Side effect expert Prakash Masand once observed that “the difference between a good clinician and a great clinician is that a great clinician is better at managing side effects.”

It has become more and more painful for us to prescribe SSRIs and SNRIs over the last few years. The reason? Sexual dysfunction.

Yes, side effects can be your (and your patients’) friend. Here are several common clinical scenarios, culled from conversations with astute clinicians and from reflections on my own practice.

Dr. Pies, as an expert psychopharmacologist you’ve seen a lot of patients experiencing both therapeutic effects and side effects of medications. What do you actually say to your patients to prepare them for SSRI side effects?

Perhaps the most dreaded side effect in all of psychiatry is the MAOI-cheese interaction. We now understand its mechanism fairly well, namely, that most cheeses contain high amounts of the amino acid tyramine, which has the effect of increasing the release of norepinephrine (NE) from nerve terminals.

Alicia Powell, M.D., is a psychiatrist in private practice in Jamaica Plain, Mass. Like many psychiatrists, she deals with sexual side effects of antidepressants on a daily basis.

There’s nothing like a close friend suffering psychiatric difficulties to motivate a psychiatrist to do some serious reading. Recently, your humble editor encountered this situation.

You may not know it, but this year marks a milestone in the world of SSRI teratology research. Ten years ago, JAMA published the first controlled study of Prozac exposure in pregnancy (1). The results? Neither Prozac nor tricyclics caused more birth defects than controls, but both antidepressants caused more neonatal complications.

It’s not all about meds. This is especially true in treating postpartum depression, because so many women are understandably reluctant to expose their breast-feeding infants to antidepressants. This article reviews interpersonal therapy (IPT) as an effective modality for post-partum depression.

Dr. Hendrick, there has been a lot of confusing and seemingly contradictory data about the safety of SSRIs during pregnancy. What’s your take?