Common side effects include drowsiness, dry mouth, loss of appetite, sweating, trouble sleeping, and sexual dysfunction. Serious side effects may include suicide in those under the age of 25, serotonin syndrome, and mania. While the rate of side effects appears similar compared to other SSRIs and SNRIs, antidepressant discontinuation syndromes may occur more often. Use in pregnancy is not recommended while use during breastfeeding is relatively safe.<unk>  shares many of the common adverse effects of SSRIs, including (with the corresponding rates seen in people treated with placebo in parentheses): * nausea 26% (9%) * diarrhea 12% (8%) * constipation 14% (9%) * dry mouth 18% (12%) * somnolence 23% (9%) * insomnia 13% (6%) * headache 18% (17%) * hypomania 1% (0.3%) * blurred vision 4% (1%) * loss of appetite 6% (2%) * nervousness 5% (3%) * paraesthesia 4% (2%) * dizziness 13% (6%) * asthenia (weakness; 15% (6%)) * tremor 8% (2%) * sweating 11% (2%) * sexual dysfunction (≥10% incidence). Most of these adverse effects are transient and go away with continued treatment. Central and peripheral 5-HT3 receptor stimulation is believed to result in the gastrointestinal effects observed with SSRI treatment. Compared to other SSRIs, it has a lower incidence of diarrhea, but a higher incidence of anticholinergic effects (e.g., dry mouth, constipation, blurred vision, etc.), sedation/somnolence/drowsiness, sexual side effects, and weight gain. Due to reports of adverse withdrawal reactions upon terminating treatment, the Committee for Medicinal Products for Human Use (CHMP) at the European Medicines Agency recommends gradually reducing over several weeks or months if the decision to withdraw is made. See also Discontinuation syndrome (withdrawal). Mania or hypomania may occur in 1% of patients with depression and up to 12% of patients with bipolar disorder. This side effect can occur in individuals with no history of mania but it may be more likely to occur in those with bipolar or with a family history of mania. Suicide Like other antidepressants,<unk>  may increase the risk of suicidal thinking and behaviour in people under the age of 25. The FDA conducted a statistical analysis of<unk>  clinical trials in children and adolescents in 2004 and found an increase in suicidality and ideation as compared to placebo, which was observed in trials for both depression and anxiety disorders. In 2015 a paper published in The BMJ that reanalysed the original case notes argued that in Study 329, assessing<unk>  and imipramine against placebo in adolescents with depression, the incidence of suicidal behavior had been under-reported and the efficacy exaggerated for<unk> . Sexual dysfunction Sexual dysfunction, including loss of libido, anorgasmia, lack of vaginal lubrication, and erectile dysfunction, is one of the most commonly encountered adverse effects of treatment with<unk>  and other SSRIs. While early clinical trials suggested a relatively low rate of sexual dysfunction, more recent studies in which the investigator actively inquires about sexual problems suggest that the incidence is higher than 70%. Symptoms of sexual dysfunction have been reported to persist after discontinuing SSRIs, although this is thought to be occasional. Pregnancy Antidepressant exposure (including<unk>  is associated with shorter duration of pregnancy (by three days), increased risk of preterm delivery (by 55%), lower birth weight (by ), and lower Apgar scores (by <0.4 points). The American College of Obstetricians and Gynecologists recommends that for pregnant women and women planning to become pregnant,<unk>  "be avoided, if possible", as it may be associated with increased risk of birth defects. Babies born to women who used<unk>  during the first trimester have an increased risk of cardiovascular malformations, primarily ventricular and atrial septal defects (VSDs and ASDs). Unless the benefits of<unk>  justify continuing treatment, consideration should be given to stopping or switching to another antidepressant.<unk>  use during pregnancy is associated with about 1.5–1.7-fold increase in congenital birth defects, in particular, heart defects, cleft lip and palate, clubbed feet or any birth defects. Discontinuation syndrome Many psychoactive medications can cause withdrawal symptoms upon discontinuation from administration. Evidence has shown that<unk>  has among the highest incidence rates and severity of withdrawal syndrome of any medication of its class. Common withdrawal symptoms for<unk>  include nausea, dizziness, lightheadedness and vertigo; insomnia, nightmares and vivid dreams; feelings of electricity in the body, as well as rebound depression and anxiety. Liquid formulation of<unk>  is available and allows a very gradual decrease of the dose, which may prevent discontinuation syndrome. Another recommendation is to temporarily switch to fluoxetine, which has a longer half-life and thus decreases the severity of discontinuation syndrome. In 2002, the U.S. FDA published a warning regarding "severe" discontinuation symptoms among those terminating<unk>  treatment, including paraesthesia, nightmares, and dizziness. The Agency also warned of case reports describing agitation, sweating, and nausea. In connection with a Glaxo spokesperson's statement that withdrawal reactions occur only in 0.2% of patients and are "mild and short-lived", the International Federation of Pharmaceutical Manufacturers Associations said GSK had breached two of the Federation's codes of practice.<unk>  prescribing information posted at GlaxoSmithKline has been updated related to the occurrence of a discontinuation syndrome, including serious discontinuation symptoms.
Paroxetine
Atomoxetine
Dapoxetine
Citalopram
Reboxetine
Escitalopram
Duloxetine
Fluoxetine