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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Paroxetine and sertraline are listed under the old FDA category B drugs, but recent research calls the safety of paroxetine use during pregnancy into question. The frequency of congenital anomalies was not increased above background among 394 infants exposed to paroxetine during the first trimester (Diav-Citrin et al., 2002; Ericson et al., 1999; Inman et al., 1993; Kulin et al., 2002; McElhatton et al., 1996; Wilton et al., 1998). However, as recently as July 2006, the manufacturer of Paxil (paroxetine) reported that first trimester use increased the risk of birth defects by between two and three times, with the risk of congenital heart defects being doubled. This contradicts prior studies of the drug’s use during the first trimester.
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Published in Charles E. Dean, The Skeptical Professional's Guide to Rational Prescribing, 2022
These reports and studies clearly add another threat to balancing the risk–benefit ratio, no matter the field of medicine, and thus undermines the possibility of rational prescribing. This was demonstrated as well in a clever study by Kravitz et al.,20 who created a randomized trial of standardized patients (SPs), e.g., actors portraying either a patient with symptoms commonly found in major depression, or a patient with an adjustment disorder accompanied by a depressed mood and low back pain. The SPs were seen as outpatients by internists and family physicians in four large physician collectives. The physicians were recruited by the authors, and were told only that they would be seeing two SPs several months apart. The SPs would present with common symptoms. Some of the SPs had been instructed to make a DTCA-driven request for Paxil (paroxetine) within the first ten minutes of the visit, or a general request for medication, or no explicit request at all.
The Forensic Toxicological Aspects of Deaths Due to Drowning and Bodies Recovered from Fluid Environments
Published in Kevin L. Erskine, Erica J. Armstrong, Water-Related Death Investigation, 2021
The following are but a few examples of adverse effects of some psychiatric medications. The antidepressant paroxetine (Paxil) can produce symptoms of somnolence, agitation, and muscular weakness.3 This medication is also prescribed for anxiety and obsessive compulsive disorder. One other antidepressant medication, amitriptyline (Elavil, Endep), has been found to impair the skilled performance, such as driving, an effect that is increased with the addition of ethanol.3 Clinical signs of toxicity and overdosage produced by this medication include seizures, coma, and cardiac arrhythmias.5 Specifically, cardiac arrhythmias can lead to drops in blood pressure, fainting, and seizure-like activities, potentially life-threatening situations, when combined with water-related activities. Toxicity related to lithium usage, a medication prescribed for bipolar disorder, includes drowsiness, weakness, unsteadiness, and blurred vision. Methadone, which is prescribed for heroin addiction and chronic pain conditions, can give rise to sedation, weakness, and respiratory depression.5 Overdose and potentially death can occur at therapeutic doses and blood levels, especially in individuals who are naïve to or lack tolerance for this medication.
Irving Kirsch opens a window on antidepressant medications
Published in American Journal of Clinical Hypnosis, 2023
Emma Grace Chen, Alison Kate Oliver, Amir Raz
Some mental health professionals and certainly most patients are unaware of the extent to which the pharmaceutical industry influences academic psychiatry (Harris & Carey, 2008; Harris, Carey, & Roberts, 2007). In the early 2000s, this emerging controversy had sufficiently surfaced to reach some public awareness. At that time, the Food and Drug Administration (FDA) held a series of hearings on whether antidepressant drugs – for example, Paxil, Prozac, and Zoloft – had backfired in a small number of patients, causing suicidal thinking and dangerously desperate behavior. By 2004, based on these hearings, the FDA concluded that all antidepressants should saliently display a cautionary label (Lenzer, 2006) – a so-called black-box warning – to explicitly cite the risk of suicide for children and adolescents taking antidepressants; by 2006, the warning included young adults (Carey, 2006). Many psychiatrists felt it was the wrong decision; such a stern notice might inadvertently discourage the use of psychiatric drugs by many patients who could benefit from them. Against this backdrop, clinical psychologist and researcher Irving Kirsch was already underway in launching a data-driven, evidence-based campaign toward developing a clearer picture of antidepressant medications. It is befitting that Kirsch, a champion of suggestion, expectation, and placebo research, has made indispensable contributions to our scientific understanding of our current treatment methods for depression.
Comparing Perika St. John’s Wort and Sertraline for Treatment of Posttraumatic Stress Disorder in Mice
Published in Journal of Dietary Supplements, 2020
Sandra L. McFadden, Brianna L. Hooker
Current treatments for PTSD include various psychological approaches and oral pharmaceuticals, particularly antidepressant medications, either alone or in combination (Sharpless and Barber 2011). There is no standard treatment approach for PTSD as the effectiveness of any treatment depends on the person being treated and the resources available, but trauma-focused psychotherapy (i.e., any therapy that uses cognitive, emotional, or behavioral techniques to facilitate trauma processing) is currently recommended over other psychological and pharmacological approaches as the first-line intervention (U.S. Department of Veterans Affairs 2017). Psychotherapy may not be effective for, or available to, some patients with PTSD, and others may simply prefer medications. In these cases, selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (e.g., Paxil) and sertraline (e.g., Zoloft) are considered first-line pharmacological treatments (Reisman 2016; U.S. Department of Veterans Affairs 2017). Numerous studies have found that combining pharmacological (antidepressant) medication with psychotherapy is more effective than either approach alone (Reisman 2016).
Psychiatry through History: Is it Evolving or Blowing with the Wind?
Published in Issues in Mental Health Nursing, 2020
In the 1980s the case for a biologic cause for mental illness got a big boost from the entrance of Prozac into the market and the rise of the ‘chemical imbalance’ theory of mental illness, especially depression. The idea exploded into public view in the 1990s (known as the decade of the brain) with the advent of direct-to-consumer advertising of prescription drugs, antidepressants in particular. Zoloft, Paxil and other selective serotonin re-uptake inhibitors (SSRIs) followed. The medications were billed as repairing an underlying biological problem and the strategy worked brilliantly. At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants (Greenberg, 2019). According to Harrington (2019b) a range of different studies increasingly seemed to suggest that these antidepressants, although they seemed to be helping a lot of people, when compared to placebo versions of themselves, didn’t seem to do much better. But the public ignored these findings; it was much more acceptable and less stigmatizing to have a chemical imbalance than a mental illness. The chemical imbalance theory, like the DSM, may have failed as science, but as a description of what ails us it has turned out to be a wild success (Greenberg, 2019).