Follow-up: Managing Antidepressants Side Effects

Scale for assessing side effects FIBSER.pdf


Side effects	Treatment Plan
Gastrointestinal symptoms like nausea & diarrhea	Wait... Suggest general measures to manage minor illness, in more severe or prolong cases switching to another antidepressant might be necessary.
Activating symptoms like agitation, insomnia and headaches	Wait...often gets better with time. Try giving in the morning. In severe / more prolonged symptoms, use less activating antidepressant. If very agitated or tremor present consider reducing or stopping the medication.
Suicidal ideation (Mostly in ages <25)	Please refer to Assessing suicide risk
Sexual side effects (Reduced libido, anorgasmia, delayed ejaculation, reduced erection quality)	Reducing the dose of antidepressant. Try a different antidepressant from the table like bupropion, mirtazapine or vortioxetine. Might consider Sildenafil, Tadalafil if not medically contraindicated. Consider adding Wellbutrin for reduced libido providing no seizure risk.
Activation of mania / hypomania (~0.1%)	Stop the antidepressant. Assess for safety Consult Psychiatry or refer the patient to Psychiatry emergency services (PES)