Successful management of side effects enhances adherence, permits adequate dosing, improves patient comfort and function, and prevents premature discontinuation of therapy. Appropriate management, includes thoughtful drug selection, the anticipation of common and rare but serious side effects with patients, and striving for the lowest effective dose and simplest, drug regimens consistent with appropriately vigorous treatment. It also includes the addition of appropriate adjunctive therapies to manage emergent complaints. Inhibitors,research,lifescience,medical Fatigue and somnolence Fatigue or drowsiness is a common side effect experienced by 10% to 38% of antidepressant-treated outpatients.1-13 In one study of 401

outpatients,1 70% of people who experienced fatigue had Inhibitors,research,lifescience,medical it by 2 weeks, and 63% continued to experience it at 3 months. In comparative studies, SSRIs had a higher rate of sleepiness than bupropion14 and the noradrenergic reuptake inhibitor, reboxetine,15 and equivalent rates as nefazodonc,16-18 venlafaxine,19-21 and duloxetine22-23 and the reversible Inhibitors,research,lifescience,medical monoamine oxidase inhibitor moclobemide.24 Mirtazapine25 and trazodone26 are associated with greater rates of somnolence

and fatigue than SSRIs. The differential of drowsiness should include residual symptoms of depression, a primary sleep disorder such as obstructive sleep apnea or restless leg syndrome or altered sleep cycle, and substance-use disorders. Management of drowsiness Inhibitors,research,lifescience,medical includes careful evaluation of sleep patterns and counseling on sleep hygiene measures (such as avoidance of daytime napping), changes

in antidepressant dosing schedule such as a shift from morning to nighttime administration, divided dosing or use of a slower release preparation, as well as pharmacological management, with psychostimulants, Inhibitors,research,lifescience,medical modafinil, bupropion, rcboxetine, or protriptylinc, or consideration of alternative remedies such as methylfolate or S-adenosylmethionine. For some patients, a graduated increase in exercise may also help reduce fatigue. Sexual Dorsomorphin purchase dysfunction Sexual dysfunction is a common long-term problem on antidepressants. Medication side effects typically affect libido, arousal, orgasm, and ejaculation,27 and may affect lubrication and erection. These side Isotretinoin effects have traditionally been greatly underreported, largely related to patients’ and clinicians’ reticence to address this topic. In a study of 344 patients by Montejo-Gonzalez et al,28 58% of patients reported sexual dysfunction when physicians directly inquired, compared with only 14% of those who spontaneously reported sexual dysfunction. In a naturalistic study that directly inquired about, side effects through closed-ended questions,1 34% of patients reported sexual dysfunction, with half of these patients (17% of the overall group) deeming it bothersome. Seventy percent of patients who experienced sexual dysfunction did so by 2 weeks, with 80% experiencing it at 3 months.