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Diem, Susan J., Kristine Ruppert, Jane A. Cauley, YinJuan Lian, Joyce T. Bromberger, Joel S. Finkelstein, Gail A. Greendale, and Daniel H. Solomon. "Rates of Bone Loss Among Women Initiating Antidepressant Medication Use in Midlife." Journal of Clinical Endocrinology & Metabolism 98, no. 11 (November 1, 2013): 4355–63. http://dx.doi.org/10.1210/jc.2013-1971.
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Context: Concern has been raised that medications that block serotonin reuptake may affect bone metabolism, resulting in bone loss. Objective: The aim of the study was to compare annual bone mineral density (BMD) changes among new users of selective serotonin reuptake inhibitors (SSRIs), new users of tricyclic antidepressants (TCAs), and nonusers of antidepressant medications. Design and Setting: We conducted a prospective cohort study at five clinical centers in the United States. Participants: The study included 1972 community-dwelling women, aged 42 years and older, enrolled in the Study of Women's Health Across the Nation (SWAN). Exposure: The use of antidepressant medications was assessed by interview and verified from medication containers at annual visits. Subjects were categorized as nonusers (no SSRI or TCA use at any examination), SSRI users (initiated SSRI use after the baseline SWAN visit), or TCA users (initiated TCA use after the baseline visit), using a computerized dictionary to categorize type of medication. Main Outcome Measures: BMD at the lumbar spine, total hip, and femoral neck was measured using dual-energy x-ray absorptiometry at annual visits. Results: BMD was compared among 311 new users of SSRIs, 71 new users of TCAs, and 1590 nonusers. After adjustment for potential confounders, including age, race, body mass index, menopausal status, and hormone therapy use, mean lumbar spine BMD decreased on average 0.68% per year in nonusers, 0.63% per year in SSRI users (P = .37 for comparison to nonusers), and 0.40% per year in TCA users (P = .16 for comparison to nonusers). At the total hip and femoral neck, there was also no evidence that SSRI or TCA users had an increased rate of bone loss compared with nonusers. Results were similar in subgroups of women stratified by the Center for Epidemiologic Studies Depression Scale (<16 vs ≥16). Conclusions: In this cohort of middle-aged women, use of SSRIs and TCAs was not associated with an increased rate of bone loss at the spine, total hip, or femoral neck.
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Ferguson, James M. "SSRI Antidepressant Medications." Primary Care Companion to The Journal of Clinical Psychiatry 03, no. 01 (February 1, 2001): 22–27. http://dx.doi.org/10.4088/pcc.v03n0105.
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Altay, Mehmet Ali, Alper Sindel, Öznur Özalp, Nelli Yildirimyan, Dinçer Kader, Uğur Bilge, and Dale A. Baur. "Does the Intake of Selective Serotonin Reuptake Inhibitors Negatively Affect Dental Implant Osseointegration? A Retrospective Study." Journal of Oral Implantology 44, no. 4 (August 1, 2018): 260–65. http://dx.doi.org/10.1563/aaid-joi-d-17-00240.
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The success of osseointegration is influenced by several factors that affect bone metabolism and by certain systemic medications. Selective serotonin reuptake inhibitors (SSRIs) have been previously suggested to be among these medications. This study aims to investigate the association between systemic intake of SSRIs and failure of osseointegration in patients rehabilitated with dental implants. A retrospective cohort study was conducted, including a total of 2055 osseointegrated dental implants in 631 patients (109 implants in 36 SSRI \users and 1946 in 595 nonusers). Predictor and outcome variables were SSRI intake and osseointegration failure, respectively. The data were analyzed with Mann–Whitney test or Fisher exact test accordingly. Both patient-level and implant-level models were implemented to evaluate the effect of SSRI exposure on the success of osseointegration of dental implants. Median duration of follow-up was 21.5 months (range = 4–56 months) for SSRI users and 23 months (range –60 months) for nonusers (P = .158). Two of 36 SSRI users had 1 failed implant each; thus, the failure rate was 5.6%. Eleven nonusers also had 1 failed implant each; thus, the failure rate was 1.85%. The difference between the 2 groups failed to reach statistical significance at patient and implant levels (P = .166, P = .149, respectively). The odds of implant failure were 3.123 times greater for SSRI users compared with nonusers. Patients using SSRIs were found to be 3.005 times more likely to experience early implant failure than nonusers. The results of this study suggest that SSRIs may lead to increase in the rate of osseointegration failure, although not reaching statistical significance.
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Adams, Nicholas Norman. "Do Newer Antidepressant Drugs Really Have Reduced Side Effects? Examining a Random “Real World” Sample of 300+ Receivers of Medications." IAFOR Journal of Psychology & the Behavioral Sciences 6, no. 1 (December 12, 2020): 75–100. http://dx.doi.org/10.22492/ijpbs.6.1.05.
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Newer antidepressant drugs are frequently cited as having reduced side effect profiles to that of their older counterparts. However, recent studies have begun to dispute this claim, citing selective sampling, short clinical trials, and clinical trial environments as influencing reported outcomes. At present, little research on antidepressant side effects draws on RWD (Real-World Data). Despite this, interest in examining RWD samples for antidepressant drug side effects is increasing as of 2020. The reported study asked a random sample of 300+ individuals taking a variety of different antidepressant medications to complete online drug side effect self-report scales with previously high validity. Newer antidepressants belonging to the atypical antidepressant drug class were reported as having only slightly reduced side effects of weight gain compared with older SSRI-class medications. No reduced side effects of increased depression, anxiety, sexual dysfunction (SD), sleepiness, or suicidal ideation (SI) were found for the newer atypical-class medications vs older SSRI-class agents. Medication adherence did not differ significantly between SSRI and atypical classes. No evidence for reduced side effects was found for newer SSRI and atypical antidepressants vs older same-class drugs when comparing six new and old medications drawn from atypical and SSRI classes. However, atypical antidepressants were associated with increased use of adjunct medications to bolster primary treatment.
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Powell, Kerry K., Wei Wang, Kelly J. Kelleher, and Sarah H. O’Brien. "Use of SSRIs Not Associated with Increased Bleeding Events in Children: An Analysis of the Michigan Medicaid Database from 2000–2003." Blood 112, no. 11 (November 16, 2008): 2389. http://dx.doi.org/10.1182/blood.v112.11.2389.2389.
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Abstract Background and Aim : Serotonin reuptake inhibitors (SSRIs) have been used in children for a variety of psychiatric illnesses including depression, anxiety and eating disorders. In adults, there have been several studies demonstrating an association between SSRIs and increased bleeding events, particularly gastrointestinal bleeds. It is thought that SSRIs affect platelet aggregation by inhibiting serotonin uptake by platelets, resulting in decreased intra-platelet serotonin concentration. To date there are no pediatric studies evaluating bleeding risk in children taking SSRIs. The objective of this study was to evaluate the incidence of bleeding events in children who are prescribed SSRIs Methods : We performed a review of the Michigan Medicaid database from 2000–2003 and identified all children ages 0–18 years prescribed six commonly used SSRIs: citalopram, escitalopram, fluvoxamine, fluoxetine, paroxetine and sertraline. Children prescribed Attention deficit hyperactivity disorder (ADHD) or antipsychotic medications were used as comparison groups. We obtained demographic data including age, gender and race for individuals with both SSRI prescriptions and bleeding events. Bleeding events were defined according to previously published definitions for major and minor bleeding using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) diagnostic codes. Bleeding events must have occurred within 90 days of an SSRI prescription. For individuals with bleeding events, we evaluated all inpatient, outpatient and long term records during the 6 months before and after the event. We compared the incidence of bleeding events in the SSRI, ADHD, and antipsychotic medication groups by using Proc GENMOD in SAS 9.1.3. This accounted for the fact that there were patients on multiple medications. We found no statistical difference in the total number of bleeding events between the three medication categories. Results : Of 20,631 children prescribed SSRIs in the study population, six children experienced bleeding events (Table 1). The incidence of bleeding was 29 in 100,000 persons. Two events were associated with traumatic injuries and one was observed in a critically ill patient. There were 52,050 children on ADHD medication and 17,340 on atypical antipsychotics. The incidence of bleeding events in these groups was 13 in 100,000 and 40 in 100,000 respectively. Of note, two of six children in the SSRI group with bleeding events were also prescribed ADHD medication. TABLE 1 Patient Age (years) Gender Race Bleeding Event Associated Diagnosis 1 11.3 Male Black Intracerebral hemorrhage Subdural hemorrhage Lymphoid leukemia Sepsis Aspergillosis Acute respiratory failure Acute renal failure Perforation of intestine Adjustment disorder 2 12.3 Male White Hematoma-complication of procedure Femur fracture Closed reduction of fracture ADHD with hyperactivity Depressive disorder 3 13.4 Female White Subarachnoid hemorrhage Extradural hemorrhage Closed fracture base of skull Convulsive disorder Developmental delay 4 17.7 Female White Subdural hemorrhage ADHD with hyperactivity Intracranial injury 5 17.5 Female White Hemorrhage complicating a procedure Acute pharyngitis and tonsillitis Tonsillectomy 6 15.4 Female White Subdural hemorrhage Cerebral palsy Spastic hemiplegia Discussion : We found that the incidence of bleeding events in children taking SSRIs is not increased as compared to those taking ADHD and antipsychotic medication. The majority of bleeding events that occurred in the 6 children prescribed SSRIs were either associated with trauma or a known complication of a surgical procedure. There were no gastrointestinal bleeding events in the SSRI group. Our study suggests that the use of SSRIs does not confer an increased risk of abnormal bleeding events in children.
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Caley, Charles F. "Extrapyramidal Reactions and the Selective Serotonin-Reuptake Inhibitors." Annals of Pharmacotherapy 31, no. 12 (December 1997): 1481–89. http://dx.doi.org/10.1177/106002809703101208.
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OBJECTIVE: To review the known published reports of extrapyramidal reactions (EPRs) associated with the use of selective serotonin-reuptake inhibitors (SSRIs). DATA SOURCES: Information was selected from a MEDLINE search (January 1990 to January 1996) of English-language medical literature. Manual searches of pertinent journal article bibliographies were also performed. DATA EXTRACTION: Appropriate information from all reports obtained was included, with specific attention directed toward patient age, gender, primary psychiatric diagnosis, total daily SSRI dosage, dosage escalation strategy, and concurrent psychotropic medications. DATA SYNTHESIS: Reports of EPRs associated with SSRI use have been accumulating in the medical literature for several years. More commonly associated with high-potency antipsychotics, EPRs can have an adverse impact on medication compliance and hospital readmissions. The proposed hypothesis for EPRs occurring with SSRI use involves serotonin's inhibitory actions on extrapyramidal dopamine activity. Other possible contributing factors include pharmacokinetic interactions or drug—disease interactions. EPRs may include dystonias, dyskinesias, akathisia, parkinsonism, exacerbations of Parkinson's disease, and possibly the neuroleptic malignant syndrome. The majority of SSRI-related reactions appear to occur within the first month of treatment. Information from available case reports does not strongly support any consistent risk factor, although some worth considering may include total SSRI daily dose, rapid dose escalation strategies, increased age, female gender, concurrent psychotropics known to also precipitate EPRs, and concurrent disease states such as Parkinson's disease. Since SSRI-related EPRs have occurred in different situations with different possible contributing factors, clinical pharmacy practitioners and other healthcare providers should remain aware of these reactions and carefully consider educating and monitoring their patients accordingly. CONCLUSIONS: The use of SSRIs may be associated with the development of EPRs; therefore, appropriate monitoring should be considered for patients so that optimal pharmaceutical care may be provided.
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Al-Ghamdi, Badr Rashed. "Effect of High Selective Serotonin-Reuptake Inhibitor Doses on the Development and Treatment of Sarcoid-Like Reaction." Case Reports in Medicine 2020 (April 25, 2020): 1–4. http://dx.doi.org/10.1155/2020/9751837.
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Sarcoidosis is a systemic disorder characterized by the presence of noncaseating granulomas that are most commonly observed in the lungs. Sarcoid-like reaction has been reported to develop in response to several immune modulator agents and antidepressants. In this report, a case of pulmonary sarcoidosis that was strongly related to the use of more than the average recommended dose of selective serotonin-reuptake inhibitor (SSRI) medications has been described. The patient, a 37-year-old, single, Caucasian woman, who suffered from severe depression and who presented to the emergency department with shortness of breath, low-grade fever, a dry cough, fatigue, and the loss of appetite, was diagnosed with this condition, and she failed to respond to the administered sarcoidosis treatment until the SSRI medications that she was using were discontinued; furthermore, she relapsed when one of these medications was reintroduced. Based on these observations, we were able to show a possible relationship between sarcoid-like reaction and SSRIs, and therefore, in the case of patients with interstitial lung diseases who are using SSRIs, we recommend that meticulous precautions be taken while planning their treatment and careful follow-ups be implemented to monitor their progress.
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Marchocki, Zbigniew, Noirin E. Russell, and Keelin O’ Donoghue. "Selective serotonin reuptake inhibitors and pregnancy: A review of maternal, fetal and neonatal risks and benefits." Obstetric Medicine 6, no. 4 (August 8, 2013): 155–58. http://dx.doi.org/10.1177/1753495x13495194.
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Depression is common in women of childbearing age. Whereas non-pharmacological interventions are recommended as first line interventions, pharmacological treatment may be required. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants in pregnancy. Ideally, discussion of the risks and benefits of SSRI use in pregnancy should occur prior to pregnancy. The potential risks of psychotropic medications need to be balanced against the risks associated with untreated psychiatric conditions and the discontinuation of necessary medications.
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Lenze, Eric J., David Dixon, Petra Nowotny, Francis E. Lotrich, Peter M. Doré, Bruce G. Pollock, Anthony L. Hinrichs, and Meryl A. Butters. "Escitalopram reduces attentional performance in anxious older adults with high-expression genetic variants at serotonin 2A and 1B receptors." International Journal of Neuropsychopharmacology 16, no. 2 (April 17, 2012): 279–88. http://dx.doi.org/10.1017/s1461145712000351.
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Abstract Older adults are among the most vulnerable to adverse cognitive effects of psychotropic medications and, therefore, the personalization of psychotropic treatment based on adverse drug reactions in this demographic is of great importance. We examined changes on neuropsychological tests of attention attributable to selective serotonin reuptake inhibitor (SSRI) treatment in anxious older adults. We also examined whether variation in serotonin receptor genes was associated with reduced attentional performance with SSRIs. We examined change from pre- to post-treatment in two attention measures – digit span and coding – in 133 adults aged ⩾60 yr with generalized anxiety disorder in a 12-wk trial of escitalopram vs. placebo. We also examined attentional change in relation to genetic variability in four central serotonin receptors: the serotonin transporter and serotonin 1A, 2A and 1B receptors. Digit span scores were significantly lowered in patients receiving escitalopram relative to placebo, indicating reduced attentional performance attributable to the SSRI. Individuals with high-transcription variants in the receptors 5-HTR2A rs6311 and 5-HTR1B rs11568817 had greater reductions in attention with SSRI treatment compared to placebo. We conclude that SSRIs reduce attention in older adults, particularly in those with high-expression genetic variants at the serotonin 2A and 1B receptors. Analysing neuropsychological changes with SSRIs in relation to genetic variation in the serotonin system may be a useful strategy for detecting subgroups of older adults who are more susceptible to side-effects of SSRIs. These results, if confirmed, could lead to the personalization of SSRI use to reduce adverse neurocognitive effects.
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Levinson, Michael H., Mortimer Ostow, Edward Wolpert, Larry S. Sandberg, Frederic J. Levine, and Richard M. Gottlieb Responds. "On the Therapeutic Action of SSRI Medications." Journal of the American Psychoanalytic Association 52, no. 2 (June 2004): 483–98. http://dx.doi.org/10.1177/00030651040520020801.
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Iro, Chidiebere Michael, and Rami Hamati. "Pharmacogenetics of Major Depressive Disorder (MDD): Progress in Two Serotonergic Targets." University of Ottawa Journal of Medicine 8, no. 2 (November 15, 2018): 35–39. http://dx.doi.org/10.18192/uojm.v8i2.3858.
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Major depressive disorder (MDD) is a multifaceted, debilitating condition affecting over 300 million people worldwide. It contributes significantly to social, psychological and economic burdens on individuals and on society at large. Currently, the most widely prescribed antidepressant medications are selective serotonin reuptake inhibitors (SSRIs), which act by blocking serotonin (5-HT) reuptake into presynaptic neurons, thereby increasing the extracellular 5-HT concentration in the brain. However, response to SSRIs and other psychotropic medications used to treat depression is highly variable, with only about one third of patients responding to treatment with an SSRI. This may reflect, at least in part, the genetic heterogeneity of depressed individuals. Studies investigating the genetic components of depression aim to improve treatment outcomes and possibly pave the way for personalized medicine in which the first medication prescribed is the one most likely to result in remission. This review presents the results of several studies on two 5-HT related genes: SLC6A4 and HTR2A, which encode for the serotonin transporter and the serotonin-2A receptor, respectively. Extensive studies have demonstrated that possessing two copies of the long allele (L/L) of the SLC6A4 gene can predict better responses to the SSRI Escitalopram. However, this finding was significant only in the Caucasian population. In addition to this, several single nucleotide polymorphisms in the HTR2A gene also predict clinical outcome, although molecular mechanisms remain unclear. Hence, the results indicate that while there is significant potential for predicting treatment response associated with these and other genetic targets, there is much work left to be done to establish conclusive evidence for and feasibility of pharmacogenetic testing.
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AUSTIN, MARIE-PAULE. "To treat or not to treat: maternal depression, SSRI use in pregnancy and adverse neonatal effects." Psychological Medicine 36, no. 12 (July 25, 2006): 1663–70. http://dx.doi.org/10.1017/s003329170600835x.
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Recent pharmaceutical company and regulatory body circulars warning against the use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy have left clinicians in somewhat of a quandary as to how to manage their more severely depressed patients in pregnancy. Conversely, up to 75% of depressed women ceasing their antidepressants periconceptually will relapse. Studies reporting on adverse neonatal outcomes following exposure to SSRIs in the latter half of pregnancy suggest that the fetus is exposed to significant concentrations of these medications during this time. Adverse neonatal effects affecting the respiratory, gastrointestinal and neurological systems are, however, predominantly mild and self-limiting. One small retrospective case study suggests that SSRI exposure in the latter half of pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the neonate (PPHN), however, the absolute risk of developing PPHN remains very small and these findings will require replication with a prospective study. While the studies to date suggest the need to closely monitor SSRI-exposed neonates in the immediate postnatal period, preferably with a neonatal withdrawal scale and access to neonatology services, there is currently no clear argument for women to be weaned off their SSRI in late pregnancy. The decision to use SSRIs at this time will have to be made on a case-by-case basis in close consultation with the mother and her partner.
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Thom, Robyn P., Michelle L. Palumbo, Claire Thompson, Christopher J. McDougle, and Caitlin T. Ravichandran. "Selective Serotonin Reuptake Inhibitors for the Treatment of Depression in Adults with Down Syndrome: A Preliminary Retrospective Chart Review Study." Brain Sciences 11, no. 9 (September 15, 2021): 1216. http://dx.doi.org/10.3390/brainsci11091216.
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Background: Depression is a common psychiatric comorbidity in individuals with Down syndrome (DS), particularly adults, with an estimated lifetime prevalence of at least 10%. The current literature on the treatment of depression in adults with DS is limited to case series published more than two decades ago, prior to the widespread use of modern antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs). The purpose of this retrospective chart review study was to examine the effectiveness, tolerability, and safety of SSRIs for depression in adults with DS. Methods: Medical records of 11 adults with DS and depression were reviewed. Assignment of scores for severity (S) of symptoms of depression and improvement (I) of symptoms with treatment with an SSRI was made retrospectively using the Clinical Global Impression Scale (CGI). Demographic and clinical characteristics of the study population, SSRI name, dose, and duration of treatment; and adverse effects were also recorded. Results: All 11 patients (7 male, 4 female; mean age = 27.2 years, range 18–46 years) completed a 12-week treatment course with an SSRI. The median duration of time after initiation of the SSRI covered by record review was 2.1 years, with a range of 24 weeks to 6.7 years. Nine of the 11 patients (82%; 95% CI 52%, 95%) were judged responders to SSRIs based on a rating of “much improved” or “very much improved” on the CGI-I after 12 weeks of treatment (median time of follow-up was 14.4 weeks, with a range of 12.0–33.0 weeks). Adverse effects occurred in four patients (36%). The most common adverse effects were daytime sedation and anger. Conclusions: In this preliminary retrospective study, the majority of patients responded to a 12-week course of SSRI treatment and some tolerated long-term use. Controlled studies are needed to further assess the efficacy, tolerability, and safety of SSRIs for the treatment of depression in adults with DS.
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GM Bolton, Patrick, Steven W Tipper, and Judith L Tasker. "Medication review by GPs reduces polypharmacy in the elderly: A quality use of medicines program." Australian Journal of Primary Health 10, no. 1 (2004): 78. http://dx.doi.org/10.1071/py04011.
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This paper describes a Quality Use of Medicines program, addressing polypharmacy in the elderly through a quality assurance program that assisted GPs to improve their prescribing through medication reviews. Sixty-two GPs from four Divisions of General Practice each enrolled up to 12 of their patients aged over 65 for medication review. Data about the total number of medications, and number and dosage of selected cardiovascular and psychotropic medications taken by these patients, were collected. A statistically significant reduction in the total number of medications (p < 0.00005), and the dose (p = 0.028) and number (p = 0.0077) of benzodiazepines, and an increase in the number of Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants (p = 0.0075) were observed. We conclude that these results suggest that medication review by GPs on patients who have complex care needs can be associated with a reduction in the median number of medications that these patients take.
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Rai, Salakan, and Aizad Yusof. "An audit on prescribing practice and risk of serotonin syndrome among patients with chronic pain." BJPsych Open 7, S1 (June 2021): S152. http://dx.doi.org/10.1192/bjo.2021.425.
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AimsTo determine the incidence of prescribing practice with associated risk of serotonin toxicity among patients with chronic pain conditions.BackgroundSerotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity, usually from drug interactions. Concurrent use of antidepressants is strongly linked to serotonin syndrome, with recent data revealing record numbers of NHS prescribed antidepressants in 2019. Antidepressant medications are also used in chronic pain management for their anti-neuropathic pain properties. However, it is well-recognised that a significant number of chronic pain patients suffer from anxiety and depression. This cohort of patients is therefore vulnerable to being exposed to multiple concurrent antidepressant agents, and thus at relatively higher risk of serotonin syndrome compared to other patient groups. Additionally, these patients are likely to be exposed to the concurrent use of antidepressants and certain analgesic agents particularly phenylpiperidine derivatives which increases serotonin toxicity risk.MethodMedications of patients presenting to a secondary care pain clinic within the last year were looked into. Patients were selected at random by pain management secretaries. Concurrent use of multiple antidepressant agents including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Noradrenaline Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs) or Tetracyclic Antidepressant (TeCA) was noted. Additionally, concurrent use of any of these antidepressant agents and phenylpiperidine derivatives such as Fentanyl and Tramadol was noted.ResultData on medications of 97 patients were collected. A total of 28 patients (28.8%) were observed to have at-risk medication combinations. Out of these, five patients were on both SSRI and TCA. Two patients were on both TCA and TeCA. Four other patients were on either a combination of SSRI and SNRI, SNRI and TCA, SSRI and TeCA, or TCA and TCA. Three patients were on both Fentanyl patches and an antidepressant. Fourteen patients were on both an antidepressant and Tramadol. None of these patients were diagnosed with serotonin syndrome; however, it is unclear as to whether these patients experienced milder symptoms of the syndrome.ConclusionA considerable number of patients in this group were on medication combinations putting them at risk of serotonin syndrome. Despite no documented patient harm, there is an urgent need for an increased awareness among prescribers on drug interactions which may lead to this syndrome and a subsequent change in prescribing practice.
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Del Casale, Antonio, Serena Sorice, Alessio Padovano, Maurizio Simmaco, Stefano Ferracuti, Dorian A. Lamis, Chiara Rapinesi, et al. "Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)." Current Neuropharmacology 17, no. 8 (July 25, 2019): 710–36. http://dx.doi.org/10.2174/1570159x16666180813155017.
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Background:Obsessive-compulsive disorder (OCD) is associated with affective and cognitive symptoms causing personal distress and reduced global functioning. These have considerable societal costs due to healthcare service utilization.Objective:Our aim was to assess the efficacy of pharmacological interventions in OCD and clinical guidelines, providing a comprehensive overview of this field.Methods:We searched the PubMed database for papers dealing with drug treatment of OCD, with a specific focus on clinical guidelines, treatments with antidepressants, antipsychotics, mood stabilizers, off-label medications, and pharmacogenomics.Results:Prolonged administration of selective serotonin reuptake inhibitors (SSRIs) is most effective. Better results can be obtained with a SSRI combined with cognitive behavioral therapy (CBT) or the similarly oriented exposure and response prevention (ERP). Refractory OCD could be treated with different strategies, including a switch to another SSRI or clomipramine, or augmentation with an atypical antipsychotic. The addition of medications other than antipsychotics or intravenous antidepressant administration needs further investigation, as the evidence is inconsistent. Pharmacogenomics and personalization of therapy could reduce treatment resistance.Conclusion:SSRI/clomipramine in combination with CBT/ERP is associated with the optimal response compared to each treatment alone or to other treatments. New strategies for refractory OCD are needed. The role of pharmacogenomics could become preponderant in the coming years.
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Zimmerman, Mark. "Introduction: Selecting an Antidepressant." CNS Spectrums 14, S12 (2009): 4–7. http://dx.doi.org/10.1017/s1092852900026341.
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Four years ago, my colleagues and I published an article titled “Why isn't bupropion the most frequently prescribed antidepressant?” The goal of that article was not to advocate bupropion as the preferred agent for treating depression, but rather to stimulate discussion about how psychiatrists choose an antidepressant as well as to highlight the gap between results of efficacy studies and clinical decision making in real-world practice.The argument in support of bupropion being the preferred antidepressant was based on three premises: all antidepressants are equally effective; adverse effects (AEs) of greatest concern to patients who take antidepressants are weight gain and sexual dysfunction; and bupropion does not cause either of these AEs. Acceptance of these three premises suggested the title of that article.Although many reviews of the antidepressant literature, including the revised American Psychiatric Association Practice Guideline for the Treatment of Major Depressive Disorder, conclude that antidepressants are equally effective in general, several experts in the treatment of depression have suggested that medications with >1 mechanism of action may be more effective than agents that have more selective neurotransmitter effects. In a meta-analysis of eight studies comparing the remission rates in patients treated with the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine or selective serotonin reuptake inhibitors (SSRIs), Thase and colleagues demonstrated that venlafaxine was more effective than SSRIs in achieving remission in depressed patients. However, these conclusions were tentative as most of the included studies were comparisons of venlafaxine and fluoxetine; only one study included sertraline, and there were no studies of citalopram included in the review. In addition, patients who had previously failed treatment with an SSRI were not excluded, and, although patients who fail with one SSRI may respond to subsequent treatment with another SSRI, the inclusion of SSRI failures may favor venlafaxine in comparisons with SSRIs. Lastly, all of the studies included in the meta-analysis were funded by the manufacturer of venlafaxine.
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Fleischmann, Arnold W., and Simon Mantha. "Effect of Selective Serotonin Reuptake Inhibitors On Intraoperative Blood Loss in Patients Undergoing Prostatectomy." Blood 114, no. 22 (November 20, 2009): 4454. http://dx.doi.org/10.1182/blood.v114.22.4454.4454.
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Abstract Abstract 4454 Background Selective serotonin reuptake inhibitors (SSRI's) are commonly used in the treatment of depression and anxiety disorders. They induce a mild inhibition of platelet aggregation; this is thought to be mediated by a depletion of platelet serotonin. Some studies have shown an association between SSRI intake and GI bleeding; aspirin and non-steroidal anti-inflammatory drugs (NSAID's) might increase the risk even more when used concomitantly. An increase in surgical bleeding during orthopedic procedures has also been noted in users of this class of medications. To our knowledge, there is no published data on the effect of SSRI's on hemostasis during prostatectomy. The objective of this study was to examine if patients taking a SSRI and undergoing prostatectomy had a higher rate of bleeding and required more red cell transfusions than patients not taking such a medication. Methods Institutional review board approval was obtained to perform this retrospective study; the initial phase was conducted on 1,308 adults undergoing either suprapubic, retropubic, perineal, laparoscopic or robotic-assisted laparoscopic prostatectomy for prostate cancer between 2002 and 2008 at the Lahey Clinic. The Department of Urology database was queried to identify relevant surgical cases, the amount of blood lost and the number of red cell transfusions given during each procedure. Patient records available through the Lahey electronic system were reviewed to identify pre-operative medications and comorbidities having a potential to affect surgical hemostasis. The use of antidepressants by type, aspirin, clopidogrel, NSAID's and anticoagulants was recorded, as were a history of liver disease, renal insufficiency, thrombocytopenia or any coagulopathy. Statistical analysis was conducted with the SAS software, version 9.2; means were compared using Student's T-test. Results 3.2% of the patients included in the analysis were on a SSRI until the day of the surgery. Aspirin, clopidogrel and warfarin were discontinued in view of the upcoming procedure, with rare exceptions. Analysis was stratified according to the type of prostatectomy, either open (suprapubic, retropubic or perineal) or laparoscopic (with or without robotic assistance). Mean age was 58.2 years for SSRI users and 59.2 years for non-users (p=0.31). There was no significant difference in the distribution of comorbidities between SSRI users and non-users. In the open prostatectomy group, use of aspirin in the immediate pre-operative period was more prevalent in the group of SSRI users compared to non-users (6.3% vs 0.8%, p=0.03), as was the uninterrupted use of NSAID's (6.3% vs 0.2%, p=0.0002); please see table 1 for details. In the open surgery group, mean volume of blood lost was 794 mL for SSRI users, compared to 878 mL for non-users (p=0.57). In the laparoscopic surgery group, mean blood loss was 178 mL in SSRI users vs 188 mL in non-users (p=0.69). In the laparoscopic procedure group, only 1 out of 807 patients was transfused. In the open surgery group, 31.3% of SSRI users required one unit of red cells, compared to 29.8% for non-users (p=NS). Only one patient died in the hospital; he belonged to the laparoscopic approach group (SSRI non-user). Conclusion In this study, the use of a SSRI did not confer an increased risk of surgical bleeding. This was noted even in patients undergoing open prostatectomy, in spite of more patients in the SSRI user group taking aspirin or a NSAID up to the day of the surgery. Disclosures: No relevant conflicts of interest to declare.
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Bezabhe, Woldesellassie M., Luke R. Bereznicki, Jan Radford, Barbara C. Wimmer, Mohammed S. Salahudeen, Ivan Bindoff, Edward Garrahy, and Gregory M. Peterson. "Five-Year Trends in Potential Drug Interactions with Direct-Acting Oral Anticoagulants in Patients with Atrial Fibrillation: An Australian-Wide Study." Journal of Clinical Medicine 9, no. 11 (November 5, 2020): 3568. http://dx.doi.org/10.3390/jcm9113568.
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Background: Co-prescribing medications that can interact with direct-acting oral anticoagulants (DOACs) may decrease their safety and efficacy. The aim of this study was to examine the co-prescribing of such medications with DOACs using the Australian national general practice dataset, MedicineInsight, over a five-year period. Methods: We performed five sequential cross-sectional analyses in patients with atrial fibrillation (AF) and a recorded DOAC prescription. Patients were defined as having a drug interaction if they had a recorded prescription of an interacting medication while they had had a recorded prescription of DOAC in the previous six months. The sample size for the cross-sectional analyses ranged from 5333 in 2014 to 19,196 in 2018. Results: The proportion of patients who had potential drug interactions with a DOAC decreased from 45.9% (95% confidence interval (CI) 44.6%–47.4%) in 2014 to 39.9% (95% CI 39.2%–40.6%) in 2018, p for trend < 0.001. During this period, the most frequent interacting class of medication recorded as having been prescribed with DOACs was selective serotonin/serotonin and norepinephrine reuptake inhibitor (SSRI/SNRI) antidepressants, followed by non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (CCBs) and amiodarone. Conclusions: Overall, potential drug interactions with DOACs have decreased slightly over the last five years; however, the rate of possible interaction with SSRIs/SNRIs has remained relatively unchanged and warrants awareness-raising amongst prescribers.
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Avrahamy, Hamutal, Gal Shoval, Moshe Hoshen, Ran D. Balicer, Shiri Kamhi-Nesher, Gil Zalsman, Abraham Weizman, and Amir Krivoy. "Association between Adherence to SSRI Treatment and Mortality among Individuals with Metabolic Syndrome Components." Pharmacopsychiatry 54, no. 05 (April 14, 2021): 232–39. http://dx.doi.org/10.1055/a-1425-7246.
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ABSTRACT Introduction Depression and anxiety have been associated with type 2 diabetes mellitus and metabolic syndrome, major causes of cardiovascular morbidity and mortality. The effect of antidepressants in this association is unknown. This study aimed to examine the association between adherence to selective serotonin receptor inhibitors (SSRIs) and all-cause mortality among individuals with metabolic syndrome components (hypertension, obesity, and diabetes mellitus). Methods Data on 201 777 patients who were prescribed SSRIs during the years 2008–2011 were analyzed retrospectively. Adherence was measured using prescription purchase records. The moderating effect of SSRI and statin adherence on the association between metabolic syndrome load and mortality hazard risk (HR) during the study period were analyzed. The Cox-proportional hazard model adjusted to background variables was used to this end. Results During the study period, the maximal metabolic load was associated with mortality HR=1.89 (95% CI: 1.79–2) compared to participants without metabolic risk factors. A slight reduction in mortality HR was demonstrated among those with low and moderate SSRI adherence rates. Adherence to statins was negatively associated with the risk of mortality across all levels of adherence. A significant association (r=0.214, p<0.01) was found between adherence to statins and adherence to SSRIs, with higher rates of adherence to statins across all metabolic load categories. Discussion While a high metabolic load is associated with a higher risk of mortality, adherence to SSRIs only partially moderated the risk of mortality, in contrast to the protective effect of statins. Adherence differences to statins and SSRIs among individuals prescribed both medications merit further investigation.
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Gottlieb, Richard. "A Psychoanalytic Hypothesis Concerning the Therapeutic Action of SSRI Medications." Journal of the American Psychoanalytic Association 50, no. 3 (June 2002): 969–71. http://dx.doi.org/10.1177/00030651020500030801.
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Wilson, Lindsay B., Mark R. Cox, Matthew V. Benns, Christina M. Pinkston, and Leigh A. Scherrer. "Serotonin-Modulating Antidepressants and Risk of Bleeding after Trauma." American Surgeon 84, no. 11 (November 2018): 1727–33. http://dx.doi.org/10.1177/000313481808401126.
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Serotonin-modulating antidepressants have been associated with increased risk of gastrointestinal bleeding and increased blood loss during elective surgery. This study sought to investigate the effect of preinjury selective-serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI) use on transfusion requirements after trauma, and to evaluate whether resumption of SSRI/SNRI after trauma may worsen bleeding risk. This was a retrospective matched-cohort study evaluating patients with solid organ injury. Preinjury SSRI/SNRI users were matched to non-SSRI/SNRI users based on age, preinjury aspirin use, Injury Severity Score, and abdominal Abbreviated Injury Severity Score. The primary endpoint was transfusion requirement during hospitalization. The absolute need for transfusion was higher in SSRI/SNRI users throughout hospitalization (50.9% vs 37.3%, P = 0.02). After logistic multivariate analysis, SSRI/SNRI users were more likely to require transfusion at 24 hours (odds ratio (95% confidence interval): 2.73 (1.41, 5.29), P = 0.003), but this difference did not persist for overall hospitalization (odds ratio (95% confidence interval): 1.32 (0.74, 2.36), P = 0.35). Fewer patients restarted on SSRI/SNRI therapy within 72 hours required packed red blood cell transfusion compared with those who were restarted later or not at all (43.2% vs 60.3%; P = 0.04). Preinjury use of serotonin-modulating antidepressants led to an increased requirement of blood transfusions after solid organ injury. Although clinicians should weigh bleeding risk before reinitiation of SSRI/SNRI, the results of this study indicate that reasonable efforts to restart these medications after stabilization do not result in further risk for transfusion.
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Lavan, Amanda, Deirdre O'Mahony, Mary Buckley, Denis O'Mahony, and Paul Gallagher. "150 Severe Drug Interactions (SDIs) and Potentially Inappropriate Prescriptions (PIPs) in Older Adults with Cancer." Age and Ageing 48, Supplement_3 (September 2019): iii1—iii16. http://dx.doi.org/10.1093/ageing/afz102.33.
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Abstract Background The objectives of this study were to identify the prevalence of severe drug interactions (SDIs) and potentially inappropriate prescriptions (PIPs) in older adults with cancer. Methods A 12-month prospective observational study of patients ≥65 years admitted to an oncology centre was conducted. SDIs were assessed using Stockley’s interaction checker; PIPs were identified using STOPP/START criteria. Logistic regression was applied to determine the influence of age, gender, co-morbidities and medication number on the likelihood of an SDI and a PIP. Results We enrolled 186 participants; mean age 72.5 (SD5.7) years, 46.2% female, mean co-morbidity number 7.5 (SD3.4), median medication number 7 (IQR4-9). Polypharmacy (≥6 medications) and major polypharmacy (≥11 medications) were identified in 60.8% and 17.7% respectively. Systemic anti-cancer therapies (SACTs) were concomitantly prescribed to 60.2%. SDIs were identified in 50.5% participants; 7.5% ≥1 SACT-SACT SDI, 41.4% ≥1 drug-drug SDI and 10.2% ≥1 drug-SACT SDI. The most common SDIs were beta-blocker/alpha-blocker (n=12), Selective serotonin re-uptake inhibitor (SSRI)/proton pump inhibitor (PPI) (n=11) and SSRI/Aspirin (n=8). A strong correlation between medication and SDI number was identified (r2=0.61, p-value <0.001). For each additional prescription, the odds of an SDI increased by 50.8% (Odds ratio 1.508, 95% CI1.288–1.764, p<0.001). PIPs were observed in 73.1%; median 2(IQR1-3). The most common PIPs were drugs prescribed beyond the recommended duration (46.8%), high-dose PPIs >8 weeks (34.9%) and regular opioids without laxatives (20.4%). Patients prescribed ≥1 PIP had more co-morbidities (8.4(SD3.4) vs 5.2(SD2.4), p< 0.001), a higher cumulative illness rating score (18(IQR12-20) vs 11(IQR10-14), p<0.001) and more prescribed medications (8(IQR6-10) vs 3(IQR1-4.25), p<0.001). For each additional prescription, the odds of receiving a PIP increased by 79.2% (Odds ratio 1.792, 95% CI1.459–2.02, p<0.001). Conclusion SDIs and PIPs are common in older adults with cancer and higher than previously reported. Comprehensive specialist medication evaluation, by a Geriatrician, may benefit patients.
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Wenzel, Richard G., Stewart Tepper, William E. Korab, and Fredrick Freitag. "Serotonin Syndrome Risks When Combining SSRI/SNRI Drugs and Triptans: is the FDA's Alert Warranted?" Annals of Pharmacotherapy 42, no. 11 (October 28, 2008): 1692–96. http://dx.doi.org/10.1345/aph.1l260.
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In 2006 the Food and Drug Administration (FDA) issued an alert, based on 27 case reports gathered over a 5-year span, regarding serotonin syndrome resulting from concurrent use of either a selective serotonin-re uptake inhibitor (SSRI) or a selective serotonin/norepinephrine reuptake inhibitor (SNRI) with a triptan. These diagnoses have been subsequently challenged as not meeting validated criteria for serotonin syndrome, in part because the FDA has yet to publicly disseminate important case report data. As a result of the FDA's alert, some clinicians are reluctant or refuse to provide these drugs concomitantly to patients. We believe that withholding these medications due to fears of serotonin syndrome is difficult to justify. In contrast to the small number of case reports, research shows that approximately 700,000 patients annually take SSRIs or SNRIs with triptans and that this drug combination has been effectively used by millions of individuals over the past decade. We encourage healthcare professionals to familiarize themselves with data on serotonin syndrome and to administer SSRIs/SNRIs with triptans when clinically appropriate.
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Leo, Jonathan. "The SSRI Trials in Children: Disturbing Implications for Academic Medicine." Ethical Human Psychology and Psychiatry 8, no. 1 (March 2006): 29–41. http://dx.doi.org/10.1891/ehpp.8.1.29.
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The recent announcement by the Food and Drug Administration (FDA) requiring pharmaceutical companies to warn patients about the increased likelihood of suicidal thoughts when taking antidepressants was largely due to the recent availability of data that had gone unreported in the original research reports. The current article is a summary of the comparison between the published literature and the recently released data available on the FDA web site, with a focus on Prozac, Paxil, and Zoloft. The discrepancies between the two versions suggest that the scientific community was not given enough information in the published medical literature to make adequately informed decisions about the optimal method for treating emotionally distressed children. There are many voices that want to blame the FDA for its role in the widespread use of these medications. The current article focuses on the role that academic medicine, played in the process whereby these medications became so widely accepted.
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Srivastava, S., A. Kumar, V. Agarwal, P. Chubey, L. Donaldson, and J. Potokar. "Relationship between taste thresholds and antidepressant response: Preliminary findings." European Psychiatry 41, S1 (April 2017): S371—S372. http://dx.doi.org/10.1016/j.eurpsy.2017.02.384.
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IntroductionIn healthy volunteers, light acting through serotonin pathways, decreases the threshold for sweet, but not salt taste; similar to SSRI paroxetine. In depressive disorders, there is deficiency of serotonin throughput, which is remedied by SSRI medications, and results in improvement in symptoms of depression. Thus, we report on taste thresholds before and after SSRI treatment.ObjectivesTo study the variation in thresholds for sweet with SSRI treatment in depressed patients in short- and long-term.AimsTo compare the threshold for sweet (test) and salt (control) after 1 and 4 weeks of SSRI escitalopram therapy in depressed patients.MethodsThe project was approved by the institutional ethics committee. Following informed consent, depressed patients were initiated on escitalopram 10 mg/d (increased to 15 or 20 mg, if required after 1 week,). Taste recognition threshold, intensity and pleasantness were measured for sweet and salt. Each tastant was made −1 to −3 (100 mM–1 mM). Regional recognition thresholds were determined at the tip of the tongue using a cotton bud well soaked in the tastant.ResultsThree males and 4 females of mean ages 39.1 years completed the study. There was significant shift to the left for sweet thresholds between days 0 and 7, and 7 and 28 [F(Dfn, Dfd) = 9.242 (4.162) P < 0.0001]. A similar shift to the left was seen for salt but day 7 only [F(Dfn, Dfd) = 6.213 (4.162)].ConclusionThe increase in serotonin throughput as envisaged through SSRI treatment was paralleled by decrease in sweet thresholds.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Goldstein, Burton J., and Paul J. Goodnick. "Selective serotonin reuptake inhibitors in the treatment of affective disorders—III. Tolerability, safety and pharmacoeconomics." Journal of Psychopharmacology 12, no. 4_suppl (July 1998): 55—S87. http://dx.doi.org/10.1177/0269881198012003041.
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The clinical use of tricyclic antidepressants (TCAs) is often complicated by toxicity and safety problems due to their effects on multiple mechanisms of action, many of which are unnecessary for therapeutic effect. The development of the selective serotonin reuptake inhibitors (SSRIs), with their selective mode of action, has resulted in a class of antidepressant drugs possessing an improved side-effect profile, while retaining good clinical efficacy. Their introduction into clinical practice has led to enhanced patient compliance with antidepressant therapy and the ability to maintain treatment over longer periods of time at an adequate therapeutic dose. Although, as a result of their selective action, side-effects associated with SSRI therapy are minimised, distinct variations between individual SSRIs in terms of their tolerability profiles have been observed. The wealth of clinical data now available has revealed differences in their potential to cause psychiatric and neurological side-effects, dermatological reactions, anticholinergic side-effects, changes in body weight, sexual dysfunction, cognitive impairment, discontinuation reactions and drug-drug interactions. Patients who suffer from concomitant depression and physical illness may experience different tolerability profiles, in addition to the greater likelihood that they will be receiving concomitant medications with the potential for pharmacokinetic drug-drug interactions with coadministered SSRI therapy. In addition, the safety margin of SSRIs in overdose may vary within the group. Knowledge of the differences that exist among the SSRIs in respect of tolerability and safety will aid physicians in the selection of the most beneficial treatment strategy for their patients. A successful clinical outcome leads to a reduced economic burden for the patient, their family and the healthcare services. Thus, pharmacoeconomic considerations are also important in choosing antidepressant therapy. The SSRIs, despite relatively higher prescription costs, have been demonstrated to be a more cost-effective option than the TCAs. Furthermore, there is evidence that the emerging clinical differences between SSRIs may translate into significantly different economic outcomes within the group.
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Prasitlumkum, Narut, Wisit Cheungpasitporn, Nithi Tokavanich, Kimberly R. Ding, Jakrin Kewcharoen, Charat Thongprayoon, Wisit Kaewput, Tarun Bathini, Saraschandra Vallabhajosyula, and Ronpichai Chokesuwattanaskul. "Antidepressants and Risk of Sudden Cardiac Death: A Network Meta-Analysis and Systematic Review." Medical Sciences 9, no. 2 (April 23, 2021): 26. http://dx.doi.org/10.3390/medsci9020026.
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Background: Antidepressants are one of the most prescribed medications, particularly for patients with mental disorders. Nevertheless, there are still limited data regarding the risk of ventricular arrhythmia (VA) and sudden cardiac death (SCD) associated with these medications. Thus, we performed systemic review and meta-analysis to characterize the risks of VA and SCD among patients who used common antidepressants. Methods: A literature search for studies that reported risk of ventricular arrhythmias and sudden cardiac death in antidepressant use from MEDLINE, EMBASE, and Cochrane Database from inception through September 2020. A random-effects model network meta-analysis model was used to analyze the relation between antidepressants and VA/SCD. Surface Under Cumulative Ranking Curve (SUCRA) was used to rank the treatment for each outcome. Results: The mean study sample size was 355,158 subjects. Tricyclic antidepressant (TCA) patients were the least likely to develop ventricular arrhythmia events/sudden cardiac deaths at OR 0.24, 0.028–1.2, OR 0.32 (95% CI 0.038–1.6) for serotonin and norepinephrine reuptake inhibitors (SNRI), and OR 0.36 (95% CI 0.043, 1.8) for selective serotonin reuptake inhibitors (SSRI), respectively. According to SUCRA analysis, TCA was on a higher rank compared to SNRI and SSRI considering the risk of VA/SCD. Conclusion: Our network meta-analysis demonstrated the low risk of VA/SCD among patients using antidepressants for SNRI, SSRI and especially, TCA. Despite the relatively lowest VA/SCD in TCA, drug efficacy and other adverse effects should be taken into account in patients with mental disorders.
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Kelley, Amanda M., Kyle Bernhardt, Mark McPherson, James L. Persson, and Steven J. Gaydos. "Selective Serotonin Reuptake Inhibitor Use Among Army Aviators." Aerospace Medicine and Human Performance 91, no. 11 (November 1, 2020): 897–900. http://dx.doi.org/10.3357/amhp.5671.2020.
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INTRODUCTION: Mental health is an important aspect of Army aviation medicine given that it significantly impacts career longevity, readiness, and healthcare usage. One of the most commonly used classes of medications to treat mental health disorders is the selective serotonin reuptake inhibitor (SSRI). Here we present a descriptive epidemiological review of SSRI use in Army aviators over a 10-yr period.METHODS: An archival dataset retrieved from the U.S. Army Aeromedical Electronic Resource Office covering the years 2005 to 2015 was queried for cases of SSRI use. Frequencies were generated by primary diagnoses and aeromedical disposition for the SSRI subset of data.RESULTS: A total of 114 unique cases of SSRI use were identified (122 total aeromedical outcomes). These cases included 41 waiver recommendations, 59 suspension recommendations, and 22 cases of waiver continuations. The top five most common primary diagnoses were depressive disorder (N 32), anxiety state (N 21), posttraumatic stress disorder (N 16), single major depressive episode (N 13), and adjustment disorder with depressed mood (N 12).DISCUSSION: Understanding of the etiology, pathophysiology, and treatment of mental health disorders particularly within the safety-focused and unforgiving aviation environment has continued to evolve. With the application of evidence-based policy, deliberate aeromedical decision-making, and methodical risk mitigation, SSRI use does have a place within aviation. Aviators suffering in silence with deleterious impact to performance and safety or aircrew seeking services on the outside without knowledge or oversight of certification authorities must remain in the past.Kelley AM, Bernhardt K, McPherson M, Persson JL, Gaydos SJ. Selective serotonin reuptake inhibitor use among Army aviators. Aerosp Med Hum Perform. 2020; 91(11):897900.
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King, Bryan H. "Association Between Maternal Use of SSRI Medications and Autism in Their Children." JAMA 317, no. 15 (April 18, 2017): 1568. http://dx.doi.org/10.1001/jama.2016.20614.
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Dardennes, R., G. Berdeaux, A. Lafuma, and F. Fagnani. "Comparison of the cost-effectiveness of milnacipran (a SNRI) with TCAs and SSRIs: a modeling approach." European Psychiatry 14, no. 3 (June 1999): 152–62. http://dx.doi.org/10.1016/s0924-9338(99)80734-2.
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SummaryA simulation model based on the theory of clinical decision analysis was used to compare outcomes and costs when treating patients with major depressive episodes using either a selective serotonin re-uptake inhibitor (SSRI) or a tricyclic antidepressant (TCA), in comparison with milnacipran (a serotonin), and a norepinephrine re-uptake inhibitor (SNRI). The clinical data used were taken from published meta-analyses. This analysis supports: (1) a comparable efficacy of milnacipran and TCA with a better tolerance; and, (2) an advantage of milnacipran over SSRI for efficacy with a comparable tolerance. Based on these findings, a decision tree was constructed with the assistance of a panel of psychiatrists in order to provide a model of usual clinical practice. Estimates not available from clinical studies were obtained either from literature analysis or from the panel.Economic appraisal was performed according to the viewpoint of the French national sickness fund (sécurité sociale), and expenditure assessment was limited to direct costs (hospitalizations, antidepressant medications, visits, and laboratory tests). The results suggest that milnacipran is a cost-effective alternative: the expected cost of treatment per depressive episode is lower than either a French representative panel of TCAs (a saving of 288 FF), or SSRIs (a savings of 961 FF). The expected length of clinical remission is slightly higher than comparators. The robustness of these findings was supported by sensitivity analyses.
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Claxton, Ami J., Zhiming Li, and Jan McKendrick. "Selective serotonin reuptake inhibitor treatment in the UK: Risk of relapse or recurrence of depression." British Journal of Psychiatry 177, no. 2 (August 2000): 163–68. http://dx.doi.org/10.1192/bjp.177.2.163.
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BackgroundPatients with depression are often not prescribed antidepressants for an adequate period of time.AimsThe impact of antidepressant prescribing patterns on the risk of relapse or recurrence of depression is examined.MethodThe Medi Plus UK Primary Care Database was used to identify patients treated for depression with a selective serotonin reuptake inhibitor (SSRI). Records were used to construct hierarchical prescription patterns (less than 120 days, switching/augmentation, upward titration, or stable use) as indicators for the occurrence of relapse or recurrence of depression.ResultsPatients with stable use experienced the lowest risk of relapse or recurrence. Factors significantly associated with increased risk include prior use of anxiolytic medications, more comorbid conditions and younger age.ConclusionsThe SSRI prescription pattern most consistent with recommended depression treatment guidelines was associated with the lowest risk of relapse or recurrence.
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Ben-Ami Shor, Dana, Dahlia Weitzman, Shani Dahan, Omer Gendelman, Yael Bar-On, Daniela Amital, Varda Shalev, Gabriel Chodick, and Howard Amital. "Adherence and Persistence with Drug Therapy among Fibromyalgia Patients: Data from a Large Health Maintenance Organization." Journal of Rheumatology 44, no. 10 (August 1, 2017): 1499–506. http://dx.doi.org/10.3899/jrheum.170098.
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Objective.To assess 1-year persistence and adherence rates with drug therapy among patients with fibromyalgia (FM) and to identify factors associated with therapy discontinuation.Methods.This retrospective, cohort study included members ≥ 21 years old from the Maccabi Healthcare Services, a large health maintenance organization in Israel, who were diagnosed with FM from 2008 through 2011. Medications of interest included the anticonvulsant pregabalin, antidepressants [selective serotonin reuptake inhibitor (SSRI), serotonin/norepinephrine reuptake inhibitor (SNRI)], and tricyclic antidepressants (TCA). Time to treatment discontinuation and proportion of days covered (PDC) with FM-specific therapies during the year from first dispensed were analyzed. PDC < 20% was considered low adherence and PDC ≥ 80% was considered high adherence. Logistic regression models were constructed for multivariable analyses.Results.Overall, 3932 patients with FM were included; 88.7% were female. Pre-diagnosis use of medication of interest was documented in 41% of the study population. Of the remaining 2312 patients, 56.1% were issued a prescription, 45.0% were dispensed at least 1 medication in the year following diagnosis, and only 28.8% had prescriptions filled twice within the first year from diagnosis. Among newly prescribed patients, 1-year discontinuation was highest for TCA (91.0%) and lowest for SSRI/SNRI antidepressants (73.7%). Over half of the patients (60.5%) had fewer than 20% of the days covered by any medication during the year and only 9.3% were very adherent (PDC ≥ 80%).Conclusion.This study clearly shows that in an Israeli “real-life” population of patients with FM, persistence and adherence with FM therapy in the year following diagnosis is remarkably low.
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Pawluski, Jodi L., and Mary Gemmel. "Perinatal SSRI medications and offspring hippocampal plasticity: interaction with maternal stress and sex." Hormones 17, no. 1 (March 2018): 15–24. http://dx.doi.org/10.1007/s42000-018-0011-y.
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Avalos, Lyndsay Ammon, Hong Chen, and De-Kun Li. "Antidepressant medication use, depression, and the risk of preeclampsia." CNS Spectrums 20, no. 1 (February 2015): 39–47. http://dx.doi.org/10.1017/s1092852915000024.
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ObjectiveTo assess the effects of depression and antidepressant medication use during pregnancy on the risk of preeclampsia.MethodsWe conducted a retrospective, population-based cohort study that linked automated clinical and pharmacy databases including comprehensive electronic medical records of 21,589 pregnant Kaiser Permanente Northern California members between 2010 and 2012.ResultsThe overall risk of preeclampsia was 4.5%. The timing of antidepressant medication exposure was an important factor. A significant increase in the risk of preeclampsia emerged for women with a depression diagnosis who took antidepressant medications during the second trimester compared to women with untreated depression (adjusted relative risk [aRR]: 1.6, 95% CI: 1.06, 2.39) and to women without depression (aRR: 1.70, 95% CI: 1.30, 2.23). Similar associations existed for women who took antidepressant medications, but without depression. In contrast, depressed women with psychotherapy showed no increased risk of preeclampsia compared to women with untreated depression or no depression. There was also a statistically significant relationship between the duration of antidepressant medication use and preeclampsia. The observed association appeared stronger for selective serotonin reuptake inhibitor (SSRI) use, although a nonsignificant trend was also noted for use of norepinephrine-dopamine reuptake inhibitors (NDRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).ConclusionStudy findings suggest that antidepressant use during pregnancy may increase the risk of preeclampsia, especially use during the second trimester.
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Mishra, Dheerendra Kumar, and Pradeep Kumar. "Electrocardiographic changes of antidepressant medication in depressive episode." International Journal of Advances in Medicine 5, no. 3 (May 22, 2018): 505. http://dx.doi.org/10.18203/2349-3933.ijam20181409.
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Introduction: Depressive disorder is leading cause of mortality in the world, with the help of recent therapeutic strategies it is easily manageable. Antidepressant medication is the most commonly used for management of depressive disorders. Among the side effects of antidepressant, cardiovascular effects of antidepressant deserve close monitoring. Invariably, it is observed that patients undergoing antidepressant therapy are not screened for pre-existing cardiovascular diseases and more so for cardiotoxicity. Various antidepressant medications are available, with different cardiac side effects profile. Ignorance, over clinical burden, poor follow up and under evaluation of cardiovascular side effects could be attributable to an ultimate surveillance of such cases. So, this study conducted to evaluate electrocardiographic changes in therapeutic doses of antidepressant medication.Methods: An Open label-controlled study was conducted on 386 subjects to evaluate the antidepressant-induced electrocardiographic changes. Treatment seeking subjects for the depressive episode was recruited from outpatient and inpatient section of Psychiatry department after fulfilling inclusion and exclusion criteria. Data was collected on socio-demographic characteristics, and detailed pre-treatment and post-treatment clinical evaluation and electrocardiographic assessment were done.Results: Data collected and analyzed from 204 subjects, mean age of subjects taking tricyclics and SSRI (Fluoxitine) 43.6±7.5 years vs 41.5±9.6 years respectively. The study sample consists of 66% females, 33% males. Among them, 35% study subject expose to tricyclics and 65% subjects taking SSRI. 19% study subjects presented electrocardiograph changes especially tachycardia among them 55% was taking the tricyclic antidepressant. Only 10% subjects taking SSRI had post-treatment abnormal electrocardiograph changes.Conclusions: Conclusively, antidepressant form a safe therapeutic modality for the management of major depression. Its cardiovascular side effects warrant against indiscriminate use of particularly in high dose and old aged person and preexisting cardiac disease.
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Plener, P., S. A. Gatz, C. Schuetz, A. G. Ludolph, and M. Kölch. "A Case of Selective Mutism in an Eight-Year Old Girl with Thalassaemia Major After Bone Marrow Transplantation." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71189-7.
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Objective:Selective Mutism (DSM-IV: 313.23, ICD-10: F94.0) is a rare phenomenon in child and adolescent psychiatry, with prevalence rates below 1%. Patients limit their verbal communication and social functioning is severely impaired. Evidence for treatment strategies is scarcely available, especially in patients with concomitant pediatric disorders.Method:This case report provides information on the psychotherapeutic and psychopharmacological treatment of selective mutism in an eight-year old girl with thalassemia major. The patient presented to the psychiatric department after her second (successful) bone marrow transplantation for treatment of her selective mutism which was present already prior to transplantation. As permanent medications she received penicillin prophylaxis (500.000 IE/d) and deferasirox (Exjade; 20-25 mg/kg/d), a recently approved iron chelator.Results:Long term psychotherapy (CBT) in a day-time clinic, supported by the use of the SSRI Fluoxetine (10 mg), led to a decrease in the Selective Mutism score from 29 to 17 points - GAF improved by 21 points. Reintegration in the school context was established. Mean levels of Fluoxetin and N-Fluoxetin were 287,8 ng/ml without significant level fluctuations.Conclusion:This case adds further evidence, that a combination of psychotherapy and psychopharmacological interventions (SSRI) proves effective in treatment resistant Selective Mutism. Monitoring blood levels of the SSRI is crucial in providing treatment to patients receiving multi-pharmacological treatment.
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Roy, D. "A rare instance of tardive dyskinesia with SSRI use: A case study." European Psychiatry 41, S1 (April 2017): S759. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1424.
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IntroductionCase presentation of a middle aged lady Mrs. C.K., who developed tardive dyskinesia (TD) after a trial of an SSRI.Case reportA 49-year-old Australian aboriginal lady, presented with involuntary movement of her face (bucco-linguo masticatory), movements after a 3 months trial of sertraline (maximum dose of 100 mg daily) for her depressive illness. There was no history of trials with anti-psychotics or any other medications, which may have caused the oral dyskinesias. Routine examinations including cognitive testing, EEG and MRI revealed no pathological findings. Her sertraline was ceased and she was commenced on mirtazapine 15 mg at night, which was hiked to 30 mg after 1 week and continued on this dose over the next 3 months. She exhibited good improvement in her depressive symptoms and a significant attenuation of her TD's. Involuntary movement scale rating: she was rated on the abnormal involuntary movement scale (AIMS) and showed gradual improvement in the severity of her orofacial dyskinetic movement. Her scores were–initial presentation (scored 22/36); at 4 weeks (9/36); 8 weeks (6/36) and at 16 weeks (4/36).DiscussionAlthough TD's are seen in approximately 1 to 5% of mental health patients treated with anti-psychotics (and some other medications like Levodopa, Metochlorpromide, etc.), research studies on SSRI's causing TD's are rare and few (Leo et al., 1996; Gerber et al., 1998).ConclusionsTo alert and educate clinicians about a relatively rare adverse-effect of SSRI producing an involuntary movement disorder.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
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Stock, Eileen M., John E. Zeber, Catherine J. McNeal, Javier E. Banchs, and Laurel A. Copeland. "Psychotropic Pharmacotherapy Associated With QT Prolongation Among Veterans With Posttraumatic Stress Disorder." Annals of Pharmacotherapy 52, no. 9 (April 11, 2018): 838–48. http://dx.doi.org/10.1177/1060028018769425.
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Background: In 2012, the Food and Drug Administration issued Drug Safety Communications on several drugs associated with QT prolongation and fatal ventricular arrhythmias. Among these was citalopram, a selective serotonin reuptake inhibitor (SSRI) approved for depression and commonly used for posttraumatic stress disorder (PTSD). Evaluation of the risk for QT prolongation among other psychotropic drugs for individuals with PTSD remains limited. Objective: Explore psychotropic drugs associated with QT prolongation among veterans with PTSD. Methods: Patients in the Veterans Health Administration in 2006-2009 with PTSD and QT prolongation (176 cases) were matched 1:4 on age, gender, visit date and setting, and physical comorbidity. Classification trees assessed QT prolongation risk among prescribed medications (n=880). Results: Receipt of any drug with known risk of QT prolongation varied by group (23% QT cases vs 15% control, p<0.01). Psychotropic medications conferring significant risks included ziprasidone (3% vs 1%, p=0.02) and buspirone (6% vs 2%, p=0.01). Increased risk was not observed for the SSRIs, citalopram and fluoxetine. Classification trees found that sotalol and amitriptyline carried greater risk among cardiac patients and methadone, especially if prescribed with quetiapine, among noncardiac patients. Per adjusted survival model, patients with QT prolongation were at increased risk for death (hazard ratio=1.60; 95% CI=1.04-2.44). Conclusions: Decision models are particularly advantageous when exploring nonlinear relationships or nonadditive interactions. These findings may potentially affect clinical decision-making concerning treatment for PTSD. For patients at higher risk of QT prolongation, antidepressants other than amitriptyline should be considered. Medications for comorbid conditions should also be closely monitored for heightened QT prolongation risk.
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Montagnini, Bruno Garcia, Simone Bortolan, Bárbara Daiane dos Santos, Ana Paula Moreno, Nathália de Azevedo Camin, Daniela Cristina Ceccatto Gerardin, and Estefânia Gastaldello Moreira. "Evaluation of Escitalopram, Sertraline, and Methylphenidate in the Immature Rat Uterotrophic Assay." International Journal of Toxicology 32, no. 6 (November 2013): 426–30. http://dx.doi.org/10.1177/1091581813509674.
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Psychotropics are among the most prescribed medications. There are indications in the literature that fluoxetine (FLX; selective serotonin reuptake inhibitor [SSRI] antidepressant) and methylphenidate (MPH) could have a hormonal mode of action. This study was designed to evaluate the immature rat uterotrophic assay Substitute by (1) if sertraline (SER) and escitalopram (ESC) 2 other SSRI antidepressants would share the estrogenicity described for FLX and (2) MPH for estrogenicity and antiestrogenicity. The 18-day-old Wistar rats with were divided into olive oil, estradiol (0.3 mg/kg), estradiol + tamoxifen (10 mg/kg), SER (5, 15, or 45 mg/kg), ESC (2, 6, or 18 mg/kg), MPH (2.5 or 5 mg/kg), and estradiol + MPH groups. As expected, estradiol increased the weight of uterus, and this effect was counterbalanced by concomitant treatment with tamoxifen. The SER, ESC, and MPH had no effect on the uterus weight. The results suggest that ESC and SER do not share the estrogenicity described for FLX and that MPH does not disrupt estrogenic signaling.
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Brandt, Alyssa M., and Michael J. Doherty. "VEEG models of seizure frequency — Do SSRI medications or vitamin D supplements alter seizure collections?" Epilepsy & Behavior 41 (December 2014): 208–9. http://dx.doi.org/10.1016/j.yebeh.2014.10.006.
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Kaye, Alan David. "Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review." July 2015 18;4, no. 4;18 (July 14, 2015): 395–400. http://dx.doi.org/10.36076/ppj.2015/18/395.
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Background: Serotonin syndrome is a mild to potentially life-threatening syndrome associated with excessive serotonergic activity within the central nervous system. Serotonin syndrome is associated with medication use, drug interactions, and overdose. While serotonin syndrome is often associated with the use of selective serotonin inhibitors (SSRI), an increasing number of reports are being presented involving the use of tramadol. Methods: This review article contains an overview of serotonin syndrome while specifically looking at tramadol’s pharmacology and risk factors for serotonin syndrome. With tramadol’s increasing popularity, the goal of this article is to make physicians more alert and aware of this potential side effect associated with tramadol. Conclusions: In conclusion, with the increasing incidence of serotonin syndrome, prescribing physicians should be aware of and educate their patients on the potential side effects of tramadol. It is important that the prescribing physician reviews patient medications for concurrent serotonergic drugs and monitors for potential abuse. Key words: Tramadol, serotonin syndrome, drug interactions, analgesics
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Markos, A. R. "The male genital skin burning syndrome (Dysaesthetic Peno/Scroto-dynia)." International Journal of STD & AIDS 13, no. 4 (April 1, 2002): 271–72. http://dx.doi.org/10.1258/0956462021924938.
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Men may complain of penile and/or scrotal skin burning with no evidence of positive physical signs or investigations. The condition is cumbersome and leads to stress and disruption in social and sexual relationships. The patients report no response to previous medications (including antibiotics, antifungals and topical corticosteroids); and identify improvement in symptoms and quality of life on selective serotonin re-uptake inhibitors (SSRI). A similar condition has been recognized in the female patients (dysaesthetic vulvodynia). We report the occurrence of this condition in three men and suggest it being recognized as 'the male genital skin burning syndrome' (Dysaesthetic Peno/Scroto-dynia).
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Montgomery, Stuart A., and Siegfried Kasper. "Pharmacotherapy Update: Pregabalin in the Treatment of Generalized Anxiety Disorder." Clinical Medicine Insights: Therapeutics 2 (January 2010): CMT.S1103. http://dx.doi.org/10.4137/cmt.s1103.
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Generalized anxiety disorder (GAD) is a common disorder that is chronic, disabling, and often goes undiagnosed. Currently, four distinct classes of medications have demonstrated efficacy in the treatment of GAD: benzodiazepines, serotonin and/or norepinephrine reuptake inhibitors (SSRIs/SNRIs), histamine H1 receptor blockers (hydroxyzine), and pregabalin. Pregabalin acts via binding to an α2-δ subunit presynaptic membrane protein that inhibits neurotransmitter release in excited neurons. Pregabalin is renally excreted and undergoes minimal (<2%) hepatic metabolism, thus limiting the risk of drug–drug interactions. The efficacy of pregabalin for the treatment of GAD has been established based on the results of 8 double-blind, placebo-controlled, short-term led trials, and one 6-month relapse prevention study. The current review summarizes data showing that pregabalin has a significantly different safety profile from the benzodiazepines (eg, less sedation, less cognitive and psychomotor impairment, less risk of dependence and withdrawal), and SSRI/SNRI anxiolytics (eg, less gastrointestinal side effects and sexual dysfunction). The review also summarizes efficacy data showing that pregabalin is a broad spectrum anxiolytic that with a speed of onset similar to the benzodiazepines.
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Kogut, Stephen J. "Do Triptan Antimigraine Medications Interact with SSRI/SNRI Antidepressants? What Does Your Decision Support System Say?" Journal of Managed Care Pharmacy 17, no. 7 (September 2011): 547–51. http://dx.doi.org/10.18553/jmcp.2011.17.7.547.
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Prisco, V., T. Iannaccone, and G. Di Grezia. "Use of buspirone in selective serotonin reuptake inhibitor-induced sleep bruxism." European Psychiatry 41, S1 (April 2017): s855. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1701.
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Sleep bruxism is characterized by the involuntary clenching or grinding of the teeth during sleep and can cause severe health problems, including the destruction of tooth structure, temporo-mandibular joint dysfunction, myofascial pain, and severe sleep disturbances. Iatrogenic sleep bruxism may be common during treatment with psychotropic medications, such as anti-psychotics and antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). Bruxism is a common movement disorder that affects 8–21% of the population. The majority of bruxism symptoms are mild or moderate, although rare but severe cases may lead to serious periodontal damage, temporo-mandibular dysfunction, sleep disturbances, jaw pain, and stiffness. As a result, such cases must be treated with medication. It has been hypothesized that the mechanism of SSRI-induced bruxism may involve excessive serotonergic action on the meso-cortical neurons arising from the ventral tegmental area. It has been argued that,the addition of buspirone, was necessitated by the high level of residual anxiety. As a result, these symptoms may have been prevented through the use of buspirone alone. Buspirone, is an agonist of the 5-HT1A receptor that increases dopaminergic neuron, firing in the ventral tegmental area and increases the synaptic release of dopamine in the prefrontal cortex. These effects ameliorate drug-induced bruxism. Buspirone can also ameliorate extrapyramidal side effects, such as akathisia and tardive dyskinesia, and this property may be an additional explanation for the bruxism-related effects of the drug. Furthermore, buspirone may be an effective treatment for the bruxism associated with the use of these medications.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Clemens, Zsófia, and András Holló. "Comment on “VEEG models of seizure frequency — Do SSRI medications or vitamin D supplements alter seizure collections?”." Epilepsy & Behavior 45 (April 2015): 81. http://dx.doi.org/10.1016/j.yebeh.2015.01.029.
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Rae-Grant, Quentin. "Erratum." Canadian Journal of Psychiatry 45, no. 4 (May 2000): 398. http://dx.doi.org/10.1177/070674370004500415.
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The following letter originally appeared in the March 2000 issue of The Canadian Journal of Psychiatry. It contained substantial errors in dosages and was printed without the authors' approval. We apologize to the authors and readers. The corrected text appears here in its entirety. Paroxetine and Tardive Akathisia Dear Editor: There have been several reports of akathisia associated with the use of selective serotonin reuptake inhibitors (SSRIs), usually rapid in onset and occurring within days of drug initiation (1). This report describes the case of a patient who developed delayed-onset or tardive akathisia with paroxetine treatment. Case Report Mr A was a 38-year-old male with obsessive-compulsive disorder (OCD), with compulsions to view morgues and operating rooms. In addition, he suffered from multiple paraphilias, including pedophilia, exhibitionism, and voyeurism. He was born prematurely to a mother who had abused drugs and alcohol throughout the pregnancy, and he had a cleft lip and palate repaired after birth. He also had significant facial dysmorphism. Despite this background, he had a normal to above-average intellect and good insight into his psychiatric problems. He was compliant with his treatment, with few emergency visits and no history of drug-seeking behaviour. He had been treated with paroxetine 70 mg once daily for 2 years for his OCD. In addition, he received leuprolide (Lupron) 7.5 mg intramuscularly (IM) every 4 weeks for 7 years for his paraphilias, and alendronate (Fosamax)5 mg once daily for 3 years for osteoporosis. Previously, a trial of clomipramine had also been used for his OCD. In addition, a diagnosis of Tourette syndrome had been considered in his past because of the presence of motor tics, which resulted in the trial of pimozide 3 years ago. However, this medication was stopped shortly thereafter because the patient developed an acute akathisia. At this time, Mr A presented with a subjective inner restlessness, which he described as being identical to his reaction to pimozide 3 years previously. Objectively, he was noted to have restless leg movements. There had been no change to his medication regimen for 2 years. He was started on lorazepam 1 mg 3 times daily as needed, and all complaints of restlessness disappeared after 4 days. No further treatment or medication change was required. Discussion Tardive akathisia is defined as an akathisia of delayed onset, in the absence of a change of drug dose or type within 3 months (2). The incidence of acute akathisia with neuroleptics is in the range of 20% to 30% (3), compared with 9.8% to 25% for SSRIs (1). The incidence of tardive akathisia with neuroleptics has been reported to be between 18% and 41% (2). Tardive akathisia has not been reported previously in relation to drugs other than antipsychotics (2). While the differential diagnosis for this case could include anxiety related to the patient's OCD, or the combination of medications, the subjective similarityto the previous akathisia and its quick resolution with lorazepam led to a diagnosis of tardive akathisia. Of his 3 medications, paroxetine was the only psychoactive substance and, thus, was the most likely cause of this reaction. Given this patient's complex medical history, there may have been a genetic predisposition to the development of akathisia in this particular case. It has been suggested that SSRIs may inhibit dopaminergic neuronal activity in the ventral tegmental area to produce akathisia (4). While previous reports have indicated that the clinician must be aware of the possibility of akathisia when initiating an SSRI, this case illustrates that this side effect may occur without a recent change in the medication.
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Sri, Mamatha S., and K. S. Jayashree. "ROLE OF GUDUCHI TINOSPORA CORDIFOLIA (WILLD) MIERS. IN COUNTERACTING THE ADVERSE DRUG REACTIONS INDUCED BY ANTIDEPRESSANT DRUGS." International Journal of Research in Ayurveda and Pharmacy 12, no. 3 (July 6, 2021): 25–30. http://dx.doi.org/10.7897/2277-4343.120367.
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In the present scenario psychosomatic stressful situation is been increasing which has resulted in increased incidence in Psychiatric disorders. The prevalence of all mental disorders was observed to be 65.4 per 1000 population. In 2017, 197.3 million people had mental disorders in India, including 45.7 million with depressive disorders and 44.9 million with anxiety disorders. Depression and other mood disorders need long term treatment. Among antidepressants SSRI group of drugs are more frequently advocated followed by Tricyclics. Due to long term medications, patients often complaints of adverse drug reactions which many times leads to discontinuation of treatment. In this study Guduchi was chosen to address the ADRs induced by antidepressant drugs at GI level. It was a randomized single blind comparative clinical study, where 40 volunteers undergoing antidepressant treatment and have developed ADRs were selected. Subjects were randomly assigned into two group A and B with 20 patients each. Guduchi Rasakriya 1 gram in divided dose was given to group A and symptomatic conventional treatment to group B. It was observed that Guduchi was effective in major number of problems raised in GIT like Dryness of mouth, Gastric irritation, Nausea, Anorexia, Loose stools. In this clinical study Guduchi ghanasara (rasakriya) exhibited significant response in adverse drug reactions at the level of GIT induced by Antidepressant drugs (SSRI and Tricyclics) when compared to conventional symptomatic treatment.
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Jing, Elizabeth, and Kristyn Straw-Wilson. "Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review." Mental Health Clinician 6, no. 4 (July 1, 2016): 191–96. http://dx.doi.org/10.9740/mhc.2016.07.191.
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Abstract Sexual dysfunction is an underdiscussed adverse effect to selective serotonin reuptake inhibitors (SSRIs) and may increase the risk for discontinuation and nonadherence to antidepressant pharmacotherapy. Given the prevalence of depression, health care providers should educate patients about SSRI-associated sexual dysfunction in order to promote patient awareness and medication adherence. This study evaluated primary literature from 1997 to 2015 to identify SSRI-related sexual side effects, therapeutic alternatives, and treatment strategies. The results indicate that paroxetine is associated with the greatest rate of sexual dysfunction among the SSRIs. Potential alternatives to SSRI treatment include bupropion, mirtazapine, vilazodone, vortioxetine, and serotonin-norepinephrine reuptake inhibitors. In the event that a subject responds solely to SSRIs but experiences unwanted sexual side effects, bupropion may be added as an adjunctive medication. Some limited evidence also suggests that saffron may reduce some aspects of sexual dysfunction, excluding ability to reach orgasm.