SSRIs May Prolong Seizure Duration but Shorten Post-Seizure Depression in Patients With Epilepsy: Presented at AES

Use of selective serotonin reuptake inhibitors (SSRIs) appears to be associated with longer seizures in patients with epilepsy, confounding basic science results suggesting SSRIs reduce the frequency of epileptic seizures in animal models, according to a study presented here at the American Epilepsy Society (AES) 63rd Annual Meeting.

"What we found was not necessarily a causal relationship, but an association, between SSRI use and longer seizures," study presenter Eugen Trinka, MD, MSc, Innsbruck Medical University, Innsbruck, Austria. "Based on our study, we cannot conclude that SSRIs prolong seizures." However, "doctors should use caution in using SSRIs in patients with epilepsy," Dr. Trinka added during his poster presentation held on December 5.

The study found that epilepsy seizures in those on SSRIs lasted a median 132 seconds, compared with 85 seconds in those not using SSRIs.

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UK study warns against anti-psychotics for dementia

* Most dementia patients given anti-psychotics needlessly

* Report could inform clinical practice around the world

* Global dementia cases seen doubling to 66 mln by 2030

More than 140,000 dementia patients in Britain are given anti-psychotic drugs needlessly and overprescribing of the medicines is linked to an extra 1,800 deaths in elderly people each year, a report said on Thursday.

The government-backed review showed that only around 36,000 of around 180,000 dementia patients prescribed anti-psychotics got any benefit from them -- findings it said could affect clinical practice in dementia across the world.

"Anti-psychotics are used too often in dementia," Sube Banerjee, the report's author and a professor of mental health and ageing at the Institute of Psychiatry at King's College London, said in a statement.

He said use of anti-psychotics drugs for dementia should be cut to a third of current levels in Britain and said his study would "provide international leadership in this complex clinical area."

Alzheimer's Disease International predicted in September that more than 35 million people around the world will suffer from dementia in 2010. That number is expected to almost double every 20 years, to 66 million in 2030 and more than 115 million in 2050. [ID:nN20262573]

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Weight Gain Associated With Antipsychotic Drugs

Young children and adolescents who take the newest generation of antipsychotic medications risk rapid weight gain and metabolic changes that could lead to diabetes, hypertension and other illnesses, according to the biggest study yet of first-time users of the drugs.

The study, to be published Wednesday in The Journal of the American Medical Association, found that 257 young children and adolescents in New York City and on Long Island added 8 to 15 percent to their weight after taking the pills for less than 12 weeks.

The patients, ages 4 to 19, added an average of one to one-and-a-half pounds a week.

“The degree of weight gain is alarming,” said Dr. Wayne K. Goodman, head of a Food and Drug Administration advisory panel on the drugs last summer and chairman of psychiatry at Mount Sinai School of Medicine in Manhattan. “The magnitude is stunning,” he said.

Although the drugs’ influence on weight and metabolism had been previously detected, Dr. Goodman, who was not involved in the study, said the speed and magnitude of the effects found in the study were greater than previously reported — findings he said were made possible by looking exclusively at new patients.

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Increase In Long-term Antidepressant Drug Use, UK Study Reveals

A dramatic rise in antidepressant prescriptions issued by GPs has been caused by a year on year increase in the number of people taking antidepressant drugs on a long-term basis, according to researchers from the University of Southampton.


In a paper, published in the printed edition of British Medical Journal (BMJ), scientists found that despite a drop in the number of new patients diagnosed with depression over 11 years, the number of prescriptions doubled.

"We estimate that more than 2 million people are now taking antidepressants long-term over several years, in particular women aged between 18 and 30," comments Tony Kendrick, a professor in Primary Medical Care of the University's School of Medicine, who led the study.

The number of prescriptions issued per patient rose from 2.8 in 1993 to 5.6 in 2004.

Prescription Pricing Authority data shows that more than 30 million prescriptions for SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Seroxat, are now issued per year, twice as many as the early 1990s. Researchers at the University of Southampton found 90 per cent of people diagnosed with depression are now taking SSRIs either continuously or as repeated courses over several years.

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Men on Tricyclic Antidepressant More Likely to Think of Suicide

All antidepressants may not be created equal when it comes to worsening of suicidal ideation during treatment, researchers found.

Men taking nortriptyline (Aventyl, Pamelor) were 2.4 times more likely to have an increase in suicidal thoughts than were those taking escitalopram (Lexapro), Nader Perroud, MD, of King's College London, and colleagues reported online in BMC Medicine.

Nortriptyline, a tricyclic antidepressant, was also associated with a 9.8-fold higher risk of new onset of suicidal ideation compared with the selective serotonin reuptake inhibitor (SSRI) in the prospective open-label trial.

The reason behind the difference may be that nortriptyline acts predominantly on the noradrenergic system, which, when overactive, is associated with anxiety and agitation.
Because "suicidal ideation is more common in agitated and irritable types of depression," the researchers said, "it is possible that nortriptyline may induce or worsen suicidal thoughts in some male subjects possibly through an induction of this more agitated type of depression."

Another possibility is that nortriptyline is less effective against mood symptoms, they noted.

All antidepressants now carry black box warnings of suicidality risk, particularly in children and young adults, and especially early in treatment, but whether this risk differs between agents or by gender has been debated.

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Older antidepressant spurs more suicidal thinking in men than newer medication

The largest clinical trial to date comparing an older, tricyclic antidepressant with a newer antidepressant of the selective serotonin reuptake inhibitor (SSRI) class has found that the emergence of suicidal thinking was almost 10 times more common in men taking the older drug than in those taking the newer medication.

The study also found that for men and women taking either medication, suicidal thinking was spread over the first six weeks of treatment, but peaked at roughly the fifth week before declining significantly after week six. Taking place at academic medical institutions across Europe, the trial, called Genome-Based Therapeutic Drugs for Depression--or GENDEP--gauged the responses to antidepressants of 811 persons ranging from 18 to 72 with depression.

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SSRI Use May Correlate With Lower Bone Mineral Density in Middle-Aged Women: Presented at ASBMR

A study presented at the 31st Annual Meeting of the American Society for Bone and Mineral Research (ASBMR) found that use of some antidepressants may have a correlation with reduced bone mineral density (BMD) in women.

While data have been circulated since the late 1990s associating the use of selective serotonin reuptake inhibitors (SSRIs) with an increased risk of hip fractures, the studies have been in elderly women.

"They were based on database studies and were not able to control for important variables such as bone density and other health conditions," said Susan Diem, MD, University of Minnesota, Minneapolis, Minnesota, on September 12. "Basic science data in the last few years have also found that serotonin transcriptors may exist on bone cells. SSRIs, which block serotonin transcription, might then have an effect on bone density."
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Antidepressants once seen as miracle drugs: now risks are becoming evident

Since the horror of the Thalidomide scandal in the 1960s, pharmaceutical companies and medicines regulators have been acutely aware of the dangers drugs may pose to the unborn child.

Establishing what the effect of a drug may be on a foetus, however, is no simple task. Companies must rely on animal studies in the early stages of research and hope that the drug will behave in humans in the same way. Trials on pregnant women are rarely carried out, for obvious reasons.

Depression and anxiety became big business for the pharmaceutical industry in the 1990s as doctors became better at diagnosing the problems, exposing a population of over-achieving, highly-stressed, worried-well.

Women, always more willing to see a doctor than men, were a large proportion of those diagnosed and put on SSRIs (selective serotonin reuptake inhibitors) such as Prozac and the British drug Seroxat, known as Paxil in the US. For a while, these seemed to be the new miracle drugs. They were safer than older antidepressants because the severely depressed could not overdose on them.

But in court cases about to begin in the US, it will be argued that insufficient attention was paid to the possible dangers for young women who were pregnant or might become pregnant and more particularly, for their babies.

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Popular Breast Cancer Drug Used with Certain Antidepressants Puts New Jersey Women at Risk

A new analysis finds that women in New Jersey who take the breast cancer drug tamoxifen in conjunction with certain popular antidepressants may be at a higher risk for a breast cancer recurrence.

In May, Medco Health Solutions, Inc. (NYSE: MHS) and Indiana University School of Medicine released a study revealing that women using tamoxifen to prevent a recurrence of breast cancer who also use certain selective serotonin reuptake inhibitors (SSRI), for example Prozac(R) (fluoxetine), Paxil(R) (paroxetine) and Zoloft(R) (sertraline), have up to twice the chance of having a recurrence of the disease.

In a separate New Jersey-specific analysis, Medco found that among nearly 2,000 tamoxifen patients in the state during 2008, 12 percent were also taking SSRIs, including those that could put them in the at-risk population.

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Stopping antidepressants can cause side effects - Recognizing withdrawal symptoms and working with your doctor are key.

Ryan Yorke, now 21, started taking Paxil after an out-of-the-blue panic attack his freshman year of high school. At first it worked great. But he gained weight and had other problems -- he started acting up in school and failing classes, for example. So after a year, he -- along with his mother and his psychologist -- decided it was time to stop.

Every time he reduced his dose, things got out of control, says his mother, Laurie Yorke, a registered nurse and now an administrator of paxilprogress.org, an antidepressant-withdrawal support site.

After the first big dose drop, Ryan slashed his wrists in front of his mother in the living room. "It was a six-hour psychotic episode. He was quoting Shakespeare and saying he wanted to die," she recalls.

A few weeks later, after more gradual dose changes, Ryan was still so sensitive to light and sound that he taped shut the window shades in his bedroom. His memory and concentration were poor. He dropped out of school and got his GED later, after the withdrawal process was over.

Mental health professionals aren't sure how many people have problems when stopping antidepressant medication. It's not even clear how to define the cluster of withdrawal symptoms people report, or even what causes the effects. "It's a difficult corner of the field," says Dr. Kenneth Duckworth, medical director of the National Alliance on Mental Illness and psychiatry professor at Harvard Medical School. "It's hard to know whether the person's depression is worsening or if they're having a variation on a discontinuation syndrome.

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Depression Treatment Wanes Following FDA Warnings

Newly diagnosed cases of depression in America have dropped sharply since the government's warning of an increased risk of suicidal behavior among children and teens taking antidepressants, a new analysis finds.

Researchers at the University of Colorado say the U.S. Food and Drug Administration's advisories about the use of selective serotonin reuptake inhibitors (SSRIs) appear to be associated with "unintended" and "persistent" changes in the diagnosis and treatment of depression, especially in children and teens. They also observed a "spillover effect" on adult depression care.

"We don't know why; we just do know after the warnings these things did change, so it had an effect on treatment patterns for depression," said study co-author Robert J. Valuck, a professor of clinical pharmacy at the University of Colorado Denver's School of Pharmacy.

The report appears in the June issue of the Archives of General Psychiatry.

From the time the FDA issued its warning in 2003 through June 2007, primary-care physicians wrote 44 percent fewer SSRI prescriptions for pediatric patients than historical trends predicted, and 37 percent fewer for young adults. Yet there was no change in alternative medications or psychotherapy to compensate for the decline in SSRI prescriptions for these patients.

"It does look concerning, that the patients are not getting treated," said John F. Curry, director of clinical psychology training at Duke University Medical Center in Durham, N.C.

In October 2003, the FDA warned about the increased risk to children and teens of taking SSRIs, citing an increased risk of attempted suicide and suicidal behavior. A little over a year later, the agency directed pharmaceutical manufacturers to add a "black box" warning to medication labels, urging close monitoring of patients taking these drugs.

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Results of phase III study on Labopharm's novel antidepressant published in Psychiatry (Edgemont) Journal

Labopharm Inc. (TSX: DDS; NASDAQ: DDSS) today announced the publication of Extended Release Trazodone in Major Depressive Disorder: A Randomized, Double-Blind, Placebo-Controlled Study in the May 2009 issue of the journal Psychiatry (Edgemont) (Volume 6, Number 5) (www.psychiatrymmc.com). The results of this Phase III clinical trial (study 04ACL3-001), which were originally reported by the Company in February 2008, demonstrate clear benefits for Labopharm's novel antidepressant.

More than 120 million people around the world suffer from depression. Treatment is often challenging because response to antidepressant drug therapy can vary significantly. Clinically depressed patients are typically treated with two different types of drug therapy: selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)). However, some 40 to 50% of patients being treated for depression stop taking these antidepressant drugs within the first 12 months of treatment. Frequently cited reasons for discontinuing therapy include suboptimal efficacy on depression symptoms, exacerbation of sleep disturbance, increased agitation, slow onset of action, sexual dysfunction and weight gain.

Labopharm's novel formulation of the antidepressant trazodone is designed to optimize the efficacy of trazodone, and address the major challenges in treating depression.

Summary of Results of Labopharm's Phase III Clinical Trial on Trazodone

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Antidepressants: The right people aren't always getting them

The medications are widely used to treat complaints such as loneliness or low energy. Meanwhile, studies say many with depression go untreated.

It was just over 20 years ago that the antidepressant Prozac was first approved by the U.S. Food and Drug Administration. The medication was touted as nothing short of a miracle: Not only was it was highly effective in treating depression, it also caused very few side effects.

The drug's popularity grew rapidly, and pharmaceutical companies got busy developing a variety of other, chemically similar antidepressants, collectively referred to as selective serotonin reuptake inhibitors (or SSRIs). There are at least half a dozen SSRIs on the market, including Lexapro, Paxil, Zoloft, Celexa and Luvox.

Since the introduction of these drugs, the number of Americans being treated for depression has increased dramatically; the Centers for Disease Control and Prevention says antidepressants are the most commonly prescribed medication in the country. But it's not always the right people taking them. Some who probably have very little to gain from their use are on SSRIs; others who stand to benefit are not.

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Why Antidepressants Don't Live Up to the Hype

In the '90s, Americans grew fond of the idea that you can fix depression simply by taking a pill — most famously fluoxetine (better known as Prozac), though fluoxetine is just one of at least seven selective serotonin reuptake inhibitors (SSRIs) that have been prescribed to treat hundreds of millions of people around the world.

But in the past few years, researchers have challenged the effectiveness of Prozac and other SSRIs in several studies. For instance, a review published in the Journal of Affective Disorders in February attributed 68% of the benefit from antidepressants to the placebo effect. Likewise, a paper published in PLoS Medicine a year earlier suggested that widely used SSRIs, including Prozac, Effexor and Paxil, offer no clinically significant benefit over placebos for patients with moderate or severe depression. Meanwhile, pharmaceutical companies maintain that their research shows that SSRIs are powerful weapons against depression. (Here's a helpful blog post that summarizes the debate.)

Now a major new study suggests that both critics and proponents might be right about SSRIs: the drugs can work, but they appear to work best for only a subset of depressed patients — those with a limited range of psychological problems. People whose depression is compounded with, say, substance abuse or a personality disorder may not get much help from SSRIs — which is unfortunate for the 45% to 60% of patients in the U.S. who have been diagnosed with a common mental disorder like depression and also meet the criteria for at least one other disorder, like substance abuse. (Multiple diagnoses are known in medical parlance as comorbidities.)

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Drugs 'can help mild depression'

Antidepressants can help mild to moderate depression and should not just be used in bad cases, researchers say.

Current guidelines urge doctors to avoid antidepressants as an initial treatment in mild depression.

But an NHS-funded study of 200 patients from across England found the drugs, called SSRIs, were more effective than GP advice and support alone.

The team hope national advisers will look at their findings, reported on the Health Technology Assessment website.

Study leader Professor Tony Kendrick, a GP and researcher at the University of Southampton, said although the National Institute of Health and Clinical Excellence wants doctors to restrict SSRIs to the most severe cases, GPs frequently prescribe them for milder cases.

"Just because someone has mild depression does not mean it is a mild illness, because it can cause them to be off work for months," he said.

"And often you don't have psychological treatments to offer because they're not available so you end up prescribing quite frequently."

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What Is Neuropathy? What Causes Neuropathy?

Neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders, and exposure to toxins. One of the most common causes of neuropathy is diabetes.

Neuropathy can affect nerves that control muscle movement (motor nerves) and those that detect sensations such as coldness or pain (sensory nerves). In some cases - autonomic neuropathy - it can affect internal organs, such as the heart, blood vessels, bladder, or intestines.

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Pitt Study Of Pregnant Women Shows Antidepressants, Depression May Raise Risk Of Premature Birth

Pregnant women who had untreated major depression in all three trimesters of pregnancy, as well as those who took certain antidepressants, had preterm birth rates exceeding 20 percent, according to a study by University of Pittsburgh School of Medicine researchers published in the March issue of American Journal of Psychiatry.

Approximately 10-to-20 percent of women struggle with symptoms of major depression during their pregnancies, but treating it can be complicated. Selective serotonin reuptake inhibitor (SSRI) antidepressants are usually the first line of depression treatment, but can lead to unwanted outcomes such as preterm births if used continuously throughout pregnancy, the findings suggest.

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SSRIs as Antihypertensives in Patients With Autonomic Panic Disorder Is There a Link Between Panic Disorder and Hypertension?

We would like provisionally to name it serotonin, which indicates that its source is serum and its activity is one of causing constriction.
Rapport M, et al

The cardiovascular properties of serotonin (5-HT) have been known for some time—its name reflects its presence in serum and its action in increasing vascular tone. Serotonergic medications are routinely used to treat depressive and anxiety disorders, and the association of depression with cardiovascular disease has become well established.2 Recent studies have confirmed the colloquial wisdom that anxiety (especially panic) and hypertension are linked.

In this article, we examine the trinity of serotonin—serotonergic dysfunction, autonomic panic, and normal-weight essential hypertension— and the evidence that hypertensive individuals who experience panic with autonomic symptoms may be a group of patients in whom serotonergic dysfunction plays a key role. We discuss implications of this model, including the potential utility of SSRIs as antihypertensives in this cohort.

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Antidepressant Has Modest Benefits in Anxious Older Patients

Treating generalized anxiety disorder in patients 60 and older with a selective serotinin reuptake inhibitor (SSRI) significantly improved their symptoms as long as they took the drug, researchers here said.

The response rate among patients taking escitalopram (Lexapro) for up to 12 weeks was 69%, compared with 51% assigned to placebo in a randomized trial (P=0.03), reported Eric J. Lenze, M.D., of Washington University, and colleagues in the Jan. 21 issue of the Journal of the American Medical Association.

There were significantly greater improvements with the active drug versus placebo for activity limitations, social function, worry questionnaire scores, and overall anxiety symptoms and role functioning, the researchers said.

But the researchers characterized the improvements in the 179-patient trial as "modest," and diminished further by nonadherence.

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Birth Defects and SSRIs—How's a Mother to Know?

In 2006, Elissa's doctor prescribed Cymbalta to help with her depression. Shortly after starting on the antidepressant Elissa became pregnant. On her doctor's advice she continued taking Cymbalta. But it soon became apparent her baby was developing life-threatening defects.

"I had my first ultrasound at 3 months," Elissa said. "That's when I found out something wasn't right. The doctor explained that my baby appeared to have a heart defect, a hole in her heart. Shortly after Elissa's baby girl was born, prematurely, the infant had to undergo heart surgery to repair the damage that could have been induced by the antidepressant. But Elissa was not aware of the association between SSRIs—or selective serotonin reuptake inhibitors—and birth defects.

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