One size doesn’t fit all: UAE doctors on antidepressant side effects

Antidepressants, a mainstay in treating depression and related mental health conditions, do not affect everyone in the same way, according to leading psychiatrists in the UAE.

Experts told Gulf News that the choice of medication should be individualised, based on patient symptoms, lifestyle, and biological makeup, rather than a one-size-fits-all approach.

Recent research by King’s College London and the University of Oxford, which analysed 151 studies covering 30 antidepressants and more than 58,500 patients, ranked the side effects of different medications for the first time. The study highlights how physical side effects vary depending on the drug type, reinforcing the need for careful selection under medical supervision.

Depression affects millions

Dr Sheena Geetha Soman, Specialist, Psychiatry at NMC Specialty Hospital, Al Nahda, Dubai, said depression is highly prevalent worldwide, affecting more than 332 million people, with women at double the risk of men.
“Awareness is improving, but globally, only about 9 per cent of those in need actually seek treatment. In the UAE, mental health treatment seeking has increased over the years,” she said.

Neurochemical systems

Depression is complex, involving biological, psychological, and social factors, and antidepressants target multiple neurochemical systems, including serotonin, noradrenaline and dopamine.
“There are more than 30 antidepressants across different classes such as SSRIs, SNRIs, NDRIs, SARIs, and NaSSAs, each acting on different neurochemicals making its effects and side effects quite varied,” said Dr Soman.

Main classes

SSRIs (Selective Serotonin Reuptake Inhibitors)

Examples: sertraline, fluoxetine, escitalopram, paroxetine, citalopram

Most commonly prescribed first-line antidepressants.

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

Examples: venlafaxine, duloxetine, desvenlafaxine, levomilnacipran

Tricyclic antidepressants (TCAs)

Examples: amitriptyline, nortriptyline, imipramine, clomipramine

Atypical antidepressants

Examples: mirtazapine, bupropion, agomelatine, trazodone, vortioxetine

Symptoms guide choice

She explained that the choice of antidepressant is highly individualised based on age, gender and metabolic profile.

“For someone with sleeplessness, sertraline or mirtazapine, which has sedation as a known side effect, may help. Similarly, someone who has daytime somnolence (drowsiness) would feel better with fluoxetine or bupropion,” she said.

Side effects can vary

Dr Jasmine Mumtaz Jahanara, Specialist Psychiatrist at Lifeline Clinic, Sharjah, echoed that effects and side effects vary even within the same drug class.
“If one type of medication used to treat certain mental health conditions like depression and anxiety disorders fails, another may still work. Side effects also can differ.”

Dr Jahanara added that side effects can be unpredictable.
Sharing cases from her practice, she said: “A 24-year-old male patient improved after switching from paroxetine to fluoxetine but reported weight gain. Another patient on mirtazapine, which usually causes weight gain, lost weight instead. In a 27-year-old woman, high prolactin and delayed periods occurred on starting the medication, but upon re-initiation, the adverse effects did not reappear.”

Supervision maximises safety, effectiveness

Both psychiatrists emphasised close medical supervision and personalised treatment as the key to minimising side effects and maximising outcomes.
Dr Soman stressed that there is no single antidepressant suitable for everyone.
“Different drugs act differently with varied effects and side effects. Some drugs are preferred over the others considering multiple factors and there is no one antidepressant fit for all.”
With the growing availability of newer-generation antidepressants that combine efficacy with fewer side effects, doctors are increasingly adopting individualised approaches to help patients manage depression safely and effectively.