Systematic Overview of Drug Interactions with Antidepressant Medications

• Published in: Canadian journal of psychiatry 2006-04, Vol.51 (5), p.300-316
• Main Authors: Nieuwstraten, Carmine, Labiris, N Renee, Holbrook, Anne
• Format: Article
• Language: English
• Subjects: Antidepressants; Biological and medical sciences; Clinical outcomes; Cytochrome P-450 Enzyme System - drug effects; Depressive Disorder, Major - drug therapy; Drug Interactions; Drug Therapy - mortality; Drug-Related Side Effects and Adverse Reactions; Drugs; Humans; Hypericum; Hypertension - epidemiology; Medical sciences; Monoamine Oxidase Inhibitors - therapeutic use; Neuropharmacology; Patients; Pharmacology; Pharmacology. Drug treatments; Phytotherapy; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Sample size; Serotonin Syndrome - epidemiology; Serotonin Uptake Inhibitors - therapeutic use
• ISSN: 0706-7437; 1497-0015
• DOI: 10.1177/070674370605100506

Objective: Antidepressants are commonly used drugs with potential for numerous drug interactions. This study aims to systematically review the literature on drug interactions with antidepressants. Methods: We searched MEDLINE (1966 to November 2003) and EMBASE (1980 to 2003), using the heading drug interactions combined with individual antidepressant names. We restricted searches to English-language articles and human studies. We screened drug interaction texts and review articles for relevant studies. We included articles reporting original human data on drug interactions with antidepressants commonly used in North America. Articles were independently evaluated by 2 reviewers on clinical effect, clinical significance, and quality of evidence. Discrepancies were resolved by consensus. Results: There were 904 eligible interactions, involving 9509 patients, for a total of 598 summary interactions. Of these, 439 (73%) demonstrated an interaction, 148 (25%) had no effect, and 11 (2%) had conflicting evidence. For 510 interactions (85%), the quality of evidence was poor. It was fair for 67 (11%) interactions and good for 10 (2%) interactions. There were no interactions with excellent quality of evidence. There were 145 (24%) interactions of major clinical significance. These were predominantly hypertensive emergencies and serotonin syndrome. Most interacting drugs had central nervous system (CNS) activity. As expected, monoamine oxidase inhibitors (MAOIs) appear to be the most problematic family in terms of potential for serious drug interactions. Conclusions: Drug interactions with antidepressants are an important cause for concern, but this concern is based primarily on poor evidence. We recommend caution when combining antidepressants with other CNS drugs, particularly when coadministering MAOIs with other substances. Objectif: Les antidépresseurs sont des médicaments fréquemment employés qui ont un potentiel d'interaction avec de nombreux médicaments. Cette étude vise à examiner systématiquement la documentation sur les interactions des médicaments avec les antidépresseurs. Méthodes: Nous avons cherché dans MEDLINE (de 1966 à novembre 2003) et EMBASE (de 1980 à 2003) au moyen de l'en-tête interactions des médicaments combinés avec le nom individuel des antidépresseurs. Nous avons limité les recherches aux articles en anglais et aux études sur les humains. Nous avons extrait les études pertinentes des textes sur l'interaction des médicaments et des articles