Tolerability of Modern Antidepressants

Antidepressant side effects may have implications with regard to patient safety as well as the overall tolerability of treatment. Side effects relevant to patient safety can contribute to an increased risk of morbidity and mortality, but may or may not result in patient distress or discomfort. In contrast, side effects related to tolerability can contribute to patient discomfort but are not associated with an immediate increase in risk of morbidity or mortality. Common tolerability-related side effects of modern antidepressants include nausea, insomnia, somnolence, fatigue, sexual dysfunction, and weight gain. Because these side effects can result in patient discomfort and distress, they can lead to poor compliance or noncompliance with treatment that, in turn, may result in an increased risk of depressive relapse or recurrence. Modern antidepressants have varying tolerability profiles, and clinicians should be vigilant about balancing treatment efficacy with side effects when choosing antidepressants. This article compares the rates of common tolerability-related side effects among the newer (post-tricyclic era) antidepressants with the selective serotonin reuptake inhibitors, the most popular contemporary first-line treatment for depression.