by S.E. Gunn, PhD, All News Pipeline:
With the number of mass shooters who have been identified as being prescribed SSRIs (Selective serotonin reuptake Inhibitors) I thought it might be helpful to discuss SSRIs. A serotonin is a neurotransmitter (chemical messenger) that plays an important role in regulating mood, appetite, sleep, memory, social behavior, and sexual desire. It is claimed that SSRIs work by blocking serotonin reabsorption leading to gradual changes in brain signaling and receptor regulation. Wikipedia cautions that:
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Positive antidepressant trial results are much more likely to be published than negative ones, and many meta-analyses have conflicts of interest due to pharmaceutical industry involvement, often downplaying potential risks.
SSRIs are different from SNRIs (serotonin and norepinephrine reuptake inhibitors) in that SSRIs block serotonin uptake whereas SNRIs block both serotonin and norepinephrine increasing the levels of these neurotransmitters in the brain.
SSRIs are the most prescribed antidepressant according to the Mayo Clinic. Cleveland Clinic states more than 1 in 10 people in the US take an antidepressant (noting that SSRIs are the most commonly prescribed out of all the antidepressants available and that Prozac (Fluoxetine) is the most well-known SSRI). Wikipedia notes that SSRIs are also used for not only depression but also for social anxiety disorder, post-traumatic stress disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, eating disorders, stroke recovery, premature ejaculation, and other mental disorders.
SSRI’s have been associated with a more than 33% increase in death and a more than 14% increase in cardiovascular complications (it did not matter if the person was predisposition to cardiovascular disease). It has also been found that SSRIs cross the placenta to the baby if taken during pregnancy and no long-term studies have been published on babies whose mothers were taking SSRIs during pregnancy.
SSRIs have been used to treat “off-label” or non-FDA-approved uses such as binge eating disorders, body dysmorphic disorders, chronic pelvic pain syndrome, rheumatoid arthritis, and/or premature ejaculation.
The following drugs may cause serotonin syndrome in people taking SSRIs: Linezolid; Monoamine oxidase inhibitors (MAOIs) including moclobemide, phenelzine, tranylcypromine, selegiline and methylene blue; Lithium; Sibutramine; MDMA (ecstasy); Dextromethorphan; Tramadol; 5-HTP; Pethidine/meperidine; St. John’s wort; Yohimbe; Tricyclic antidepressants (TCAs); Serotonin-norepinephrine reuptake inhibitors (SNRIs); Buspirone; Triptan; Mirtazapine; Methylene blue. SSRI’s taken with aspirin, ibuprofen (advil or nurofen) and/or naproxen (aleve) may increase risk of gastrointestinal bleeds.
Symptoms of serotonin syndrome include: Nervousness; Nausea and vomiting; Diarrhea; Dilated pupils; Muscle issues, like twitching, involuntary contractions, spasms and rigidity; Sweating and shivering; and/or Side-to-side eye movements. Severe symptoms include Confusion or delirium; Rapid heart rate (tachycardia); High blood pressure; Fever; Seizures; and/or Loss of consciousness.
The FDA has approved these SSRIs to treat depression:
Citalopram (Celexa) commonly prescribed for depression but can be used for other purposes.
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- Contra Indications: Bipolar disorder or a family history of bipolar disorder; Bleeding disorder; Glaucoma; Heart disease; History of irregular heartbeat; Kidney disease; Liver disease; Low levels of magnesium or potassium in the blood; Receiving electroconvulsive therapy; Seizures; Suicidal thoughts, plans, or attempt by you or a family member; Take medications that treat or prevent blood clots; Thyroid disease; An unusual or allergic reaction to citalopram, other medications, foods, dyes, or preservatives; Pregnant or trying to become pregnant; and/or Breastfeeding.
- Major Side Effects (call your doctor if you experience any of the following): Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat; Bleeding—bloody or black, tar-like stools, red or dark brown urine, vomiting blood or brown material that looks like coffee grounds, small, red or purple spots on skin, unusual bleeding or bruising; Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing; Low sodium level—muscle weakness, fatigue, dizziness, headache, confusion; Serotonin syndrome—irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea; Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss; and/or Thoughts of suicide or self-harm, worsening mood, feelings of depression.
- Minor Side Effects (tell your doctor if they bother you): Change in sex drive or performance; Diarrhea; Dry mouth; Excessive sweating; Nausea; Tremors or shaking; Upset stomach.
- Medication Interactions: Certain medications for fungal infections, such as fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole; Cisapride; Dronedarone; Escitalopram; Linezolid; MAOIs, such as Carbex, Eldepryl, Marplan, Nardil, and Parnate; Methylene blue (injected into a vein); Pimozide; and/or Thioridazine.
- Other Possible Interactions: Alcohol; Amphetamines; Aspirin and aspirin-like medications; Carbamazepine; Certain medications for infections, such as chloroquine, clarithromycin, erythromycin, furazolidone, isoniazid, pentamidine; Certain medications for mental health conditions; Certain medications for migraine headaches, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan; Certain medications for sleep; Certain medications that treat or prevent blood clots, such as dalteparin, enoxaparin, warfarin; Cimetidine; Diuretics; Dofetilide; Fentanyl; Lithium; Methadone; Metoprolol; NSAIDs, medications for pain and inflammation, such as ibuprofen or naproxen; Omeprazole; Other medications that cause heart rhythm changes; Procarbazine; Rasagiline; Supplements, such as St. John’s wort, kava kava, valerian; Tramadol; Tryptophan; and/or Ziprasidone.
Escitalopram (Lexapro) prescribed to treat depression and anxiety.
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- Contra Indications: Bipolar disorder or a family history of bipolar disorder; Diabetes; Glaucoma; Heart disease; Kidney disease; Liver disease; Receiving electroconvulsive therapy; Seizures; Suicidal thoughts, plans, or attempt by you or a family member; An unusual or allergic reaction to escitalopram, other medications, foods, dyes, or preservatives; Pregnant or trying to become pregnant; and/or Breastfeeding.
- Major Side Effects (call your doctor if you experience any of the following): Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat; Bleeding—bloody or black, tar-like stools, red or dark brown urine, vomiting blood or brown material that looks like coffee grounds, small, red or purple spots on skin, unusual bleeding or bruising; Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing; Low sodium level—muscle weakness, fatigue, dizziness, headache, confusion; Serotonin syndrome—irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea; Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss; and/or Thoughts of suicide or self-harm, worsening mood, feelings of depression.
- Minor Side Effects (tell your doctor if they bother you): Change in sex drive or performance; Diarrhea; Excessive sweating; Nausea; Tremors or shaking; and/or Upset stomach.
- Medication Interactions: Certain medications for fungal infections, such as fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole; Cisapride; Citalopram; Dronedarone; Linezolid; MAOIs, such as Carbex, Eldepryl, Marplan, Nardil, and Parnate; Methylene blue (injected into a vein); Pimozide; and/or Thioridazine
- Other Possible Interactions: Alcohol; Amphetamines; Aspirin and aspirin-like medications; Carbamazepine; Certain medications for mental health conditions; Certain medications for migraine headache, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan; Certain medications for sleep; Certain medications that treat or prevent blood clots, such as warfarin, enoxaparin, dalteparin; Cimetidine; Diuretics; Dofetilide; Fentanyl; Furazolidone; Isoniazid; Lithium; Metoprolol; NSAIDs, medications for pain and inflammation, such as ibuprofen or naproxen; Other medications that cause heart rhythm changes; Procarbazine; Rasagiline; Supplements, such as St. John’s wort, kava kava, valerian; Tramadol; Tryptophan; and/or Ziprasidone.
Fluoxetine (Prozac) which has been approved for veterinary use for canine separation anxiety as well as reducing Raynaud syndrome is prescribed to treat depression, anxiety, obsessive-compulsive disorder (OCD), and eating disorders.
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- Contra Indications: Bipolar disorder or a family history of bipolar disorder; Bleeding disorder; Glaucoma; Heart disease; Liver disease; Low levels of sodium in the blood; Seizures; Suicidal thoughts, plans, or attempt by you or a family member; Take an MAOI, such as Carbex, Eldepryl, Marplan, Nardil, or Parnate; Take medications that treat or prevent blood clots; Thyroid disease; An unusual or allergic reaction to fluoxetine, other medications, foods, dyes, or preservatives; Pregnant or trying to get pregnant; and/or Breastfeeding.
- Major Side Effects (call your doctor if you experience any of the following): Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat; Bleeding—bloody or black, tar-like stools, red or dark brown urine, vomiting blood or brown material that looks like coffee grounds, small, red or purple spots on skin, unusual bleeding or bruising; Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing; Loss of appetite with weight loss; Low sodium level—muscle weakness, fatigue, dizziness, headache, confusion; Serotonin syndrome—irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea; Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss; and/or Thoughts of suicide or self-harm, worsening mood, feelings of depression.
- Minor Side Effects (tell your doctor if they bother you): Anxiety, nervousness; Change in sex drive or performance; Diarrhea; Dry mouth; Headache; Excessive sweating; Nausea; Tremors or shaking; Trouble sleeping; and/or Upset stomach.
- Medication Interactions: Other medications containing fluoxetine, such as Sarafem or Symbyax; Dronedarone; Linezolid; MAOIs, such as Carbex, Eldepryl, Marplan, Nardil, and Parnate; Methylene blue (injected into a vein); Pimozide; and/or Thioridazine.
- Other Possible Interactions: Alcohol; Amphetamines; Aspirin and aspirin-like medications; Carbamazepine; Certain medications for mental health conditions; Certain medications for migraine headache, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan; Digoxin; Diuretics; Fentanyl; Flecainide; Furazolidone; Isoniazid; Lithium; Medications that help you fall asleep; Medications that treat or prevent blood clots, such as warfarin, enoxaparin, and dalteparin; NSAIDs, medications for pain and inflammation, such as ibuprofen or naproxen; Other medications that cause heart rhythm changes; Phenytoin; Procarbazine; Propafenone; Rasagiline; Ritonavir; Supplements, such as St. John’s wort, kava kava, valerian; Tramadol; Tryptophan; and/or Vinblastine.
Paroxetine (Paxil, Pexeva) prescribed for depression, anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).
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