Most likely side effect of SSRI

[studylol]

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Hello friends,

What is the most likely side effect of SSRI's between sedation and sexual dysfunction. The answer being the latter.

I am really stuck. Why would I pick one over the other? I just picked what I have experienced when I took the meds which was sedation.

Could anybody please explain why one answer would be better than the other? Thanks!

 

[Slade009]

Ok so from my knowledge between the two choices if I had to chose I would go with sedation but that in and of itself would technically be wrong, let me explain. Sexual dysfunction would only be noticed in people who are sexually active postpubescent and in the real world patients would either 1.) Not tell their doctor out of shyness or embarrassment or 2.) Simply just stop taking the drug (loss of compliance) and most likely not mention it. As for sedation that is a side effect dependent on the drug. This question of yours is really a drug-dependent question. Here I'll show you how:

Most notable
Fluoxetine: Most commonly prescribed/Safest (Least toxicity of overdose)
Sertraline: Metabolized fastest
Paroxetine: Most potent
Fluvoxamine: Causes Sedation (Used for depression with insomnia)
Citalopram: Lowest cost per dose

So they may all cause sedation but each one has it's own level of sedation.
Just remember by its name SSRI's increase Serotonin so just think of all the physiologic effects of Serotonin and you should have all it's possible side effects right there.

Personally I don't think I know a question that had me choosing between 2 SSRI's. That sounds like a Step 2 or 3 exam question unless the drug was infamous for a unique side effect or a side effect particular to it more over the others. Don't get stalled by things like these, the Step 1 will most likely ask you (SSRI related) the best drug of choice in which SSRI's triumph over the others (mostly because they selectively work on Serotonin leading to less side effects compared to other drugs) or Serotonin Syndrome.

 

[stevesteve123]

sexual dysfunction 100% every time put a gun to my head are you serious how is this a question no offense dude

 

[stevesteve123]

sexual dysfunction 100% every time put a gun to my head are you serious how is this a question no offense dude

unless you are talking about a specific, "atypical" anti depressant

 

[Promethean]

Sexual dysfunction would only be noticed in people who are sexually active and in the real world patients would either 1.) Not tell their doctor out of shyness or embarrassment or 2.) Simply just stop taking the drug (loss of compliance) and most likely not mention it.

I think you mean "people who are post-pubescent." Sexual dysfunction isn't just about impotence and sexual performance. Virtually all people who have gone through puberty have sexual thoughts, at least, and they notice when their libido disappears, whether they are frequently engaged in sexual relations with other people or not. Even folks who aren't "sexually active" find it disconcerting to have their thoughts and emotions regarding their sexuality blunted.

You are right that a lot of people aren't comfortable discussing this side effect, even with their physicians. And it is a major reason for noncompliance. But those are all the more reasons why this side effect needs to be something about which the physician is very conscious. Patients need to be educated about the potential effect, and to be encouraged to report any concerns they have about this issue.

Sedation does happen for some people, but I'd say that it is much less prevalent... and for some folks, the effect is just the opposite. Many people take SSRIs in the morning to avoid insomnia as a side effect. I'd say whether it has a stimulating or sedating effect is very drug and person dependent, while sexual side effects are a prominent feature of all the drugs in this class--and that they are more distressing to patients, since simply changing the time of day one takes the med doesn't resolve the problem. Also, sedation tends to self-correct after a period of taking the drugs, while sexual dysfunction can be persistent throughout therapy, and even for a while after discontinuing.

 

[Promethean]

unless you are talking about a specific, "atypical" anti depressant

The question is about SSRIs in specific, so no, buproprion and venlafaxine are not under consideration.

 

[seminoma]

sexual dysfunction 100% every time put a gun to my head are you serious how is this a question no offense dude

Unless GI upset is an answer. Then it's GI upset. Can't remember if this was a Kaplan question or school exam question, but lots of people picked sexual dysfunction rather than GI upset and got it wrong.

 

[sloop]

Hello friends,

What is the most likely side effect of SSRI's between sedation and sexual dysfunction. The answer being the latter.

I am really stuck. Why would I pick one over the other? I just picked what I have experienced when I took the meds which was sedation.

Could anybody please explain why one answer would be better than the other? Thanks!

The truth is, there's not a lot to explain here. The most common class side-effect of SSRIs is sexual dysfunction.

That said, the reason sedation is not a good answer is because SSRIs are not particularly sedating. In fact, many depressed patients who are put on SSRIs have an upsurge in their activity level after being put on it. This is why SSRIs had a bad rap a few years ago when the media kept reporting people committing suicide after being put on them. Activity-related depressive symptoms improve faster on SSRIs than the mood symptoms.

SSRIs may be sedating (some more than others), but this is not the most common side-effect.

Of antidepressants, sedation is most prominently a side-effect of Tricyclics because of their antihistaminergic properties.

In a pinch, it might be helpful to think of sedating drugs as drugs that have one of the following properties: anti-histaminergic, anti-adrenergic, anti-glutaminergic or GABA-ergic. There are other drugs that can cause sedation, but these are the neurotransmitter systems most frequently indicated.

 

[zheng]

Unless GI upset is an answer. Then it's GI upset. Can't remember if this was a Kaplan question or school exam question, but lots of people picked sexual dysfunction rather than GI upset and got it wrong.

I remember having this question in -Rx. I know it doesn't answer OP's question but the question asked "what is the most common side-effect of SSRIs" and the answer for that was GI distress.
However, the answer for the question: "what is the most common side effect of SSRIs that causes people to stop using them" is sexual dysfunction.

 

[dfib slim]

Unless GI upset is an answer. Then it's GI upset. Can't remember if this was a Kaplan question or school exam question, but lots of people picked sexual dysfunction rather than GI upset and got it wrong.

It was Rx

 

[Promethean]

I remember having this question in -Rx. I know it doesn't answer OP's question but the question asked "what is the most common side-effect of SSRIs" and the answer for that was GI distress.
However, the answer for the question: "what is the most common side effect of SSRIs that causes people to stop using them" is sexual dysfunction.

Well, the most common side effects of all medications would be things like headache and GI distress, since those are also the most common side effects of placebos. People always have some minor discomforts and complaints. Once they have taken a medication, those incidental issues are attributed to a side-effect.

GI distress from SSRIs is just not remotely comparable in incidence or severity to GI distress from, say metformin/glucophage.

You will never be wrong in saying that GI distress is a side effect from a med. Or even the most common side effect. It just isn't always the most irksome or clinically relevant.

 

[studylol]

I must be missing a detail in the question stem if the answer is not this obvious. Sorry for the confusion.

This is a UWORLD question so...spoiler alert!!

55 year old male with depression is treated with sertraline. PMH of hypertension controlled with lisinopril and DM, controlled with diet. He doesn't use tobacco and drinks a glass of wine with dinner a few times a week. His vital signs are all within normal limits and no abnormalities are noted on physical examination. His HbA1C is within normal limits. Which of the following is the most likely side effect of the treatment prescribed for this patients depression?

 

[Promethean]

I must be missing a detail in the question stem if the answer is not this obvious. Sorry for the confusion.

This is a UWORLD question so...spoiler alert!!

55 year old male with depression is treated with sertraline. PMH of hypertension controlled with lisinopril and DM, controlled with diet. He doesn't use tobacco and drinks a glass of wine with dinner a few times a week. His vital signs are all within normal limits and no abnormalities are noted on physical examination. His HbA1C is within normal limits. Which of the following is the most likely side effect of the treatment prescribed for this patients depression?

Okay... so I'm still pre-med for another few weeks, but:

Hypertension and DM, even controlled with diet, are independent risk factors for erectile dysfunction. 55 year old male = someone who is likely to be particularly sensitive about sexual side effects. Non smoking is good for him, but moderate alcohol use may also play a role in diminished sexual function, especially if "a glass" really means 2+, almost every day.

So... if you could only tell this patient 1 side effect to be on the lookout for... 1 side effect which would impact his quality of life and possibly make him discontinue therapy, with or without discussing it with you first;

Would you really be most keen on mentioning sedation or GI upset rather than sexual side effects?

The only way they could make the correct answer more plain would be if he was taking a beta blocker instead of an ACE inhibitor.

 

[studylol]

Hypertension and DM, even controlled with diet, are independent risk factors for erectile dysfunction

that's it then! thanks I didn't know that.

The question explanation doesn't include this detail.

 

[Promethean]

that's it then! thanks I didn't know that.

The question explanation doesn't include this detail.

https://scholar.google.com/scholar?q=diabetes hypertension and erectile dysfunction&hl=en&as_sdt=0&as_vis=1&oi=scholart&sa=X&ei=_EtrVaelIYu9sAXwr4K4DA&sqi=2&ved=0CCIQgQMwAA

Hope that shows up. I just googled diabetes, hypertension, erectile dysfunction and chose scholarly articles, but the three are known to travel together.

ED can be the first symptom of one or both of the other issues which actually gets some older guys to go to the doctor. Not actually their first symptom, but the first one they don't shrug off and fail to get checked out. Polyuria, polydypsia? Eh, whatever. Headaches? Take an asprin and get over it. Something wrong with their penis? Gotta get that checked right out!

Doesn't mean they will be forthcoming when they come into the office. They may be embarrassed to talk about it, even though they want help, and hope that you will happen upon an answer that solves the problem without them having to bring it up. Which is why not being too shy to take a thorough sexual history is important. Sexually transmitted infections and fertility issues aren't the only concerns. Sexual health correlates with general wellness in ways that are less obvious to superficial consideration. At the very minimum, in a full exam, patients need to be asked, privately, "Do you have any concerns about your sexual health?"

 

[studylol]

Thanks again.