After many years of trying, Wyeth finally received FDA approval for its new antidepressant, Pristiq (desvenlafaxine). Don’t get too excited, though – Pristiq is simply the active metabolite of Effexor and it’s unclear whether it adds anything of value to our current quiver of antidepressants.

We typically warn our patients about common side effects, such as headache, GI distress and sexual dysfunction when we start SSRIs. Here are some of the side effects that we don’t necessarily talk to patients about, but should be able to recognize and discuss in particular contexts.

A former FDA reviewer and his colleagues obtained all FDA data on studies of 12 antidepressants approved between 1987 and 2004. They then scoured the journals to figure which of these studies had been published. They found that of the 74 FDA-registered trials of antidepressants, 23 (31%) had never been published.

Researchers used the Freedom of Information Act to retrieve all clinical trials data from the FDA on four different antidepressants: fluoxetine, venlafaxine, nefazodone, and paroxetine.

Psychostimulants are commonly added to antidepressants in order to augment their effects, but most of the clinical trials have been either open or small controlled trials. In what may be the largest trial done to
date, these investigators (who received funding from Janssen-Ortho, the maker of Concerta) randomized 145 depressed patients...

Recall that in October of 2003, the FDA issued a public health advisory about the possibility that antidepressants cause suicidal ideation in children and adolescents.

Researchers randomly assigned 202 depressed older adults (average age, 53 years old, 75% women) to four conditions: supervised group exercise 3 times a week, at-home aerobic exercise (unsupervised),
sertraline, 50-200 mg/day, or placebo.

A recent issue of Archives of Internal Medicine contained two articles suggesting that SSRIs may result in loss of bone density in the elderly.

Clinical lore has it that SSRIs are preferable to bupropion for depressed patients who present with anxiety and insomnia. Papakostas and colleagues tested this assumption by obtaining patient data from 10 studies funded by GlaxoSmithKline (makers of brand name Wellbutrin) over the years.

About 20% of patients with cancer develop major depression, and at least 60% present with significant symptoms of sadness and anxiety not severe enough to meet criteria for a DSM-4 disorder.