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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Some authorities have anecdotally noted similar symptoms of abstinence among adults who abruptly discontinue SSRI use. Furthermore, it is suggested by some psychiatrists that infants antenatally exposed to SSRIs, and perhaps other antidepressants, remain at risk for depression as teenagers and adults.
Using Medication Wisely
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
The next family of medicines is selective serotonin reuptake inhibitors (SSRIs). The first, and most famous, SSRI was Prozac (Fluoxetine), but there are many others, including:Sertraline (Zoloft)Citalopram (Celexa)Escitalopram (Lexapro)Paroxetine (Paxil)
Drugs in pregnancy and lactation
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The cerebral cortex is widely innervated by serotonin (5-HT)-containing axons originating from neurons in the raphe nuclei. This system is present at early stages of brain development and different studies have shown that serotonin is important for neuronal proliferation, migration and differentiation, and for apoptotic cell death inhibition [53]. Furthermore, there is a serotonergic regulation of somatosensory cortical development [54]. SSRI, used as antidepressants in humans, will increase 5-HT concentrations in the synaptic cleft. Therefore, if taken by a pregnant woman, SSRI could potentially disturb several steps of fetal brain development. Experimentally, excess of 5-HT, alters the segregation of retinogeniculate and somatosensory projections in monoamine oxidase A knockout newborn mice [55].
SSRI withdrawal syndrome in children and adolescents: a narrative literature review
Published in Expert Opinion on Drug Safety, 2023
Yasser Saeed Khan, Mohamed Adil Shah Khoodoruth, Yahia Albobali, Peter M. Haddad
The distinction between SSRI withdrawal symptoms and relapse of a depressive illness can be complicated and may pose a significant challenge to clinicians [49]. The nature and timing of onset of symptoms can help distinguish withdrawal symptoms from relapse. Whilst SSRI withdrawal symptoms typically arise suddenly, and within days of stopping or reducing the dose, symptoms of a depressive relapse will have a more gradual onset, often weeks or months after stopping an antidepressant [50]. Moreover, discontinuation symptoms typically resolve completely within hours to a few days after reintroducing the SSRI, whereas symptoms of a relapse will usually take several weeks to respond. There can be significant overlap in the symptoms seen with SSRI withdrawal and depressive relapse, but some symptoms are more characteristic of the former, including dizziness, gait disturbance, and ‘shock-like sensations.’
A longitudinal study of restless legs symptoms among patients with depression
Published in Nordic Journal of Psychiatry, 2022
Piritta Auvinen, Hannu Koponen, Hannu Kautiainen, Katariina Korniloff, Tiina Ahonen, Mauno Vanhala, Pekka Mäntyselkä
Recent studies have shown that drug treatment of restless legs symptoms improves mood, which is plausible as dopamine agonists may also alleviate depressive symptoms [27]. In the present study, a decreasing level of depressive symptoms was associated with decreasing odds of having restless legs symptoms in the follow-up. Therefore, it can be assumed that effective treatment of depression probably relieves restless legs symptoms. About seven out of 10 clinically depressed patients in our study used antidepressants at the baseline. Among them, the follow-up BDI-score was markedly lower (10 points) in the follow-up compared with baseline, suggesting a treatment response. There are also studies in which antidepressant use has been linked to restless legs symptoms [28,29] though recent results have strongly questioned the relationship [30,31]. It is known that SSRI medications can be used for diseases other than depression alone. In this study, 31% of patients with depressive symptoms without diagnosed depression received SSRI medication and it may be possible that patients with SSRIs no longer suffered equally from depressive symptoms. On the other hand, the majority of the patients in the group did not use medication. In this study, the potential effect of antidepressant use on restless legs symptoms has been considered, and no association between symptoms and antidepressant or SSRIs use has been identified. In the future, it would be necessary to explore this particular role of antidepressants in the course of restless legs symptoms based on a prospective setting.
Safety considerations for prescribing SSRI antidepressants to patients at increased cardiovascular risk
Published in Expert Opinion on Drug Safety, 2022
Janne Kaergaard Mortensen, Grethe Andersen
All known side effects to SSRI treatment should be taken into consideration when using these drugs, especially when prescribing them to patients at increased cardiovascular risk. Stroke and MI patients are, on average, older and potentially more susceptible to side effects due to a higher prevalence of co-medication and comorbidity. Stroke patients have a higher risk of falls [63,64], a higher risk of fractures [65] as well as a higher risk of developing post-stroke epilepsy [66]. SSRI treatment has also been shown to increase the risk of falls, fractures, and seizures [38,67]. Other commonly described side effects to SSRIs are gastrointestinal symptoms, drowsiness, hyponatremia, and sleep disturbances. These side effects may have particularly negative consequences for stroke patients, who may have residual neurological impairments such as mobility impairments and visual field defects, a combination that could make stroke patients even more prone to falling. In both the FOCUS (n = 3127), EFFECTS (n = 1500), AFFINITY (n = 1280), and TALOS (n = 642) stroke trials, significantly more patients in the SSRI treated groups (fluoxetine and citalopram) had bone fractures as compared to the placebo treated patients [10–12,51]. In the AFFINITY trial, there were also significantly more patients with falls and seizures and in the EFFECTS trial, there were significantly more patients with hyponatremia in the fluoxetine treated group. Falls and seizures may be mediators of the increased risk of fractures, but SSRIs have also been associated to a decrease in bone mineral density [68,69].