Detecting Potential Medication Side Effects in Treating Depression and Anxiety

New findings in a cross-sectional study by Michael V. Heinz, MD, a postdoctoral research fellow affiliated with the AI and Mental Health: Innovation in Technology Guided Healthcare Lab at Geisel School of Medicine’s Center for Technology and Behavioral Health, published in JAMA Network Open, suggest a significant association between antidepressant use and measured movement, even when accounting for depression. Individuals treated with antidepressants had an overall lower level of physical activity.

Selective serotonin reuptake inhibitors (SSRIs) are a common first-line pharmacotherapy for managing some of the most common psychiatric conditions, including depression and anxiety. Although SSRIs have an improved adverse effect profile compared with their predecessors—the monoamine oxidase inhibitors and the tricyclic antidepressants—clinical evidence from the past several decades suggests that SSRIs are not benign.

Michael V. Heinz, MD

Generally well tolerated, SSRIs reported adverse effects include movement problems, sleep disruption, and gastrointestinal problems such as nausea and upset stomach. So far, there have been no large-scale studies using naturalistic, longitudinal, objective data to validate physical activity findings.

Relying on actigraphy that records acceleration or deceleration of body movements, Heinz and his team were able to examine longitudinally collected wearable movement data within a cross-sectional sample of 7,162 participants from the 2005-2006 National Health and Nutrition Examination Survey—a nationally representative population-based sample of noninstitutionalized persons in the U.S. with both medication information and passive movement data.

"Information passively collected from wearable devices shows great promise for detecting potential medication side effects in mental health,” says Heinz who is also an attending psychiatrist at Dartmouth Hitchcock Medical Center.

Improved knowledge of such movement-related adverse effects associated with the use of SSRIs is beneficial because this drug class is not generally associated with reduced physical movement and could better inform health care professionals about the potentially problematic downstream effects of these drugs. This awareness may also prevent movement-related problems associated with SSRIs from being misdiagnosed, unobserved, or untreated.

“As far as we know, this research is the first to investigate adverse effect profiles of SSRIs using naturalistic, passively collected, longitudinal data,” Heinz says. “Our analysis demonstrates an overall reduction in movement among those taking SSRIs compared with those who are not. And individuals prescribed SSRIs seem to have overall slower increase in movement in the morning and likewise a slower tapering of movement in the evening, suggesting less well-defined sleep-wake boundaries.”

The results, he says, highlight the utility of passively collected data for the exploration and characterization of adverse effects of medications and suggest the importance of future prospective research aimed at further understanding the association between antidepressants and movement.

Additional authors include George D. Price, BS; Franklin Ruan; Robert J. Klein, PhD; Matthew Nemesure, BS; Aliza Lopez; Nicholas C. Jacobson, PhD

Funding for this study was provided by the Neukom Institute for Computational Science, Dartmouth College, and Dartmouth College Open Access Fund. This work was partially funded by the National Institute of Mental Health and the National Institute of General Medical Sciences under grant 1 R01 MH123482-01.