The Pharmacologic Management of SSRI-Induced Side Effects: A Survey of Psychiatrists
Abstract
Despite the superior side effect profile of the newer antidepressants over the tricyclics and monoamine oxidase inhibitors, all newer antidepressants are associated with a wide array of side effects. Clinicians are constantly confronted with the challenge of managing these side effects in the context of minimal research to prove one management strategy is more effective than another. The purpose of this study was to examine prescribing practices regarding the management of SSRI-associated side effects in a sample of psychiatrists attending a psychopharmacology review course. A total of 439 out of 800 clinicians (55%) attending a psychopharmacology review course responded to our questionnaire that was given prior to beginning the review course, though not all respondents answered all four items on the questionnaire. Among these items were questions designed to assess clinician preference for the management of SSRI-induced side effects. As a treatment for SSRI-induced sexual dysfunction, 43% (143/330) chose adding bupropion, while 36% (120/330) opted to switch agents as their first choice; for SSRI-induced insomnia, 78% (264/326) chose adding trazodone. Switching agents was the first choice of 61% (214/353) of clinicians for managing SSRI-induced agitation, 93% (339/363) for managing SSRI-associated weight gain. In an effort to manage most SSRI-associated side effects (with the exception of sexual dysfunction and insomnia), the majority of the clinicians responding to our survey opted to switch agents rather than add a specific medication to the existing SSRI. In our opinion, this practice may reflect the relative lack of research studies on the role of adjunctive treatments in the management of SSRI-induced side effects and/or the tendency to favor monotherapy over polypharmacy.
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Side effects more specific to serotonin or norepinephrine have become a concern.
“In addition, side effects which are more specific to serotonin or norepinephrine also have become a concern.56”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [5]
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- Authors
- Dording, C., Mischoulon, D., Petersen, T., Kornbluh, R., Gordon, J., Nierenberg, A., Rosenbaum, J., & Fava, M.
- Affiliations
- Massachusetts General Hospital (US)
- Venue
- Annals of Clinical Psychiatry
- Publisher
- SAGE Publications
- Published
- 2002-09-01
- Volume
- 14
- Issue
- 3
- Pages
- 143-147
- ISSN
- 1040-1237 (ISSN-L)
- OpenAlex
- W2144749508
- Cited by
- 109
- References
- 0
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 2 · 2023: 6 · 2022: 2 · 2021: 2 · 2020: 5 · 2018: 6 · 2017: 1 · 2016: 8 · 2015: 6 · 2014: 3 · 2013: 7 · 2012: 7
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- SSRI side effects, prescribing patterns, psychiatrists, sexual dysfunction, insomnia, agitation, weight gain, bupropion, trazodone, antidepressant switching, adjunctive therapy, polypharmacy, monotherapy
- MeSH terms
- Data Collection, Depressive Disorder, Drug Therapy, Combination, Female, Hospitals, General, Humans, Sleep Initiation and Maintenance Disorders, Male, Massachusetts, Sexual Dysfunction, Physiological, Trazodone, Weight Gain, Bupropion, Akathisia, Drug-Induced, Selective Serotonin Reuptake Inhibitors, Antidepressive Agents, Second-Generation, Critical Pathways
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