Adverse Events and SSRI Changes According to Online Drug Reviews

Su Golder, PhD

Credit: University of York

By analyzing patient and caregiver online drug reviews, an investigation shed light on the reasons behind selective serotonin reuptake inhibitors (SSRIs) medication changes and the importance of patient-reported adverse events (AEs).¹

These medications are widely prescribed for treating various mental disorders. However, maintaining patient adherence to SSRIs remains a significant challenge, necessitating a deeper understanding of the reasons behind discontinuation, according to the research.²

To address these crucial issues, Su Golder, PhD, Department of Health Sciences, University of York, leveraged natural language processing and machine learning techniques to extract valuable insights from patients' and caregivers' online drug reviews, with the aim to identify the primary reasons for SSRI discontinuation or changes in medication.¹

The study analyzed 667 drug reviews posted on the WebMD online health forum between September 2007 and August 2021. The reviews provided first-hand accounts from patients and caregivers, which were manually annotated to determine the type of medication change including discontinuation, switching to another medication, or a dose change.

It also assessed the underlying reasons for the change. Adverse events reported in the reviews were categorized using the Medical Dictionary for Regulatory Activities primary system organ class (SOC) codes. The frequency of adverse events was compared with spontaneous reporting systems maintained by regulatory agencies such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare Products Regulatory Agency.

The study sample consisted of 659 patients or caregivers, with 516 (78%) female patients and 410 (62%) who were between the ages of 25 - 54. Among the 667 reviews, 335 indicated SSRI discontinuation, 188 reported dose changes, and 179 reflected medication switches.

The majority of respondents (95%) were patients and the primary reason for medication discontinuation or switching was experiencing adverse events. Results showed dose changes were predominantly driven by the need for titration, with both uptitration and downtitration being initiated by either healthcare professionals or patients.

The most commonly reported adverse events were classified as psychiatric disorders, including insomnia, loss of libido, and anxiety. When compared with regulatory data, psychiatric adverse events, investigation-recorded adverse events (weight gain), and adverse events associated with the reproductive system (erectile dysfunction) were reported disproportionately more frequently in online drug reviews.

The data provided valuable insights into the medication behavior of patients receiving SSRIs, the study stated. The findings highlight the significance of patient-reported adverse events and the potential influence of these events on SSRI persistence.

Investigators noted the study suggests individuals may be more inclined to report adverse events on social media platforms than to healthcare professionals or regulatory agencies and these data obtained directly from patients or their caregivers offer a valuable source of information that can inform interventions aimed at improving medication adherence.

References:

1. Golder S, Medaglio D, O’Connor K, Hennessy S, Gross R, Gonzalez Hernandez G. Reasons for Discontinuation or Change of Selective Serotonin Reuptake Inhibitors in Online Drug Reviews. JAMA Netw Open. 2023;6(7):e2323746. doi:10.1001/jamanetworkopen.2023.23746
2. Cutler A; Mattingly G. Treatment Options in MDD. HCPLive. December 30, 2023. https://www.hcplive.com/view/treatment-options-in-mdd