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Antidepressant Medications
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Selecting and Managing Antidepressants

Drug Side Effects
All SSRIs and venlafaxine can have sexual side effects, including decreased libido and delayed orgasm/ejaculation. Sexual side effects may occur in both men and women. They are fairly common, but are reversible after the medication is stopped and may abate somewhat over time.

There are limited data about how to treat sexual side effects related to antidepressant treatment. One approach is to switch medications from one SSRI to another or to a completely different class of antidepressants. For example, bupropion is less likely to cause sexual difficulties and should be considered for patients who report sexual dysfunction.

SSRIs can also cause insomnia or sedation in some patients. To minimize these effects, patients should be counseled to modify the dosing schedule of the SSRI so it is taken once daily, either in the morning or evening.

It is important to address sleep disturbances and pain problems. If patients have difficulties with sleep, consider their possibilities of having sleep apnea, restless leg syndrome, and/or other diagnoses. In addition, interferon may cause or worsen insomnia. Frequently, insomnia is due to poor sleep hygiene, and a # sleep hygiene program is essential.

Medications to treat insomnia can also be useful. Trazodone, temazepam, and zolpidem are frequently used in clinical practice. In addition, pain is common in patients with hepatitis C and frequently worsens during interferon therapy. Addressing pain can improve sleep and alleviate some depressive symptoms. Thus, adequate pain relief is an important part of care for patients with hepatitis C.

Dose adjustment or a change in medication may be needed if there is minimal positive response or intolerable side effects. When switching a patient from an SSRI or venlafaxine to another class of antidepressants, doses may need to be gradually tapered to minimize withdrawal symptoms.

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