognition Disorders, Drug Tolerance, Humans, Meta-Analysis as Topic, Selective Serotonin Reuptake Inhibitors
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