Common side effects and considerations based on patient profile

One of the key aspects of pharmacological treatment for depression is the identification and management of side effects. Among the most common adverse effects of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, are gastrointestinal disturbances (nausea, diarrhea), drowsiness or insomnia, decreased sexual desire, weight gain, and, in some cases, mild tremors or initial anxiety.

These effects vary significantly from person to person and depend on the type of medication, the dose, and the individual patient's response. It is essential to keep in mind that, although these effects usually appear in the first few weeks, many tend to diminish over time as the body adapts to the medication.

Patient profile and drug selection

The patient's profile is crucial in anticipating side effects and guiding treatment choices. For example, in adolescents and young adults, it is essential to monitor symptoms of agitation or suicidal ideation at the start of treatment, as these groups are more vulnerable to these paradoxical effects.

In older adults, drugs with high anticholinergic potential or that increase the risk of falls, such as some tricyclics or antipsychotics used in augmentation, should be avoided.

In addition, it is important to consider medical comorbidities: patients with cardiovascular disease, for example, require drugs with less impact on blood pressure or heart rate.

In overweight individuals or those with dyslipidemia, drugs with a lower risk of weight gain, such as bupropion or escitalopram, are preferred over mirtazapine or olanzapine, which can induce significant weight gain.

Impact on quality of life and treatment adherence

One of the factors that most affects treatment continuity is the appearance of side effects that impair the patient's quality of life. Weight gain and sexual dysfunction, for example, are common causes of treatment discontinuation.

Psychoeducation plays an essential role at this point: when patients understand that these effects may be temporary and that therapeutic alternatives exist, they tend to be more tolerant and adherent.

Sometimes, it may be decided to change the medication, adjust the dose, or add complementary treatments such as topiramate, which has shown potential to counteract weight gain induced by other drugs.

Adaptation strategies and treatment personalization

Individualization of treatment is ke