Hatcher and Arroll did not mention enough the relevance of severe adverse drug reactions (ADR) associated with newer antidepressants.

Degner et al.(1) observed in an European Drug Surveillance project an overall incidence of severe ADRs of all antidepressants of 1.4% of exposed psychiatric in-patients. There is an increase of polypharmacy in psychiatric patients. Rüther et al.(2) observed that only 30% of in-patients recieved a single antidepressant.

Different antipychotic groups (SSRI, SNRI vs. tricyclic antidepressants) differed significantly in their ADR profiles. There are relevant ADRs associated with SSRI. The risk of (gastrointestinal) bleedings (3) and of osteoporosis and fractures (especially in older patients)(4). Suicidal behaviour and ideations(5) remain unclear in younger depressed patients and are discussed in public(6). A further problem is a QTc prolongation in treatment with citalopram and escitalopram(7). The extensive use of newer antidepressants in older patients may be a high risk. Good cooperation between general practitioners and psychiatrists is necessary.

1) Degner D, Grohmann R, Kropp S, Rüther E, Bender S, Engel RR, Schmidt LG.Severe adverse drug reactions of antidepressants: results of the German multicenter drug surveillance program AMSP. Pharmacopsychiatry 2004;37 S1:S39-45
2) Rüther, E., Grohmann, R., Degner D, Gruber-Rüther, A., Loosen, P. Drug Surveillance in Psychiatry: Update on Antidepressants. Abstract, ACNP-Meeting, 2007
3) Andrade C, Sandarsh S, Chethan KB, Nagesh KS.Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. J Clin Psychiatry 2010;71(12):1565-75
4) Ziere G, Dieleman JP, van der Cammen TJ, Hofman A, Pols HA, Stricker BH.Selective serotonin reuptake inhibiting antidepressants are associated with an increased risk of nonvertebral fractures. J Clin Psychopharmacol. 2008;28(4):411-7
5) Goldsmith L, Moncrieff J.The psychoactive effects of antidepressants and their association with suicidality. Curr Drug Saf. 2011;6(2):115-21
6) Hernandez JF, Mantel-Teeuwisse AK, van Thiel GJ, Belitser SV, Raaijmakers JA, Pieters T.Publication trends in newspapers and scientific journals for SSRIs and suicidality: a systematic longitudinal study. BMJ Open. 2011 Dec 6;1(2):e000290. Print 2011.
7) Howland RH.A critical evaluation of the cardiac toxicity of citalopram: part 1. J Psychosoc Nurs Ment Health Serv. 2011;49(11):13-6

Competing interests: None declared