Drugs are well known causes of eosinophilic lung disease. In many patients, drug-induced eosinophilic lung disease presents with transient eosinophilic infiltrates that disappear after discontinuation of the drug. Some patients, however, experience a fulminant, acute eosinophilia-like disease. Recently, we experienced a case of amitriptyline-associated acute eosinophilic pneumonia with respiratory failure in a diabetic hemodialysis patient. Eight days after treatment with amitriptyline, sudden fever, chill, dry cough and dyspnea developed. Subsequently, multiple patch consolidations appeared on the chest radiographs. Bronchoalveolar lavage (BAL), established a diagnosis of acute eosinophilic pneumonia. After immediate discontinuation of amitriptyline, a rapid clinical and radiological improvement was observed. The present case indicates that the possibility of acute eosinophilic pneumonia should be fully considered in dialysis patients developing unexplained respiratory symptoms while on amitriptyline therapy.
Acute Disease ; Adult ; Amitriptyline/*adverse effects ; Antidepressive Agents, Tricyclic/*adverse effects ; Female ; Human ; Pulmonary Eosinophilia/*etiology ; *Renal Dialysis

Randomized trials have shown that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have better safety profiles than classical tricyclic antidepressants (TCAs). However, an increasing number of studies, including meta-analyses, naturalistic studies, and longer-term studies suggested that SSRIs and SNRIs are no less safe than TCAs. We focused on comparing the common side effects of TCAs with those of newer generation antidepressants including SSRIs, SNRIs, mirtazapine, and bupropion. The main purpose was to investigate safety profile differences among drug classes rather than the individual antidepressants, so studies containing comparison data on drug groups were prioritized. In terms of safety after overdose, the common belief on newer generation antidepressants having fewer side effects than TCAs appears to be true. TCAs were also associated with higher drop-out rates, lower tolerability, and higher cardiac side-effects. However, evidence regarding side effects including dry mouth, gastrointestinal side effects, hepatotoxicity, seizure, and weight has been inconsistent, some studies demonstrated the superiority of SSRIs and SNRIs over TCAs, while others found the opposite. Some other side effects such as sexual dysfunction, bleeding, and hyponatremia were more prominent with either SSRIs or SNRIs.
Antidepressive Agents* ; Antidepressive Agents, Tricyclic ; Bupropion ; Depressive Disorder ; Drug-Related Side Effects and Adverse Reactions ; Hemorrhage ; Hyponatremia ; Mouth ; Seizures ; Serotonin and Noradrenaline Reuptake Inhibitors ; Serotonin Uptake Inhibitors

OBJECTIVETo compare the incidences of sexual dysfunction induced by mirtazapine and SSRI in the treatment of patients with depression.

METHODSUsing key-word retrieval from the compact disks of the Chinese biological medicine (CBM) data base, we analyzed the rates of sexual dysfunction from the published clinical control trials on depression treated with mirtazapine and SSRI by applying the fixed effects model (FEM) of evidence-based medicine (EBM).

RESULTSAmong 1108 cases in 14 studies, there were 5 cases of mirtazapine-induced and 106 cases of SSRI-induced sexual dysfunction, accounting for 0.90% and 19.2% respectively, OR = 0.07 (95% CI: 0.04-0.14), Z = 8.03, P < 0.01.

CONCLUSIONSSRI is far more likely to induce sexual dysfunction than mirtazapine in the treatment of depression.

Antidepressive Agents, Tricyclic ; adverse effects ; Depressive Disorder ; drug therapy ; Erectile Dysfunction ; chemically induced ; Humans ; Male ; Mianserin ; adverse effects ; analogs & derivatives ; Serotonin Uptake Inhibitors ; adverse effects

We present a case with decreased metabolic activity of CYP2D6, a cytochrome P450 enzyme catalyzing the metabolism of nortriptyline (NT). Conventional dosage regimen led to toxic plasma concentration of NT and adverse effects such as dry mouth, constipation, and dizziness in this case with genotype CYP2D6*5/*10B. This case suggests the clinical usefulness of pharmacogenetic testing in individualized dosage adjustments of NT.
Antidepressive Agents, Tricyclic/*adverse effects/pharmacokinetics ; Cytochrome P-450 CYP2D6/*genetics/metabolism ; Depression/*drug therapy/genetics ; Genotype ; Humans ; Male ; Middle Aged ; Nortriptyline/*adverse effects/pharmacokinetics