A 55-year-old man comes to the office for a checkup. His medical history is significant for major depression treated with sertraline for the past 4 months, hypertension controlled with lisinopril, and diabetes mellitus controlled with diet. He does not use tobacco and drinks a glass of wine with dinner a few times a week. Vital signs are all within normal limits, and no abnormalities are noted on physical examination. Hemoglobin A1c is within normal limits. Which of the following is the most likely side effect of the treatment prescribed for this patient's depression?

Question

A 55-year-old man comes to the office for a checkup.  His medical history is significant for major depression treated with sertraline for the past 4 months, hypertension controlled with lisinopril, and diabetes mellitus controlled with diet.  He does not use tobacco and drinks a glass of wine with dinner a few times a week.  Vital signs are all within normal limits, and no abnormalities are noted on physical examination.  Hemoglobin A1c is within normal limits.  Which of the following is the most likely side effect of the treatment prescribed for this patient's depression?

Quizplus · Accepted Answer

Sertraline is one of the selective serotonin reuptake inhibitors (SSRIs) frequently used as first-line antidepressant therapy. Compared with older antidepressants (eg, tricyclic antidepressants [TCAs]), SSRIs have minimal activity at alpha-adrenergic, cholinergic, and histaminic receptors. They are generally more tolerable and significantly safer in overdose. However, SSRIs commonly cause sexual dysfunction, including decreased libido, decreased arousal, anorgasmia in women, and increased ejaculation latency in men. Sexual dysfunction can occur in more than 50% of patients receiving SSRIs and is a frequent cause of nonadherence. Physicians should routinely assess SSRI-treated patients for sexual dysfunction because some may be reluctant to discuss this side effect. (Choice A) Although SSRIs can prolong the QT interval slightly, they are unlikely to cause arrhythmias when used in recommended doses in patients who lack other risk factors. Cardiac arrhythmias are a serious side effect of TCA overdose. (Choice B) This patient's hypertension is well controlled. Hypertensive crisis is not associated with SSRIs but may occur if a patient taking a monoamine oxidase inhibitor (MAOI) ingests foods containing tyramine. (Choices C and G) Orthostatic hypotension and urinary hesitancy are common side effects of TCAs due to their antagonism of alpha-adrenergic and cholinergic receptors. However, these side effects are rarely seen with SSRIs. (Choices D and H) SSRIs are associated with a slightly increased risk of seizures and weight gain, but these effects are less common than sexual dysfunction. Seizures are more of a concern in patients taking TCAs and the norepinephrine-dopamine reuptake inhibitor bupropion. (Choice E) Serotonin syndrome can occur if an SSRI is combined with another serotonergic agent, such as an MAOI, or an illicit serotonergic substance, such as MDMA. It would be uncommon in a patient taking a single serotonergic drug at a normal dosage. Educational objective: Selective serotonin reuptake inhibitors (SSRIs) have improved tolerability and a better side-effect profile compared with tricyclic antidepressants and monoamine oxidase inhibitors but are associated with sexual dysfunction. Physicians should routinely inquire about sexual dysfunction because it is a relatively common side effect of SSRIs that may lead to nonadherence. __________ References: Sexual side-effects of antidepressant and antipsychotic drugs. (http://www.ncbi.nlm.nih.gov/pubmed/26382168) Prevalence and impact of antidepressant-associated sexual dysfunction in three European countries: replication in a cross-sectional patient survey. (http://www.ncbi.nlm.nih.gov/pubmed/19329551)

A 55-Year-Old Man Comes to the Office for a Checkup