An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes (2005) people with a depressive illness will experience a therapeutic effect to their mood; however, this will not be experienced in healthy individuals. Drugs including the monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), tetracyclic antidepressants (TeCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) are most commonly associated with the term. These medications are among those most commonly prescribed by psychiatrists and other physicians, and their effectiveness and adverse effects are the subject of many studies and competing claims. Many drugs produce an antidepressant effect, but restrictions on their use have caused controversy and off-label prescription is a risk, despite claims of superior efficacy.

Opioids were used to treat major depression until the late 1950s. Amphetamines were used until the mid 1960s. Prescribing opioids or amphetamines for depression falls into a legal grey area. Research has only rarely been conducted into the therapeutic potential of opioid derivatives for depression in the past sixty years, whereas amphetamines have found a thriving market for conditions as widely arrayed as attention deficit disorder, narcolepsy, and obesity, and continue to be studied for myriad applications. Both opioids and amphetamines induce a therapeutic response very quickly, showing results within twenty-four to forty-eight hours; the therapeutic ratios for both opioids and amphetamines are greater than those of the tricyclic anti-depressants. In some of this little, heavily restricted research, the opioid buprenorphine has shown the greatest potential for treating severe, treatment-resistant depression of any known pharmaceutical in a small study that is generally recognized and was published in 1995, but has never been pursued due to the social stigma attached to opioids in addition to that attached to mental illness in America.

Most typical antidepressants have a delayed onset of action (2–6 weeks) and are usually administered for anywhere from months to years. Despite the name, antidepressants are often used controversially, and with a dearth of empirical evidence to support their indication, off-label to treat other conditions, such as anxiety disorders, obsessive compulsive disorder, eating disorders, chronic pain, and some hormone-mediated disorders such as dysmenorrhea. Alone or together with anticonvulsants (e.g., Tegretol or Depakote), these medications can be used to treat attention-deficit hyperactivity disorder (ADHD) and substance abuse by addressing underlying depression. Also, antidepressants have been used sometimes to treat snoring and migraines.

Other medications that are not usually called antidepressants, including antipsychotics in low doses and benzodiazepines,  may be used to manage depression, although benzodiazepines cause a physical dependence to form. Stopping benzodiazepine treatment abruptly can cause unpleasant withdrawal symptoms. An extract of the herb St John’s Wort is commonly used as an antidepressant, although it is labeled as a dietary supplement in some countries. The term antidepressant is sometimes applied to any therapy (e.g., psychotherapy, electro-convulsive therapy, acupuncture) or process (e.g., sleep disruption, increased light levels, regular exercise) found to improve a clinically depressed mood.

Inert placebos can have significant antidepressant effects, and so to establish a substance as an “antidepressant” in a clinical trial it is necessary to show superior efficacy to placebo. A review of both published and unpublished trials submitted to the U.S. Food and Drug Administration (FDA) found that the published trials had a 94% success in treating depression while the unpublished literature had below 50% success. Combined, all studies showed 51% efficacy – only two points better than that of placebo. The difference in effect between active placebos and several anti-depressants appeared small and strongly affected by publication bias. There is some evidence to suggest that mirtazapine and venlafaxine may have greater efficacy than other antidepressants in the treatment of severe depression.

Source: http://en.wikipedia.org/wiki/Antidepressant

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Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants considered the current standard of drug treatment. A possible cause of depression is an inadequate amount of serotonin, a chemical used in the brain to transmit signals between neurons. SSRIs are said to work by preventing the reuptake of serotonin (also known as 5-hydroxytryptamine, or 5-HT) by the presynaptic neuron, thus maintaining higher levels of 5-HT in the synapse. Chemists Klaus Schmiegel and Bryan Molloy of Eli Lilly discovered the first SSRI, fluoxetine. This class of drugs includes:
Citalopram (Celexa, Cipramil)
Escitalopram (Lexapro, Cipralex, Seroplex, Lexamil)
Fluoxetine (Prozac, Sarafem, Symbyax)
Fluvoxamine (Luvox)
Paroxetine (Paxil, Aropax)
Sertraline (Zoloft)
Vilazodone (Viibryd)

These antidepressants typically have fewer adverse effects than the tricyclics or the MAOIs, although such effects as drowsiness, dry mouth, nervousness, anxiety, insomnia, decreased appetite, long-term weight gain and decreased ability to function sexually may occur. Some side effects may decrease as a person adjusts to the drug, but other side effects may be persistent.

Work by two researchers has called into question the link between serotonin deficiency and symptoms of depression, noting that the efficacy of SSRIs as treatment does not in itself prove the link. Research indicates that these drugs may interact with transcription factors known as “clock genes”, which may play a role in the addictive properties of drugs (drug abuse), and possibly in obesity.

A systematic review of randomized controlled trials published in the Archives of General Psychiatry showed that up to one-third of the 6-week effect of SSRI Treatment can be seen in the first week. The same study also found that patients treated with SSRIs were 64% more likely to achieve a 50% absolute reduction in HRSD than patients given a placebo.[1]

Citalopram (Celexa): usual dosing is 20 mg initially; maintenance 40 mg per day; maximum dose 60 mg per day.
Escitalopram (Lexapro, Cipralex): usual dosing is 10 mg and shown to be as effective as 20 mg in most cases. Maximum dose 20 mg. Also helps with anxiety.
Paroxetine (Paxil, Seroxat): Also used to treat panic disorder, OCD, social anxiety disorder, generalized anxiety disorder and PTSD. Usual dose 25 mg per day; may be increased to 40 mg per day. Available in controlled release 12.5 to 37.5 mg per day; controlled release dose maximum 50 mg per day. Less cycling in patients who are bipolar.
Fluoxetine (Prozac): Also used to treat OCD, bulimia, and panic disorder. Long half-life; less withdrawal when medication is stopped. Dosing is 20 mg to a maximum of 80 mg.
Fluvoxamine (Luvox): Although primarily used in the treatment of OCD, a doctor may prescribe it for depression. Initial dose is 50 mg, increasing by 50 mg every 4-7 days. If daily dose is greater than 100 mg give in equally divided doses or give larger dose at bedtime not to exceed 300 mg per day.
Sertraline (Zoloft, Lustral): Also used to treat panic disorder, OCD, PTSD, social anxiety disorder, premenstrual dysphoric disorder. Dosing is 50-200 mg per day and should be titrated upward.

Be aware of drug interactions. Dextromethorphan (found in many brands of over-the-counter cough syrup) as well as the opioids tramadol (Tramal, Ultram), and pethidine/meperidine are contraindicated with all SSRIs as they are serotonin reuptake inhibitors (SRIs) themselves and the combination could cause the potentially fatal serotonin syndrome. Many SSRIs inhibit the metabolism of dextromethorphan as well, further adding to the risk.

Drug interactions may also occur when concurrently taking phenytoin (Dilantin) and warfarin (Coumadin) (phenytoin and warfarin levels are increased).

Always check with pharmacy regarding potential drug interactions.[2]

Source:

[1]http://en.wikipedia.org/wiki/Antidepressant

[2]http://en.wikipedia.org/wiki/List_of_antidepressants

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Depression is a serious disorder that can cause significant problems in mood, thinking, and behavior at home, in school, and with peers. It is estimated that major depressive disorder (MDD) affects about 5 percent of adolescents.

Research has shown that, as in adults, depression in children and adolescents is treatable. Certain antidepressant medications, called selective serotonin reuptake inhibitors (SSRIs), can be beneficial to children and adolescents with MDD. Certain types of psychological therapies also have been shown to be effective. However, our knowledge of antidepressant treatments in youth, though growing substantially, is limited compared to what we know about treating depression in adults.

Recently, there has been some concern that the use of antidepressant medications themselves may induce suicidal behavior in youths. Following a thorough and comprehensive review of all the available published and unpublished controlled clinical trials of antidepressants in children and adolescents, the U.S. Food and Drug Administration (FDA) issued a public warning in October 2004 about an increased risk of suicidal thoughts or behavior (suicidality) in children and adolescents treated with SSRI antidepressant medications. In 2006, an advisory committee to the FDA recommended that the agency extend the warning to include young adults up to age 25.

More recently, results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders. The study, partially funded by NIMH, was published in the April 18, 2007, issue of the Journal of the American Medical Association.1

What Did the FDA Review Find?

In the FDA review, no completed suicides occurred among nearly 2,200 children treated with SSRI medications. However, about 4 percent of those taking SSRI medications experienced suicidal thinking or behavior, including actual suicide attempts—twice the rate of those taking placebo, or sugar pills.

In response, the FDA adopted a “black box” label warning indicating that antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents with MDD. A black-box warning is the most serious type of warning in prescription drug labeling.

The warning also notes that children and adolescents taking SSRI medications should be closely monitored for any worsening in depression, emergence of suicidal thinking or behavior, or unusual changes in behavior, such as sleeplessness, agitation, or withdrawal from normal social situations. Close monitoring is especially important during the first four weeks of treatment. SSRI medications usually have few side effects in children and adolescents, but for unknown reasons, they may trigger agitation and abnormal behavior in certain individuals.
What Do We Know About Antidepressant Medications?

The SSRIs include:
fluoxetine (Prozac)
sertraline (Zoloft)
paroxetine (Paxil)
citalopram (Celexa)
escitalopram (Lexapro)
fluvoxamine (Luvox)

Another antidepressant medication, venlafaxine (Effexor), is not an SSRI but is closely related.

SSRI medications are considered an improvement over older antidepressant medications because they have fewer side effects and are less likely to be harmful if taken in an overdose, which is an issue for patients with depression already at risk for suicide. They have been shown to be safe and effective for adults.

However, use of SSRI medications among children and adolescents ages 10 to 19 has risen dramatically in the past several years. Fluoxetine (Prozac) is the only medication approved by the FDA for use in treating depression in children ages 8 and older. The other SSRI medications and the SSRI-related antidepressant venlafaxine have not been approved for treatment of depression in children or adolescents, but doctors still sometimes prescribe them to children on an “off-label” basis. In June 2003, however, the FDA recommended that paroxetine not be used in children and adolescents for treating MDD.

Fluoxetine can be helpful in treating childhood depression, and can lead to significant improvement of depression overall. However, it may increase the risk for suicidal behaviors in a small subset of adolescents. As with all medical decisions, doctors and families should weigh the risks and benefits of treatment for each individual patient.

What Should You Do for a Child With Depression?

A child or adolescent with MDD should be carefully and thoroughly evaluated by a doctor to determine if medication is appropriate. Psychotherapy often is tried as an initial treatment for mild depression. Psychotherapy may help to determine the severity and persistence of the depression and whether antidepressant medications may be warranted. Types of psychotherapies include “cognitive behavioral therapy,” which helps people learn new ways of thinking and behaving, and “interpersonal therapy,” which helps people understand and work through troubled personal relationships.

Those who are prescribed an SSRI medication should receive ongoing medical monitoring. Children already taking an SSRI medication should remain on the medication if it has been helpful, but should be carefully monitored by a doctor for side effects. Parents should promptly seek medical advice and evaluation if their child or adolescent experiences suicidal thinking or behavior, nervousness, agitation, irritability, mood instability, or sleeplessness that either emerges or worsens during treatment with SSRI medications.

Once started, treatment with these medications should not be abruptly stopped. Although they are not habit-forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse. Families should not discontinue treatment without consulting their doctor.

All treatments can be associated with side effects. Families and doctors should carefully weigh the risks and benefits, and maintain appropriate follow-up and monitoring to help control for the risks.

What Does Research Tell Us?

An individual’s response to a medication cannot be predicted with certainty. It is extremely difficult to determine whether SSRI medications increase the risk for completed suicide, especially because depression itself increases the risk for suicide and because completed suicides, especially among children and adolescents, are rare. Most controlled trials are too small to detect for rare events such as suicide (thousands of participants are needed). In addition, controlled trials typically exclude patients considered at high risk for suicide.

One major clinical trial, the NIMH-funded Treatment for Adolescents with Depression Study (TADS)2, has indicated that a combination of medication and psychotherapy is the most effective treatment for adolescents with depression. The clinical trial of 439 adolescents ages 12 to 17 with MDD compared four treatment groups—one that received a combination of fluoxetine and CBT, one that received fluoxetine only, one that received CBT only, and one that received a placebo only. After the first 12 weeks, 71 percent responded to the combination treatment of fluoxetine and CBT, 61 percent responded to the fluoxetine only treatment, 43 percent responded to the CBT only treatment, and 35 percent responded to the placebo treatment.

At the beginning of the study, 29 percent of the TADS participants were having clinically significant suicidal thoughts. Although the rate of suicidal thinking decreased among all the treatment groups, those in the fluoxetine/CBT combination treatment group showed the greatest reduction in suicidal thinking.

Researchers are working to better understand the relationship between antidepressant medications and suicide. So far, results are mixed. One study, using national Medicaid files, found that among adults, the use of antidepressants does not seem to be related to suicide attempts or deaths. However, the analysis found that the use of antidepressant medications may be related to suicide attempts and deaths among children and adolescents.3

Another study analyzed health plan records for 65,103 patients treated for depression.4 It found no significant increase among adults and young people in the risk for suicide after starting treatment with newer antidepressant medications.

A third study analyzed suicide data from the National Vital Statistics and commercial prescription data. It found that among children ages five to 14, suicide rates from 1996 to 1998 were actually lower in areas of the country with higher rates of SSRI antidepressant prescriptions. The relationship between the suicide rates and the SSRI use rates, however, is unclear.5

New NIMH-funded research will help clarify the complex interplay between suicide and antidepressant medications. In addition, the NIMH-funded Treatment of Resistant Depression in Adolescents (TORDIA) study, will investigate how best to treat adolescents whose depression is resistant to the first SSRI medication they have tried. Finally, NIMH also is supporting the Treatment of Adolescent Suicide Attempters (TASA) study, which is investigating the treatment of adolescents who have attempted suicide. Treatments include antidepressant medications, CBT or both.

Complete list of all NIMH Clinical Trials.
Bridge JA, Iyengar S, Salary CB, Barbe RP, Birmaher B, Pincus HA, Ren L, Brent DA, MD. Clinical Response and Risk for Reported Suicidal Ideation and Suicide Attempts in Pediatric Antidepressant Treatment: A Meta-analysis of Randomized Controlled Trials. JAMA. 2007;297:1683-1696.
Treatment for Adolescents with Depression Study (TADS) Team. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. Journal of the American Medical Association, 2004 Aug 18; 292(7):807-20.
Olfson M, Marcus SC, Shaffer D. Antidepressant Drug Therapy and Suicide in Severely Depressed Children and Adults. Archives of General Psychiatry. 2006 Aug. 63:865-72
Simon GE, Savarino J, Operskalski B, Wang P. Suicide Risk During Antidepressant Treatment. American Journal of Psychiatry. 2006. 163 (1): 41-47.
Gibbons RD, Hur K, Bhaumik DK, Mann JJ. The relationships between antidepressant prescription rates and rate of early adolescent suicide. American Journal of Psychiatry 2006. 163 (11): 1898-1904
Source: http://www.nimh.nih.gov

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THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has included representing psychiatric “patients”. His pamphlets are not copyrighted. You are encouraged to make copies for distribution to those who you think will benefit.

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When was the SSRI discontinuation syndrome first recognized?

Reports began to emerge soon after the SSRIs were introduced in the late 1980s.

How common is it? The incidence and prevalence of this syndrome is not yet known. The few available discontinuation studies indicate minor forms of the syndrome may be common and severe forms unusual. A retrospective chart review of 171 clinic patients who discontinued an SSRI while under supervision, reported at least one new symptom in 20% and 14% of patients stopping paroxetine (Paxil) and fluvoxamine (Luvox), respectively. Abrupt discontinuation of fluvoxamine was associated with new symptoms in 12 of 14 subjects (86%) in a prospective, open-label panic study. In a randomized placebo-controlled trial of paroxetine for panic, 19/55 (34%) experienced withdrawal symptoms. Abrupt discontinuation of fluoxetine (Prozac) in a randomized placebo controlled study of 299 subjects did not appear to cause many symptoms. No published study of sertraline (Zoloft) discontinuation symptoms is yet available but there are several case reports.

What are the signs and symptoms of the SSRI discontinuation syndrome?

Neurologic symptoms (dizziness, vertigo, lightheadedness and gait instability) are most commonly reported, followed by somatic complaints (nausea, emesis, fatigue and headache) and not uncommonly, insomnia. Still characteristic but reported less frequently are shock-like sensations, parasthesia, visual disturbances, diarrhea, myalgias and chills. A range of nonspecific mental symptoms including agitation, impaired concentration, vivid dreams, depersonalization, irritability and suicidal thoughts have been reported. When allowed to run its course, the syndrome duration is variable (one to several weeks) and ranges from mild-moderate intensity in most patients, to extremely distressing in a small number.

What other factors should clinicians consider when identifing this syndrome?

The duration of SSRI use is usually 1 month with symptoms developing 2-5 days after SSRI discontinuation or dose reduction. When symptoms emerge in this context, clinicians should be encouraged to include the discontinuation syndrome on their list of differential diagnoses. Awareness of some of the more unusual symptoms, such as dizziness and shock-like sensations, and re-education of patients prior to stopping or tapering an SSRI, should prevent unnecessary and expensive medical investigations.

What is the mechanism behind this problem?

The biological mechanisms underlying this syndrome are not well understood, although an acute decrease in synaptic serotonin in the face of down-regulated or desensitized serotonin receptors has been postulated.

Who is at risk?

The SSRI discontinuation syndrome does not appear to discriminate based on age, sex, diagnosis or dose of SSRI (both low and high doses have been reported). As I mentioned, there appears to be less risk with the abrupt interruption of fluoxetine. Paroxetine is the SSRI most often mentioned in the case reports and the reason for this may be as simple as the fact that it is most frequently prescribed. An alternative explanation may involve paroxetine s affinity for cholinergic (muscarinic) receptors, causing cholinergic rebound on discontinuation. However, this explanation wouldn’ t account for the full spectrum of symptoms described.

Can it be avoided or treated?

Review of the SSRI discontinuation literature suggests that symptoms may occur even if the SSRI dose is tapered gradually. In half of 50 reported cases, an attempt was made to taper the SSRI, although details concerning the duration and rapidity of taper were not provided consistently. At this point, it is unclear whether tapering SSRIs will reduce the risk nor is it clear whether we should advocate the routine taper of SSRIs when stopping treatment. The only known effective treatment is the re-introduction of the SSRI which is associated with rapid resolution of symptoms. Unfortunately, the syndrome tends to recur in approximately 75% of patients when the same SSRI is later discontinued.

Source: http://www.circlemedhealthcare.com/ssri.pdf

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Are antidepressants addictive?

Antidepressants do not cause an addiction as with opioid drugs (such as heroin), barbiturates, amphetamines (speed), alcohol and nicotine. This means that taking your medicine regularly should not cause tolerance or craving.

• Tolerance: This occurs when the body gets used to the drug or medicine when it is taken regularly, so that you need to take higher doses to have the same effect.

• Craving: This is a physical urge, where the body needs the drug or medicine to maintain a desired state or feeling such as euphoria (feeling high), or to avoid an unwanted one such as delirium tremens (the shakes). It can also have a psychological element to it.

What are discontinuation symptoms?

Antidepressants can sometimes cause symptoms called ‘discontinuation’ symptoms. These may happen if the dose is reduced, if you miss a dose or if you suddenly stop taking the medicine. At least one in every three people may get these symptoms.

Symptoms are usually mild and should go away after a few days, but occasionally can be more severe. Symptoms may take up to five days to occur and may last for up to two weeks. Be careful not to confuse discontinuation/withdrawal symptoms with the side effects of any new antidepressants prescribed. The following table lists some of the main discontinuation/withdrawal symptoms:

How do I avoid discontinuation symptoms?

Your antidepressant should be taken as prescribed, and should only be discontinued after discussing with your doctor. Antidepressants should not be stopped suddenly. They should be discontinued gradually, generally by reducing the dose over a four-week period until they have stopped completely. Your doctor or pharmacist will advise you on how to do this for the medicine that you are taking.

Some people still experience discontinuation symptoms despite stopping the antidepressant slowly. If you think that you are experiencing troubling symptoms, discuss this with your doctor, as you may need to decrease more slowly, or in smaller steps.

Please refer to the manufacturer’s patient information leaflet that comes with your medicine for more information and the full list of side effects and precautions. If you have any questions or concerns about your medicines, or if you are worried about anything you think might be a side effect, ask your doctor, pharmacist or nurse.

This leaflet gives you some information about this medicine. It does not replace the expertise or judgement of a doctor, pharmacist or other healthcare professional. It is not a manufacturer’s patient information leaflet and is not to be taken as a substitute for, or an endorsement of, the manufacturer’s information or advice in respect of any medicine referred to in this leaflet. You might find more information in other leaflets or books, or on the internet but remember, the internet is not always accurate.

Whilst every care has been taken in the compilation of this leaflet, CNWL is not responsible for any loss or damage howsoever caused as a result of any inaccuracy or error contained in this leaflet, including (for the avoidance of doubt) in relation to breach of contract, misrepresentation or negligence whether of CNWL or any other person; but nothing in this leaflet shall exclude or restrict liability for death or personal injury resulting from negligence.

The information given in this leaflet is current as at the publication date.

This leaflet has been written by Central and North West London Mental Health NHS Trust Pharmacy Department, 30 Eastbourne Terrace, London W2 6LA www.cnwl.org – Publication Date: May 2007

Source: http://beh.zedcore.com

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What are tricyclic antidepressants (TCAs) used for?

Tricyclic antidepressants (TCAs) are a group of medicines usually used to help treat people with depression. Medicines are often used to treat more than one condition, so if you are not sure why you have been prescribed a TCA, you should discuss this with your doctor. Types of TCAs are amitryptyline, clomipramine, dosulepin (dothiepin), imipramine, lofepramine, nortriptyline and trimipramine. Your medicine may also have a trade or brand name. This is the name that the manufacturer gives to the medicine, for example Anafranil® is a brand name for clomipramine.

What are the benefits of taking TCAs?

People with depression may feel fed up, unhappy and miserable most of the time, and this usually interferes with their everyday life. This feeling of depression is worse than short periods of unhappiness that people can experience from time to time. Restlessness, agitation and tiredness are common, as well as difficulty in sleeping and loss of appetite. People with depression may also feel hopeless and inadequate, and find it difficult to enjoy life. They may also have thoughts of harming themselves or committing suicide.

TCAs can help to treat these symptoms in people who are unwell, and may also help to keep people well in the longer term. They may also help people to cope better so that they can enjoy life and be able to deal with any problems they may have.

How quickly do TCAs work?

TCAs work over a period of weeks. Some symptoms may start to improve before others, but it may take up to four weeks until they have their full effect. Not everybody benefits from TCAs, but most people do. If you do not feel any benefit after four to six weeks, you should discuss this with you doctor or healthcare worker. Occasionally, thoughts of suicide or self-harm may increase in the first few weeks of treatment until your medicine has taken its full effect. If this happens to you tell your doctor immediately or go to the nearest hospital.

What are the usual doses of TCAs and how should I take them?

Refer to the manufacturer’s patient information leaflet for the TCA that you have been given. TCAs are usually started at low doses that are gradually increased, depending on how you respond to the treatment. The usual doses of some TCAs are given below, but do not change your dose of medication without checking with your doctor, as doing so may affect your response to the medication or be harmful.

• The usual dose of amitriptyline is between 150milligrams (mg) and 200mg daily.

• The usual dose of clomipramine is between 10mg and 150mg daily. The maximum dose is 250mg daily.

• The usual dose of imipramine is between 150mg and 200mg daily. The maximum dose is 300mg daily.

• The usual dose of lofepramine is between 140mg and 210mg daily usually given in two doses.

• The usual dose of nortriptyline is between 75mg and 100mg daily. The maximum dose is 150mg daily.

• The usual dose of trimipramine is between 150mg and 300mg daily.

What should I do if I miss a dose?

You will get the most out of your medication when taken correctly and regularly. If you miss, or forget to take a dose at your usual time, but remember within an hour or two then take it straight away. If it is longer than this just leave out the missed dose. Take the next dose at the usual time. If you miss a few doses you may experience ‘discontinuation’ symptoms (see below). Never take extra medication at the next dose. If you find it difficult to remember taking medication speak to your pharmacist or healthcare worker.

For how long should I take TCAs?

Your doctor will discuss with you the length of treatment, which will vary depending on the type of illness you have. It may be for a few months or longer. TCAs are usually taken for at least six months after you start to feel better. Taking medication regularly may prevent you from becoming unwell again. Your doctor should regularly review your medication to make sure that you do not take medicines for longer than needed. If you stop taking TCAs suddenly you may get unpleasant symptoms called ‘discontinuation’ or ‘withdrawal’. These are usually mild and disappear by themselves, but occasionally can cause problems. TCAs are not addictive.

What are the side effects of TCAs?

As with all medicines there is a risk of unwanted effects (side effects). Some can occur soon after starting treatment so you may experience these before you feel better. Most are temporary and should go away after a few days or weeks. Not everyone will get side effects and many people experience them to different degrees. If you feel that you have side effects that are causing you discomfort, discuss this with your doctor, pharmacist, nurse or healthcare worker. The table on the following page lists some of the main recognised side effects of TCAs but the chance of experiencing each of these side effects will depend on the individual TCA that you have been prescribed.

What about alcohol or ‘street’ drugs?

Both alcohol and TCAs can affect the brain so it is not recommended that you drink alcohol while taking TCAs. Drinking alcohol can cause drowsiness and in combination with TCAs can cause severe drowsiness. Once you are used to taking medication, and know the effects of taking alcohol you may be able to drink occasionally and in small amounts. It is good to be cautious because alcohol affects people in different ways, especially when taking medication.

Do not stop taking your medication because you feel like drinking alcohol. If you drink alcohol, drink only small amounts. Never drink alcohol and drive while taking medication.

‘Street’ drugs (for example, cannabis, ecstasy, speed, heroin and cocaine) may affect your antidepressant treatment. Taking amphetamines, ecstasy and cocaine whilst taking TCAs may increase their toxicity and can cause an abnormal heart rhythm, which potentially can be very serious. Taking cannabis whilst on TCAs can cause tachycardia (a rapid heart beat). There is very little information on taking TCAs with other ‘street’ drugs and so the effect and safety of doing this is unknown. It is best if you do not take any ‘street’ drugs whilst taking TCAs. You may need to get advice and support to help you do this.

What about other medicines?

If you take any other medicines or herbal remedies including any that have been newly prescribed or bought, it is important to check with your doctor or pharmacist that they are safe with TCAs.

When I should be cautious?

It is usually safe to take TCAs regularly, as prescribed by your doctor, but they are not suitable for everyone. If any of the following situations apply to you, you should tell your doctor immediately:

1 If you are allergic to TCAs (if you have taken one before and developed a rash, itching, swollen mouth or throat);

2 If you are taking or have recently been taking medicines called monoamine oxidase inhibitors (MAOIs), used to treat depression;

3 If you have previously had thoughts about harming yourself or committing suicide;

4 If you have diabetes, epilepsy (or have had a fit in the past), suffer from kidney, thyroid or liver disease or heart problems;

5 If you have an eye condition known as glaucoma;

6 If you have phaeochromocytoma (a tumour of the adrenal gland);

7 If you have difficulty passing urine or have an enlarged prostate;

8 If you have episodes of mania (overactive behaviour or thoughts);

9 If you are having electro-convulsive therapy (ECT);

10 If you are an older person and have a history of falls;

11 If you are pregnant, or are planning to become pregnant; or

12 If you are breastfeeding.

Please refer to the manufacturer’s patient information leaflet that comes with your medicine for more information and the full list of side effects and precautions. If you have any questions or concerns about your medicines, or if you are worried about anything you think might be a side effect, ask your doctor, pharmacist or nurse.

This leaflet gives you some information about this medicine. It does not replace the expertise or judgement of a doctor, pharmacist or other healthcare professional. It is not a manufacturer’s patient information leaflet and is not to be taken as a substitute for, or an endorsement of, the manufacturer’s information or advice in respect of any medicine referred to in this leaflet. You might find more information in other leaflets or books, or on the internet but remember, the internet is not always accurate.

Whilst every care has been taken in the compilation of this leaflet, CNWL is not responsible for any loss or damage howsoever caused as a result of any inaccuracy or error contained in this leaflet, including (for the avoidance of doubt) in relation to breach of contract, misrepresentation or negligence whether of CNWL or any other person; but nothing in this leaflet shall exclude or restrict liability for death or personal injury resulting from negligence.

The information given in this leaflet is current as at the publication date.

This leaflet has been written by Central and North West London Mental Health NHS Trust Pharmacy Department, 30 Eastbourne Terrace, London W2 6LA www.cnwl.org - Publication Date: May 2007

Source: http://beh.zedcore.com

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(Including Tricyclics, Tetracyclics and MAOIs)

Brand Names (Generic Names):

Tricyclics

Adapin (doxepin)

Anafranil (clomipramine)

Asendin (amoxapine)

Aventyl (nortriptyline)

Elavil (amitriptyline)

Endep (amitriptyline)

Etrafon (amitriptyline and perphenazine)

Janimine (imipramine)

Maneon (amitriptyline)

Norpramin (desipramine hydrochloride)

Nortilen (nortriptyline)

Pamelor (nortriptyline)

Pertofrane (norpramin)

Saroten (amitriptyline)

Sinequan (doxepin hydrochloride)

SK-Pramine Oral (imipramine)

Surmontil (trimipramine maleate)

Tofranil (imipramine hydrochloride)

Triavil (amitriptyline hydrochloride

and perphenazine)

Triptazine (amitriptyline)

Triptil (protriptyline)

Tryptizol (amitriptyline)

Tryptanol (amitriptyline)

Vivactil (protriptyline hydrochloride)

Tetracyclics

Avanza (mirtazapine)

Ludiomil (maprotiline hydrochloride)

Remergil (mirtazapine)

Remeron (mirtazapine)

Tolvon (mianserin hydrochloride)

Zispin (mirtazapine)

MAOIs

Aurorix (moclobemide)

Emsam (selegiline – skin patch)

Manerix (moclobemide)

Marplan (isocarboxazid)

Nardil (phenelzine sulfate)

Parnate (tranylcypramine sulfate)

Side Effects:

Anxiousness

Black tongue

Blurred vision

Breast enlargement in men and women

Changes in appetite or weight

Changes in sex drive or ability

Cold, clammy skin

Coma

Confusion

Constipation

Crushing chest pain

Decreased memory or concentration

Delirium

Delusions

Depression

Diarrhea

Difficulty breathing or swallowing

Difficulty falling asleep or staying asleep

Difficulty thinking

Dizziness

Drowsiness

Dry mouth

Excessive sweating

Excitement or anxiety

Extreme restlessness

Eye pain

Eyes more sensitive to light than usual

Fainting

Fast, irregular, or pounding heartbeat

Flu-like symptoms, fever, chills, sore throat, or other signs of infection

Flushing

Forgetfulness

Frequent, painful, or difficult urination

Gas

Hair loss

Hallucinations

Heartburn

Hives

Hyperactivity

Itching

Jaw, neck, and back muscle spasms

Lethargy

Lightheadedness

Liver problems

Lowered white blood cell count (with risks of infection)

Manic reactions

Muscle pain or weakness

Muscle twitching or jerking

Nausea

Neck stiffness or soreness

Nervousness

Nightmares

Numbness, burning, or tingling

Panic feelings

Rash or blisters

Ringing in the ears

Sedation

Seizures

Severe headache

Severe muscle stiffness

Shakiness

Shuffling walk

Slow or difficult speech

Stomach pain or cramps

Stroke

Stuffy nose

Sudden, severe nausea and vomiting

Sweating

Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs

Tightness in the chest or throat

Tiredness

Uncontrollable shaking of any part of the body

Unsteadiness

Unusual bleeding or bruising

Unusual movements that are difficult to control

Unusual taste in the mouth

Unusual tiredness or weakness

Weakness or tiredness

Widened pupils (black circles in the middle of the eyes)

Yellowing of the skin or eyes78

EXPLANATORY NOTE:

Tricyclics: (TCAs) were introduced in the late 1950s/early 60s and the name refers to the three rings in the chemical structure of the drugs.

Tetracyclics: The name derives from the drug’s molecular structure that consists of fourring- like structures in a T-shape.

MAOIs: Monoamine Oxidase Inhibitors (MAOIs). Monoamine Oxidase is an enzyme that has the function of getting rid of used neurotransmitters found in the gap between nerve cells. It was theorized (not proved) that too low concentrations of neurotransmitters may cause depression and MAOIs blocked the activity of this enzyme, resulting in higher levels of neurotransmitters (serotonin, norepinephrine and dopamine, which are all “monoamines” meaning they have a single amino acid – a compound used to form proteins that are essential for function and structure of cells in the body.)

GENERAL WARNINGS AND STUDIES ON OLDER ANTIDEPRESSANTS:

October 15, 2004: The FDA ordered pharmaceutical companies to add a “black box” warning to all antidepressants, saying the drugs could cause suicidal thoughts and actions in children and teenagers.79

October 21, 2004: The New Zealand Medicines Adverse Reactions Committee recommended that old and new antidepressants not be administered to patients less than 18 years of age because of the potential risk of suicide.80

September 26, 2005: The Italian Gazette (official news agency of the Italian government) published a resolution of the Agenzia Italiana del Farmaco (Italian Drug Agency, equivalent to the FDA) ordering a warning label for older antidepressants stating that the drugs should not be prescribed for under 18 year olds. They also determined that they were associated with heart attacks in people of any age. 81

September 28, 2005: The British National Health Service’s Institute for Health and Clinical Excellence warned that “all antidepressant drugs have significant risks when given to children and young people.” 82

May 2, 2007: The FDA told makers of all antidepressants to update the existing black box warning on their products’ labeling to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment.83

October 2007: A study released at the 54th Annual Meeting of the American Academy of Child & Adolescent Psychiatry found that babies born to mothers who take antidepressant medication during pregnancy have high levels of cortisol (a hormone that helps regulate blood pressure) in umbilical cord-blood at birth, and their mothers are more likely to experience delivery complications. When examined at 2 weeks of age, the infants of women taking antidepressants were more excitable than infants born to women not taking antidepressants. 84

February 28, 2009: Pharmacotherapy published a study on “Antidepressant drug use and risk of venous thromboembolism [blockage of a blood vessel due to a clot],” which concluded, “Current exposure to amitriptyline [antidepressant], particularly at high does, was associated with an increased risk of idiopathic [of unknown cause] venous thromboembolism.”

References

1 Physicians’ Desk Reference, http://www.pdrhealth.com; “Adderall,” DrugStore.com, Internet URL: http://www.drugstore.com;

“Study Suggests Focalin (TM) LA Capsules (d-MPH-ER) Are Safe and Effective for ADHD in Adults,” PR Newswire, 5 May 2004;

A.D.D. Warehouse website; ADHDHelp, Internet URL: http://www.adhdhelp.org/metadate.htm. Journal of the Royal Society of Med.,

Vol 92, Mar. 99 “letters to the editor” p. 156. Medline Plus, www.nim.nih.gov/medlineplus: Millichap, J.Gordon “Methylphenidate

Role in Tourettes Syndrome Prevalence.

2 Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), American Psychiatric Association, Washington, D.C., 1987, p. 136.

3 “Drug Scheduling,” U.S. Drug Enforcement Administration Online, Internet URL: http://www.dea.gov.

4 Raul R. Gainetdinov; William C. Wetsel; Edward D. Sara; R. Levin Jones; Mohamed Jaber; Marc G. Caron, “Role of Serotonin in the

Paradoxical Calming Effect of Psychostimulants on Hyperactivity,” Science, 15 Jan. 1999.

5 “Statement on Concerta and Methylphenidate,” Statement posted on the FDA website, 28 June 2005.

6 Marian S. MacDonagh, PharmaD, and Kim Peterson, MS, “Drug Class Review on Pharmacologic Treatment for ADHD: Final

Report,” Oregon Health and Science University, Sept. 2005, pp. 13-20.

7 “FDA will study safety of attention-deficit drugs,” Kansas City Star, 5 Jan. 2006.

8 “Stimulants in children with ADHD may have negative CV effect,” Mental Health Law Weekly, 4 Feb. 2006.

9 Ricardo Alonso-Zaldivar, “Warning Urged for ADHD Drugs,” Los Angeles Times, 10 Feb. 2006.

10 Todd Zwillich, “FDA Panel Recommends Warnings of Rare Reports of Aggressive Behavior or Psychotic Symptoms,” WebMD, 23

Mar. 2006.

11 “Dark side of a wonder drug,” The Australian, 28 Mar. 2006.

12 Almut G. Winterstein, et al., “Cardiac Safety of Central Nervous System Stimulants in Children and Adolescents With Attention-

Deficit/Hyperactivity Disorder,” Pediatrics, Vol. 120, Dec. 2007, pp. e1494-e1501.

13 W. Goldman, et al., “Association between treatment with central nervous system stimulants and Raynaud’s Syndrome in children: a

study of rheumatology patients,” Arthritis & Rheumatism, Vol. 58, No. l, 2 Feb. 2008, pp. 563-566.

14 Brian Vastig, “Pay Attention: Ritalin Acts Much Like Cocaine,” JAMA, 22/29 Aug. 2001, Vol. 286, No. 8, p. 905.

15 Joel Turtel, Public Schools, Public Menace: How Public Schools Lie to Parents and Betray Our Children, (Library Books, New

York), 2004-2005, p. 135.

16 “Partnership Attitude Tracking Study” of teens in 2004, 17th Annual report by Partnership for a Drug-Free America, 21 Apr. 2005;

“Survey: 1 in 5 teens getting high on medications, over-counter drugs,” NewsItem.com, 2 May 2005.

17 Larry A. Kroutil, et al., “Nonmedical use of prescription stimulants in the United States,” Drug and Alcohol Dependence, Feb. 2006.

18 Brian Witte, “Slaying blamed on reaction to hyperactivity drug,” Associated Press, 25 Oct. 1999.

19 “J & J Psychiatric Safety Labeling, Cardiovascular Events Are Topic For Cmte,” FDAAdvisoryCommittee.com, June 2005.

20 “Health Canada Suspends Marketing of Adderall,” FDA Alert, 9 Feb. 2005.

21 “Health Canada allows Adderall XR® back on the Canadian market,” Health Canada News Release, 24 Aug. 2005.

22 Partnership Attitude Tracking Study, Teens – 2004, Partnership for a Drug-Free America, 21 Apr. 2005, p. 7; “Cylert recall

demanded over safety concerns,” Lifestyle News, www.mynippon.com/news/2005/03/cylert-recall-demanded-over-safety-concerns.

23 “Injured by Cylert?” Parker Waichman Alonso, LLP, http://www.yourlawyer.com/topics/overview/cylert.

24 “FDA Withdraws Approval for ADD Drug,” Associated Press, 24 Oct. 2005.

25 “Updated Safety Information: Warnings regarding serious rash, including Stevens-Johnson Syndrome and hypersensitivity reactions,

and psychiatric symptoms,” Cephalon, Inc., Sept. 2007.

26 Op. cit., DSM-III-R, pp. 136, 175.; Medical Economics Company, Physicians Desk Reference (Montvale, NJ: Medical Economics

Co, 1998), pp. 1,897.

27 “Methylphenidate (A Background Paper),” U.S. Drug Enforcement Administration, Oct. 1995, p. 16.

28 “Antidepressant Ritalin to be delisted because of abuse,” Daily Yomiuri Online, 19 Oct. 2007.

29 Ritalin Drug Label, fda.gov.

30 Physicians’ Desk Reference, http://www.pdrhealth.com; Joseph Glenmullen, M.D. Prozac Backlash, (Simon & Schuster, New York,

2000), p. 8; “Antidepressants Lift Clouds, But Lost ‘Miracle Drug’ Label,” The New York Times, 30 June 2002; Alice Park, “More

Drugs To Treat Hyperactivity,” TIME Magazine, 10 Sept. 2001; Wellbutrin/Bupropion, Prozac Truth website; “Teen Suffers Seizure

After Snorting Antidepressant,” HealthScoutNews Reporter, 23 Apr. 2003.

31 Dr. Candace B. Pert, Letter to the Editor, TIME Magazine, 20 Oct. 1997, p. 8.

32 “Worsening Depression and Suicidality in Patients Being Treated with Antidepressant Medication,” FDA Public Health Advisory, 22

Mar. 2004.

33 Gardiner Harris, “Antidepressant Study Seen to Back Expert,” The New York Times, 20 Aug. 2004.

34 “Antidepressant aggression concern,” BBC News Online, 21 Sept. 2004.

35 “Suicidality in Children and Adolescents Being Treated With Antidepressant Medications,” FDA Public Health Advisory, 15 Oct. 2004.

36 “New advice on prescribing anti-depressants,” New Zealand Ministry of Health Media Release, 21 Oct. 2004.

37 “Use of SSRI antidepressants in children and adolescents,” Australian Adverse Drug Reactions Bulletin, Vol. 23, No. 6, Dec. 2004.

38 “European Medicines Agency finalises review of antidepressants in children and adolescents,” European Medicines Agency Press

Release, 25 Apr. 2005.

39 Sarah Boseley, “Suicide fear from antidepressants,” The Guardian (London), 18 Feb. 2005.

40 Joanna Moncrieff and Irving Kirsch, “Efficacy of Antidepressants in Adults,” British Medical Journal, Vol. 331, 16 July 2005, pp.

155-157; Salynn Boyles, “Battle Brews Over Antidepressant Use,” Fox News, 15 Jul. 2005.

41 “Suicidality with SSRIs: adults and children,” Australian Adverse Drug Reactions Bulletin, Vol. 24, No. 4, Aug. 2005.

42 “Annex II,” Commission Decision of 19-VIII-2005, Commission of the European Communities, 19 Aug. 2005.

43 Ivar Aursnes, et al., “Suicide Attempts in Clinical Trials with Paroxetine Randomised Against Placebo,” BMC Medicine, Vol. 3, pp.

14-18.

44 Sheryl Ubelacker, “SSRI antidepressants may raise suicide risk in elderly patients: study,” Sympatico, 1 May 2006.

45 “Antidepressants should list new risks: FDA,” Reuters, 19 July 2006; “Combined Use of 5-Hydroxytryptamine Receptor Agonists (Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) May

Result in Life-threatening Serotonin Syndrome,” FDA Public Health Advisory, 19 July 2006.

46 “FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressants,” FDA News, 2 May 2007.

47 “Antidepressants and suicidal thoughts and behaviour,” Pharmacovigilance Working Party, Jan. 2008.

48 Yan Chen, et al., “Risk of Cerebrovascular Events [CVE] Associated with Antidepressant Use in Patients with Depression: A

Population-Bases, Nested Case-Control Study,” The Annals of Pharmacotherapy, Vol. 42, No. 2, pp. 177-184, 22 Jan. 2008.

49 “Implementation of warnings on suicidal thoughts and behaviour in antidepressants,” MHRA, 5 February 2008.

50 Irving Kirsch, et al., “Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug

Administration,” Public Library of Science, Vol. 5, Iss. 2, 26 Feb. 2008.

51 “Antidepressant drug use and risk of venous thromboembolism,” Pharmacotherapy, Vol. 28, No. 2, 28 Feb. 2008.

52 Thomas Laughren, M.D., Letter to GlaxoSmithKline Attn: Randal L. Batenhorst, Food and Drug Administration, Jan. 2009.

53 Benedict Carey, “Treatment of Depression in Pregnancy Affects Babies,” The New York Times, 4 Feb. 2005.

54 “General information concerning use of SSRI antidepressants in pregnant women,” Therapeutic Goods Administration, 7 Sept. 2005.

55 “Paroxetine HCL – Paxil and generic paroxetine,” 2005 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary

Supplements, FDA MedWatch, 27 Sept. 2005.

56 Steve Mitchell, “Analysis: SSRIs’ risk to infants,” United Press International, 6 Feb. 2006.

57 “Advisory – Newer antidepressants linked to serious lung disorder in newborns,” Health Canada press release, 10 Mar. 2006.

58 Maria Bishop, “Use of Antidepressants in Pregnancy Affects Neonatal Outcomes: Presented at AACAP,” Doctor’s Guide, 29 Oct.

2007.

59 “Paxil, Prozac, Zoloft and Other SSRI Antidepressants Tied to Premature Birth,” News Inferno, 6 May 2008.

60 “Duloxetine hydrochloride (marketed as Cymbalta) information,” FDA information sheet, 30 June 2005.

61 “Cymbalta (duloxetine hydrochloride),” 2005 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary Supplements, FDA

MedWatch, 17 Oct. 2005.

62 “NDA # 21-733. CYMBALTA® (duloxetine hydrochloride) Delayed-release Capsules. MACMIS # 14550,” FDA, 2 Oct. 2007.

63 “Paroxetine,” FDA Public Health Advisory, 8 Dec. 2005.

64 Benedict Carey and Gardiner Harris, “Antidepressant May Raise Suicide Risk,” The New York Times, 12 May 2006.

65 Corrado Barbui, M.D., et al., “Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic reexamination

of published and unpublished data from randomized trials,” Canadian Medical Association Journal, Vol. 178, No. 3, 29

Jan. 2008.

66 “New Warning for Strattera,” FDA Talk Paper, 17 Dec. 2004.

67 “Attention Drug to Get New Warning,” Los Angeles Times, 18 Dec. 2004.

68 “Strattera to Get New Risk Label,” The Washington Post, 18 Dec. 2004.

69 “New Drugs in Pipeline,” Psychiatric News, 21 Dec. 2001.

70 “Lilly to add suicide warning to Strattera,” ABC News, 29 Sept. 2005.

71 “Atomoxetine and suicidal behavior: update,” Canadian Adverse Reaction Newsletter, Vol. 18, Iss. 3, July 2008.

72 “Atomoxetine: risk of psychotic or manic symptoms,” Drug Safety Update, MHRA, Vol. 2, Iss. 8, March 2009.

73 “Teen Suffers Seizure After Snorting Antidepressant,” HealthScoutNews Reporter, 23 Apr., 2003.

74 Op. cit., Prozac Truth website.

75 Alice Park, “More Drugs To Treat Hyperactivity,” TIME Magazine, 10 Sept. 2001.

76 Op. cit., Prozac Truth website.

77HealthScoutNews Reporter.

78 Op. cit. Physicians’ Desk Reference, http://www.pdrhealth.com.

79 “Suicidality in Children and Adolescents Being Treated With Antidepressant Medications,” FDA Public Health Advisory, 15 Oct.

2004.

80 Op cit.New Zealand Ministry of Health.

81 Italian Official Gazette, No. 224, 26 Sept. 2005.

82 “Depression in Children and Young People,” National Institute for Health and Clinical Excellence, Sept. 2005, pp. 16, 18 and 28.

83 FDA, “Antidepressant Use in Children, Adolescents, and Adults,” www.fda.gov/CDER/Drug/antidepressants?default.html, updated

2 May 2007.

84 Op. Cit.Maria Bishop.

85 “Antidepressant drug use and risk of venous thromboembolism,” Pharmacotherapy, Vol. 28, No. 2, 28 Feb. 2008.

86 Physicians’ Desk Reference, http://www.pdrhealth.com; “ABILIFY Rx Only (aripiprazole) Tablets,” Package Insert, revised Mar.

2004; “GENERIC NAME: Aripiprazole BRAND NAME: Abilify,” Internet URL: http://www.MedicineNet.com, Last Editorial

Review: 9/8/04; “Aripiprazole Brand Name: Abilify,” Internet URL: http://www.HealthyPlace.com, Ty C. Colbert, Rape of the Soul,

How the Chemical Imbalance Model of Modern Psychiatry has Failed its Patients, (Kevco Publishing, California, 2001), p. 106.

87 Robert Whitaker, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, (Perseus

Publishing, New York, 2002), pp. 182, 186.

88 Op. cit., Robert Whitaker, p. 208.

89 George Crane, “Tardive Dyskinesia in Patients Treated with Major Neuroleptics: A Review of the Literature,” American Journal of

Psychiatry, Vol. 124, Supplement, 1968, pp. 40-47.

90 Michael J. Burns, “The Pharmacology and Toxicology of Atypical Antipsychotic Agents,” Journal of Toxicology, 1 Jan. 2001.

91 Ibid.

92 “FDA: Antipsychotic Drugs, Diabetes Linked,” Associated Press Online, 18 Sept. 2003.

93 “Atypical antipsychotics and hyperglycaemia,” Australian Adverse Drug Reactions Bulletin, Vol. 23, No. 3, June 2004.

94 Jeffrey A. Lieberman, M.D., et al., “Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia,” The New England Journal of Medicine, Vol. 353, No. 12, 22 Sept. 2005.

95 Philip S. Wang, et al., “Risk of Death in Elderly Users of Conventional vs. Atypical Antipsychotic Medication,” The New England

Journal of Medicine, Vol. 353, No. 22, 1 Dec. 2005.

96 Marilyn Elias, “New antipsychotic drugs carry risks for children; Side effects can lead to bigger health problems,” USA Today, 2

May 2006.

97 Peter Tyrer, et al., “Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with

intellectual disability: a randomized controlled trial,” The Lancet, Vol. 371, 5 Jan. 2008.

98 Wilma Knol, M.D., et al., “Antipsychotic Drug Use and Risk of Pneumonia in Elderly People,” The American Geriatrics Society, Vol.

56, No. 4, pp. 661-666, Apr. 2008.80

99 Hugo Lovheim, M.D., Stig Karlsoon, R.N., Ph.D., et al., “The use of central nervous system drugs and analgesics among very old

people with and without dementia,” Pharmacoepidemiology and Drug Safety, 9 Apr. 2008.

100 Paula A. Rochon, M.D., MPH, FRCPC, et al., “Antipsychotic Therapy and Short-term Serious Events in Older Adults With

Dementia,” The Archives of Internal Medicine, Vol. 168, No. 10, 26 May 2008.

101 “Information for Healthcare Professionals Antipsychotics,” FDA, June 2008; “US FDA expands antipsychotic drug warning,”

Reuters UK, 17 June 2008.

102 “Update on the safety of antipsychotic medicines – risk of stroke and increased risk of mortality in elderly patients treated for

dementia,” Drug Safety Newsletter, Iss. 30, Apr. 2009, p. 5.

103 MedicineNet.com, Last Editorial Review: 9/8/04.

104 “Abilify Information,” Pharma-Help.com.

105 “The New Anti-Psychotic Drug Aripiprazole (ABILIFY),” Public Citizen’s eLetter, Apr. 2003.

106 Op. cit., “ABILIFY Rx Only (aripiprazole) Tablets,”

107 “Clozapine and Achy Breaky Hearts,” MedSafe, May 2008.

108 Watching Briefs, MedSafe, June 2008.

109 “Information for Healthcare Professionals Haloperidol (marketed as Haldol, Haldol Decanoate and Haldol Lactate),” FDA ALERT,

17 Sept. 2007.

110 Jeff Swiatek, “Uncertainty was Driver in Zyprexa Deal,” IndianapolisStar.com, 11 June 2005.

111 Op. cit., Jeffrey A. Lieberman, M.D., et al.

112 “Study: New drugs little better for schizophrenia,” St. Petersburg Times, 20 Sept. 2005.

113 “Important Safety Information about ZYPREXA® (olanzapine),” Eli Lilly and Company, 5 Oct. 2007; “Lilly Announces Updates

to the Zyprexa and Symbyax U.S. Labels,” PRNewswire, Bio-Medicine, 5 Oct. 2007.

114 ZYPREXA Safety Information, www.zyprexa.com.

115 Physicians’ Desk Reference, http://www.pdrhealth.com.

116 Tracey McVeigh, “Tranquilizers ‘more lethal than heroin,’” The Observer, 5 Nov. 2000.

117 Matt Clark, Mary Hager, “Valium Abuse: The Yellow Peril,” Newsweek, 24 Sept. 1979; Dr. Patrick Holford, “How to Quit

Tranquilizers,” www.patrickholdford.com, 2008.

118 Ibid.

119 Op. cit., Tracey McVeigh.

120 “Elderly On Long-Acting Anxiety, Insomnia Drugs Have More Car Crashes,” Doctor’s Guide citing Journal of American Medical

Association, 30 June 1997.

121 “Agression, Violence & Bezodiazapines,” Benzo.org.uk, citing British National Formulary, 2001.

122 Benzo.org.uk, citing Professor C. Heather Ashton, Benzodiazepines: How They Work and How To Withdraw, Feb. 2001.

123 “The Influence on the Pharmaceutical Industry,” House of Commons, UK, Health Committee, Vol. 1, Mar. 2005. p. 65.

124 Tarja-Brita R. Wahlin, et al., “Falls and fall risk among nursing home residents,” The Journal of Clinical Nursing, Vol. 17, pp. 126-

134, Jan. 2008.

125 “Europe-wide review recommends updates to product information for varenicline (brand name Champix),” MHRA, 14 Dec. 2008.

126 “Early Communication About an Ongoing Safety Review Varenicline (marketed as Chantix),” FDA, 20 Nov. 2007.

127 “Varenicline (marketed as Chantix) Information,” FDA Alert, 1 Feb. 2008.

128 Op. cit., House of Commons, UK, Health Committee, p. 65.

129 Anna Maria Dademan, “Flunitrazepam and violence—psychiatric and legal issues,” Department of Clinical Neuroscience,

Occupational Therapy and Elderly Care, Research Division of Forensic Psychiatry, Karolinska Institute, Sweden, 2000, p. 43.

130 “Zolpidem (‘Stilnox’) – Updated information – February 2008,” Theraputic Goods Administration, 21 Feb. 2008; “Club Drugs: An

Update,” Drug Intelligence Brief, Drug Enforcement Administration, Sept. 2001.

131 “FDA Safety Changes: Ambien, Primazin IM/IV, Hepsera,” Medscape, 28 Aug. 2008.

132 Peter Breggin, Toxic Psychiatry, (St. Martin’s Press, New York, 1991) p. 245.

133 Jerrold F. Rosenbaum, et al., “Emergence of Hostility During Alprazolam Treatment in Borderline Personality Disorder,” The

American Journal of Psychiatry, Vol. 141, No. 6 (June 1984), pp. 792-793.

134 David L. Gardner and Rex W. Cowdrey, “Alprazolam-Induced Dyscontrol in Borderline Personality Disorder,” The American

Journal of Psychiatry, Vol. 142, No. 1 (Jan. 1985), pp. 98-100.

135 “Xanax addiction extremely tough to kick,” MSNBC News Online, 2001.

136 Statement by Joseph A. Califano, Jr., Chairman and President, “Under the Counter: The Diversion and Abuse of Controlled

Prescription Drugs in the U.S.” The National Center on Addiction and Substance Abuse at Columbia University, July 2005.

137 Physicians’ Desk Reference, (Medical Economics Company, New Jersey, 1998), pp. 2822-2823; David L. Richman, M.D., Leonard

Roy Frank, and Art Mandler, Dr. Caligari’s Psychiatric Drugs (Alonzo Printing Co., Inc., California, 1984), p. 39.

138 Op. cit., David L. Richman, M.D., et al., pp. 38-39.

139 Ibid.

Source: http://www.cchrint.org/pdfs/The_Side_Effects_of_Common_Psychiatric_Drugs.pdf

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(Including Selective Serotonin Reuptake Inhibitors or SSRIs; Selective or Serotonin/Norepinephrine Reuptake Inhibitors or SNRIs)

BRAND NAMES (generic names):

SSRIs (Selective Serotonin Reuptake Inhibitors*)

1. Akarin (citalopram)

2. Apo-Sertral (sertraline)

3. Aropax (paroxetine)

4. Asentra (sertraline)

5. Celexa (citalopram)

6. Cipralex (escitalopram)

7. Cipram (citalopram)

8. Cipramil (citalopram)

9. Citopam (citalopram)

10. Deroxat (paroxetine)

11. Dumyrox (fluvoxamine)

12. Eufor (fluoxetine)

13. Faverin (fluvoxamine)

14. Floxyfral (fluvoxamine)

15. Fluctine (fluoxetine)

16. Fluocim (fluoxetine)

17. Fluox (fluoxetine)

18. Fluvox (fluvoxamine)

19. Gladem (sertraline)

20. Ladose (fluoxetine)

21. Lexapro (escitalopram oxalate)

22. Lovan (fluoxetine)

23. Lustral (sertraline)

24. Luvox (fluvoxamine)

25. Paroxat (paroxetine)

26. Paxil (paroxetine)

27. Pexeva (paroxetine)

28. Prisdal (citalopram)

29. Prozac (fluoxetine hydrochloride)

30. Psiquial (fluoxetine)

31. Sarafem (fluoxetine hydrochloride)

32. Sercerin (sertraline)

33. Serlift (sertraline)

34. Seroplex (escitalopram)

35. Seroplexa (escitalopram)

36. Seropram (paroxetine)

37. Seroxat (paroxetine)

38. Sipralexa (escitalopram)

39. Tolrest (sertraline)

40. Veritina (fluoxetine)

41. Zoloft (sertraline hydrochloride)

42. Xydep (sertraline)

SNRIs (Serotonin-norepinephrine reuptake inhibitors*)

1. Ariclaim (duloxetine)

2. Cymbalta (duloxetine)

3. Dalcipran (milnacipran)

4. Dobupal (venlafaxine)

5. Efectin (venlafaxine)

6. Effexor (venlafaxine)

7. Ixel (milnacipran)

8. Pristiq (desvenlafaxine)

9. Yentreve (duloxetine)

SNRIs (Selective norepinephrine reuptake inhibitors*)

1. Edronax (reboxetine)

2. Outonin (nefazodone)

3. Merital (nomifensine)

4. Norebox (reboxetine)

5. Serzone (nefazodone)

6. Strattera (atomoxetine)

7. Vestra (reboxetine)

NDRIs (Norepinephrine-Dopamine Reuptake Inhibitors*)

1. Odranal (bupropion)

2. Wellbutrin (bupropion)

3. Zyban (bupropion)

OTHER

1. Desyrel (trazodone) 2. Dutonin (nefazodone) 3. Ludiomil (maprotiline hydrochloride) 4. Nedafar (nefazodone) 5. Serzone (nefazodone) 6. Symbyax (fluoxetine and olanzapine – antidepressant/antipsychotic mix)

SIDE EFFECTS:

§ Abnormal bleeding or bruising

§ Abnormal thoughts

§ Agitation

§ Akathisia (severe

§ restlessness)

§ Anxiety

§ Black and tarry stools

§ Blisters

§ Blood in stools

§ Bloody vomit

§ Blurred or changes in vision

§ Burning or tingling in the hands, arms, feet, or legs

§ Burping

§ Changes in ability to taste food

§ Changes in sexual desire or ability

§ Chest pain

§ Coma

§ Confusion

§ Constipation

§ Cough

§ Dark colored urine

§ Delusions

§ Diarrhea

§ Difficult, frequent, or painful urination

§ Difficulty breathing or swallowing

§ Difficulty concentrating

§ Dizziness or faintness

§ Drowsiness

§ Dry mouth

§ Emotional numbing

§ Enlarged pupils (black circles in the middle of the eyes)

§ Eye pain or redness

§ Fast, pounding, or irregular heartbeat

§ Fever

§ Flu-like symptoms

§ Flushing

§ Forgetfulness

§ Gas or bloating

§ Hallucinations

§ Headache

§ Heart attacks

§ Heartburn

§ Hives

§ Hoarseness

§ Hostility

§ Hot flashes or flushing

§ Hypomania (abnormal excitement)

§ Impotence

§ Increased appetite

§ Increased sweating

§ Indigestion

§ Insomnia

§ Itching

§ Joint pain

§ Loss of appetite

§ Lump or tightness in throat

§ Mania

§ Memory lapses

§ Mood swings

§ Muscle weakness or tightness

§ Nausea

§ Nervousness

§ Neuroleptic Malignant Syndrome*

§ Nightmares

§ Numbness in your hands, feet, arms, or legs

§ Pain in the back, muscles, joints, or anywhere in the body

§ Pain in the upper right part of the stomach

§ Painful erection that lasts for hours

§ Painful or irregular menstruation

§ Panic attacks

§ Paranoia

§ Problems with coordination

§ Problems with teeth

§ Psychotic episodes

§ Rash

§ Restlessness

§ Ringing in the ears

§ Runny nose

§ Seizures

§ Sensitivity to light

§ Sexual dysfunction

§ Slow or difficult speech

§ Small purple spots on the skin

§ Sneezing

§ Sore throat, fever, chills, and other signs of infection

§ Stomach pain

§ Sudden muscle twitching or jerking that can’t be controlled

§ Sudden upset stomach

§ Suicidal thoughts or behavior

§ Swelling of the eyes, face, lips, tongue, throat, hands, arms, feet, ankles, or lower legs

§ Swelling, itching, burning, or infection in the vagina

§ Tightness in hands and feet

§ Twitching

§ Uncontrollable shaking of a part of the body

§ Violent behavior

§ Vomiting

§ Vomiting material that looks like coffee grounds

§ Weakness or numbness of an arm or leg

§ Weakness or tiredness

§ Weight gain

§ Weight loss

§ Withdrawal symptoms include deeper depression

§ Yellowing of the skin or eyes30

Explanatory Note:

The newer antidepressants, Selective Serotonin Reuptake Inhibitors (SSRIs) emerged in the late 1980s/1990s, marketed as being capable of selectively targeting a chemical—serotonin—in the brain that was theorized to influence depression. This has remained a theory only. Serotonin (of which about only 5% is found in the brain) is one of the chemicals by which brain cells signal each other. SSRIs prevent serotonin from being naturally reabsorbed and thus create continued stimulation of cells. Norepinephrine is a hormone secreted by the adrenal gland that increases blood pressure and rate and depth of breathing, raises the level of blood sugar, and decreases the activity of the intestines.

Norepinephrine is very similar to its cousin, adrenaline. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) boost levels of norepinephrine in addition to serotonin.

There is another SNRI, which is called Selective Norepinephrine Reuptake Inhibitors, and is largely prescribed for “ADHD” but carries the same suicide warning as SSRIs and other antidepressants. Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs) are said to influence norepinephrine and dopamine, another chemical messenger that is similar to adrenaline. There are no physical tests or scientific evidence to substantiate the theory that a chemical imbalance in the brain causes depression or any mental disorder.

Wellbutrin is a short-acting antidepressant and amphetamine-like drug similar to Ritalin and Dexedrine.

Strattera (atomoxetine) increases norepinephrine and dopamine in the frontal part of the brain and is a Selective NRI. The precise mechanism by which atomoxetine produces its effects on so-called ADHD is unknown.

General Warnings And Studies On Newer Antidepressants :

1997: Candace B. Pert, Research Professor at Georgetown University Medical Center in Washington, D.C., and credited as one of the researchers that helped develop Prozac, wrote that SSRIs “may also cause cardiovascular problems in some susceptible people after longterm use, which has become common practice despite the lack of safety studies.” In 2002, she added, “They are supposed to help but they actually cause violence. There’s scientific literature that supports that.”31

March 22, 2004: The FDA warned that SSRIs could cause “anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania [abnormal excitement] and mania [psychosis characterized by exalted feelings, delusions of grandeur].”32

August 20, 2004: A Columbia University review of the pediatric clinical trials of Zoloft, Celexa, Effexor, Paxil, Prozac and another older antidepressant, found that young people who took them could experience suicidal thoughts or actions.33

2004: The British Healthcare Products Regulatory Authority (MHRA, similar to the FDA) issued guidelines that children should not be given most SSRIs because clinical trial data showed an increased rate of harmful outcomes, including hostility.34

October 15, 2004: The FDA ordered pharmaceutical companies to add a “black box” warning to all antidepressants because the drugs could cause suicidal thoughts and actions in children and teenagers. The agency also directed the manufacturers to print and distribute medication guides with every antidepressant prescription and to inform patients of the risks.35

October 21, 2004: The New Zealand Medicines Adverse Reactions Committee recommended that old and new antidepressants not be administered to patients less than 18 years of age because of the potential risk of suicide.36

December 2004: The Australian Therapeutic Goods Administration said children and adolescents prescribed SSRI antidepressants should be carefully monitored for the emergence of suicidal ideation. In a study involving Prozac, it said, there was an increase in adverse psychiatric events (acts and thoughts of suicide, self-harm, aggression and violence).37

December 9, 2004: The European Medicines Agency’s Committee for Medicinal Products

for Human Use, representing 25 European countries, recommended that product information

should be changed for antidepressants (including SSRIs, SNRIs) to warn of the risk of

suicide-related behavior in children and adolescents and of withdrawal reactions when

stopping treatment. This was reaffirmed in April 2005, warning that the drugs increased

suicide-related behavior and hostility in young people.38

February 18, 2005: A study published in the British Medical Journal determined that

adults taking SSRI antidepressants were more than twice as likely to attempt suicide as

patients given placebo (a substance with no real effect; it contains no active ingredients

and is given to a patient in a clinical trial to assess and compare the performance of a new

drug).39

July 16, 2005: The British Medical Journal published a study, “Efficacy of antidepressants

in adults,” by Joanna Moncrieff, senior lecturer in psychiatry at University College London

who found that antidepressants, especially SSRIs, were no more effective than placebo and

did not reduce depression. In a media interview Dr. Moncrieff stated, “The bottom line is

that we really don’t have any good evidence that these drugs work.” 40

August 2005: The Australian Therapeutic Goods Administration found a relationship

between SSRIs and suicidality, akathisia (severe restlessness), agitation, nervousness and

anxiety in adults. It also determined that similar symptoms could occur during withdrawal

from the drugs.41

August 19, 2005: The European Medicines Agency’s Committee for Medicinal Products

for Human Use issued its strongest warning against child SSRI antidepressant use, stating

that the drugs caused suicide attempts and thoughts, aggression, hostility, oppositional

behavior and anger.42

August 22, 2005: Norwegian researchers determined that patients taking SSRI

antidepressants were seven times more likely to experience suicide than those taking

placebo.43

May 1, 2006: An American Journal of Psychiatry study revealed that elderly people

prescribed SSRI antidepressants such as Prozac, Paxil and Zoloft are almost five times

more likely to commit suicide during the first month on the drugs than those given other

classes of antidepressants.44

July 19, 2006: The FDA warned that migraine sufferers should not take SSRI or SNRI

antidepressants while taking migraine drugs known as triptans as it could result in a lifethreatening

condition called serotonin syndrome. Serotonin syndrome occurs when the

body has too much serotonin; symptoms may include restlessness, hallucinations, loss of

coordination, fast heartbeat, rapid changes in blood pressure, increased body temperature,

overactive reflexes, nausea, vomiting, and diarrhea. Serotonin syndrome may be more

likely to occur when starting or increasing the dose of a triptan, SSRI or SNRI, according

to the FDA.45

May 2, 2007: The FDA officially extended the age group for the black box warning about

antidepressants inducing suicide from 18 to 24.46

January 2008: The Pharmacovigilance Working Party (advises on the safety and adverse

reactions of medicinal products authorized for use in the European Union) recommended

an update to product labeling and all antidepressant patient information leaflets to warn

about the increased risk of suicide in children and young adults taking them.47

January 22, 2008: The Annals of Pharmacotherapy published a study on the risk of

cerebrovascular (of or relating to the brain and the blood vessels that supply it) events

(CVE) associated with antidepressant use and found that a “24% increased risk of a CVE

was noted in patients with current exposure to selective serotonin-reuptake inhibitors…

34% increased risk for current exposure to tricyclic antidepressants (older form of

antidepressant)… and 43% increased risk for current exposure to other antidepressants.”48

February 5, 2008: Britain’s Medicines and Healthcare Products Regulatory Agency

advised that antidepressant manufacturers would be required to update warnings about

suicidal thoughts and behavior to align with EU agreements, as noted above in January

2008.49

February 26, 2008: Public Library of Science (PLoS) published an antidepressant efficacy study, which found that at moderate levels of depression there was virtually no difference

between antidepressants and placebo. Further, there was only a relatively small difference

for patients with very severe depression. The study concluded: “increased benefit for

extremely depressed patients seems attributable to a decrease in responsiveness to placebo,

rather than an increase in responsiveness to medication.”50

March 2008: Researchers conducted a study monitoring the daily news for accurate

scientific data regarding the theory that depression is caused by a chemical imbalance

and found there was no evidence to support it. Jeffrey Lacasse, a Florida State University

doctoral candidate and visiting lecturer in the College of Social Work, and Jonathan Leo, a

neuroanatomy professor at Lincoln Memorial University in Tennessee, found that reporters

were unable to cite or provide any evidence to substantiate that a chemical imbalance

or lack of serotonin caused depression, requiring antidepressants. Further, “[T]here are

few scientists who will rise to its defense, and some prominent psychiatrists publicly

acknowledge that the serotonin hypothesis is more metaphor than fact.” As such, SSRIs

cannot correct an imbalance that does not exist. The researchers said the popularity of the

theory was in large part based on the presumed efficacy of the SSRIs, but that several large

studies now cast doubt on this efficacy. 51

January 2009: The FDA issued a letter requiring the manufacturers of Paxil, to update

their drug safety label to include information on Serotonin Syndrome or Neuroleptic

Malignant Syndrome -like reactions associated with selective serotonin reuptake inhibitors

and serotonin norepinephrine reuptake inhibitors.

Warnings Against newer antidepressants Ta ken During Pregnancy:

February 5, 2005: An analysis of World Health Organization medical records found that infants whose mothers took SSRI antidepressants while pregnant could suffer withdrawal effects.53

September 7, 2005: The Australian Therapeutic Goods Administration warned that SSRI antidepressant use during pregnancy could cause “withdrawal effects that can be severe or life-threatening.”54

September 27, 2005: The FDA warned that Paxil and other SSRI antidepressants taken during the first trimester of pregnancy could cause increased risk of major birth defects, including heart malformations in newborn infants.55

February 6, 2006: A study published in the Archives of Pediatrics and Adolescent Medicine determined that nearly one-third of newborn infants whose mothers took SSRI antidepressants during pregnancy experienced withdrawal symptoms that included highpitched crying, tremors and disturbed sleep.56

March 10, 2006: Health Canada issued a warning that pregnant women taking SSRIs and other newer antidepressants placed newborns at risk of developing a rare lung and heart condition.57

October 2007: A study released at the 54th Annual Meeting of the American Academy of Child & Adolescent Psychiatry showed that babies born to mothers who took antidepressants during pregnancy had high levels of cortisol (hormone that helps manage blood pressure) in umbilical cord-blood at birth and that the mothers were more likely to experience delivery complications. When examined at two weeks of age, these infants were more excitable than those born to women who did not take antidepressants.58

May 6, 2008: The results of a study of 200 pregnant women, was presented at the

annual meeting of the American Psychiatric Association. About half of the women were

diagnosed with depression, and half of these took SSRIs throughout pregnancy. About

23% of those who took SSRIs gave birth to pre-term babies at a rate that was nearly four

times that experienced by women (6%) who did not take antidepressants or did not have

depression.59

WARNINGS ON SPECIFIC newer antidepressants:

CYMBALT A (duloxetine, SNRI):

June 30, 2005: The FDA warned that Cymbalta could increase suicidal thinking or behavior

in pediatric patients taking it.60

October 17, 2005: The FDA ordered Eli Lilly & Co. to add a warning to the packaging of

Cymbalta that it could cause liver damage.61

October 2, 2007: The FDA faxed Eli Lilly & Co. about its professional mailer for Cymbalta,

stating that it was “false or misleading in that it overstates the efficacy of Cymbalta and

omits some of the most serious and important risk information associated with its use.”62

PAXIL (paroxetine, SSRI):

September 27, 2005: The FDA warned that Paxil taken by pregnant women in their first

trimester might cause birth defects, including heart malformations.63

May 12, 2006: GlaxoSmithKline, the manufacturer of Paxil, wrote to doctors warning that

Paxil increased the risk of suicide in adults.64

January 29, 2008: The Canadian Medical Association Journal published a study on the

effectiveness of Paxil that involved data from 40 trials and “showed an absence of a positive

effect of paroxetine [Paxil].”65

STRATTERA (atomoxetine, SNRI):

Often prescribed to treat ADHD as well as depression.

December 17, 2004: The FDA required that Strattera packaging carry a new warning

advising, “Severe liver injury may progress to liver failure resulting in death or the need

for a liver transplant in a small percentage of patients.”66 The drug should be discontinued

in patients who develop jaundice (condition that causes yellowness of the skin, eyes and

body fluids) or liver injury. The FDA also noted, “The labeling warns that severe liver

injury may progress to liver failure resulting in death or the need for a liver transplant in

a small percentage of patients.”67 Signs of the possible liver problems included jaundice,

dark urine, unexplained flu-like symptoms, upper right-side abdominal tenderness and a

form of itchy skin known as pruritus (caused by irritation of the sensory nerve endings).68

Other common side effects were headache, abdominal pain, nausea and vomiting, anorexia

(eating “disorder”) and weight loss, nervousness, somnolence (drowsiness).69

September 29, 2005: The FDA directed Eli Lilly & Co. to revise Strattera labeling to

include a boxed warning about the increased risk of suicidal thinking in children and

adolescents taking it.70

July 2008: Health Canada published an article entitled “Atomoxetine [Strattera] and

suicidal behavior: update” in its Canadian Adverse Reaction Newsletter, stating that as of

December 2007, 1989 adverse reactions had been reported. Of these, 55 were classified

as suicide attempt with about 75% of those being children. They stressed that health care

providers needed to remind patients and family members to monitor moods, behaviors,

thoughts and feelings when ADHD medication was used.71

March 2009: The Medicines and Healthcare products Regulatory Agency (UK) published

in their Drug Safety Update newsletter new information about atomoxetine (Strattera, a

non-stimulant ADHD drug). They warned that atomoxetine is associated with treatmentemergent

psychotic or manic symptoms in children without a history of such disorders.72

WELLBUTRIN (bupropion):

The FDA approved Wellbutrin as an antidepressant in 1985 but because of the significant

incidence of seizures at the originally recommended dose (400-600 mg), the drug was

withdrawn in 1986. It was reintroduced in 1989 with a maximum dose of 450 mg per

day. In 1996, the FDA approved a sustained release (taken twice daily) for treatment of

depression. The same drug is marketed in slow-release form as Zyban for people trying

to quit smoking.73 While Wellbutrin is not FDA-approved to treat ADHD, doctors still

prescribe it for this.

It can cause seizures and at rates of four times that of other antidepressants.74 Fatal heart

attacks in those with a history of heart-rhythm disturbances have occurred.75 Other side

effects include agitation, insomnia, increased restlessness, anxiety, delusions, hallucinations,

psychotic episodes, confusion, weight loss and paranoia.76 Teens have abused the drug by

crushing and snorting it, causing seizures.77

*Neuroleptic malignant syndrome: A potentially fatal toxic reaction where patients break into

fevers and become confused, agitated and extremely rigid. An estimated 100,000 Americans have

died from it after taking the older antipsychotics.88

References

1 Physicians’ Desk Reference, http://www.pdrhealth.com; “Adderall,” DrugStore.com, Internet URL: http://www.drugstore.com;

“Study Suggests Focalin (TM) LA Capsules (d-MPH-ER) Are Safe and Effective for ADHD in Adults,” PR Newswire, 5 May 2004;

A.D.D. Warehouse website; ADHDHelp, Internet URL: http://www.adhdhelp.org/metadate.htm. Journal of the Royal Society of Med.,

Vol 92, Mar. 99 “letters to the editor” p. 156. Medline Plus, www.nim.nih.gov/medlineplus: Millichap, J.Gordon “Methylphenidate

Role in Tourettes Syndrome Prevalence.

2 Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), American Psychiatric Association, Washington, D.C., 1987, p. 136.

3 “Drug Scheduling,” U.S. Drug Enforcement Administration Online, Internet URL: http://www.dea.gov.

4 Raul R. Gainetdinov; William C. Wetsel; Edward D. Sara; R. Levin Jones; Mohamed Jaber; Marc G. Caron, “Role of Serotonin in the

Paradoxical Calming Effect of Psychostimulants on Hyperactivity,” Science, 15 Jan. 1999.

5 “Statement on Concerta and Methylphenidate,” Statement posted on the FDA website, 28 June 2005.

6 Marian S. MacDonagh, PharmaD, and Kim Peterson, MS, “Drug Class Review on Pharmacologic Treatment for ADHD: Final

Report,” Oregon Health and Science University, Sept. 2005, pp. 13-20.

7 “FDA will study safety of attention-deficit drugs,” Kansas City Star, 5 Jan. 2006.

8 “Stimulants in children with ADHD may have negative CV effect,” Mental Health Law Weekly, 4 Feb. 2006.

9 Ricardo Alonso-Zaldivar, “Warning Urged for ADHD Drugs,” Los Angeles Times, 10 Feb. 2006.

10 Todd Zwillich, “FDA Panel Recommends Warnings of Rare Reports of Aggressive Behavior or Psychotic Symptoms,” WebMD, 23

Mar. 2006.

11 “Dark side of a wonder drug,” The Australian, 28 Mar. 2006.

12 Almut G. Winterstein, et al., “Cardiac Safety of Central Nervous System Stimulants in Children and Adolescents With Attention-

Deficit/Hyperactivity Disorder,” Pediatrics, Vol. 120, Dec. 2007, pp. e1494-e1501.

13 W. Goldman, et al., “Association between treatment with central nervous system stimulants and Raynaud’s Syndrome in children: a

study of rheumatology patients,” Arthritis & Rheumatism, Vol. 58, No. l, 2 Feb. 2008, pp. 563-566.

14 Brian Vastig, “Pay Attention: Ritalin Acts Much Like Cocaine,” JAMA, 22/29 Aug. 2001, Vol. 286, No. 8, p. 905.

15 Joel Turtel, Public Schools, Public Menace: How Public Schools Lie to Parents and Betray Our Children, (Library Books, New

York), 2004-2005, p. 135.

16 “Partnership Attitude Tracking Study” of teens in 2004, 17th Annual report by Partnership for a Drug-Free America, 21 Apr. 2005;

“Survey: 1 in 5 teens getting high on medications, over-counter drugs,” NewsItem.com, 2 May 2005.

17 Larry A. Kroutil, et al., “Nonmedical use of prescription stimulants in the United States,” Drug and Alcohol Dependence, Feb. 2006.

18 Brian Witte, “Slaying blamed on reaction to hyperactivity drug,” Associated Press, 25 Oct. 1999.

19 “J & J Psychiatric Safety Labeling, Cardiovascular Events Are Topic For Cmte,” FDAAdvisoryCommittee.com, June 2005.

20 “Health Canada Suspends Marketing of Adderall,” FDA Alert, 9 Feb. 2005.

21 “Health Canada allows Adderall XR® back on the Canadian market,” Health Canada News Release, 24 Aug. 2005.

22 Partnership Attitude Tracking Study, Teens – 2004, Partnership for a Drug-Free America, 21 Apr. 2005, p. 7; “Cylert recall

demanded over safety concerns,” Lifestyle News, www.mynippon.com/news/2005/03/cylert-recall-demanded-over-safety-concerns.

23 “Injured by Cylert?” Parker Waichman Alonso, LLP, http://www.yourlawyer.com/topics/overview/cylert.

24 “FDA Withdraws Approval for ADD Drug,” Associated Press, 24 Oct. 2005.

25 “Updated Safety Information: Warnings regarding serious rash, including Stevens-Johnson Syndrome and hypersensitivity reactions,

and psychiatric symptoms,” Cephalon, Inc., Sept. 2007.

26 Op. cit., DSM-III-R, pp. 136, 175.; Medical Economics Company, Physicians Desk Reference (Montvale, NJ: Medical Economics

Co, 1998), pp. 1,897.

27 “Methylphenidate (A Background Paper),” U.S. Drug Enforcement Administration, Oct. 1995, p. 16.

28 “Antidepressant Ritalin to be delisted because of abuse,” Daily Yomiuri Online, 19 Oct. 2007.

29 Ritalin Drug Label, fda.gov.

30 Physicians’ Desk Reference, http://www.pdrhealth.com; Joseph Glenmullen, M.D. Prozac Backlash, (Simon & Schuster, New York,

2000), p. 8; “Antidepressants Lift Clouds, But Lost ‘Miracle Drug’ Label,” The New York Times, 30 June 2002; Alice Park, “More

Drugs To Treat Hyperactivity,” TIME Magazine, 10 Sept. 2001; Wellbutrin/Bupropion, Prozac Truth website; “Teen Suffers Seizure

After Snorting Antidepressant,” HealthScoutNews Reporter, 23 Apr. 2003.

31 Dr. Candace B. Pert, Letter to the Editor, TIME Magazine, 20 Oct. 1997, p. 8.

32 “Worsening Depression and Suicidality in Patients Being Treated with Antidepressant Medication,” FDA Public Health Advisory, 22

Mar. 2004.

33 Gardiner Harris, “Antidepressant Study Seen to Back Expert,” The New York Times, 20 Aug. 2004.

34 “Antidepressant aggression concern,” BBC News Online, 21 Sept. 2004.

35 “Suicidality in Children and Adolescents Being Treated With Antidepressant Medications,” FDA Public Health Advisory, 15 Oct. 2004.

36 “New advice on prescribing anti-depressants,” New Zealand Ministry of Health Media Release, 21 Oct. 2004.

37 “Use of SSRI antidepressants in children and adolescents,” Australian Adverse Drug Reactions Bulletin, Vol. 23, No. 6, Dec. 2004.

38 “European Medicines Agency finalises review of antidepressants in children and adolescents,” European Medicines Agency Press

Release, 25 Apr. 2005.

39 Sarah Boseley, “Suicide fear from antidepressants,” The Guardian (London), 18 Feb. 2005.

40 Joanna Moncrieff and Irving Kirsch, “Efficacy of Antidepressants in Adults,” British Medical Journal, Vol. 331, 16 July 2005, pp.

155-157; Salynn Boyles, “Battle Brews Over Antidepressant Use,” Fox News, 15 Jul. 2005.

41 “Suicidality with SSRIs: adults and children,” Australian Adverse Drug Reactions Bulletin, Vol. 24, No. 4, Aug. 2005.

42 “Annex II,” Commission Decision of 19-VIII-2005, Commission of the European Communities, 19 Aug. 2005.

43 Ivar Aursnes, et al., “Suicide Attempts in Clinical Trials with Paroxetine Randomised Against Placebo,” BMC Medicine, Vol. 3, pp.

14-18.

44 Sheryl Ubelacker, “SSRI antidepressants may raise suicide risk in elderly patients: study,” Sympatico, 1 May 2006.

45 “Antidepressants should list new risks: FDA,” Reuters, 19 July 2006; “Combined Use of 5-Hydroxytryptamine Receptor Agonists (Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) May

Result in Life-threatening Serotonin Syndrome,” FDA Public Health Advisory, 19 July 2006.

46 “FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressants,” FDA News, 2 May 2007.

47 “Antidepressants and suicidal thoughts and behaviour,” Pharmacovigilance Working Party, Jan. 2008.

48 Yan Chen, et al., “Risk of Cerebrovascular Events [CVE] Associated with Antidepressant Use in Patients with Depression: A

Population-Bases, Nested Case-Control Study,” The Annals of Pharmacotherapy, Vol. 42, No. 2, pp. 177-184, 22 Jan. 2008.

49 “Implementation of warnings on suicidal thoughts and behaviour in antidepressants,” MHRA, 5 February 2008.

50 Irving Kirsch, et al., “Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug

Administration,” Public Library of Science, Vol. 5, Iss. 2, 26 Feb. 2008.

51 “Antidepressant drug use and risk of venous thromboembolism,” Pharmacotherapy, Vol. 28, No. 2, 28 Feb. 2008.

52 Thomas Laughren, M.D., Letter to GlaxoSmithKline Attn: Randal L. Batenhorst, Food and Drug Administration, Jan. 2009.

53 Benedict Carey, “Treatment of Depression in Pregnancy Affects Babies,” The New York Times, 4 Feb. 2005.

54 “General information concerning use of SSRI antidepressants in pregnant women,” Therapeutic Goods Administration, 7 Sept. 2005.

55 “Paroxetine HCL – Paxil and generic paroxetine,” 2005 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary

Supplements, FDA MedWatch, 27 Sept. 2005.

56 Steve Mitchell, “Analysis: SSRIs’ risk to infants,” United Press International, 6 Feb. 2006.

57 “Advisory – Newer antidepressants linked to serious lung disorder in newborns,” Health Canada press release, 10 Mar. 2006.

58 Maria Bishop, “Use of Antidepressants in Pregnancy Affects Neonatal Outcomes: Presented at AACAP,” Doctor’s Guide, 29 Oct.

2007.

59 “Paxil, Prozac, Zoloft and Other SSRI Antidepressants Tied to Premature Birth,” News Inferno, 6 May 2008.

60 “Duloxetine hydrochloride (marketed as Cymbalta) information,” FDA information sheet, 30 June 2005.

61 “Cymbalta (duloxetine hydrochloride),” 2005 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary Supplements, FDA

MedWatch, 17 Oct. 2005.

62 “NDA # 21-733. CYMBALTA® (duloxetine hydrochloride) Delayed-release Capsules. MACMIS # 14550,” FDA, 2 Oct. 2007.

63 “Paroxetine,” FDA Public Health Advisory, 8 Dec. 2005.

64 Benedict Carey and Gardiner Harris, “Antidepressant May Raise Suicide Risk,” The New York Times, 12 May 2006.

65 Corrado Barbui, M.D., et al., “Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic reexamination

of published and unpublished data from randomized trials,” Canadian Medical Association Journal, Vol. 178, No. 3, 29

Jan. 2008.

66 “New Warning for Strattera,” FDA Talk Paper, 17 Dec. 2004.

67 “Attention Drug to Get New Warning,” Los Angeles Times, 18 Dec. 2004.

68 “Strattera to Get New Risk Label,” The Washington Post, 18 Dec. 2004.

69 “New Drugs in Pipeline,” Psychiatric News, 21 Dec. 2001.

70 “Lilly to add suicide warning to Strattera,” ABC News, 29 Sept. 2005.

71 “Atomoxetine and suicidal behavior: update,” Canadian Adverse Reaction Newsletter, Vol. 18, Iss. 3, July 2008.

72 “Atomoxetine: risk of psychotic or manic symptoms,” Drug Safety Update, MHRA, Vol. 2, Iss. 8, March 2009.

73 “Teen Suffers Seizure After Snorting Antidepressant,” HealthScoutNews Reporter, 23 Apr., 2003.

74 Op. cit., Prozac Truth website.

75 Alice Park, “More Drugs To Treat Hyperactivity,” TIME Magazine, 10 Sept. 2001.

76 Op. cit., Prozac Truth website.

77HealthScoutNews Reporter.

78 Op. cit. Physicians’ Desk Reference, http://www.pdrhealth.com.

79 “Suicidality in Children and Adolescents Being Treated With Antidepressant Medications,” FDA Public Health Advisory, 15 Oct.

2004.

80 Op cit.New Zealand Ministry of Health.

81 Italian Official Gazette, No. 224, 26 Sept. 2005.

82 “Depression in Children and Young People,” National Institute for Health and Clinical Excellence, Sept. 2005, pp. 16, 18 and 28.

83 FDA, “Antidepressant Use in Children, Adolescents, and Adults,” www.fda.gov/CDER/Drug/antidepressants?default.html, updated

2 May 2007.

84 Op. Cit.Maria Bishop.

85 “Antidepressant drug use and risk of venous thromboembolism,” Pharmacotherapy, Vol. 28, No. 2, 28 Feb. 2008.

86 Physicians’ Desk Reference, http://www.pdrhealth.com; “ABILIFY Rx Only (aripiprazole) Tablets,” Package Insert, revised Mar.

2004; “GENERIC NAME: Aripiprazole BRAND NAME: Abilify,” Internet URL: http://www.MedicineNet.com, Last Editorial

Review: 9/8/04; “Aripiprazole Brand Name: Abilify,” Internet URL: http://www.HealthyPlace.com, Ty C. Colbert, Rape of the Soul,

How the Chemical Imbalance Model of Modern Psychiatry has Failed its Patients, (Kevco Publishing, California, 2001), p. 106.

87 Robert Whitaker, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, (Perseus

Publishing, New York, 2002), pp. 182, 186.

88 Op. cit., Robert Whitaker, p. 208.

89 George Crane, “Tardive Dyskinesia in Patients Treated with Major Neuroleptics: A Review of the Literature,” American Journal of

Psychiatry, Vol. 124, Supplement, 1968, pp. 40-47.

90 Michael J. Burns, “The Pharmacology and Toxicology of Atypical Antipsychotic Agents,” Journal of Toxicology, 1 Jan. 2001.

91 Ibid.

92 “FDA: Antipsychotic Drugs, Diabetes Linked,” Associated Press Online, 18 Sept. 2003.

93 “Atypical antipsychotics and hyperglycaemia,” Australian Adverse Drug Reactions Bulletin, Vol. 23, No. 3, June 2004.

94 Jeffrey A. Lieberman, M.D., et al., “Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia,” The New England Journal of Medicine, Vol. 353, No. 12, 22 Sept. 2005.

95 Philip S. Wang, et al., “Risk of Death in Elderly Users of Conventional vs. Atypical Antipsychotic Medication,” The New England

Journal of Medicine, Vol. 353, No. 22, 1 Dec. 2005.

96 Marilyn Elias, “New antipsychotic drugs carry risks for children; Side effects can lead to bigger health problems,” USA Today, 2

May 2006.

97 Peter Tyrer, et al., “Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with

intellectual disability: a randomized controlled trial,” The Lancet, Vol. 371, 5 Jan. 2008.

98 Wilma Knol, M.D., et al., “Antipsychotic Drug Use and Risk of Pneumonia in Elderly People,” The American Geriatrics Society, Vol.

56, No. 4, pp. 661-666, Apr. 2008.80

99 Hugo Lovheim, M.D., Stig Karlsoon, R.N., Ph.D., et al., “The use of central nervous system drugs and analgesics among very old

people with and without dementia,” Pharmacoepidemiology and Drug Safety, 9 Apr. 2008.

100 Paula A. Rochon, M.D., MPH, FRCPC, et al., “Antipsychotic Therapy and Short-term Serious Events in Older Adults With

Dementia,” The Archives of Internal Medicine, Vol. 168, No. 10, 26 May 2008.

101 “Information for Healthcare Professionals Antipsychotics,” FDA, June 2008; “US FDA expands antipsychotic drug warning,”

Reuters UK, 17 June 2008.

102 “Update on the safety of antipsychotic medicines – risk of stroke and increased risk of mortality in elderly patients treated for

dementia,” Drug Safety Newsletter, Iss. 30, Apr. 2009, p. 5.

103 MedicineNet.com, Last Editorial Review: 9/8/04.

104 “Abilify Information,” Pharma-Help.com.

105 “The New Anti-Psychotic Drug Aripiprazole (ABILIFY),” Public Citizen’s eLetter, Apr. 2003.

106 Op. cit., “ABILIFY Rx Only (aripiprazole) Tablets,”

107 “Clozapine and Achy Breaky Hearts,” MedSafe, May 2008.

108 Watching Briefs, MedSafe, June 2008.

109 “Information for Healthcare Professionals Haloperidol (marketed as Haldol, Haldol Decanoate and Haldol Lactate),” FDA ALERT,

17 Sept. 2007.

110 Jeff Swiatek, “Uncertainty was Driver in Zyprexa Deal,” IndianapolisStar.com, 11 June 2005.

111 Op. cit., Jeffrey A. Lieberman, M.D., et al.

112 “Study: New drugs little better for schizophrenia,” St. Petersburg Times, 20 Sept. 2005.

113 “Important Safety Information about ZYPREXA® (olanzapine),” Eli Lilly and Company, 5 Oct. 2007; “Lilly Announces Updates

to the Zyprexa and Symbyax U.S. Labels,” PRNewswire, Bio-Medicine, 5 Oct. 2007.

114 ZYPREXA Safety Information, www.zyprexa.com.

115 Physicians’ Desk Reference, http://www.pdrhealth.com.

116 Tracey McVeigh, “Tranquilizers ‘more lethal than heroin,’” The Observer, 5 Nov. 2000.

117 Matt Clark, Mary Hager, “Valium Abuse: The Yellow Peril,” Newsweek, 24 Sept. 1979; Dr. Patrick Holford, “How to Quit

Tranquilizers,” www.patrickholdford.com, 2008.

118 Ibid.

119 Op. cit., Tracey McVeigh.

120 “Elderly On Long-Acting Anxiety, Insomnia Drugs Have More Car Crashes,” Doctor’s Guide citing Journal of American Medical

Association, 30 June 1997.

121 “Agression, Violence & Bezodiazapines,” Benzo.org.uk, citing British National Formulary, 2001.

122 Benzo.org.uk, citing Professor C. Heather Ashton, Benzodiazepines: How They Work and How To Withdraw, Feb. 2001.

123 “The Influence on the Pharmaceutical Industry,” House of Commons, UK, Health Committee, Vol. 1, Mar. 2005. p. 65.

124 Tarja-Brita R. Wahlin, et al., “Falls and fall risk among nursing home residents,” The Journal of Clinical Nursing, Vol. 17, pp. 126-

134, Jan. 2008.

125 “Europe-wide review recommends updates to product information for varenicline (brand name Champix),” MHRA, 14 Dec. 2008.

126 “Early Communication About an Ongoing Safety Review Varenicline (marketed as Chantix),” FDA, 20 Nov. 2007.

127 “Varenicline (marketed as Chantix) Information,” FDA Alert, 1 Feb. 2008.

128 Op. cit., House of Commons, UK, Health Committee, p. 65.

129 Anna Maria Dademan, “Flunitrazepam and violence—psychiatric and legal issues,” Department of Clinical Neuroscience,

Occupational Therapy and Elderly Care, Research Division of Forensic Psychiatry, Karolinska Institute, Sweden, 2000, p. 43.

130 “Zolpidem (‘Stilnox’) – Updated information – February 2008,” Theraputic Goods Administration, 21 Feb. 2008; “Club Drugs: An

Update,” Drug Intelligence Brief, Drug Enforcement Administration, Sept. 2001.

131 “FDA Safety Changes: Ambien, Primazin IM/IV, Hepsera,” Medscape, 28 Aug. 2008.

132 Peter Breggin, Toxic Psychiatry, (St. Martin’s Press, New York, 1991) p. 245.

133 Jerrold F. Rosenbaum, et al., “Emergence of Hostility During Alprazolam Treatment in Borderline Personality Disorder,” The

American Journal of Psychiatry, Vol. 141, No. 6 (June 1984), pp. 792-793.

134 David L. Gardner and Rex W. Cowdrey, “Alprazolam-Induced Dyscontrol in Borderline Personality Disorder,” The American

Journal of Psychiatry, Vol. 142, No. 1 (Jan. 1985), pp. 98-100.

135 “Xanax addiction extremely tough to kick,” MSNBC News Online, 2001.

136 Statement by Joseph A. Califano, Jr., Chairman and President, “Under the Counter: The Diversion and Abuse of Controlled

Prescription Drugs in the U.S.” The National Center on Addiction and Substance Abuse at Columbia University, July 2005.

137 Physicians’ Desk Reference, (Medical Economics Company, New Jersey, 1998), pp. 2822-2823; David L. Richman, M.D., Leonard

Roy Frank, and Art Mandler, Dr. Caligari’s Psychiatric Drugs (Alonzo Printing Co., Inc., California, 1984), p. 39.

138 Op. cit., David L. Richman, M.D., et al., pp. 38-39.

139 Ibid.

Source: http://www.cchrint.org/pdfs/The_Side_Effects_of_Common_Psychiatric_Drugs.pdf

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Suicide rates doubled for children of 5-14 years old over the past 20 years!   Research by James W. Prescott, Ph.D.

For youth age 15-24 suicide has been the third leading cause of death for well over a generation. Last year 15 million prescriptions were written for (SSRI) antidepressants for children and teenagers. Suicide rates have now DOUBLED for children of 5-14 years old in the past generation…

Suicide is the third highest cause of death among teenagers age 15-24. Suicide rates have doubled for children of 5-14 years old in the past generation. Last year 15 million prescriptions were written for (SSRI) antidepressants for children and teenagers.

Recently the (FDA) acknowledged an increased suicide risk associate with children taking (SSRI) antidepressants. The mental health of our children is worse off today than it was 50 years ago. But for years the National Institute of Health (NIH) has been following a biomedical model that seeks a drug to solve every problem. It’s clearly been a massive failure.

Dr. James W. Prescott, past Health Scientist Administrator of the Development Behavioral Biology Program of the National Institute of Child Health and Human Development (NIH) says “Clearly something is wrong in our culture when our children and teens are driven into suicide, despair, and [legal] drug addiction. The NIH and America are not asking the important question: “Where is all of this coming from and what can we do to prevent it?”

AMERICA’S LOST DREAM: Life, Liberty and the Pursuit of Happiness

By James W. Prescott, Ph.D.

(http://www.violence.de/prescott/appp/ald.pdf)

V. Depression and Suicide in Children and Youth of America

Depression and suicide are of epidemic proportions in America. Suicide has been the third leading cause of death in the youth age group of 15-24 years for the past generation (1979-1997) and is the fifth and sixth leading cause of death in the 5-14 year age group for the years 1979 and 1997, respectively. Tables 2 & 3 show that the suicide rates have doubled in the 5-14 year age group from 1979-1997. Table 4 gives the number of suicidal and homicidal deaths for the years 1979, 1994 and 1998 for the age groups of 1-4 years; 5-14 years and 15-24 years. The total number of suicidal deaths in these age groups for the years 1979, 1994 and 1998 are 5,398; 5,274 and 4,321, respectively. This represents an average of 4,999 suicide deaths per year for these years.

Given the average of 5,000 suicidal deaths per year, the estimated total number of suicidal deaths in these age groups from 1979-2000 is 105,000 children and youth who have committed suicide over this past generation. More children and youth (ages 5-24 years) have committed suicide in the past ten years than the total number of American combat lives lost in the ten year Vietnam War (est. 55,000 v 47,355), yet little or no public attention has been given to this reality and what it represents.

There are an estimated 60,828 suicides in the 25-44 year age group for the five years from 1994-1998 (12,166×5=60,828), an estimated total of 121,656 American lives lost to suicide for ten years in this age group that is more than double all the American lives lost in the ten year Vietnam War.

Table 5 gives the suicide rates as a percent of the homicide rates for these specific age groups and for the years 1979, 1994 and 1998. For the 5-14 year old age group, suicide rates, as a percent of homicide rates, have systematically increased from 1979 to 1998, as follows: 1979:36%; 1994: 60 %; 1998:73 %.

Suicidal death, relative to homicidal death, has dramatically increased for our children and youth in the 5- 14 year age group from 1979-1998. The question that remains unanswered is why do our children and youth prefer suicidal death to living in America, presumably the healthiest, wealthiest, and greatest nation of the world? Clearly, these dramatic increases in suicide rates over a single generation cannot be attributed to any changes in the human gene pool.

These statistics indicate that America is an unsafe nation to rear its children and this conclusion is also supported by the epidemic of depression that afflicts our children and youth, as evidenced by their massive psychiatric medication (Zito, et.al, 2000). Some 1.5 million prescriptions of the anti-depressant class of drugs called the serotonin re-uptake inhibitors (SRIs, e.g., Prozac) are given annually to children and youth and some 3 million prescriptions of Ritalin are prescribed annually. The problem of underestimating child/youth suicides in our society is as real as it is for child abuse homicides, previously cited (Herman-Giddens, et.al, 1999), where they found that child abuse homicides were underascertained by 62%. It is reasonable to project a similar or larger underestimation of suicidal deaths, given the higher societal and family shame and guilt that is associated with suicidal death, particularly of children and youth. Undoubtedly, many suicidal deaths are hidden in the accidental death statistics and are a greater problem than the current statistics indicate.

The pioneering study of Salk, et al (1985) found prenatal and perinatal stress factors in 81% of teen suicides that represented a 400% increased risk of suicide compared to the control subjects. The studies of the Jacobson group in Sweden also documented the role of perinatal trauma and obstetric medications on later adult behaviors of suicide, homicide and drug addictive behaviors, where increased risks for some of these behaviors was as high as 500% compared to control groups (Jacobson, et al, 1987,1988, 1990, 1998/ 2000). The study of Raine, et al (1994) found birth complications and maternal rejection predicting violent crime at 18 years of age, which adds additional evidence that prenatal/perinatal trauma contributes to adult behavioral disorders. The report of Levy (1945) that the trauma of circumcision can lead to homicidal and suicidal emotional states should not be neglected in the overall assessment of prenatal, perinatal and postnatal factors that contribute to child, teen and adult emotional-behavioral disorders.

VI. Psychiatric Medications of the Children and Youth of America.

Breggin (1994, 1995, 1998) has warned America about the effects of a Toxic Psychiatry upon the children and youth of America, which have gone unheeded. The psychiatric drugging of the children, youth and adults of America have become worse where there is little or no questions being asked by the psychiatric-political establishment as to why are all these psychiatric drugs are necessary. Breggin (2000) provides a framework for the prevention of the psychiatric drugging of the children and youth of America and a path to follow, if natural happiness is to become a reality, which is the true prevention of depression and violence.

Zito, et al (2000) have reviewed the prevalence of psychotropic medication use in children and youth; and in preschool-aged children from 1991-1995 from two state Medicaid programs and an HMO. They reported: The prevalence of psychotropic medication treatment for children and adolescents with emotional and behavioral disorders has significantly increased in the United States during the last few decades, particularly in the last 15 years. Specifically the 5 through 14-yearold age group has experienced a great increase in stimulant treatment for attention-deficit/hyperactivity disorder (ADHS), and the 15 through 19 -year- old age group has had sizable increases in the use of antidepressant medications (pp.1-2)… The rate of psychotropic medication prescribed for preschoolers in the MWM program increased substantially from 1991-1995. The increase was greatest for clonidine (28.2-fold), stimulants (3.0-fold), and antidepressants (2.2-fold). By contrast, neuroleptic use did not increase substantially during this time (p.4)… Methylphenidate (Ritalin) use according to age group in children and adolescents in the MWM program was most prominent for those aged 5-14 years… The largest methylphenidate increase (311%) was among 15 through19- year olds, whereas the 2 through 4- year-olds, like the 5-through 14 -year-olds, had a smaller but still substantial increase (169% to 176%) (pp.4-5)…

Several prominent trends characterized the use of psychotropic medications in preschoolers during the early to mid 1990s. Overall, there were large increases for all study medications (except the neuroleptics) and considerable variation according to gender, age, geographic region, and health care system. These findings are remarkable in light of the limited knowledge base that underlies psychotropic medication use in very young children. Controlled clinical studies to evaluate the efficacy and safety of psychotropic medications for preschoolers are rare. Efficacy data are essentially lacking for clonidine and the SSRIs and methylphenidate’s adverse effects for preschool children are more pronounced than for older youths. Consequently, the vast majority of psychotropic medications prescribed for preschoolers are being used offlabel. (P.5).

Recall that this 5-14 year age group showed a doubling of suicide rates over the past twenty years (supra).

Source: http://www.antidepressantsfacts.com/2004-09-22-suicide-rates-doubled-5-14.htm

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SSRI & SSNRI antidepressants induced side-effects (Iatrogenic Extrapyramidal Symptoms) are recognized to be similar to Neuroleptic (anti-psychotic) induced side-effects. These side-effects are known as Tardive Dyskinesia/Dystonia (severe body movement disorder, mostly permanent), Parkinsonism (a sign of future Parkinson’s disease) and Akathisia (a Neurological driven severe mania/agitation that can lead to suicidality, suicide attempts, self-harm & suicide). It is well documented in the medical literature that these neuroleptic induced side-effects refer to damage at dopaminergic neurons in the “motor system” of the

“Basal Ganglia”, a structure deep in the “Limbic System” of the brain. 1, 2, 3, 4, http://www.emedicine.com/EMERG/topic338.htm

Serotonin Syndrome

The Serotonin Syndrome is a potentially lethal condition caused by excessive serotonergic activity. It is a very dangerous and a potentially fatal side effect of the serotonergic enhancing drugs such as SSRI & SSNRI antidepressants and is diagnosed by the presence of at least 3 of 10 symptoms: mental status changes (confusion, hypomania), agitation, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, diarrhea, incoordination, and fever. This “hyperserotonergic” toxic condition requires heightened clinical awareness in order to prevent, recognize, and treat the condition promptly. Promptness is vital because, as we just mentioned, the serotonin syndrome can be fatal and death from this side effect can come very rapidly. The Serotonin syndrome is brought on by excessive levels of serotonin and is difficult to distinguish from the “Neuroleptic Malignant Syndrome” because the symptoms are so similar. The “Neuroleptic Malignant Syndrome” is a serious condition brought on by the use of neuroleptic drugs (anti-psychotics).

Source: Prozac: Panacea or Pandora? by Dr Ann Blake Tracy http://members.aol.com/atracyphd/syndrome.htm

Source: Journal of Clinical Psychiatry

Antidepressant induced neurological and/or physical toxicity (body and/or brain damage) either as a result of prolonged inhibition of P450-2D6 liver-enzymes, or as a result of impairing serotonin metabolism, can take on many forms as described below. A few examples are:   Hyperserotonemia, such as the lifethreatening condition the Serotonin Syndrome, Epileptiform Discharges, Epileptic Seizures and/or Epilepsy, Hypoglycaemia/Hyperglycemia (Low/Elevated Blood Sugar Imbalance), Stroke/Hemorrhagic Syndromes, Frontal Lobe Syndrome, Tardive Dyskinesia/Dystonia, Parkinsonism, Akathisia, Mania, etc…

Source: http://www.antidepressantsfacts.com/antidepressants-ADF.htm

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Lustral tablets contain the active ingredient sertraline hydrochloride, which is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). (NB. Sertraline tablets are also available without a brand name, ie as the generic medicine.)

Antidepressant medicines act on nerve cells in the brain. In the brain there are numerous different chemical compounds called neurotransmitters. These act as chemical messengers between the nerve cells. Serotonin is one such neurotransmitter and has various functions that we know of.

When serotonin is released from nerve cells in the brain it acts to lighten mood. When it is reabsorbed into the nerve cells, it no longer has an effect on mood. It is thought that when depression occurs, there may be a decreased amount of serotonin released from nerve cells in the brain.

SSRIs work by preventing serotonin from being reabsorbed back into the nerve cells in the brain. This helps prolong the mood lightening effect of any released serotonin. In this way, sertraline helps relieve depression.

Sertraline may also be used in the treatment of obsessive compulsive disorder and post-traumatic stress disorder. It is not fully understood how it works in these conditions.

It may take between two to four weeks for the benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn’t seem to make much difference at first. If you feel your depression has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.
What is it used for?
Depression in adults
A psychiatric disorder in which tasks are excessively repeated (obsessive-compulsive disorder) in adults and children aged six years and over
Post-traumatic stress disorder in adult women
Warning!
Depression and other pschiatric illnesses are associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least two to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts, or feelings about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.
This medicine may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won’t affect your performance.
It is recommended that you avoid drinking alcohol while taking this medicine.
SSRI antidepressants have been associated with the development of unpleasant or distressing restlessness and the need to move, often accompanied by an inability to sit or stand still. This is most likely to occur within the first few weeks of treatment. If you experience these symptoms you should consult your doctor.
Antidepressants may cause the amount of sodium in the blood to drop – a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine, so that your blood sodium level can be checked if necessary.
If you experience seizures (convulsions or fits) while taking this medicine, consult your doctor immediately, as you will need to stop treatment with this medicine. This also applies if you suffer from epilepsy and experience more seizures than normal after starting this medicine.
You should not suddenly stop taking this medicine, as this can cause withdrawal symptoms such as dizziness, sleep disturbances (including intense dreams), nausea, headache, a feeling of weakness, pins and needles and anxiety. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it is time to stop treatment with this medicine. On very rare occasions some people have experienced withdrawal symptoms after accidentally missing a dose of this medicine.
Following a review of the safety and efficacy of SSRIs to treat depression in children under 18 years of age (unlicensed use), the Committee on Safety of Medicines (CSM) has concluded that the risks of sertraline outweigh the benefits for treating depressive illness in this age group. If you are under 18 and taking sertraline for depression you should consult your doctor for advice, but do not suddenly stop taking it as this can cause withdrawal symptoms. Sertraline may be used for obsessive-compulsive disorder in children aged six years and over, but is not recommended for younger children.
Use with caution in
Elderly people
Young adults
History of suicidal behaviour or thoughts
History of mania or hypomania
People also receiving electroconvulsive therapy (ECT)
Decreased kidney function
Decreased liver function
Diabetes
Epilepsy
History of bleeding disorders
People taking medicine that affects blood clotting (eg anticoagulants such as warfarin)
Not to be used in
Children and adolescents under 18 years of age for the treatment of depressive illness
People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days
Manic episodes of manic depression (bipolar affective disorder)
Severely decreased liver function
Uncontrolled epilepsy
People taking the antipsychotic medicine pimozide

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
The safety of this medicine in pregnancy has not been established. It should therefore be used with caution during pregnancy, and only if the benefits to the mother outweigh any risks to the foetus. Seek medical advice from your doctor.
This medicine passes into breast milk, however the effect of this on the nursing infant is unknown. For this reason women who need to take this medicine should consider not breastfeeding. Seek medical advice from your doctor.
Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Disturbances of the gut such as nausea, vomiting, diarrhoea or abdominal pain
Indigestion (dyspepsia)
Loss of appetite
Shaking, usually of the hands (tremor)
Dizziness
Difficulty in sleeping (insomnia)
Sleepiness (somnolence)
Increased sweating
Dry mouth
Sexual problems
Headache
Anxiety and agitation
Pins and needles (paraesthesia)
Changes in blood pressure
Seizures
Loss of memory (amnesia)
Liver disorders

The side effects listed above may not include all of the side effects reported by the drug’s manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Sertraline should not be taken at the same time as monoamine oxidase inhibitor medicines (MAOIs). These include monoamine oxidase inhibitor antidepressants such as phenelzine, tranylcypromine and moclobemide, the antibiotic linezolid and the anti-Parkinson’s medicine selegiline. Sertraline should not be started until at least at least a day after stopping moclobemide or linezolid, and at least two weeks after stopping other monoamine oxidase inhibitors. Similarly, treatment with any MAOIs should not be started until at least two weeks after stopping treatment with sertraline.

Sertraline must not be taken with the antipsychotic medicine pimozide.

Sertraline should not be taken in combination with benzodiazepines or other tranquilisers by people who need to drive or operate machinary.

There may be an increased risk of side effects if sertraline is taken with the following medicines, which also enhance the activity of serotonin in the brain:
lithium
triptans for migraine, eg sumatriptan
tramadol
tryptophan.

The herbal remedy St John’s wort should not be taken with sertraline for the same reason.

Sertraline may increase the blood levels of the following medicines:
clozapine
some tricyclic antidepressants (imipramine, desipramine, nortriptyline and possibly amitriptyline).

Sertraline may increase the effect of anti-blood-clotting medicines (anticoagulants) such as warfarin, and this may increase the risk of bleeding. If you are taking an anticoagulant with this medicine, your blood clotting time should be regularly monitored.

As SSRIs have been associated with bleeding abnormalities, the following medicines, which are known to affect the ability of the blood to clot, should be used with caution with sertraline:
tricyclic antidepressants
some antipsychotic medicines
some antisickness medicines, eg prochlorperazine
aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
ticlopidine
dipyridamole.

Treatment with this medicine may alter control of blood sugar in people with diabetes, who may need an adjustment in their dose of insulin or antidiabetic tablets. People with diabetes should discuss this with their doctor.

Sertraline blood levels may be increased by cimetidine and this may increase the risk of sertraline side effects.
Other medicines containing the same active ingredient

Sertraline tablets are available without a brand name, ie as the generic medicine.

Source: http://www.netdoctor.co.uk/medicines/100001555.html

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Zoloft is well tolerated and effective for the treatment of depression and certain anxiety conditions.

Zoloft is FDA approved to treat depression, certain types of social anxiety conditions, posttraumatic stress disorder (PTSD), panic disorder, obsessive-compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD) in adults over age 18. It is also approved for OCD in children and adolescents age 6-17 years.

For more than 15 years, Zoloft has safely and effectively treated millions of people with depression and certain anxiety conditions. Zoloft is available in multiple strengths, so your doctor can decide a dose for you.

Zoloft® (sertraline HCl) is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). It’s approved to treat depression, social anxiety disorder, posttraumatic stress disorder (PTSD), panic disorder, obsessive-compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD) in adults over age 18. It is also approved for OCD in children and adolescents age 6-17 years.

Important Safety Information

Depression is a serious medical condition, which can lead to suicidal thoughts and behavior. Children, adolescents, and young adults taking antidepressants may be at increased risk for suicidal thoughts and behavior within the first few months of treatment. This risk must be balanced with the medical need. Those starting medication or changing doses should be watched closely for suicidal thoughts, worsening of depression, or unusual changes in mood or behavior. In children and teens, Zoloft is only approved for use in those with obsessive-compulsive disorder. A patient Medication Guide about “Antidepressant Medicines, Depression and Other Serious Mental Illnesses, and Suicidal Thoughts or Actions” is available.
Zoloft is not for everyone. People taking MAOIs or pimozide shouldn’t take Zoloft. Concomitant use of Zoloft with NSAIDs or aspirin may be associated with an increased risk of bleeding. Side effects may include dry mouth, insomnia, sexual side effects, diarrhea, nausea and sleepiness. In studies, few people were bothered enough by side effects to stop taking Zoloft. Side effects may result from stopping Zoloft particularly when abrupt. You should, however, stop taking Zoloft if you get any of the following symptoms of Serotonin Syndrome, a rare but life-threatening reaction, such as fever, sweating, muscle stiffness, trouble thinking clearly, a change in mental functioning, sleepiness, or change in your breathing, heartbeat and blood pressure.
You should tell your doctor if you are pregnant or plan to become pregnant, as there is a potential risk to the fetus with Zoloft. Like many antidepressants, Zoloft can be present in breast milk so tell your doctor if you are nursing.
Zoloft is approved to treat depression, social anxiety disorder, posttraumatic stress disorder (PTSD), panic disorder, obsessive-compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD) in adults over age 18. It is also approved for OCD in children and adolescents age 6-17 years.
Zoloft is not habit-forming and is not associated with weight gain. So talk to your doctor about how Zoloft might help you. Zoloft comes in 25-mg, 50-mg, and 100-mg tablets. You and your doctor can discuss a dose for you.
Source: http://www.zoloft.com

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Indication

Cymbalta is indicated for the treatment of major depressive disorder (MDD). The efficacy of Cymbalta was established in four short-term and one maintenance trial in adults.

Cymbalta is indicated for the treatment of generalized anxiety disorder (GAD). The efficacy of Cymbalta was established in three short-term and one maintenance trial in adults.

Cymbalta is indicated for the management of diabetic peripheral neuropathic pain and fibromyalgia.
Important Safety Information About Cymbalta

Antidepressants can increase suicidal thoughts and behaviors in children, teens, and young adults. Suicide is a known risk of depression and some other psychiatric disorders. Call your doctor right away if you have new or worsening depression symptoms, unusual changes in behavior, or thoughts of suicide. Be especially observant within the first few months of treatment or after a change in dose. Approved only for adults 18 and over.
What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.
Who should NOT take Cymbalta?

You should not take Cymbalta if:
You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (increased eye pressure)
You are taking Mellaril® (thioridazine)

What other important information should I discuss with my healthcare provider?

Before starting Cymbalta, talk with your healthcare provider:
about all of your medical conditions, including kidney or liver problems, glaucoma, diabetes, seizures, or if you have bipolar disorder. Cymbalta may worsen a type of glaucoma or the control of blood sugar in some patients with diabetes about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life-threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, talk with your healthcare provider:
if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose
about your blood pressure. Cymbalta can increase your blood pressure. Your healthcare provider should check your blood pressure prior to and while taking Cymbalta
if you experience headache, weakness, confusion, problems concentrating, memory problems, or feel unsteady while taking Cymbalta which may be signs of low sodium levels
if you develop problems with urine flow

If you have any questions, talk to your healthcare provider before taking Cymbalta.
What are the possible side effects of Cymbalta?

The most common side effect of Cymbalta was nausea. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.
Other safety information about Cymbalta:

Cymbalta may cause sleepiness and dizziness. Until you know how Cymbalta affects you, you should not drive a car or operate hazardous machinery.

Important Safety Information About Cymbalta

Antidepressants can increase suicidal thoughts and behaviors in children, teens, and young adults. Suicide is a known risk of depression and some other psychiatric disorders. Call your doctor right away if you have new or worsening depression symptoms, unusual changes in behavior, or thoughts of suicide. Be especially observant within the first few months of treatment or after a change in dose. Approved only for adults 18 and over.
What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.
Who should NOT take Cymbalta?

You should not take Cymbalta if:
You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (increased eye pressure)
You are taking Mellaril® (thioridazine)
What other important information should I discuss with my healthcare provider?

Before starting Cymbalta, talk with your healthcare provider:
about all of your medical conditions, including kidney or liver problems, glaucoma, diabetes, seizures, or if you have bipolar disorder. Cymbalta may worsen a type of glaucoma or the control of blood sugar in some patients with diabetes
about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life-threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, talk with your healthcare provider:
if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose
about your blood pressure. Cymbalta can increase your blood pressure. Your healthcare provider should check your blood pressure prior to and while taking Cymbalta
if you experience headache, weakness, confusion, problems concentrating, memory problems, or feel unsteady while taking Cymbalta which may be signs of low sodium levels
if you develop problems with urine flow

If you have any questions, talk to your healthcare provider before taking Cymbalta.
What are the possible side effects of Cymbalta?

The most common side effect of Cymbalta was nausea. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.
Other safety information about Cymbalta:

Cymbalta may cause sleepiness and dizziness. Until you know how Cymbalta affects you, you should not drive a car or operate hazardous machinery.
Source: http://www.cymbalta.com

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Below are some common drug slang terms or drug street names:

STREET NAMES AND SLANG FOR HALLUCINOGENS
Marijuana
Pot, Reefer, Grass, Weed, Dope, Ganja, Mary Jane, or Sinsemilla, Urb,
Hashish
Hash
Mescaline and Peyote
Mesc, Buttons, and Cactus
Psilocybin (Shrooms)
Magic Mushrooms, ‘shrooms
Lysergic acid diethylamide
Acid, Microdot, White lightning, Blue heaven, and Sugar Cubes
Analog of Amphetamines or Methamphetamines
MDMA (Ecstasy, XTC, Adam, Essence), MDM, STP, PMA, 2, 5-DMA, TMA, DOM, DOB, EVE
Phencyclidine
PCP, Hog, Angel Dust, Loveboat, Lovely
Analog of Phencyclidine (PCP)
PCPy, PCE

STREET NAMES AND SLANG FOR DEPRESSANTS
Nitrous Oxide
Laughing gas or Whippets
Amyl Nitrite
Poppers or Snappers
Butyl Nitrite
Rush, Bolt, Bullet, Locker Room, and Climax
Chloro-hydrocarbons
Aerosol sprays or cleaning fluids
Hydrocarbons
Solvents
Barbiturates
Downers, Barbs, Blue Devils, Red Devils, Yellow Jackets,
Yellows, Nembutal, Tuinals, Seconal, and Amytal
Methaqualone
Quaaludes, Ludes, Sopors
Tranquilizers
Valium, Librium, Serax, Equanil, Miltown, and Tranxene

STREET NAMES AND SLANG FOR STIMULANTS
Cocaine
Coke, Snow, Nose Candy, Flake, Blow, Big C, Lady, White, and Snowbirds, Powder,
Crack Cocaine
Crack, rock, freebase, Cookie,
Amphetamines
Speed, Uppers, Ups, Black beauties, Pep pills, Co-pilots, Bumblebees, Hearts, Benzedrine, Dexedrine, Footballs, and Biphetamine
Methamphetamines
Crank, Crystal meth, Crystal methadrine, and Speed
Additional Stimulants
Ritalin, Cylert, Preludin, Didrex, Pre-State, Voranil, Sandrex, and Plegine

STREET NAMES AND SLANG FOR NARCOTICS
Heroin
Smack, Horse, Mud, Brown sugar, Junk, Black tar, and Big H
Morphine
Pectoral syrup
Opium
Paregoric, Dover’s Powder, Parepectolin
Codeine
Empirin compound with codeine, Tylenol with codeine,
Codeine in cough medicine
Meperidine
Pethidine, Demerol, Mepergan
Analog of Fentanyl (Narcotic)
Synthetic heroin, China white
Analog of Meperidine (Narcotic)
MPTP (New heroin), MPPP, synthetic heroin

Source: http://www.njlawman.com/Feature%20Pieces/Drug%20Slang.htm

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By Shankar Vedantam
Washington Post Staff Writer
Saturday, October 8, 2005; A01

washingtonpost.com

Source: j.b5z.net/i/u/2043019/i/washingtonpost.doc

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By LAURA BLUE/LONDON Tuesday, Feb. 26, 2008
Source: http://www.time.com/time/health/article/0,8599,1717306,00.html?iid=sphere-inline-bottom

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Overview
Paxil is the brand name for Paroxetine, a phenylpiperidine derivative. Paxil is an SSRI – Selective Serotonin Reuptake Inhibitor, which is a type of antidepressant. SSRIs work by increasing levels of serotonin (a neurotransmitter) to normal.

Paxil’s effects can usually be felt within one to four weeks.

Why is this drug prescribed?
Paxil is used primarily to treat Obsessive-Compulsive Disorder (OCD.)

Paxil is also used to treat:
depression
panic disorder / panic attacks
diabetic nerve pain (neuropathy)
chronic tension headaches
social anxiety disorder (social phobia)
premature ejaculation
premenstrual syndrome (PMS)

Warnings
The safety and effectiveness of Paxil in children under 18 years old have not been established.

Paxil is not addictive. Suddenly discontinuing Paxil may lead to withdrawal symptoms such as confusion, dizziness, sweating, or tremors. Dosage should be gradually tapered when Paxil is discontinued.

Paxil does not usually cause sedation, but patients should not drive or operate heavy machinery until it is known that Paxil does not affect the ability to safely engage in these activities.

For Pregnant or Nursing Mothers: One study showed no adverse effects due to Paxil during pregnancy, but further study is required and pregnant women are not advised to take Paxil. Paxil passes into human breast milk, and nursing mothers should not take Paxil.

Contraindications
Paxil should Not be used for people with an allergy or hypersensitivity to this drug or any SSRI.

Precautions
Paxil may be used with caution in people with the following conditions:
liver or kidney disease – lower dosage may be needed
seizures (epilepsy or convulsions) – risk of seizures is increased
a history of mania – Paxil may activate mania
elderly – lower dosage may be needed
brain disease or damage
mental retardation

Adverse Reactions
Paxil may cause the following reactions:
lowered blood pressure and fainting upon standing (postural hypotension)
sweating
dry mouth
nausea
headache
drowsiness
sedation
nervousness
insomnia
constipation
weakness
loss of appetite
taste disorders
tingling in hands
upset stomach
dizziness
blurred vision
itching
chills
abnormal ejaculation
impotence
sexual dysfunction
diarrhea
hypomania
seizures

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Paxil are:
MAO Inhibitors (within 14 days) – serious or even fatal interactions can occur when taken with Paxil
benzodiazepines, desipramine, Haldol (haloperidol), and Normodyne (labetalol) – Paxil may increase the effects of these drugs
Dilantin (phenytoin) – can decrease blood levels of Paxil and reduce its effects
Quinaglute (quinidine) and Tagamet(cimetidine) – can increase Paxil levels and lead to drug toxicity
Astemizole (Hismanal) – can lead to a serious change in heart rhythm when taken with Paxil
Ultram (tramadol) – can increase the risk of seizures when taken with Paxil
Tryptophan – can increase side effects such as sweating, nausea, and dizziness when taken with Paxil
Coumadin (warfarin) – can cause bleeding when taken with Paxil
Moclobemide (Manerex) within 3 to 7 days
Buspirone (BuSpar), Bromocriptine (Parlodel), Dextromethorphan (cough medicine), Levodopa (Sinemet), Lithium, Meperidine (Demerol), Nefazodone (Serzone), Pentazocine (Talwin), other SSRIs (such as: Citalopram [Celexa], fluoxetine [Prozac], fluvoxamine [Luvox], sertraline [Zoloft]), LSD, MDMA (ecstasy), marijuana, Sumatriptan (Imitrex), Tramadol (Ultram), Trazodone (Desyrel), Tryptophan, Venlafaxine (Effexor) – taking these medicines with Paxil can increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome, whose symptoms include confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching.

Source: http://whatmeds.stanford.edu/medications/paroxetine.html

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Antidepressant drugs are medicines that relieve symptoms of depressive disorders.

Purpose

Depressive disorders may either be unipolar (depression alone) or bipolar (depression alternating with periods of extreme excitation). The formal diagnosis requires a cluster of symptoms, lasting at least two weeks.

These symptoms include, but are not limited to, mood changes, insomnia or hypersomnia, and diminished interest in daily activities.

The symptoms are not caused by any medical condition, drug side effect, or adverse life event. The condition is severe enough to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Secondary depression, or depression caused by unfavorable life events, is normally self limiting, and may best be treated with cognitive/behavioral therapy rather than drugs.

Description

Antidepressant agents act by increasing the levels of excitatory neurostransmitters, or nerve cell chemicals that act as messengers in the brain’s nervous system. In 2003, a report showed that in addition to treating depression, use of antidepressant drugs may protect the brain from damage depressive episodes cause to the hippocampus, the area of the brain involved in learning and memory. Antidepressant drugs may be prescribed as a first-line treatment for depression, or in conjunction with other methods of controlling depression, such as behavioral therapy and exercise.

The main types of antidepressant drugs in use today are listed below, though the drugs available change frequently. For example, in mid-2003, the manufacturer of Wellbutrin released Wellbutrin XL, the only once-daily norepinephrine and dopamine reuptake inhibitor for treating depression in adults.

tricyclic antidepressants, such as amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor)

selective serotonin reuptake inhibitors (SSRIs or serotonin boosters), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)

monoamine oxidase inhibitors (MAO inhibitors), such as phenelzine (Nardil), and tranylcypromine (Parnate)

tetracyclic compounds and atypical antidepressants which do not fall into any of the above categories

Selective serotonin reuptake inhibitors maintain levels of the excitatory neurohormone serotonin in the brain. They do not alter levels of norepinephrine. These have become the drugs of choice for a variety of psychiatric disorders, primarily because of their low incidence of severe side effects as compared with other drugs in this therapeutic class. SSRIs show similar actions and side effect profiles, but may vary in duration of action.

Tricyclic compounds, identified by their chemical structure containing three carbon rings, are an older class of antidepressants. Although generally effective, they have a high incidence of anticholinergic effects, notably dry mouth and dry eyes, which can cause discomfort. They also cause cardiac arrythmias. Because tricyclics act on both serotonin and norepinephrine, they may have some value in treatment of patients who fail to respond to SSRIs. Drugs in this class often are available at low prices, which may be significant when cost is a major factor in treatment. They also have been found useful in control of some neurologic pain syndromes.

Tricyclic antidepressants are similar, but may vary in severity of side effects, most notably the degree of sedation and the extent of the anticholinergic effects.

Tetracyclic compounds and atypical antidepressants are chemically distinct from both the major groups and each other. Although maprotilene (no brand name, marketed in generic form only) and mirtazepine (Remeron) are similar in chemical structures, they differ in their balance of activity on serotonine and norepinephrine levels.

Monoamine oxidase inhibitors (phenelzine [Nardil], tranylcypromine [Parnate]) have largely been supplanted in therapy because of their high risk of severe adverse effects, most notably severe hypertension. They act by inhibiting the enzyme monoamine oxidase, which is responsible for the metabolism of the stimulatory neurohormones norepinephrine, epinephrine, dopamine, and serotonin. The MAOIs are normally reserved for patients who are resistant to safer drugs. Two drugs, eldepryl (Carbex, used in treatment of Parkinson’s disease) and the herb, St. John’s wort, have some action against monoamine oxidase B, and have shown some value as anti-depressants. They do not share the same risks as the non-selective MAO inhibitors.

All antidepressant agents, regardless of their structure, have a slow onset of action, typically three to five weeks. Although adverse effects may be seen as early as the first dose, significant therapeutic improvement is always delayed. Similarly, the effects of antidepressants will continue for a similar length of time after the drugs have been discontinued.

Recommended dosage

Dose varies with the specific drug and patient. Specialized references or a physician should be consulted.

Precautions

Antidepressants have many significant cautions and adverse effects. Although a few are listed here, specific references should be consulted for more complete information.

SSRIs. The most common side effect of SSRIs is excitation and insomnia. Excitation has been reported in over 20% of patients, and insomnia in 33%. Significant weight loss has been frequently reported, but most commonly in patients who are already underweight. A 2003 report showed that SSRIs also increase the risk of upper gastrointestinal tract bleeding. SSRIs may cause some sedation, and patients should be cautioned not to perform tasks requiring alertness until they have evaluated the effects of these drugs. SSRIs are pregnancy category C drugs. In 2003, a new report demonstrated that late-term (third trimester) use of these drugs could cause neurological symptoms in newborns, including tremor, restlessness and rigidity. Most SSRIs are excreted in breast milk, and there have been anecdotal reports of drowsiness in infants whose mothers were taking SSRIs while breastfeeding.

Most notably, a joint panel of the U.S. Food and Drug Administration (FDA) issued strong warnings to parents and physicians in 2004 about the risk of suicidal behavior in children and adolescents taking SSRIs.

Tricyclic antidepressants. Amoxepine (not marketed by brand, generic available), although a tricyclic antidepressant rather than a neuroleptic (major tranquilizer), displays some of the more serious effects of the neuroleptics, including tardive dyskinesias (drug induced involuntary movements) and neuroleptic malignant syndrome, a potentially fatal syndrome with symptoms including high fever, altered mental status, irregular pulse or blood pressure, and changes in heart rate. These adverse effects have not been reported with other tricyclic antidepressants.

The most common adverse effects of tricyclic antidepressants are sedation and the anticholinergic effects, such as dry mouth, dry eyes, and difficult urination. Alterations in heartbeat also are common, and may progress to congestive heart failure, stroke, and sudden death.

Tricyclic antidepressants are in pregnancy categories C or D, although there have been no formal studies of the drugs on fetal development. There are no studies of effects on newborns, but some anecdotal reports of malformations have resulted from animal studies. The drugs are excreted in breast milk.

Monoamine oxidase inhibitors. The greatest risk associated with these drugs is a hypertensive crisis which may be fatal and most often occurs when the drugs are taken with interacting foods or drugs. More common adverse reactions may include low blood pressure and slowing of heartbeat. Sedation and gastrointestinal disturbances also are common. MAOIs are in pregnancy category C. Safety in breast feeding has not been established.

Tetracyclics and atypicals. Because these drugs are individual, there are no group patterns of adverse reactions. Specific references should be consulted.

Interactions

The antidepressants have many drug interactions, some severe. Although a few are listed here, specific references should be consulted for more complete information.

SSRIs should not be administered with MAOIs. A wash-out period of about four weeks should be allowed before switching from one class of drugs to the other, five weeks if switching from fluoxetine (Prozac) to an MAOI.

MAOIs have many interactions, however the best known are those with foods containing the amino acid tyramine. These include aged cheese, chianti wine, and many others. Patients and providers should review the MAOI diet restrictions before using or prescribing these drugs. Because of the severity of MAOI interactions, all additions to the patient’s drug regimen should be reviewed with care.

Tricyclic compounds have many interactions, and specialized references should be consulted. Specifically, it is best to avoid other drugs with anticholinergic effects. Tricyclics should not be taken with the antibiotics grepafloxacin and sprafloxacin, since the combination may cause serious heart arrythmias.

Tricyclic compounds should not be taken with the gastric acid inhibitor cimetidine (Tagamet), since this increases the blood levels of the tricyclic compound. Other acid inhibiting drugs do not share this interaction.

SSRIs interact with a number of other drugs that act on the central nervous system. Care should be used in combining these drugs with major or minor tranquilizers, or with anti-epileptic agents such as phenytoin (Dilantin) or carbamazepine (Tegretol). In 2003, one of the biggest concerns regarding new prescriptions for tricyclic antidepressants was data concerning overdoses from these drugs. Information in Great Britain showed that this class of antidepressants was responsible for more than 90% of all deaths from antidepressant overdose. Physicians were being advised to prescribe SSRIs in new patients, but not to change the course of those who had taken tricyclics for years with success.

Key Terms

Cognitive behavioral therapy
A type of psychotherapy in which people learn to recognize and change negative and self-defeating patterns of thinking and behavior.

Depression
A mental condition in which people feel extremely sad and lose interest in life. People with depression also may have sleep problems and loss of appetite and may have trouble concentrating and carrying out everyday activities.

Pregnancy category
A system of classifying drugs according to their established risks for use during pregnancy. Category A: Controlled human studies have demonstrated no fetal risk. Category B: Animal studies indicate no fetal risk, but no human studies; or adverse effects in animals, but not in well-controlled human studies. Category C: No adequate human or animal studies; or adverse fetal effects in animal studies, but no available human data. Category D: Evidence of fetal risk, but benefits outweigh risks. Category X: Evidence of fetal risk. Risks outweigh any benefits.

For Your Information

Resources

Periodicals

“Antidepressant Drugs May Protect Brain from Damage.” Mental Health Weekly Digest (August 18, 2003): 2.

“FDA Approves Once-daily Supplement.” Biotech Week (September 24, 2003): 6.

“FDA Panel Urges Stronger Warnings of Child Suicide.” SCRIP World Pharmaceutical News (February 6, 2004): 24.

“GPs Told Not to Prescribe Tricyclics.” Pulse (October 13, 2003): 1.

“Late-term Exposure to SSRIs May Cause Neurological Symptoms in Babies.” Drug Week (August 8, 2003): 255.

“SSRIs Increase the Risk of Upper GI Bleeding.” Psychiatric Times (July 1, 2003): 75.

Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group The Essay Author is Samuel D. Uretsky, PharmD.
Source: http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/antidepressant_drugs.jsp

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