Monday, January 9, 2017

Patients With Depression, Panic Disorder May Experience More Side Effects on Antidepressants

Patients with chronic depression and panic disorder appear to experience more side effects from antidepressants than those without panic disorder, according to a study in the Journal of Clinical Psychiatry.

“These results have clinical importance, as side effects vary in their tolerability, need for clinical management, and effects on attrition and outcome,” Stewart Shankman, Ph.D., of the University of Illinois at Chicago and colleagues wrote. “Thus, ability to predict which side effects will more likely occur matters for adequate pharmacological management.”

The researchers analyzed data collected as part of the Research Evaluating the Value of Augmenting Medication with Psychotherapy (REVAMP) trial, during which patients with chronic depression were openly assigned to antidepressants for 12 weeks. Every two weeks, patients were asked to evaluate antidepressant side effects using the Patient-Rated Inventory of Side Effects (PRISE) and the Frequency, Intensity, and Burden of Side Effects Rating (FIBSER); depressive symptoms were also evaluated every two weeks, using the Hamilton Depression Rating Scale (HDRS).  

For the current study, Shankman and colleagues examined the associations between comorbid panic disorder, social phobia, and generalized anxiety disorder (GAD) and patient reports of side effects in eight categories: gastrointestinal, cardiovascular, dermatologic, neurologic, eye/ear, genitourinary, sleep, and sexual functioning. Of the 808 patients in the study, 85 had a lifetime diagnosis of panic disorder, 123 had a lifetime diagnosis of social phobia, and 85 had a lifetime diagnosis of GAD; 711 patients (88%) reported at least one medication side effect over the course of the 12-week trial. 

The researchers found that a diagnosis of comorbid panic disorder was positively associated with self-reported gastrointestinal, cardiovascular, neurologic, and genitourinary medication side effects—an association that was not seen in patients with GAD and social phobia. Additional analysis revealed that panic disorder significantly moderated the association between the frequency and severity of side effects and the course of depressive symptoms.

“That side effects and depressive symptoms were more strongly correlated for patients with panic disorder than for those without has important clinical implications,” the authors wrote. “Clinicians treating chronically depressed individuals should pay particular attention to gastrointestinal, cardiac, neurological, and genitourinary side effects reported by patients with comorbid panic disorder and perhaps adjust the treatment accordingly. [C]linicians may want to consider treating these patients’ panic disorder (or at least heightened interoceptive awareness) concurrent with the antidepressant treatment.

For related information, see the Psychiatric News article “Study to Answer What Comes Next When MDD Patients Don’t Respond.” 

(Image: iStock/shironosov)