Precautions when using antidepressants at general hospital

Abstract

In psychiatric outpatient care at general hospital, treatment for depressed patients is mainly focused, but at the same time, patients with physical disorders are often consulted from other department. It is said that the difference in efficacy between antidepressants is small, rather the difference in side effects is large. In addition to gastrointestinal symptoms, insomnia / irritation and drowsiness, not well-known but severe side effects which can affect QOL, such as bleeding, sexual dysfunction, weight gain, and liver dysfunction were outlined. Regarding drug-drug interactions, several antidepressants might be sometimes problematic and interact with commonly used therapeutic agents for physical disorders such as warfarin, theophylline, tramadol, statin drugs, and steroids. Considering whether a patient is suitable for antidepressant and if the antidepressant does not work, we should think about the merits and demerits for switching vs augmentation/combination. It is desirable to explain to patients about multiple options including risks and to share the decision with patients.