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Side Effects (Main Menu)

This Menu contains links to pages related to various SIDE EFFECTS. Links to other MAIN MENUS can be found by clicking on the MENUS tab at the top of every page on this website.


In the Menu below, click on the category (or the arrow to the left of its name) to EXPAND the category and see what is included in it.

When you are done, click on the category (or the arrow to the left of it) to COLLAPSE the category back.


General

Educating patients about side effects

Knowledge is power: Effective strategies for educating patients about potential adverse effects

Potential side effects of psychotropic medications (with handouts for each medication)


“Sensitive to medications“

How to assess persons who are “sensitive to medications.”

How to manage a person who is “sensitive to medications”


Boxed warnings

What are boxed warnings (so-called “black box warnings”)

What to do about boxed warnings


Other general articles about side effects

How common are side effects of antidepressants?

Side effects: what’s the big deal?

Dose reduction to manage adverse effects

Some medications have a low “therapeutic index”. What’ exactly is that?

How to identify potentially significant side effects hidden behind “misleading means”

Can medication X cause side effect Y?

How to think about rare but serious side effects

Side Effects: Test Your Knowledge

Cardiovascular risk screening form


Acne (acneiform eruptions)

What is acne vulgaris?

Why should mental health clinicians care about acne?

Lithium and acne: Evaluation and management

Acneiform eruption associated with lamotrigine

Can isotretinoin (Accutane®, Roaccutane®) cause depression or suicidality?

What do published studies on isotretinoin and depression/ suicidality show?


Akathisia

Akathisia: Introduction

Akathisia: Clinical features

Which second-generation antipsychotics have a lower or higher risk of causing akathisia?

Is lumateperone less likely to cause extrapyramidal symptoms (including parkinsonism or akathisia)?

Akathisia: Identification and evaluation

Barnes Akathisia Rating Scale


Akathisia: Treatment

Akathisia: First-line treatments

Mirtazapine may cause akathisia at higher doses

Gabapentin for the treatment of akathisia?

Anticholinergics for the treatment of akathisia?

Amantadine for the treatment of akathisia?

Vitamin B6 for the treatment of akathisia?


  Agranulocytosis—see “Neutropenia/ Agranulocytosis”


Anticholinergic toxicity

Clinical case: New onset of acute anxiety and physical symptoms

How does toxicity from anticholinergic medications present clinically?

In older adults, avoid medications with anticholinergic activity

Are doxepin’s anticholinergic effects dose-dependent?

Use a rating scale for anticholinergic burden from medications


Bleeding

How do antidepressants increase the risk of bleeding?

Antidepressants and bleeding: When and what to ask

Are antidepressants that don’t inhibit serotonin uptake less likely to increase the risk of bleeding?

Who is at a higher risk of bleeding with antidepressants?

Antidepressants and degree of inhibition of serotonin reuptake

Which antidepressants in patients with a history of, or at higher risk for, bleeding

Are some SSRIs associated with a lesser or greater risk of bleeding?

What is “easy” bruising and what could be causing it?

Key facts that we should know about von Willebrand disease

A patient with antidepressant-associated bruising and von Willebrand disease

How to manage patients with increased bruising on a serotonin reuptake inhibitor

Antidepressants and risk of stroke

Psychotropic medications and surgery or anesthesia

5-HTTLPR and adverse effects of antidepressants


Blurred vision

Psychotropic medications and blurred vision

Some questions to ask in evaluating a patient with blurred vision


Bruxism

Bruxism (teeth-grinding): Consequences and causes

Don’t miss bruxism in patients with ADHD—it can cause significant problems

Awake bruxism is common and harmful, but typically undiagnosed and untreated

How to screen for possible bruxism

Management of antidepressant-induced bruxism


Cancer risk

Some antidepressants may increase the risk of breast cancer recurrence

Which antipsychotics to avoid or prefer in women with breast cancer

Does folate/ L-methylfolate supplementation DECREASE or INCREASE the risk of breast cancer?

Semaglutide injection (Wegovy™): Serious side effects, warnings, and contraindications


Cognitive impairment

Proton pump inhibitors and cognitive impairment or dementia


Constipation

Management of clozapine-induced constipation

Non-medication interventions that we should recommend for constipation

How to choose and use a fiber supplement

Why and how to recommend increased intake of soluble fiber

Over-the-counter treatments for constipation: A simple and practical guide

Check for these “alarm” symptoms/ signs in patients with constipation

Don’t recommend docusate (Colace®) for constipation


Diarrhea

Diarrhea due to psychotropic medications


Discontinuation syndromes (withdrawal)

Discontinuation syndromes (withdrawal)—Anticholinergics

Cholinergic rebound syndrome


Discontinuation syndromes (withdrawal)—Antidepressants

Antidepressant discontinuation (withdrawal): Introduction

Antidepressant discontinuation (withdrawal): Risk factors

Antidepressant discontinuation (withdrawal): Clinical features

Antidepressant discontinuation and “brain zaps”

Differentiating antidepressant discontinuation (withdrawal) from worsening of the illness

Antidepressant discontinuation (withdrawal): Management

How exactly should desvenlafaxine be stopped?

Anticholinergic medication for antidepressant discontinuation syndrome?

Antidepressant discontinuation (withdrawal): Duloxetine

How can duloxetine be tapered very slowly?

Antidepressant discontinuation and “brain zaps”


Discontinuation syndromes (withdrawal)—Dopamine agonists

Dopamine agonist withdrawal syndrome (DAWS)


Dry mouth (Xerostomia)

Watch out for dry mouth

How to manage dry mouth

Why and how to deal with dry mouth (patient handout)

Dry mouth (xerostomia) management: pilocarpine “mouthwash”

Recommend xylitol-containing products to prevent dental cavities (caries)

XyliMelts® Dry Mouth delivers xylitol for several hours—even while sleeping


Dyslipidemia

Dyslipidemia is a huge contributor to disease and death—but often undiagnosed and untreated

How to monitor for dyslipidemia in patients treated with an antipsychotic

Elevated LDL cholesterol or triglycerides must be brought down without much delay

The lipid panel (profile): Why, when, and how to order it

Check for these causes if triglycerides are high

For moderate hypertriglyceridemia, implement these lifestyle interventions


Dystonia

Why prescribers of antipsychotic medications should know about acute dystonia

What increases or decreases the risk of medication-induced acute dystonia?

Recommendations for reducing the risk of antipsychotic-induced acute dystonia

Recommendations for treating antipsychotic-induced acute dystonia


Edema

Edema


Excessive sweating (Hyperhidrosis)

Antidepressant-induced excessive sweating (ADIES)

Antidepressant-induced excessive sweating (ADIES) or hyperhidrosis: Clinical features

Antidepressant-induced excessive sweating (ADIES) or hyperhidrosis: Management

Which topical antiperspirant when something strong is needed?

Little-known but important instructions for correctly using a topical antiperspirant

Which topical antiperspirants can be used on the face, neck, and body?

Topical anticholinergics for localized hyperhidrosis

Potential side effects of glycopyrrolate

What to do about excessive sweating in this patient with OCD


Glaucoma

Psychotropic medication induced glaucoma

Are psychiatric medications safe AFTER laser iridotomy for narrow-angle glaucoma?


Hair loss (Alopecia)

How to evaluate suspected medication-induced hair loss

Valproate and hair loss (alopecia)

All about lithium-induced hair loss

Can patchy hair loss be due to an antidepressant?

Does any antidepressant have a lower or higher risk of causing hair loss?

Which brands of selenium should we recommend?

How much selenium to recommend for valproate-induced hair loss

When to consider recommending biotin supplementation

Biotin can interfere with many laboratory tests—and lead to serious misdiagnosis

How exactly to use topical minoxidil foam


Headache

Lamotrigine and headache


Hematological side effects

Also see: Neutropenia/ Agranulocytosis

Also see: Thrombocytopenia

A patient with elevated WBC, absolute neutrophil, and platelet counts


  Hepatic damage—see “Liver damage”


Hyperammonemia (elevated serum ammonia level)

False positive elevation of plasma ammonia 

Valproate (Depakote®) and elevated serum ammonia level (hyperammonemia)

Think twice before adding topiramate to valproate

L-carnitine (levocarnitine; Carnitor®): Basic information


  Hyperlipidemia—see “Dyslipidemia”


Hyperparathyroidism

Lithium-induced hyperparathyroidism

How to screen for lithium-induced hyperparathyroidism

Lithium-induced hyperparathyroidism: Management

How to calculate corrected serum calcium

Sensipar® (cinacalcet) Prescribing Information


Hyperprolactinemia

How to measure and interpret serum prolactin

Potential harms from hyperprolactinemia

When do we say that amenorrhea or oligomenorrhea are present?

 Which antipsychotics have a low risk of increasing serum prolactin levels?

Does lurasidone (Latuda®) really have a low risk of increasing serum prolactin?

Does olanzapine (Zyprexa®) really have a low risk of increasing serum prolactin?

Does ziprasidone (Geodon®) really have a low risk of increasing serum prolactin?

Antidepressant-induced hyperprolactinemia

Can buspirone cause increased prolactin or galactorrhea?

Management of antipsychotic-induced hyperprolactinemia

A case of risperidone-induced hyperprolactinemia

*Prophylactic* bromocriptine with risperidone?


Hypersalivation (Sialorrhea)

Clozapine-induced hypersalivation (sialorrhea)

Clozapine-induced hypersalivation (sialorrhea): Treatment


Hypertension (Increased blood pressure)

How to correctly measure blood pressure

Should we use automated blood pressure instruments?

Key facts about increased blood pressure on venlafaxine

Do psychostimulant medications cause clinically significant increases in blood pressure?

How exactly should blood pressure be monitored in persons on stimulants

How to manage stimulant-induced hypertension

Don’t miss nicotine as a cause of the increase in pulse rate or blood pressure

Monitor pulse rate and blood pressure when bupropion and nicotine are combined


Hyponatremia/ Syndrome of Inappropriate ADH Secretion

Hyponatremia due to psychotropic medications

How common is new-onset hyponatremia during antidepressant treatment?

Can bupropion cause hyponatremia?

Does mirtazapine really have a lower risk of causing hyponatremia?

How to diagnose SIADH

What next after antidepressant-induced hyponatremia? 

How exactly to do fluid restriction 

Does medication-induced hyponatremia change lithium blood levels?


Hypothyroidism

An introduction to lithium-induced hypothyroidism

How common is lithium-induced hypothyroidism?

What are the risk factors for lithium-induced hypothyroidism?

How should lithium-induced hypothyroidism be evaluated?

Antithyroid antibodies: An overview

How should lithium-induced hypothyroidism be managed?


Infertility

Can antidepressants impair sperm quality and male fertility?


Insomnia

MAO inhibitor-induced insomnia


Kidney stones

Warning! Topiramate can cause kidney stones


Liver damage

Liver damage—Evaluation

How to order and interpret Hepatic (Liver) Function Tests

A resource for looking up hepatotoxicity with a medication, herb, or supplement

False-positive elevation of plasma ammonia

Liver damage—Antidepressants

Antidepressants can injure the liver, some more than others

How to use antidepressants in persons with liver disease

Liver damage—Second-generation antipsychotics

What can we do about liver injury due to a second-generation antipsychotic?

Liver damage—Disulfiram

Disulfiram and liver toxicity

When and how often should hepatic function tests be done in patients on disulfiram?


Mania or hypomania

Side effects—Mania or hypomania

Which medications can cause manic symptoms?

How to differentiate substance/medication-induced bipolar disorder from bipolar I or II disorder

Complementary/ herbal products can sometimes cause mania

Also see below: Antidepressant-induced mania or hypomania 


Side effects—Antidepressant-induced mania or hypomania

What is antidepressant-induced mania or hypomania?

What are the risk factors for antidepressant-induced mania or hypomania? 

Does bupropion really have a lower risk of switching in bipolar disorder?

Pharmacogenetics and the risk of antidepressant-induced switching to mania or hypomania

Review of studies: 5-HTTLPR polymorphisms and the risk of antidepressant-induced mania/ hypomania

How should antidepressant-induced mania or hypomania be managed?

Also see above: “Side effects—Mania or hypomania”


Metabolic acidosis

Metabolic acidosis

How to monitor for possible metabolic acidosis

What is the anion gap and how can we easily calculate it from the lab results?

Topiramate and metabolic acidosis

How to manage metabolic acidosis due to topiramate


Myocarditis

Clozapine-induced myocarditis or cardiomyopathy


Nausea

Medication-induced nausea: Introduction

Medication-induced nausea: Level 1 (basic) strategies for prevention and management

Ginger for medication-induced nausea?

What are the potential side effects of ginger root?

Medication-induced nausea: Level 2 (intermediate) strategies for prevention and management

How can vortioxetine-induced nausea be treated?

Ondansetron (Zofran®), QT prolongation, and psychotropic medications


Neutropenia/ Agranulocytosis

A primer on the absolute neutrophil count (ANC)

Why we sometimes specifically order a “Complete Blood Count with Differential”

Benign ethnic neutropenia (BEN)

Is it true that mirtazapine (Remeron®) can cause agranulocytosis?


Oral sores

Oral sores in a patient on lamotrigine 


Orthostatic hypotension

Dizziness/ Orthostatic hypotension

How to correctly measure and interpret orthostatic blood pressure and pulse

Management of orthostatic hypotension: Basic (level 1) strategies

Management of orthostatic hypotension: Intermediate (level 2) strategies

Management of orthostatic hypotension: Advanced (level 3) strategies 

Warning–the patient may faint after the very first dose

Should we use automated blood pressure instruments?

How to correctly measure blood pressure

Tamsulosin (Flomax®) and psychiatric medications: What to watch for


Pancreatitis

Pancreatitis: A very short primer specifically for mental health clinicians

Valproate-induced pancreatitis

Which antipsychotics are more likely to cause pancreatitis, and what should we do about this?

Can antidepressants cause pancreatitis?


Parkinsonism

Parkinsonism—Clinical features and causes

Antipsychotic-induced parkinsonism clinical features

Is lumateperone less likely to cause extrapyramidal symptoms (including parkinsonism or akathisia)?

Medication-induced tremors: An overview

How to examine a person with tremors

Tips on differentiating between antipsychotic-induced parkinsonism and Parkinson’s disease

What we know about VMAT2-inhibitor-induced parkinsonism

Can valproate cause parkinsonism?

Can buspirone cause dyskinesia or parkinsonism?

Can lithium cause parkinsonism?


Parkinsonism—Prevention and Management

Can we prevent neuroleptic-induced parkinsonism?

Tips on treating antipsychotic-induced parkinsonism

Does dose reduction work for neuroleptic-induced parkinsonism?

Anticholinergic medications in mental health: Menu of options

Clinically-important differences between anticholinergic medications

For how long should anticholinergics be given for antipsychotic-induced parkinsonism?

Amantadine for antipsychotic-induced parkinsonism

Amantadine (Symmetrel): Basic information


Pharmacogenomics of side effects

Serotonin transporter promoter region

Serotonin transporter linked polymorphic region (5-HTTLPR)

5-HTTLPR and efficacy of antidepressants

5-HTTLPR and adverse effects of antidepressants

5-HTTLPR and antidepressant-induced mania


Serotonergic receptors

Serotonin 2A receptor gene (HTR2A) polymorphisms and adverse effects

HTR2C polymorphisms and medication-induced weight gain


Blood-brain barrier/ P-glycoprotein

ABCB1 polymorphisms and psychotropic medications


Cytochrome P450 enzymes

Pharmacogenetic testing: Cytochrome P450 enzymes


HLA gene testing

HLA antigens and psychotropic drugs


Melanocortin 4 receptor (MC4R)

Melanocortin 4 receptor (MC4R) and weight gain


Commercially-available pharmacogenomic tests

(listed alphabetically)

CNSDose® (CNSDose, LLC)

Genecept assay® (Genomind, LLC)

GeneSight® pharmacogenomic test batteries (Assurex Health)

Commercially available pharmacogenomic test panels


Polycystic ovary syndrome (PCOS)

Do you think valproate causes Polycystic Ovary Syndrome (PCOS)?


Polyuria/ Diabetes insipidus

Lithium-induced polyuria and diabetes insipidus

Lithium-induced polyuria and diabetes insipidus: Evaluation

Lithium-induced polyuria and diabetes insipidus: Treatment


Priapism

What risk factors to look for in patients with a history of priapism

Which antipsychotics may have a lower risk of priapism?

How and why to compare antipsychotics’ affinity for alpha-1 receptors

How to reduce the risk of priapism due to trazodone

Medication-induced priapism of the clitoris


Psychiatric and behavioral side effects—Miscellaneous

Also see: Suicidality; Mania or hypomania; Psychosis


Emotional blunting

Emotional blunting/ flattening (numbing, dulling, apathy)

Management of antidepressant-induced emotional blunting/ flattening (numbing, dulling, indifference)


Psychiatric and behavioral side effects—Miscellaneous

Which SSRIs are more sedating or more activating?

Can lamotrigine cause psychiatric side effects?


Psychosis

Can stimulant medications either “cause” psychosis or make it worse?

How to reduce the risk of psychosis with stimulants in patients with a past history of psychosis

Three scenarios in which psychosis can occur in a methamphetamine user


QT prolongation and other ECG changes

QT prolongation and other ECG changes—General articles

How to look up whether a drug can cause QTc prolongation or torsades

How to think about rare but serious side effects


QT prolongation and other ECG changes—Antidepressants

Three SSRIs that may cause QT prolongation

Doesn’t escitalopram cause QTc prolongation?

Can mirtazapine increase the risk of QT prolongation?

Can sertraline cause QT prolongation?


QT prolongation and other ECG changes—Antipsychotics

Antipsychotics and QTc prolongation

When to get an ECG when prescribing an antipsychotic

Antibiotics, antipsychotics, and QTc prolongation


QT prolongation and other ECG changes—Buprenorphine

Does buprenorphine cause QT prolongation and torsades de pointes?


QT prolongation and other ECG changes—Lamotrigine

What to do about the risk of arrhythmias with lamotrigine


QT prolongation and other ECG changes—Lithium

Lithium’s effects on the electrocardiogram (ECG, EKG)


QT prolongation and other ECG changes—Methadone

What to do about the risk of QT prolongation with methadone


QT prolongation and other ECG changes—Modafinil/ Armodafinil

Do modafinil/ armodafinil need cardiovascular monitoring?


QT prolongation and other ECG changes—Ondansetron

Ondansetron (Zofran®), QT prolongation, and psychotropic medications


  Rash—see “Skin reactions”


Raynaud's phenomenon or syndrome

Can psychostimulant medications cause Raynaud’s syndrome?


Renal impairment

Lithium-induced renal impairment: Clinical recommendations

Case: Rising serum creatinine in a patient on lithium

Case: Elevated serum creatinine that remained stable for many years

Which preparation of lithium is less likely to harm the kidneys?


Seizures

Antidepressants and seizures

Bupropion and seizures: the facts and the myths

Is a history of seizures in early childhood a contraindication to using bupropion?

What factors can increase the risk of seizures with bupropion?

Key information about seizures with clozapine

Transcranial Magnetic Stimulation (TMS): Risk of seizures


Serotonin toxicity (syndrome)

How to recognize serotonin toxicity (syndrome)

How to make the diagnosis of serotonin toxicity (syndrome)

How to distinguish between serotonin toxicity and NMS

How is serotonin toxicity managed?

Can psychedelics cause serotonin toxicity (syndrome)?


Sexual side effects

General articles

How often does antidepressant-induced sexual dysfunction resolve spontaneously?

Trazodone and priapism

Beta-blockers can worsen or improve erectile dysfunction


Evaluation of sexual side effects

Arizona Sexual Experiences Scale (ASEX)

An introduction to the Changes in Sexual Functioning Questionnaire (CSFQ)

How to administer, score, and interpret the Changes in Sexual Functioning Questionnaire (CSFQ)

Which laboratory tests in men with erectile dysfunction?


Management of sexual side effects

Management of antidepressant-induced sexual dysfunction

Does bupropion treat antidepressant-induced sexual dysfunction?

PsychopharMYTH: “Vortioxetine does not cause sexual dysfunction”

How to reduce the risk of erectile dysfunction

Management of sexual dysfunction: Interview with Anita Clayton, MD

Which PDE-5 inhibitor for erectile dysfunction?

How long before sexual activity should PDE-5 inhibitors be taken?

Cyproheptadine (Periactin®) for antidepressant-induced sexual dysfunction (ADISD)?

Transdermal testosterone for hypoactive sexual desire disorder in postmenopausal women


Flibanserin (Addyi®)

Flibanserin (Addyi®)

Flibanserin (Addyi®): Basic Information

Flibanserin (Addyi®) for hypoactive sexual desire disorder in postmenopausal women

Flibanserin (Addyi®): Systematic list of references


  Sialorrhea—see “Hypersalivation (Sialorrhea)”


Skin reactions

How common are benign and serious rashes with lamotrigine?

Dermatological precautions when starting lamotrigine

Restarting lamotrigine

Restarting lamotrigine: how many days? 

Restarting lamotrigine: A case study

Is it a benign or dangerous skin rash?

Non-drug causes of Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)

Do past infections increase the risk of Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN)?

Lithium and acne: Evaluation and management

Acneiform eruption associated with lamotrigine

Rash, irritation, or itching with transdermal patches

What to do about skin rash on SSRIs

Also see: Oral sores in a patient on lamotrigine 


Suicidality

What can we do about suicidality associated with antidepressants?

In whom can antidepressants increase the risk of suicidality?

Can isotretinoin (Accutane®, Roaccutane®) cause depression or suicidality?

What do published studies on isotretinoin and depression/ suicidality show?


Tachycardia

Which psychiatric medications can cause sinus tachycardia?

Don’t miss nicotine as a cause of the increase in pulse rate or blood pressure

Monitor pulse rate and blood pressure when bupropion and nicotine are combined


Tardive dyskinesia

Screening and Evaluation

How EXACTLY to screen for tardive dyskinesia

Abnormal Involuntary Movement Scale

Abnormal Involuntary Movement Scale (AIMS): Examination procedure

How to do an AIMS examination via telepsychiatry

Abnormal Involuntary Movement Scale (AIMS): Scoring instructions

AIMS-original in Guy (1976)—PDF download, for reference only

Tips on “informal” evaluation for involuntary movements

“Masked” dyskinesia versus “withdrawal-emergent” dyskinesia

Tips on diagnosing tardive dyskinesia

Risk factors

Is TD less likely with second-generation (“atypical”) antipsychotics?

Does any atypical antipsychotic have a lower risk of tardive dyskinesia?

Antidepressant-induced tardive dyskinesia

Management

Management of tardive dyskinesia: First-line options

Management of tardive dyskinesia: Second-line options

What is VMAT2 and what do VMAT2 inhibitors do?

Comparing the VMAT2 inhibitors

An Expert answers YOUR questions about tardive dyskinesia

Is tardive dyskinesia reversible if the antipsychotic is stopped?

Valbenazine (Ingrezza®): Basic information

Deutetrabenazine (Austedo®): Basic Information

Does vitamin E work for tardive dyskinesia?

Vitamin E: Potential adverse effects and drug interactions


Testicular pain

Some psychotropic medications can cause testicular pain


Teratogenicity

Potential risks of second-generation (atypical) antipsychotics in pregnancy

Is the use of lamotrigine during pregnancy safe?

Does methylphenidate during pregnancy increase the risk of congenital malformations?

Pregnancy and psychotropic medications: Online resources

Does this medication increase the risk of bad outcomes in pregnancy?

What are the possible risks of using lurasidone (Latuda®) during pregnancy?

Pregnancy registries

Encourage pregnant women on an antiepileptic drug to enroll in these registries


Thrombocytopenia

When do we need to worry about a low platelet count (thrombocytopenia)? 

Drug-induced thrombocytopenia: A primer for mental health clinicians

Can thrombocytopenia be due to alcohol use?

What to do if a patient develops thrombocytopenia during treatment with valproate 


Tinnitus

Why tinnitus is important for mental health clinicians

Key things to ask about if a patient complains of tinnitus

Tinnitus associated with antidepressant medications


Tremors

Tremors—Evaluation

Medication-induced tremors: An overview

How to examine a person with tremors

What if a tremor is either unilateral or asymmetrical?

What is the tremor in Parkinson’s disease like?

How to monitor change in the severity of a tremor


Lithium-induced tremor

Lithium-induced benign tremor: Introduction

Lithium-induced benign tremor: Clinical features

Lithium-induced benign tremor: Evaluation

Lithium-induced benign tremor: Treatment

Beta-blockers for lithium-induced benign tremor

Antiepileptic medications for lithium-induced benign tremor?

Vitamin B6 for lithium-induced benign tremor?


Urinary hesitancy/retention

Urinary hesitancy or retention due to atomoxetine

How to manage medication-induced urinary hesitancy/retention.


Urinary incontinence

Can antidepressants cause urinary incontinence?


Weight gain/Metabolic adverse effects

General

Should we prescribe medications for weight loss?

Why it is important to treat obesity

Medications for the treatment of obesity: Overview

Metabolic side effects—Antidepressants

Why I don’t usually prescribe paroxetine (Paxil®)

Which causes more weight gain—venlafaxine or duloxetine?

Any reassuring facts about weight gain with antidepressants?

Myth or Fact? Our verdict on common beliefs about antidepressants and weight gain

Check weight after one month on an antidepressant; take action if… 

Metabolic side effects—Second-generation antipsychotics

The lipid panel (profile): Why, when, and how to order it

Does weight gain with second-generation (atypical) antipsychotics plateau after the first few months?

How long does antipsychotic-induced hyperglycemia take to resolve?

Resolution of hyperglycemia after switching to aripiprazole

Add aripiprazole to treat clozapine-induced weight gain?

Monitoring for metabolic side effects in patients on a second-generation (atypical) antipsychotic


Metabolic side effects—Second-generation antipsychotics—Children and Adolescents

Do adolescents have more metabolic side effects with second-generation antipsychotics?

Monitoring for metabolic side effects in children and adolescents on a second-generation (atypical) antipsychotic

Metformin

Metformin to prevent or treat metabolic adverse effects due to antipsychotics

Who is more likely to benefit from metformin for the management of metabolic adverse effects?

Metformin for antipsychotic-induced weight gain in children and adolescents?

Potential adverse effects of metformin

Tips on prescribing metformin

Metformin AND topiramate for metabolic adverse effects?

GLP-1 receptor agonists

A simple primer on what GLP-1 agonists are

GLP-1 receptor agonists in patients on antipsychotic medications?

Semaglutide injection (Wegovy™) for weight loss in obesity and overweight

GLP-1 receptor agonists may reduce alcohol craving/ use

Are GLP-1 receptor agonists associated with an increased risk of suicidal ideation/ behavior?

Semaglutide injection (Wegovy™): Basic information

Semaglutide injection (Wegovy™): Side effects

Semaglutide injection (Wegovy™): Serious side effects, warnings, and contraindications

Tirzepatide (Zepbound™): Basic information 

Liraglutide (Victoza®, Saxenda®)

Naltrexone plus bupropion (Contrave®)

Naltrexone and bupropion (Contrave®): Basic Information

A generic alternative to naltrexone/bupropion (Contrave®)?

Topiramate

Can we use topiramate to treat medication-induced weight gain?

Metformin AND topiramate for metabolic adverse effects?

Other medications for weight loss

Phentermine-topiramate combination (Qsymia) for weight loss

Orlistat (Xenical®): Basic Information

Phentermine (Adipex-P®, Lomaira™): Basic information

Intermittent fasting

There are three different types of intermittent fasting

Who should NOT do intermittent fasting?

How well does intermittent fasting work? And, for what?

How exactly to do time-restricted eating

What side effects can occur with intermittent fasting?

Genetic polymorphisms and weight gain

HTR2C polymorphisms and medication-induced weight gain

Melanocortin 4 receptor (MC4R) and weight gain

Miscellaneous

Can melatonin increase blood sugar?



Weight loss/ Loss of appetite (Anorexia)

Tips on managing loss of appetite due to a stimulant (in adults)


Side effects references

Side effects: References


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Disclaimer: The material on this website is provided as general education for medical professionals. It is not intended for patients or other laypersons, nor is it a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified healthcare professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most up-to-date information.

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Comments

  1. Elizabeth Duthinh says

    September 16, 2024 at 2:02 pm

    Especially if there is any data on the relative impact on weight of different medications i.e. which is least likely to cause weight gain, etc.

    Reply
    • Rajnish Mago, MD says

      September 17, 2024 at 6:09 pm

      Let me start with the most clinically important facts: Overall, we should use bupropion more often–it has been convincingly shown to not cause any more weight gain than that which can occur with a placebo. And, we should avoid paroxetine if at all possible because it has been shown to cause more weight gain than the other SSRIs. Please see Why I don’t usually prescribe paroxetine (Paxil®)
      More to follow.

      Reply
  2. Elizabeth Duthinh says

    September 16, 2024 at 2:01 pm

    Hello, could you compare what is known about SSRIs/SNRIs (other than paroxetine) and weight gain side effects (rates of people experiencing weight gain, amount of weight gain over what period of time, etc) for a patient with many specific questions about this issue and a lot of anxiety starting medication?

    Reply
  3. Chinmay Kulkarni says

    July 20, 2020 at 4:11 am

    Hello Sir, Can you please also cover Headache as a side effect. What should be the strategy if patients starts getting headache as side effect?

    Reply
    • Rajnish Mago, MD says

      July 22, 2020 at 12:26 pm

      Dr. Kulkarni: There is not much to say about headache as a side effect. The cause of the headache should be determined, of course. For example, could it be due to hypertension, migraine, etc? For our article about headache due to lamotrigine, please see https://simpleandpractical.com/lamotrigine-headache/

      Reply
  4. Mumbi Kairu says

    February 11, 2020 at 1:18 pm

    Can you please cover rhabdomyolysis and schizophrenia treatment after a patient has had rhabdomyolysis due to psychotropics? What psychotropics are more favorable and not to be given after? Thank you

    Reply

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