Complications

Complication
Timeframe
Likelihood
short term
low

May be an adverse effect of some antidepressants.[129] Patients can be switched to an alternative antidepressant.

long term
medium

Most patients with persistent depressive disorder have comorbid psychiatric conditions, which are treated accordingly.

Generalized anxiety disorder

long term
medium

Most patients with persistent depressive disorder have comorbid psychiatric conditions, which are treated accordingly.

Overview of substance abuse and overdose

variable
high

Most patients with persistent depressive disorder will experience one or more major depressive episode during their lifetime, which may be recurrent ("double depression").[13][14][15]

variable
medium

Sexual adverse effects are common with various antidepressant medications, and may be under-reported; they may reduce medication adherence. Management includes watchful waiting, decreasing antidepressant dose, medication augmentation, use of sildenafil or related medications, and other strategies.[131]

variable
low

The suicide rate for patients with persistent depressive disorder is unknown, but is likely to be higher than for the general population because persistent depressive disorder has a chronic and often unremitting course. Selective serotonin reuptake inhibitors have been associated with increased suicidal thinking, particularly in adolescents.[83][130] Patients should be monitored closely for changes in behavior and/or the emergence of suicidal thinking.

variable
low

Significant effects in blood pressure are uncommon with newer antidepressants. They are more common with tricyclic antidepressant and monoamine oxidase inhibitors which can lead to orthostatic hypotension. Of newer antidepressants, serotonin-noradrenaline reuptake inhibitors such as duloxetine can increase blood pressure.

variable
low

Tricyclic antidepressants can prolong cardiac conduction.[132] Of newer antidepressants, citalopram has been reported to cause changes in cardiac conduction at high dose particularly QTc prolongation, but a 2022 study did not find dose-associated changes.[133][134]

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