Self-reported antidepressant side effects in psychiatric patients with depressive disorders

Antidepressants (ADs) are an essential depression treatment option, but may cause side effects that affect treatment outcome, patient function, and quality of life. AD side effect assessment may be insufficient in both clinical trials and practice, potentially distorting the understanding of their prevalence and tolerability. We examined AD self-reported side effects (SRSEs) in psychiatric settings.

We evaluated AD SRSEs in 128 psychiatric out- and inpatients from the Pharmacoepidemiology and Pharmacogenetics of Antidepressant Treatment for Depressive Disorders (PEGAD) study at baseline, two- and eight weeks, using the Antidepressant Side-Effect Checklist (ASEC), and the Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale.

Predominantly mild to moderate SRSEs with a low burden on daily activities were reported by over 90% at each evaluation, and 45% of study completers reported occasional severe side effects. Nonetheless, only 6.5% of study completers consequently discontinued their AD, and symptom attribution to the ADs varied, indicating different perceived reasons for SRSEs. Depression severity was the main predictor of SRSEs, and higher depression, anxiety, and age predicted functional impairment.

When systematically evaluated, most antidepressant-treated patients with depression report multiple perceived side effects, some rated severe, that rarely result in discontinuation of their pharmacotherapy. Patients often attribute potential side effects to factors other than pharmacotherapy, and SRSEs affect overall functioning less than depression itself. Our findings highlight the difficulty of reliably ascertaining causes of perceived side effects in the absence of mechanistic biomarkers.