Clinical Guidance: Antidepressant-Induced Liver Injury
Liver dysfunction related to antidepressant use is rare, but it is unpredictable and not always reversible. Liver damage is generally unrelated to dosage and can occur with any antidepressant, but higher risks are associated with iproniazid, nefazodone, phenelzine, imipramine, amitriptyline, duloxetine, bupropion, and trazodone. In most cases, onset occurs between several days and 6 months after the beginning of antidepressant treatment. Most affected patients are clinically asymptomatic, and symptoms overlap with those of depression, e.g., fatigue, asthenia, and anorexia. If liver toxicity is suspected, Voican et al. (p. 404) recommend discontinuing antidepressants and conducting liver function tests. In most cases, liver function improves after antidepressant treatment is stopped.