Side effects to antidepressant treatment in patients with depression and comorbid panic disorder

Stewart A Shankman*, Stephanie M. Gorka, Andrea C. Katz, Daniel N. Klein, John C. Markowitz, Bruce A. Arnow, Rachel Manber, Barbara O. Rothbaum, Michael E. Thase, Alan F. Schatzberg, Martin B. Keller, Madhukar H. Trivedi, James H. Kocsis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Objective: Side effects to antidepressant medication can affect the efficacy of treatment, but few predictors foretell who experiences side effects and which side effects they experience. This secondary data analysis examined whether depressed patients with comorbid panic disorder were more likely to experience side effects than those without panic disorder. The study also examined whether greater burden of side effects predicted a poorer treatment course for patients with panic disorder than those without panic disorder. To examine the specificity of these effects, analyses also examined 2 other anxiety disorders-social phobia and generalized anxiety disorder (GAD). Methods: Between 2002 and 2006, a large sample (N = 808) of chronically depressed individuals (assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders [SCID-IV]) received antidepressants according to a predetermined algorithm for 12 weeks. Every 2 weeks, depressive symptoms (per the Hamilton Depression Rating Scale) and side effects (specific side effects as well as several indicators of side effect burden) were assessed. Results: Lifetime diagnosis of panic disorder (assessed using the SCIDIV) at baseline was associated with higher likelihood of gastrointestinal (OR = 1.6 [95% CI, 1.0-2.6]), cardiac (OR = 1.8 [95% CI, 1.1-3.1]), neurologic (OR = 2.6 [95% CI, 1.6-4.2]), and genitourinary side effects (OR = 3.0 [95% CI, 1.7-5.3]) during treatment. Increases in side effect frequency, intensity, and impairment over time were more strongly associated with increases in depressive symptoms for patients with panic disorder compared to those without panic disorder. Neither social phobia nor GAD was associated with these effects. Conclusions: Potentially due to heightened interoceptive awareness of changes in their body, chronically depressed individuals with panic disorder may be at greater risk than those without panic disorder for antidepressant side effects and to experience a worsening of depressive symptoms as a result of these side effects over time.

Original languageEnglish (US)
Pages (from-to)433-440
Number of pages8
JournalJournal of Clinical Psychiatry
Volume78
Issue number4
DOIs
StatePublished - Apr 2017

Funding

The study was supported by National Institute of Mental Health Grants U01 MH62475 (PI: Dr Kocsis), U01 MH61587 (PI: Dr Thase), U01 MH62546 (PI: Dr Klein), U01 MH61562 (PI: Dr Trivedi), U01 MH63481 (PI: Dr Rothbaum), U01 MH62465 (PI: A. J. Gelenberg), U01 MH61590 (PI: Dr Keller), U01 MH61504 (PI: Dr Schatzberg), and U01 MH62491 (PI: J. P. McCullough).

ASJC Scopus subject areas

  • Psychiatry and Mental health

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