SSRIs

  • ssris

Selective serotonin reuptake inhibitors (SSRIs) are typically used in the treatment of major depressive disorder and anxiety disorders that work by altering the levels of a mood-enhancing chemical called serotonin. The first SSRI introduced in the market was fluoxetine in 1985.

SSRI are indicated in the treatment of major depression, anxiety disorder, panic disorder, social anxiety disorder, social phobia, bulimia nervosa, obsessive-compulsive disorder, personality disorder, premenstrual disorder and posttraumatic panic disorders. Off-label use of SSRI are a migraine, diabetic neuropathy, neurocardiogenic syncope, and fibromyalgia.

The main indicator of SSRIs is a major depressive disorder; however, they are often assigned to anxiety disorders, such as social anxiety disorder, bipolar disorder, obsessive-compulsive disorder (OCD), eating disorders, chronic pain, and, in some cases, due to post-traumatic stress disorder (PTSD). They are also used to treat a person's dysfunction, although there are various side effects.

Anti-depressants are recommended by the UK National Institute for Health and Care Excellence (NICE) as a first-line treatment for major depression and treatment for mild to moderate depression that goes on after a series of steps such as psychotherapy. They recommend its regular use for those with chronic health problems and mild depression. There has been controversy over the effectiveness of SSRIs in the treatment of depression in terms of its severity and duration.

Two meta-analyzes published in 2008 (Kirsch) and 2010 (Fournier) found that in mild and moderate depression, the effect of SSRIs was small or nonexistent compared with placebo, while in severe depression the effect of SSRIs was between "small" and " great ". The 2008 meta-analysis included 35 clinical trials submitted to the Food and Drug Administration (FDA) prior to licensing four new anti-depressants (including SSRIs paroxetine and fluoxetine, a non-SSRI antidepressant and fazodone, and serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine). The authors argue that the relationship between severity and efficacy in reducing placebo effect in severely depressed patients, rather than increased drug effect. Some researchers have questioned the validity of the study's data which suggests that we underestimate the magnitude of the effect of anti-depressants.

A 2012 meta-analysis of fluoxetine and venlafaxine concluded that statistically and clinically significant treatment effects are observed in each placebo-related drug regardless of the underlying depression; some of the authors however have expressed strong links with the pharmaceutical industry.

A 2017 systematic review states that "placebo-compared SSRIs appear to have significant effects in terms of depressive symptoms, but the clinical significance of these results appears questionable and all trials were at high risk of bias. In addition, placebo-compared SSRIs significantly increased the risk of both. serious and adverse events. Our results show that the adverse effects of SSRIs compared to placebo for major depressive disorder appear to outweigh any positive outcomes. " Fredrik Hieronymus et al. have criticized the review as inaccurate and misleading, but they have also exposed many links in the pharmaceutical industry.

In 2018, systematic reviews and meta-analyses comparing the effectiveness and acceptance of the 21 anti-depressant drugs have shown escitalopram to be one of the most effective. In children, there is concern about the quality of evidence with an understanding of the perceived benefits. When a drug is used, fluoxetine appears to be the first line.

Some SSRIs are effective in disrupting social anxiety, although their effects on companies are not always strong and their use is sometimes banned due to psychotherapy. Paroxetine was the first drug to be approved for social anxiety disorders and is considered an effective treatment for the disease, sertraline, and fluvoxamine were later approved, and, escitalopram and citalopram are used off-label for legal use, while fluoxetine may be considered effective in this condition.

Post-traumatic stress disorder (PTSD) is difficult to treat and treatment is often less effective; SSRIs are also different. They do not work well for this disease and only two SSRIs are approved by the FDA for this condition, paroxetine, and sertraline. Paroxetine has higher response rates and relief from PTSD than sertraline, but both do not work well in most patients. Fluoxetine is used off-label, but with mixed results, venlafaxine, SNRI, is considered to be somewhat effective, even though it is used off-label. Fluvoxamine, escitalopram, and citalopram are not well tested in this disease. Paroxetine remains the most appropriate drug for PTSD right now, but there are limited benefits. SSRIs are recommended by the National Institute for Health and Care Excellence (NICE) in the treatment of anxiety disorder (GAD) which has failed to respond to conservative measures such as educational and self-help activities. GAD is a common disease in which the central factor is excessive worry about a wide variety of events. Key symptoms include excessive anxiety about many events and problems, and difficulty controlling anxious thoughts that last for at least 6 months. Anti-depressants provide moderate to moderate reductions in reducing anxiety in GAD, and are superior to placebo in the treatment of GAD. The effectiveness of different anti-depressants is the same.

In Canada, SSRIs are a form of first-line treatment for obsessive-compulsive disorder (OCD). In the UK, they are only first-line treatment with moderate to severe disability and as a second-line treatment for those with minor disabilities, however, from the beginning of 2019, this recommendation is reviewed. In children, SSRIs can be considered a second-line treatment for those with moderate to severe disabilities, with close monitoring of adverse psychological effects. SSRIs, especially fluvoxamine, which is the first FDA approved for OCD, are effective in its treatment; Patients treated with SSRIs are about twice as likely to respond to treatment as those treated with placebo. Efficacy has been shown for short-term treatment trials for 6 to 24 weeks and for a period of 28 to 52-week duration trials.

Doctors often put SSRIs ahead of other anti-depressants because they usually have fewer side effects. That is, SSRIs are generally safe. "Selected serotonin reuptake inhibitors are the safest drugs, in general," said Danny Carlat, MD, Associate Clinical Professor of Psychiatry at Tufts University School of Medicine.

In 2004, the FDA added a black box warning labels for SSRIs. The warning points to an increased risk of suicidal thoughts and behavior in children and adolescents. However, other studies have suggested that the benefits of antidepressant drugs may outweigh the risks of suicidal thoughts.

Physicians and mothers-to-be should compare the risks of SSRI treatment with the risks of untreated depression. Depression without treatment can also have a negative impact on pregnancy. For example, depressed women may not want the prenatal care they need.

Some pregnant women may change their SSRI to reduce the risk while treating their depression. For example, Paroxetine (Paxil) has been linked to congenital heart disease and respiratory distress, and brain disorders in the newborn. Female doctors taking paroxetine may recommend switching to fluoxetine (Prozac) or citalopram (Celexa) during pregnancy. These SSRIs have been linked to very serious side effects.

SSRIs are not for everyone. It is rarely recommended if you are pregnant, breastfeeding, or under the age of 18 because there is an increased risk of serious side effects. However, the opposite can be done if the benefits of treatment are considered to outweigh the risks. SSRIs should also be used with caution if you have any health problems, including diabetes, epilepsy, and kidney disease.

Some SSRIs may respond unexpectedly to other medications, including other over-the-counter pain medications and medications, such as St John's wort. Always read the information sheet that comes with your SSRI medication to see if there are any medications you need to avoid.

It is believed that all Ssri drugs work in a similar way, and can often cause similar side effects, though some people who are not familiar with them. Many of the side effects can occur, and then, for the first few weeks of treatment, while the other is removed, your doctor may try a different medicine.

You have to tolerate one SSRI, you have to tolerate the other, as the SSRIS, changes in the ability to block serotonin reuptake inhibitor, and this, is how quickly your body will take up the drug. If any of the side effects of Ssris can include, but are not limited to: · Nausea, vomiting, or diarrhea · Headache · Drowsiness. · Mouth · Insomnia · Nervousness, agitation or restlessness · Vertigo

The intake of a meal reduces the risk of nausea. In addition, as long as your medication interferes with your sleep, you can help reduce the effects of the disease by taking this before bed.

As for the anti-depressant drugs, which one is best for you will depend on a number of issues, your symptoms, and any other health problems you may have. Asking the doctors and pharmacists about the most common potential side effects, especially for those of SSRIs, and read patient management guide-to-follow recipes.

SSRIs are generally safe for most people. However, in some cases, it can cause problems for them. For example, a high dose of this medication can result in dangerous abnormal heart rhythms, it is necessary to prevent a denial of the more than 40 years of age, in which (mg) per day, according to the FDA and the manufacturer. It comes with a maximum daily dose of citalopram is 20 mg for people over the age of 60.

Anyone taking antidepressants should be closely monitored for exacerbation, depression, or unusual behavior. If you or someone you know is having thoughts about suicide while taking antidepressant medication, consult your doctor or the emergency contacts immediately.

Remember that anti-depressants are more likely to reduce the risk of suicide in the long run, it started in the mood.

Serious Alleged Injuries may include:

  • Risk of Suicidal attempts and violent behavior in children, adolescents and young adults (Age group - 18 to 24)
  • Anencephaly, Cranisynostosis, Omphalocele
  • Autism spectrum disorder
  • Heart defects (septal), malformations
  • Persistent pulmonary hypertension of the newborn (PPHN)
  • Lung defects
  • Respiratory distress syndrome
  • Facial malformations like Cleft palate

FDA Safety Warnings:

It was noted when pregnant women consume SSRIs, the risk of autism spectrum disorder and birth defects in newborns increased.

The Food and Drug Administration (FDA) has issued alerts regarding unreported side effects of Zoloft, Prozac, Paxil, Celexa, Lexapro, most of which have led to litigation against the manufacturers.

 

Brand Names Contents Manufacturers FDA Approved
Brintellix Vortioxetine Takeda Pharmaceutical/H. Lundbeck A/S (Lundbeck) 30-Sep-13
Celexa Citalopram Forest Laboratories 17-Jul-98
Lexapro Escitalopram Forest Laboratories 14-Aug-02
Luvox Fluvoxamine Solva pharmaceutical 12-May-94
Paxil Paroxetine GlaxoSmithKline Feb-02
Prozac Fluoxetine Eli Lilly 29-Dec-87
Viibryd Vilazodone Actavis plc 21-Jan-11
Zoloft Sertraline Pfizer 30-Dec-91

 

Legal Updates:

Many lawsuits have been filed and a few have also reached settlements: Zoloft, Prozac, Paxil, Celexa, Lexapro.

 

NEWS

Aug 16, 2019: Rejected $100K Settlement Offer, Gets $4.2M Verdict

The plaintiff who suffered spinal injuries in a multi-car wreck has been awarded $4.2 million by a Fulton County jury after an insurer refused to settle the case for $100,000 nearly a decade ago.

According to the court filings, the plaintiff, now 60, was sandwiched between two cars when the defendant hit the last vehicle in line at a stop on Old Malton Parkway in Alpharetta in March 2010. Plaintiff's Nissan Sentra was destroyed in the collision, and he complained of pain in his leg, back, and neck. He already had some preexisting spinal problems which worsened by the wreck. Defendant and another driver were taken to the hospital where the blood tests revealed that she had taken “multiple sleep and/or psychotropic drugs” including Ambien, diphenhydramine [Tylenol PM], Xanax and Paxil, an antidepressant that belongs to a group of drugs called selective serotonin reuptake inhibitors (SSRIs).

The plaintiff was diagnosed with a herniated disk in his neck a year and a half later. Plaintiff’s attorney demanded the defendant's insurer, USAA, for her $100,000 policy limit, where the insurer offered to pay $14,500. The plaintiff declined the offer and filed a suit in Fulton County State Court; another offered by the plaintiff's attorney of $1.75 million under Georgia’s Unliquidated Damages Interest Act was also declined.

On August 15, the Fulton County jury awarded $3 million in compensatory damages, $1.2 million in attorney fees, and $5,555 in litigation expenses for a total of $4,251,555.

Sep 10, 2020: Study Links SSRIs To Increased Risk Of Hemorrhagic Stroke

On August 31, Massachusetts General Hospital researchers published a single-center observational cohort study in the medical journal JAMA Neurology, indicating that selective serotonin reuptake inhibitor (SSRI) antidepressants, prescribed to individuals after suffering a stroke, may increase the risk of suffering a brain bleed later.

The intracerebral hemorrhage (ICH) study involved 1,200 adults who were hospitalized, treated, and discharged after suffering from a stroke. The ICH survivors had depression from January 2006 to December 2017 and were followed for 54 months.

SSRIs, such as Paxil or Zoloft, are widely used to treat depression after a stroke caused by brain bleeds. According to the study, the increased risk of ICH recurrence or having another brain bleed was more for patients with preexisting clinical, genetic, or neuroimaging risk factors for hemorrhagic stroke. The patients were 71 years old, on average, and the risk heightened in people who consumed SSRI antidepressants as compared to the ones who didn't, as per the report.

In a study published in 2016, SSRI antidepressants were linked to a higher risk of recurring brain bleeds among patients taking blood thinners like Warfarin or Xarelto.

The researchers concluded that although SSRIs are considered the primary treatment after stroke, it may not be the best course of treatment for patients who have a higher risk of brain bleeds after stroke and may lead to another hemorrhagic bleed in the brain. The researchers also warned doctors to weigh the decision to treat depression among stroke survivors with SSRIs against the increased risk of the patient suffering another brain bleed.

Sep 24, 2020: SSRIs Linked To Risk Of Type 2 Diabetes In Children

JAMA Psychiatry published a study earlier this month, indicating that children who were prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants, like PaxilCelexa, or Zoloft are at a higher risk of developing type 2 diabetes.

Selective serotonin reuptake inhibitors (SSRIs) are typically used in the treatment of major depressive disorder and anxiety disorders that work by altering the levels of a mood-enhancing chemical called serotonin. The first SSRI introduced in the market was fluoxetine in 1985. SSRI is indicated in the treatment of major depression, anxiety disorder, panic disorder, social anxiety disorder, social phobia, bulimia nervosa, obsessive-compulsive disorder, personality disorder, premenstrual disorder, and posttraumatic panic disorders. Off-label use of SSRI is a migraine, diabetic neuropathy, neurocardiogenic syncope, and fibromyalgia.

The national pediatric study conducted by Harvard researchers involved more than 1.5 million publicly and privately insured patients, aged between 10 to 19 years old, who were taking SSRIs as a treatment for depression. As per the findings, a 13% increased risk of type 2 diabetes was linked in publicly insured adolescents treated with SSRIs as compared to untreated patients. A 33% increased risk was seen in teenagers who continuously used SSRIs, filling one or more prescriptions every three months.

The study also implies that there might be 6.6 additional cases of diabetes per 10,000 adolescent or teen patients treated with SSRIs for the past two years, and the risk factor was statistically insignificant for privately insured young patients.

Last month, the Massachusetts General Hospital researchers also published a study in the medical journal JAMA Neurology, indicating that the antidepressants, prescribed to individuals after suffering a stroke, may increase the risk of suffering a brain bleed later.

The use of SSRIs is growing as more and more adolescents are suffering from depression and other anxiety disorders. Previous studies have indicated the link between SSRI antidepressants and diabetes among adults; children and teens are usually excluded from clinical trials, but concerns were always raised.

The researchers concluded that children and adolescents receiving SSRI treatment might be at a small increased risk of developing type 2 diabetes, and the potential small risk should be viewed concerning the effectiveness of the antidepressants.

Evidence:

  • Usage of SSRI and other antidepressants in Pharmacy Records
  • Duration of usage in pregnant females and in children/young adults from Pharmacy Records
  • Diagnosis and Treatment of birth anomalies in child; suicidal tendency and violent behavior in children/young adults after intake
  • Treatment required for birth related defects in child

Medical Record Review and claim validation of SSRIs case should take approximately 2 hours in most instances; however, this approximation may vary in cases based on the volume of records.

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