This paper provides an updated review of the use of
antidepressant drugs in dermatology. Some of the
psychiatric disorders that are usually comorbid with dermatological disorders and respond to
antidepressants include
major depressive disorder,
obsessive compulsive disorder,
body dysmorphic disorder,
social phobia and
post-traumatic stress disorder usually secondary to
trauma and abuse during early life. Cutaneous symptoms may be the feature of a primary
psychiatric disorder, e.g. cutaneous body image problems,
dermatitis artefacta, neurotic excoriations and
trichotillomania, or psychiatric syndromes may be comorbid with a primary dermatological disorder such as the association of
major depressive disorder or
social phobia with
psoriasis and
obsessive compulsive disorder with
acne excoriee. Some of the salient pharmacological properties of the
tricyclic antidepressants (TCAs) and the
selective serotonin reuptake inhibitor (SSRI)
antidepressants are reviewed. The review indicates that the SSRI
antidepressants are potentially beneficial in the management of all the major psychiatric syndromes that are encountered in dermatological disorders. The generally more favourable side-effect profile of the
SSRIs, such as lower
cardiotoxicity in contrast to the TCAs, has made them the first-line agents for the treatment of depression. Furthermore, some of the pharmacological properties of the
antidepressant agents that are not related to their
antidepressant activity, such as the
histamine H1 blocking effect of TCAs, such as
doxepin,
amitriptyline and
trimipramine, are of benefit in dermatological conditions such as
urticaria and
pruritus. This paper reviews the general guidelines for use of
antidepressants and salient
drug-drug interactions resulting mainly from the inhibition of the
cytochrome P450 (
CYP) 2D6 and 3A3/4
isoenzymes by some of the SSRI
antidepressants. Before prescribing an
antidepressant agent, the specific guidelines, side-effect profile,
drug-drug interactions and most current indications should always be obtained.