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Are all antidepressants the same? The consumer has a point

Published online by Cambridge University Press:  29 March 2022

Sebastian Camino ,
Sergio A. Strejilevich Open the ORCID record for Sergio A. Strejilevich [Opens in a new window] ,
Antonella Godoy ,
Jose Smith  and
Alejandro Szmulewicz
Sebastian Camino
Affiliation:
AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
Sergio A. Strejilevich*
Affiliation:
AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
Antonella Godoy
Affiliation:
AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
Jose Smith
Affiliation:
AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
Alejandro Szmulewicz
Affiliation:
AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
*
Author for correspondence: Sergio A. Strejilevich, E-mail: sstreji@gmail.com
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Abstract

Background

Although a large variety of antidepressants agents (AD) with different mechanisms of action are available, no significant differences in efficacy and safety have been shown. However, there have been few attempts to incorporate data on subjective experiences under different AD.

Method

We conducted a qualitative and quantitative analysis of the posts from the website www.askapatient.com from different AD. We reviewed a random sample of 1000 posts.

Result

After applying the inclusion and exclusion criteria, we included a final sample of 450 posts, 50 on each of the most used AD: sertraline, citalopram, paroxetine, escitalopram, fluoxetine, venlafaxine, duloxetine, mirtazapine, and bupropion. Bupropion, citalopram, and venlafaxine had the higher overall satisfaction ratings. Sertraline, paroxetine, and fluoxetine had high reports of emotional blunting, while bupropion very few. Overall satisfaction with AD treatment was inversely associated with the presence of the following side-effects: suicidality, irritability, emotional blunting, cognitive disturbances, and withdrawal symptoms. After adjusting for confounders, only emotional blunting was shown to be more frequently reported by users of serotonergic agents, as compared to non-serotoninergic agents.

Conclusion

This research points out that the subjective experience of patients under treatment should be taken into consideration when selecting an AD as differences between agents were evident. In contrast to the more frequent treatment decisions, users might prefer receiving a non-serotoninergic agent over a serotonergic one due to their lower propensity to produce emotional blunting.

Keywords

Antidepressantsapathydopaminergic agentsemotional bluntingpsychological side effectspsychopharmacologyselectionserotonergic agents
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 9 , July 2023 , pp. 4004 - 4011
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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