Many Patients Take to Online Forum to Vent About SSRIs

Discontinuation or dosage change of selective serotonin reuptake inhibitors (SSRIs) may be more common than one would think, according to a qualitative study of online drug reviews.

Out of 667 SSRI reviews posted to an online health forum by patients or caregivers, 335 posts were about discontinuing their medication — the most common type of medication change, reported Su Golder, PhD, of the University of York in England, and colleagues.

The most common reason for discontinuing SSRIs was adverse events, which was cited 231 times. Among the seven SSRIs included — escitalopram (Lexapro), sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), fluvoxamine (Luvox), vortioxetine (Trintellix), and fluoxetine (Prozac) — discontinuation rates ranged from 41% to 54% among the WebMD health forum reviews.

Of the adverse events mentioned in the reviews, the most common were psychiatric-related, the researchers noted in JAMA Network Open.

These mostly were related to mood disorders and disturbances, with apathy being a common complaint (64 people posting); sleep disorders and disturbances, especially insomnia (57 people posting); anxiety disorders and symptoms (48 people posting); and sexual dysfunction, disturbances, and gender identity disorders, particularly with loss of libido (38 people posting).

Nervous system disorders, with symptoms like dizziness, headache, and somnolence, were the second largest source of adverse events leading to medication changes. Gastrointestinal disorders and weight gain were also commonly reported.

Among the 335 posts that indicated a discontinuation of an SSRI, 19% of patients said they did so without consulting a healthcare professional, while 11% said they did consult one first. In the other 71% of cases, it was unclear if a healthcare professional was consulted.

Of the 60 posts that described time to their first adverse event, the median was only 1 day (range 0-180 days). Because these adverse events seemingly pop up so quickly after initiating medication, Golder’s group suggested that healthcare providers have quick follow-up discussions with patients — particularly within the first 2 weeks after beginning a new SSRI — in order to prevent patients from discontinuing medication early without proper guidance.

When comparing adverse events reported in this public online health forum to the FDA’s Adverse Event Reporting System (FAERS), psychiatric-related adverse events were more commonly cited on the forum (difference 17.3 percentage points). However, other adverse events like injury, poisoning, and procedural complications, plus general disorders and administration site conditions, were less likely to be reported on the health forum compared with the FDA system (difference -11.2 and -7.5% percentage points, respectively).

This was similar when the health forum posts were compared with U.K. Medicines and Healthcare Products Regulatory Agency (MHRA) data, with psychiatric adverse events being reported more commonly on the forum (difference 11.2 percentage points). The adverse event category of “investigation,” which included weight, hormone, and lipid analyses, were also 7.7% more likely to be reported on the health forum than in the MHRA database (mostly related to weight gain).

“Reports from the health website may reflect adverse events that are more likely to lead to medication discontinuation or that may not be reported as commonly to regulatory agencies due to, for example, patient embarrassment or the adverse event being deemed so well-known that another report is thought not to be worthwhile,” Golder and team wrote.

“It is challenging to study adverse events that are similar to the treated indication,” they added. “However, further investigation as to whether these adverse events lead to higher discontinuation is warranted.”

“This research could ascertain whether the higher proportion of psychiatric disorders in website posts reflects a higher rate of reporting or whether these types of adverse events are more salient to decisions to discontinue an SSRI,” they continued.

Trailing behind adverse events, other reasons that patients cited for changing their medication included titration, lack of effectiveness, feeling it was not necessary, or other reasons like pregnancy or running out of the medication. For those patients who reduced their dose, 18% said they did so without consulting a healthcare professional first.

“Interventions focusing on patient-centric elements, including potential adverse events, may improve medication adherence,” Golder’s group suggested.

“Future research on a larger scale could be used to examine adverse event profiles with different antidepressants and stratification by key demographic characteristics,” they concluded.

Overall, SSRIs had middling reviews from patients on a scale from 1 to 5 (with 5 being the best). Average medication ratings were 3.3 for overall satisfaction, 3.9 for ease of use, 3.1 for effectiveness, and 2.7 for satisfaction.

Most patients were on their medication for less than 6 months at the time of their review. More than half were receiving their SSRI to treat a form of depression, and 62% were ages 25 to 54.

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