No evidence for SSRIs and autism

Serotonin-specific reuptake inhibitors (SSRIs) anti-depressants are often prescribed for people with autism as it is thought that improving the amount of serotonin in the brain might improve some of the psychological problems associated with the condition. Katrina Williams from the University of New South Wales has been leading a team reviewing the evidence for SSRIs for autism on behalf of the Cochrane database. The team reviewed seven studies involving 271 patients and found that SSRIs had no benefits for children and could cause serious harm. One child, who had been taking citalopram, had had a prolonged seizure. There was some slender evidence of improvement in the trials involving adults but not enough for the treatment to be recommended.

You can find out more about this research by clicking on the title of this post.

SSRIs and cataracts

Certain types of antidepressants called SSRIs (serotonin-specific reuptake inhibitors) can increase people's risk of cataracts. Researchers from the Vancouver Coastal Health Research Institute in Canada compared 19,000 people over the age of 65 who were taking antidepressants with 190,000 people in the same age group not taking them. Three SSRIs - fluvoxamine, venlafaxine and paroxetine - were all found to increase cataract risk by 39%, 33% and 23% respectively. However, the increase in risk was associated with current rather than prior use of SSRIs.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=128735&cn=5

Antidepressants and self-poisoning risk - which are the riskiest?

Self-poisoning is a common way of killing oneself, especially among women. Because suicide is linked to depression, and antidepressants are often easily available, antidepressants are involved in around 25% of all poisoning suicides in the U.K. and 20-30% of non-fatal overdoses. It is therefore important to know if certain kinds of antidepressants are riskier than others. A team of researchers led by Keith Hawton from Oxford University compared numbers of prescriptions to numbers of deaths in cases of deaths by self-poisoning. They used data from six general hospitals in Oxford, Manchester and Derby between 2000 and 2006. The study found that older, tricyclic antidepressants were much riskier than the SNRI (Serotonin-Norepinephrine Reuptake Inhibitor) drug venlafaxine and the NaSSA (Noradrenergic and Specific Serotonin Antidepressant) drug mirtazapine. In turn these drugs were riskier than SSRIs (Serotonin Specific Reuptake Inhibitors). Among the tricyclic antidepressants dosulepin and doxepin were both riskier than amitriptyline while within the SSRIs citalopram was riskier than the other drugs.

Hawton, Keith ... [et al] - Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose British Journal of Psychiatry May 2010, 196(5), 354-358

SSRIs and cataracts

A study of more than 200,000 people in Quebec by researchers at the University of British Columbia has found that there is a statistical - though not necessarily a cause and effect - relationship between the use of SSRI (serotonin-specific reuptake inhibitors) antidepressants and the development of cataracts. The study found that people taking SSRIs were 15% more likely to be diagnosed with cataracts or to have had cataract surgery. The drug fluvoxamine was associated with a 51% higher risk while venlafaxine carried a 34% higher risk but there was no connection between fluoxetine, citalopram and sertraline and an increased chance of cataract surgery. But the study did not take into account the effects of smoking which is more common among depressed people and can cause cataracts. It is also important to remember that depression can be a very serious condition while cataracts are fairly easily treated.

You can find out more about this research at

http://www.sciencedaily.com/releases/2010/03/100308151100.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Antidepressants and suicide risk

Antidepressant treatment has been linked with an increase in suicidal thoughts among some people. Dr Nader Perroud from the Institute of Psychiatry, King's College London studied 811 people with moderate to severe depression comparing the number of suicidal thoughts in those taking nortriptyline and those taking escitalopram. Nortriptyline works by increasing the effectiveness of noradrenaline in the brain whereas escitalopram works by increasing the effectiveness of serotonin. Dr Perroud's study found that nortriptyline led to nearly ten times as many suicidal thoughts as escitalopram. The study is significant as it is the newer class of drugs known as SSRIs (serotonin-specific reuptake inhibitors) - to which escitalopram belongs - that have been linked to an increased risk of suicide in the past yet this research shows that the older drug (part of a group of drugs called the tricyclic antidepressants) which led to more suicidal thoughts.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/10/091014193213.htm

SSRI warnings affect depression care in U.S.

In 2003 the U.S. and European authorities sent out a series of public health warnings about the use of antidepressants in young people after clinical trials showed that they increased the risk of suicidal thoughts and behaviour in children and teenagers. In February 2005 the warnings were strengthened and in May 2007 they were extended to young adults between the ages of 18 and 24. Anne Libby and her colleagues from the University of Colorado analyzed health-insurance claims from the U.S. from July 1997 to June 2007 to see how the treatment and diagnosis of depression had changed over this period. They found steady increases in the rate of depression diagnoses between 1999 and 2004 but a sharp fall after that. Doctors diagnosed fewer cases of depression with a 44% lower rate among children and adolescents, a 37% lower rate among young adults and a 29% lower rate among other adults. There was an 8% rise in suicides among youth and teens in 2004. Doctors prescribed fewer SSRIs but did not turn to older drugs to treat depression and anxiety or offer psychotherapy as an alternative.

You can find out more about this research at

http://uk.reuters.com/article/healthNews/idUKTRE5507CO20090601?feedType=RSS&feedName=healthNews&sp=true

SSRIs and suicide risk

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They include paroxetine (brand name Paxil) and fluoxetine (Prozac). After 2003 authorities in the U.S. and Europe sent out warnings about their use following clinical trials which showed the drugs increased the risk of suicide in teenagers and children. A review of eight large studies involving more than 200,000 participants by researchers at the University of Verona has confirmed that the drugs do seriously raise the suicide risk for children. However, the study also found that SSRIs reduced the suicided risk for adults by 40% and for older adults by 50%.

You can find out more about this research at

http://uk.reuters.com/article/healthNews/idUKTRE5115YF20090202?feedType=RSS&feedName=healthNews&sp=true

SSRIs and gastrointestinal bleeding

There is evidence that selective serotonin reuptake inhibitors (SSRIs) which are used as antidepressants can increase the risk of bleeding in the upper gastrointestinal tract. However, more research is needed and a UK study of 11,321 patients has found that SSRIs did increase the risk of gastrointestinal bleeding particularly when people were also using nonsteroidal anti-inflammatory drugs. However, using other acid-suppressing drugs reduced the risk of bleeding.

de Abajo, Franciso J. and Garcia-Rodriguez, Luis A. - Risk of upper gastrointestinal tract bleeding associated with serotonin reuptake inhibitors and venlafaxine therapy: interaction with nonsteroidal anti-inflammatory drugs and effect of acid-suppressing agents Archives of General Psychiatry July 2008, 65(7), 795-803

Antidepressants and birth problems

Exposure to serotonin reuptake inhibitor (SRI) antidepressants late in pregnancy has been associated with an increased risk of lower birth weight, respiratory distress, seizures, jitteriness and irritability in up to 30% of exposed infants, compared with early prenatal exposure. A Canadian study of 3,500 women and their babies looked into the links between the timing of prescription of SRIs and problems with the babies. The study found that it was the length of time the women had been taking the drugs rather than the timing of the prescription that was linked to an increased risk of neonatal respiratory distress, low birth weight and reduced gestational age. The link remained the same, even allowing for maternal illness and medication dose.

Oberlander, Tim F. ... [et al] - Effects of timing and duration of gestational exposure to serotonin reuptake inhibitor antidepressants: population-based study British Journal of Psychiatry May 2008, 192(5), 338-343

Fitness to drive and mental-health problems

Mental health problems are characterized by alterations in thinking, attention, concentration, decision-making abilities, mood and behaviour and can have far-reaching effects on a person's ability to function. One such effect is on people's ability to drive and a review of the literature looked into fourteen studies on this to weigh up the evidence. In eight of the studies mental illness was linked to higher traffic accident rates. Some psychotropic drugs had the potential to affect fitness to drive, especially in the starting phase of treatment or when adjusting medications. SSRIs (Serotonin Specific Reuptake Inhibitors) improved some of the skills needed for driving. Newer antipsychotic drugs improved cognitive skills but these improvements did not translate into driving-related skills.

Menard, Ingrid and Korner-Bitensky, Nicol - Fitness to drive in persons with psychiatric disorders and those using psychotropic medications: a systematic review Occupational Therapy in Mental Health 24(1), 2008, 47-64

Depression and diabetes

A study of 2,400 residents of Saskatchewan, Canada, who were diagnosed with depression and who were taking antidepressants has found that they had a 30% increased risk of type 2 (adult onset) diabetes. The participants in the study were divided into four groups : those who took older, tricyclic antidepressants ; those who took newer SSRI antidepressants ; those who took a combination of older and newer drugs and those in the process of switching from one medication to another. The risk of developing type 2 diabetes was almost doubled for those patients who were using a combination of older and newer antidepressants. People are usually prescribed more than one type of medication if they have severe depression or if they are having a problem finding the right therapy.

You can find out more about this research at

http://psychcentral.com/news/2008/03/26/depression-ups-risk-of-diabetes/2079.html

Newer antidepressants in pregnancy

There has been lots of research on the use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy but much less is known about more recently-introduced anti-depressants such as venlafaxine, mirtazapine, mianserin and reboxetine. A study of 732 women in Sweden who used the new drugs in pregnancy looked at the kinds of people who took them and their effects on their pregnancies and babies. The study found that the women who used the new antidepressants were older, were more likely to have been having their first child, were heavier smokers, were heavier and were more likely to be native Swedes. They were more likely to have premature births and their children were more likely to suffer from symptoms such as breathing difficulties, poor health, hypoglycemia and convulsions.

Lennestal, Roland and Kallen, Bengt - Delivery outcome in relation to maternal use of some recently introduced antidepressants Journal of Clinical Psychopharmacology December 2007, 27(6), 607-613

Side effects and medication compliance in people with depression

People taking drugs for mental-health problems often stop taking their medication. It is thought this is, at least partially, due to the side effects of the drugs but the exact relationship between side effects and non-adherence to medication is unclear. An eighteen-month U.S. study of 406 people between 18 and 75 followed them up three months after their admission for depression to see what side effects they had suffered and whether they were still taking their medication. One in four of the patients had stopped taking their drugs. Among the side effects noted only 'change in weight' and 'anxiety' were significant predictors of discontinuation. Experiencing one or more 'extremely' bothersome side effect(s) was associated with a doubling of the risks of discontinuation but side effects less severe than this were not significant predictors. There were no differences among the antidepressants in terms of side effects or discontinuation rates.

Goethe, John W. ... [et al] - Selective serotonin reuptake inhibitor discontinuation : side effects and other factors that influence medication adherence Journal of Clinical Psychopharmacology October 2007, 27(5), 451-458