DHULIKHEL, NEPAL
A
new study published in Drugs - Real World Outcomes reveals that while
combining different antidepressants can help manage certain side effects like
insomnia, it significantly increases the risk of metabolic issues, including
weight gain and increased appetite,
The research, conducted at the psychiatry outpatient
department of Dhulikhel Hospital, assessed 204 patients over a three-month
period to understand the burden of self-reported adverse drug reactions (ADRs).
Researchers found that patients experienced an average of 7.8 ADRs each,
with the most common being dry mouth (65.7%), blurred vision (61.3%), and
weight gain (59.8%).
The Trade-off of Combination Therapy The
study sheds light on the "double-edged sword" of Combination
Antidepressant Therapy (CAT). About 26.9% of the participants were on a
multi-drug regimen, often involving tricyclic antidepressants (TCAs) paired
with other classes.
The data showed that patients on combination therapy were 2.21
times more likely to experience increased appetite and 1.87 times more
likely to gain weight compared to those on a single medication. However,
CAT users were significantly less likely to suffer from insomnia and sexual
dysfunction, suggesting that doctors may be using these combinations to
counteract specific "activating" side effects of certain drugs.
Predictable but Preventable The
research team, led by Ajaya Acharya and Durga Bista from Kathmandu University,
categorized all reported reactions as "Type A" reactions,
meaning they are predictable and dose-dependent based on the drugs' pharmacology,
Furthermore, 100% of these reactions were deemed "probably
preventable" through better monitoring and management.
Despite the high frequency of side effects, the study noted
that no treatment adjustments were made during the study period. Instead,
clinical pharmacists provided ethical counseling to help patients manage
symptoms, as most ADRs were judged to be mild to moderate.
A Call for Better Monitoring The
findings emphasize a critical need for strengthened pharmacovigilance (PV)
in resource-limited settings like Nepal. As mental health services expand, the
researchers argue that routine monitoring of metabolic health is essential for
patients on long-term antidepressant therapy.
"Given the increased metabolic effects observed with
combination therapy, these findings emphasize the need for routine monitoring
to improve antidepressant safety," the study concludes.
