As we enter the heart of winter, we have to be mindful of those who experience seasonal affective disorder (SAD). While many may resort to pharmaceutic antidepressants, we have to know the risks involved, and this what I'll base my first post of the New Year on.
According to a new report published in the American Journal of Psychiatry, even at recommended doses, all antidepressant drugs may potentially cause liver injury. However, some groups are more vulnerable than others, and their liver toxicity (in some cases, resulting in irreversible liver damage) has been underestimated in the scientific literature.
The researchers behind the new study reviewed clinical data on antidepressant-induced liver injury from 158 reports, including 88 case reports, 38 original articles, and 32 reviews. The results show that 0.5% to 3% of patients on antidepressants may develop mild, asymptomatic elevation of serum ALT levels (a blood test for liver function).
What makes this situation difficult is that in most cases, liver damage is unpredictable, generally not related to drug dosage, and onset of liver damage can occur from several days to six months after starting an antidepressant.
Based on the evidence, the antidepressants associated with highest risk for hepatotoxicity are monoamine oxidase (MAO) inhibitors, tricyclic/tetracyclic antidepressants, nefazodone, bupropion, duloxetine, and agomelatine (some of these causing life-threatening or severe drug-induced liver injury). Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine.
Although no dose-response relationship was clearly established, it's probably best to stick to the lowest effective dose to reduce the risk for liver injury. It's also important to make sure patients understand the possibility of liver damage, and encourage them to report any clinical symptoms suggestive of liver problems (like jaundice), see their doctor, and stop treatment immediately (taking into consideration depression risk).
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Source: Antidepressant-Induced Liver Injury: A Review for Clinicians
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