Elsevier

Psychiatry Research

Volume 216, Issue 1, 30 April 2014, Pages 67-73
Psychiatry Research

Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants

https://doi.org/10.1016/j.psychres.2014.01.042Get rights and content

Abstract

In the context of rapidly increasing antidepressant use internationally, and recent reviews raising concerns about efficacy and adverse effects, this study aimed to survey the largest sample of AD recipients to date. An online questionnaire about experiences with, and beliefs about, antidepressants was completed by 1829 adults who had been prescribed antidepressants in the last five years (53% were first prescribed them between 2000 and 2009, and 52% reported taking them for more than three years). Eight of the 20 adverse effects studied were reported by over half the participants; most frequently Sexual Difficulties (62%) and Feeling Emotionally Numb (60%). Percentages for other effects included: Feeling Not Like Myself – 52%, Reduction In Positive Feelings – 42%, Caring Less About Others – 39%, Suicidality – 39% and Withdrawal Effects – 55%. Total Adverse Effect scores were related to younger age, lower education and income, and type of antidepressant, but not to level of depression prior to taking antidepressants. The adverse effects of antidepressants may be more frequent than previously reported, and include emotional and interpersonal effects.

Introduction

In England, between 1998 and 2010, prescriptions for antidepressants [ADs] increased by 10% annually (Ilyas and Moncrieff, 2012). By 2005 one in 10 people over the age of six in the U.S.A. were being prescribed ADs annually (Olfson and Marcus, 2009). In New Zealand the number of annual prescriptions rose by 37% between 2006/07 and 2011/12, while the number of recipients increased by 35% from 304,530 to 412,631 [PHARMAC, personal communication, 2012], in a population of 4.4 million, of whom 3.7 million are aged 16 or older. Thus one in nine adults, and one in six women are prescribed ADs every year.

The adverse effects most commonly studied and reported, by researchers (Moret et al., 2009, Uher et al., 2009) and drug companies (Ely Lilly, 2012) are physical symptoms such as diarrhea, dry mouth, dyspepsia, impotence, insomnia, nausea, sweating and tremors. A study of 811 AD recipients (Uher et al., 2009) produced rates for Nortriptyline from 3% (diarrhea) to 72% (dry mouth) and for Escitalopram from 3% (disorientation) to 23% (dry mouth). Like many other studies, this study did not measure psychological or interpersonal effects, fear of addiction, withdrawal effects, or suicidality. This is unfortunate since the purpose of the study was to develop the ‘Antidepressant Side-Effect Checklist’ for researchers and doctors. The items included in the checklist, were ‘compiled from a review of the literature’ (p. 203) – with just four studies cited, none of which were surveys of the first-hand experience of AD recipients, which have identified psychological and interpersonal effects (Gibson et al., 2014). Similarly, the ‘Patient-Rated Inventory of Side Effects (PRISE)’ measures eight types, all ‘biological systems’ (Adkins et al., 2012).

An online UK survey of nearly 1500 AD users (MIND, 2012) found that over half experienced adverse effects, with 44% reporting that ADs affected their sex lives, 27% their ability to work or study, and 21% their relationships with family or friends. An analysis of 468 comments about fluoxetine and venlafaxine on a patient-oriented website found that the most common ‘psychoactive’ effects were sedative-type effects, subjectively impaired cognition, activation effects, reduced libido, emotional blunting and emotional instability (Goldberg and Moncrieff, 2011).

A 2013 review of studies of the subjective experiences of people who receive ADs (Gibson et al., 2014) identified multiple adverse effects in the psychological, emotional and interpersonal domains that have received little attention in previous studies, or measures, of adverse effects. These included a reduction of positive and negative emotions, emotional detachment, a belief that ADs prevent natural sadness, personality changes, harmful effects on relationships, fear of addiction, and suicidality (Givens et al., 2006, Liebert and Gavey, 2008, Pestello and Davis-Berman, 2008, Price et al., 2009). The review concluded that AD recipients have complex and ambivalent perspectives, which can change over time. The review found, however, that the overall attitude of most AD recipients is negative, not only because of adverse effects (Pestello and Davis-Berman, 2008, Van Geffen et al., 2009), but because of stigma (Sirey et al., 2001) and failure to address social and psychological issues (Honcamp et al., 2002). The review also found, nevertheless, that many people continue taking ADs, partly because of lack of availability of preferred alternative treatments such as psychotherapy (Backenstrass et al., 2006, Lowe et al., 2006) and, most consistently, because of a belief that they are addictive and the related fear of withdrawal effects (Bogner et al., 2009, Kessing et al., 2005, Stone et al., 2004).

A questionnaire was designed to explore the subjective experiences of AD recipients, by asking the largest sample to date about their experiences with, and attitudes and beliefs about, depression and ADs. This paper reports participants׳ experiences of 20 biological, emotional and interpersonal adverse effects.

Section snippets

Instrument

The questionnaire had 47 questions, in eight sections: demographics; the prescribing process; information about AD usage and perceptions of their effectiveness; side-effects; benefits; experiences of alternative treatment options; and beliefs about the causes of depression. The questionnaire consisted of multiple-choice questions and rating scales producing quantitative data and open-ended questions. The criteria for participation included having been prescribed ADs in the last five years and

Specific adverse effects

The number of participants responding to the questions about each of the 20 adverse effects varied. By far the lowest (1367) was for Withdrawal Effects, presumably because some participants had been on ADs continuously and had no experience of withdrawal.

Eight of the 20 effects were reported by more than half of the participants (see Table 1). The most frequent were Sexual Difficulties (62%), Feeling Emotionally Numb (60%) and Failure to Reach Orgasm (59%). The percentages reporting the other

‘Closing down’

Our findings, from the largest sample to date, suggest that it may be important to follow up results from smaller, qualitative studies, with large-scale surveys. All four of the emotional or interpersonal effects identified in previous qualitative studies (Gibson et al., 2014, Goldberg and Moncrieff, 2011, MIND, 2012) were reported to be very common: Feeling Emotionally Numb (60%), Feeling Not Like Myself (52%), Reduction In Positive Feelings (42%), Caring Less About Others (39%). Between 16%

Acknowledgments

We thank all the participants who took the time to share their experiences, and the University of Auckland for their financial support for this study via the Faculty Research Development Fund.

References (36)

  • M. Backenstrass et al.

    Preferences for treatment in primary care: a comparison of nondepressive, subsyndromal and major depressive patients

    General Hospital Psychiatry

    (2006)
  • J. Stone et al.

    What do medical outpatients attending a neurology clinic think about antidepressants?

    Journal of Psychosomatic Research

    (2004)
  • D. Adkins et al.

    Genome-wide pharmacogenomic study of citalopram-induced side effects in STAR*D

    Translational Psychiatry

    (2012)
  • C. Belaise et al.

    Patient online report of selective serotonin reuptake inhibitor-induced persistent postwithdrawal anxiety and mood disorders

    Psychotherapy and Psychosomatics

    (2012)
  • H. Bogner et al.

    Older primary care patient views regarding antidepressants: a mixed methods approach

    Journal of Mental Health

    (2009)
  • R. Byng et al.

    Patients’ experiences of consultations for depression and predictors of adherence to antidepressants

    Primary Care and Community Psychiatry

    (2007)
  • K. Dobson et al.

    Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression

    Journal of Consulting and Clinical Psychology

    (2008)
  • Education Counts, 2006. (〈http://www.educationcounts.govt.nz/data/assets/excel_doc/0007/17836/Education_attainment...
  • Eli Lilly, 2012. Highlights of Prescribing Information: Prozac....
  • Gibson, K., Cartwright, C., Read, J. (2014). Patient-centred perspectives on antidepressant use: a narrative review....
  • J. Givens et al.

    Older patients׳ aversion to antidepressants

    Journal of General Internal Medicine

    (2006)
  • L. Goldberg et al.

    The psychoactive effects of antidepressants and their association with suicidality

    Current Drug Safety

    (2011)
  • T. Hammad et al.

    Suicidality in pediatric patients treated with antidepressant drugs

    Archives of General Psychiatry

    (2006)
  • A. Himei et al.

    Discontinuation syndrome associated with paroxetine in depressed patients: a retrospective analysis of factors involved in the occurrence of the syndrome

    CNS Drugs

    (2006)
  • E. Honcamp et al.

    Patients׳ attitudes toward antidepressants

    Psychiatric Services

    (2002)
  • S. Ilyas et al.

    Trends in prescriptions and costs of drugs for mental disorders in England, 1998–2010

    British Journal of Psychiatry

    (2012)
  • L. Kessing et al.

    Depressive and bipolar disorders: patients׳ attitudes and beliefs towards depression and antidepressants

    Psychological Medicine

    (2005)
  • I. Kirsch et al.

    Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration

    PLOS Medicine

    (2008)
  • Cited by (107)

    View all citing articles on Scopus
    View full text