Taylor (2008)
| Cardiovascular symptoms | Narrative | Design: no restriction (focus on meta-analyses)
Population: people with cardiovascular diseases
Intervention: most antidepressants | TCAs: highly cardiotoxic in overdose and may induce cardiovascular disease
Reboxetine, duloxetine and venlafaxine increase blood pressure
Other antidepressants: neutral or beneficial in various cardiovascular diseases |
Swenson and colleagues (2006)
| Cardiovascular symptoms | Meta-analysis | Design: RCT
Population: people with a chronic physical health problem, people who misuse substances, and older adults
Interventions: SSRIs and TCAs | SSRIs versus placebo: reduced risk of serious adverse events (not statistically significant)
SSRIs versus TCAs: reduced risk of non-serious adverse events |
Ramasubbu (2004)
| Cerebrovascular symptoms | Narrative | Design: RCTs, controlled studies, WHO data monitoring programme, case studies
Interventions: SSRIs | Controlled studies: no association between SSRIs and increased adverse cerebrovascular effects
WHO data on SSRI induced cardiovascular effects: fluoxetine (122 cases), paroxetine (51), sertraline (47), citalopram (13), fluvoxamine (7)
Case studies: 4 cases of vasoconstrictive stroke related to SSRIs |
Weinreib and colleagues (2003)
| Bleeding | Narrative | Design: controlled studies, national prescribing databases, case studies
Intervention: SSRIs | Increased risk of bleeding associated with SSRIs and SSRI/non-steroidal anti-inflammatory drug (NSAID) use |
Yuan and colleagues (2006)
| Bleeding | Narrative | Design: controlled studies, national prescribing databases, case studies
Intervention: SSRIs | Increased risk of bleeding associated with SSRIs and SSRI/NSAID use |
Werneke and colleagues (2006)
| Sexual dysfunction | Narrative | Design: primarily RCTs, meta-analyses, supplemented with controlled studies, case studies where data were limited
Intervention: SSRIs, third-generation antidepressants, TCAs, MAOIs | SSRIs: paroxetine highest prevalence
Third generation: venlafaxine highest prevalence; reboxetine, bupropion less risk
TCAs: clomipramine highest prevalence; amitryptyline, doxepin lowest prevalence
MAOIs: high prevalence but less in moclobemide |
Gregorian and colleagues (2002)
| Sexual dysfunction | Narrative | Design: no limitations
Interventions: SSRIs, third generation | SSRIs: consistent evidence of high prevalence of sexual adverse effects compared with placebo; bupropion less adverse effects, nefazodone also compared with SSRIs |
Beasley (2000)
| Fluoxetine | Meta-analysis | Design: RCTs
Intervention: fluoxetine | Increased risk of gastrointestinal symptoms, sexual dysfunction compared with placebo
Increased risk of gastrointestinal symptoms (exception: constipation), but less risk of postural hypotension compared with TCAs |
Wernicke and colleagues (2007)
| Fluoxetine | Narrative | Design: no limitations
Intervention: fluoxetine | Acceptable tolerability in a range of populations (diabetes, stroke, cancer and cardiovascular disease)
Increased risk of gastrointestinal symptoms
One case report of loss of hypoglycaemic awareness in diabetes |
Brambilla and colleagues (2005)
| Fluoxetine | Meta-analysis | Design: RCT
Intervention: fluoxetine | Gastrointestinal symptoms (nausea, vomiting and diarrhoea) higher prevalence in fluoxetine
Weight: loss greater in fluoxetine compared with TCAs and other SSRIs |
Dhillon (2008)
| Bupropion | Narrative | Design: no limitation
Intervention: bupropion | Risk of seizures with an incidence ~0.4% but increases 10-fold with higher doses (450 to 600 mg)
Less risk of sexual dysfunction compared with SSRIs
Risk of weight loss compared with placebo
Risk of increase in blood pressure |
Demyttenaere & Jaspers (2008)
| Bupropion and SSRIs | Narrative | Design: no limitation | Reduced risk of risk of adverse sexual effects in bupropion compared with SSRIs
Risk of weight loss for bupropion
Risk of weight loss for some SSRIs early on in treatment, but risk of weight gain later on in treatment |
Duggan & Fuller (2004)
| Duloxetine | Narrative | Design: no limitation
Intervention: duloxetine | Increase in blood pressure
Possible risk of weight loss
Higher risk of sexual dysfunction compared with placebo |
Wernicke and colleagues (2007)
| Duloxetine | Narrative | Design: no limitation
Intervention: duloxetine | Increase in palpitations, tachycardia, orthostatic hypotension, cholesterol compared with placebo
Sexual dysfunction higher than placebo |
Hansen and colleagues (2005)
| Second- and third-generation antidepressants | Narrative | Design: no limitation
Intervention: duloxetine | Venlafaxine higher risk of nausea and vomiting than SSRIs
Mirtazapine associated with weight gain |
Machado and colleagues (2006)
| Antidepressants | Meta-analysis | Design: RCTs
Intervention: most antidepressants | TCAs the highest overall adverse event profile, followed by SNRIs |
Wade & Rosenberg (2001)
| Citalopram | Narrative | Design: no limitations
Intervention: citalopram | Fewer adverse events than TCAs (constipation, tachycardia)
No differences found between citalopram and other SSRIs |
Keller (2000)
| Citalopram | Narrative | Design: no limitations | Greater risk of nausea than placebo, but less than fluvoxamine. Risk of small increase in heartbeat |
Edwards & Anderson (1999)
| SSRIs | Meta-analysis and narrative | Design: minor limitation – a number of included studies also included a percentage of patients with psychosis | Committee on Safety of Medicines and prescription-event monitoring data: greater risk of adverse events, including discontinuation reaction to paroxetine and greater risk of gastrointestinal adverse events to fluvoxamine and paroxetine compared with other SSRIs
Controlled studies: more patients discontinued fluvoxamine because of adverse events. Fewer patients discontinued sertraline. |