Antidepressants are the most frequently prescribed psychiatric medications in the United States. As of 2005, approximately 27 million people in the United States had received some sort of antidepressant therapy, mostly... [ view full abstract ]
Antidepressants are the most frequently prescribed psychiatric medications in the United States. As of 2005, approximately 27 million people in the United States had received some sort of antidepressant therapy, mostly prescriptions for second generation antidepressants (SGAs), and as of 2009, they made up $9.9 billion in U.S. sales. SGAs are now used to treat depressive disorders, anxiety disorders, Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD) as well as a variety of other mental health disorders and non-psychiatric medical conditions.
More recently, SGA's (SSRI medications in particular) have been used “off-label” to treat headache disorders. Headache disorders affect one in every seven adults. Several medications are utilized to ameliorate acute headache pain that act on neurotransmitter symptoms similar to antidepressants. The “triptans” are the most commonly prescribed medication to alleviate headache pain. These medications act as 5-HT1B/1D serotonin receptor agonists. Despite being investigated as a treatment for chronic headache and migraine, nearly every SGA lists headache as a common adverse effect of treatment.
Therefore a meta-analysis was conducted of randomized, placebo-controlled trials of SGA's to determine if headache is a side-effect of SGA treatment or, alternatively, a common comorbid symptom experienced by individuals starting antidepressant treatment unrelated to actual medication use. We further sought to investigate whether there are differences in headache risk between SGA classes (SSRI vs SNRI), between individual SGA agents and as function of medication dosing and whether risk of treatment emergent headaches was associated with differences in pharmacodynamics properties among SGAs.
This meta-analysis demonstrated that there was no statistically significant difference in relative risk of headache between the SSRI and SNRI groups and bupropion and possibly trazodone were associated with increased headache risk. In addition, there was no significant difference in the relative risk of headache with SGA’s based on diagnostic indication, pharmacological properties, and dosage of medications. With SSRI and SNRI medications, treatment-emergent headache is rarely a side-effect of the medication and much more likely to be coincidental than associated with treatment. With these results, further research should be conducted on bupropion and trazodone to verify a possible comorbidity side effect with headaches.
