ABSTRACT
The incidence of treatment-emergent side effects upon initiation and maintenance of antidepressant therapy in clinical practice is difficult to estimate. Certainly, however, no currently available antidepressant is entirely free of side effects. Thus, the management of side effects is paramount in the treatment of mood and anxiety disorders, as medication tolerability may determine compliance and ultimately treatment effectiveness and the patient’s resultant quality of life. Administration of adequate doses of antidepressants both during acute and maintenance treatment has been demonstrated as critical to achieve a sustained remission in depressed patients [1]. The high rate of relapse associated with treatment discontinuation suggests that
many depressed patients may require long-term treatment with antidepressants [2]. Successful management of depression thus hinges, in part, on the patient’s ability to tolerate full doses of antidepressants over extended periods of time. Critical to the effort to optimize treatment outcome and facilitate administration of medication at adequate doses over time are the availability of better tolerated antidepressants and the timely management of treatment-emergent adverse effects. Management of antidepressant-induced side effects, including patient education about such potential adverse effects, is critical to enhance patient compliance. Compliance with prescribed medication regimens clearly diminishes as the incidence and severity of side effects increase [3,4]. The prescription of suboptimal doses of antidepressants or the rapid abandonment of one agent to switch to another in response to the emergence of side effects can significantly prolong the period of untreated illness or promote relapse in patients who have responded to pharmacotherapy. Many depressed patients labeled as ‘‘treatment resistant’’ or with residual symptoms after initial pharmacotherapy respond to an increase in dosage [5]. Attention to treatmentemergent adverse side effects may facilitate the dose increases necessary for successful treatment of refractory patients. Furthermore, physician concern and frequent assessment of side effects along with prompt education and treatment of the affected patient enhances the therapeutic alliance and minimizes premature abandonment of treatment.
