5 Things Pharmacists Should Tell Patients About Antidepressants

Pharmacists should take some time to counsel patients on the pros and cons of each antidepressant to help them select the best regimen.

Decision aids produced by the Mayo Clinic inform health care providers of the nuances between medications and how each drug may affect a patient.

The medications included in the antidepressant decision aid are:

Selective serotonin re-uptake inhibitors (SSRIs)

Citalopram (Celexa)

Escitalopram (Lexapro)

Fluoxetine (Prozac)

Fluvoxamine (Luvox)

Paroxetine (Paxil)

Sertraline (Zoloft)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Desvenlafaxine (Pristiq)

Duloxetine (Cymbalta)

Venlafaxine (Effexor)

Tricyclic antidepressants (TCAs)

Amitriptyline (Elavil)

Nortriptyline (Aventyl HCl)

Others

Bupropion (Wellbutrin)

Mirtazapine (Remeron)

Here are 5 key facts about these antidepressants that warrant clarification for patients:

1. Weight Changes

Some patients on antidepressants may experience changes in weight. The likelihood of this side effect depends largely on the patient’s current weight and is likely to occur over 6 to 12 months.

For a 150-lb person, escitalopram (Lexapro), paroxetine (Paxil), mirtazapine (Remeron), amitriptyline (Elavil), and nortriptyline (Aventyl HCl) have all been associated with 4 lbs of weight gain, on average.

Meanwhile, buproprion (Wellbutrin) and duloxetine (Cymbalta) have been associated with 2 lbs and 3 lbs of weight loss, respectively, for a 150-lb person.

2. Sexual Issues

Some patients may experience decreased libido or an inability to achieve orgasm as a side effect of nearly all antidepressants, although SSRIs are thought to cause the greatest decreases in libido.

Paroxetine (Paxil) reportedly causes the greatest decrease in libido, followed by amitriptyline (Elavil) and nortriptyline (Aventyl HCl), according to the Mayo Clinic’s decision aid.

Studies have shown that desvenlafaxine (Pristiq) has a low potential for sexual dysfunction in depressed adults.

Bupropion (Wellbutrin), on the other hand, is the only antidepressant associated with an overall increase in libido.

The remaining antidepressants are all associated with a minor decrease libido.

3. Insomnia or Sleepiness

Most antidepressants appear to have minimal effect on a patient’s ability to sleep, though a few have been linked to either insomnia or sleepiness.

Patients taking bupropion (Wellbutrin) may experience insomnia, while those taking mirtazapine (Remeron), amitriptyline (Elavil), or nortriptyline (Aventyl HCl) reportedly experience increased sleepiness.

4. Cost

Out-of-pocket cost is a main treatment factor for many patients, so the following comprehensive list of estimated antidepressant prices may be a helpful resource for health care providers to pass along:

Duloxetine (Cymbalta): $154/month

Desvenlafaxine (Pristiq): $147/month

Venlafaxine (Effexor): $130/month

Escitalopram (Lexapro): $113/month

Bupropion (Wellbutrin): $100/month

Fluvoxamine (Luvox): $80/month

Mirtazapine (Remeron): $50/month

Sertraline (Zoloft): $29/month

Citalopram (Celexa): $4/month

Fluoxetine (Prozac): $4/month

Paroxetine (Paxil): $4/month

Amitriptyline (Elavil): $4/month

Nortriptyline (Aventyl HCl): $4/month

These figures are estimates provided by the Mayo Clinic. Actual out-of-pocket costs may vary. Linked products may have coupons available.

5. Stopping Treatment

When patients stop taking an antidepressant, they may experience flu-like symptoms such as headache, nausea, and dizziness.

Stopping paroxetine (Paxil), venlafaxine (Effexor), duloxetine (Cymbalta), or desvenlafaxine (Pristiq) has been found to cause these symptoms to a greater degree than other antidepressants.

Fluoxetine (Prozac) is the only antidepressant that essentially has no adverse effects when patients stop taking it, according to the Mayo Clinic. The remaining drugs are considered to have less likelihood of a patient feeling ill after treatment is stopped.

Additional Considerations

Side effects for antidepressants may include constipation, nausea, increased risk of suicidal thoughts or behaviors, harm during pregnancy, risk of developing serotonin syndrome, and adverse drug interactions.

In addition, each antidepressant may have specific considerations worth communicating to patients, including:

· Citalopram (Celexa) could cause heart problems.

· Fluoxetine (Prozac) is more likely to interact with other prescribed drugs.

· Fluvoxamine (Luvox) is more likely to cause constipations and nausea.

· Paroxetine (Paxil) is more likely to cause issues for pregnant women.

· Sertraline (Zoloft) is more likely to cause diarrhea.

· Desvenlafaxine (Pristiq) could negatively affect patients with high blood pressure.

· Duloxetine (Cymbalta) could also negatively affect patients with high blood pressure.

· Venlafaxine (Effexor) is more likely to cause nausea, constipation, heart issues, and additional problems for patients with high blood pressure.

· Amitriptyline and nortriptyline are not optimal treatments for elderly patients and are more likely to cause constipation.

· Bupropion (Wellbutrin) has been linked to a higher risk of seizures.

· Mirtazapine (Remeron) has a quicker onset of action than other antidepressants.