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Tests and diagnosis (2)
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continued:
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin syndrome and SSRIs
A rare but potentially life-threatening side effect of SSRIs is serotonin syndrome. This condition, characterized by dangerously high levels of serotonin in the brain, can occur when an SSRI interacts with antidepressants called monoamine oxidase inhibitors (MAOIs). Because of this, don't take any SSRIs while you're taking any MAOIs or within two weeks of each other. Serotonin syndrome can also occur when SSRIs are taken with other medications, including:
- Pain relief medication such as tramadol (Ultram)
- Migraine medications such as sumatriptan (Imitrex) and rizatriptan (Maxalt)
- Supplements that affect serotonin levels, such as St. John's wort
Serotonin syndrome requires immediate medical treatment. Signs and symptoms include:
- Confusion
- Restlessness
- Hallucinations
- Extreme agitation
- Fluctuations in blood pressure
- Increased heart rate
- Nausea and vomiting
- Fever
- Seizures
- Coma
Safety concerns with SSRIs
Studies show that Paxil increases the risk of birth defects in women taking the drug during their first trimester of pregnancy. Women who take Paxil during their first three months of pregnancy are nearly two times as likely to give birth to a child with a birth defect — in particular a heart defect — as are women taking other antidepressants.
The American College of Obstetricians and Gynecologists recommends avoiding Paxil during pregnancy, if possible. If you're taking Paxil and you're considering getting pregnant, talk to your doctor or mental health provider about switching to another antidepressant or stopping treatment. Don't stop taking Paxil without contacting your doctor first, though.
Also, the FDA warns that infants whose mothers took SSRIs while pregnant may be at an increased risk of persistent pulmonary hypertension. This risk is increased in women who take SSRIs at 20 weeks or later in pregnancy. This rare but serious lung problem occurs when a newborn's circulatory system doesn't adapt to breathing outside the womb.
Use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) or anticoagulants, such as warfarin (Coumadin), while taking SSRIs may increase the risk of gastrointestinal bleeding and should be monitored by your doctor.
Recent studies have shown that Symbyax and other antipsychotics should not be prescribed to older people for treatment of dementia-related psychosis. Symbyax and other antipsychotic drugs raise the risks of heart failure, sudden death and pneumonia in older people with dementia-related psychosis.
Stopping treatment with SSRIs
SSRIs aren't considered addictive. However, stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, including:
- Nausea
- Headache
- Dizziness
- Lethargy
- Flu-like symptoms
This is sometimes called discontinuation syndrome. Talk to your doctor before stopping so that you can gradually taper off.
Suicidal feelings and SSRIs
Antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior in those ages 18 to 24. These symptoms or thoughts are most likely to occur during the first one to two months of treatment or when you change your dosage, but they can occur at any time during treatment. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring when starting treatment or changing dosage, or you may need to stop the medication if your symptoms worsen. Adults age 65 and older taking antidepressants have a decreased risk of suicidal thoughts.
Talk with your doctor or mental health provider to nix your irritability, sadness or anger and boost your mood with SSRIs. Feel good again.
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- FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. U.S. Food and Drug Administration. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html. Accessed Sept. 12, 2008.
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- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 25, 2008.
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- Symbyax ... because not all depression is the same. http://www.symbyax.com/index.jsp. Accessed Oct. 6, 2008.
- Antidepressants: Selecting one that's right for you. MayoClinic.com. http://www.mayoclinic.com/health/antidepressants/HQ01069. Accessed Oct. 16, 2008.
- Buss LK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 24, 2008.
- Ultram (prescribing information). Mississaugo, Ontario, Canada: Biovail Corp.; 2007. http://www.ortho-mcneil.com/ortho-mcneil/shared/pi/ultramer.pdf. Accessed Oct. 5, 2008.
- Single interactions table. Micromedex Healthcare Series. http:www.micromedex.com. Accessed Oct. 14, 2008.
- Imitrex (prescribing information). Research Triangle Park, N.C.: GlaxoSmithKline; 2008. http://us.gsk.com/products/assets/us_imitrex_injection.pdf. Accessed Nov. 9, 2008.
- Single interactions table. Micromedex Healthcare Series. http:www.micromedex.com. Accessed Nov. 9, 2008.
- Maxalt (prescribing information). Whitehouse Station, N.J.: Merck & Co.; 2008. http://www.merck.com/product/usa/pi_circulars/m/maxalt/maxalt_pi.pdf. Accessed Nov. 9, 2008.
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- Detailed view: Safety labeling changes approved by FDA Center for Drug Evaluation and Research (CDER) - August 2008. U.S. Food and Drug Administration. http://www.fda.gov/medwatch/safety/2008/aug08.htm. Accessed Nov. 26, 2008.
