One physician’s approach to limiting the adverse reactions to antidepressant medications:
PCPs must watch for at least the following clues to determine, post hoc, which patients might be hurt by antidepressants:
- Patient has a dramatic response (my rule of thumb: be very concerned if the patient is 50% better in less than 4 weeks or almost 100% in less than 2 months).
- Patient has either new-onset anxiety, irritability or anger or worsening of existing anxiety, irritability or anger at any time after starting the antidepressant.
- Patient starts to sleep a lot less than what would be expected and does not mind it because he’s not feeling too much tired.
All of the above could be clues of …a hypomanic or manic episode triggered by an antidepressant. Every antidepressant script should be written initially for month at a time and only after the patient has understood the importance of promptly reporting any of the above signs and symptoms.