Archive for Antidepressants

How a Touch of Prozac Could End the Hell of PMT

// November 20th, 2010 // No Comments » // Antidepressants

TINY amounts of Prozac could end the monthly misery of PMT for millions of women – and their partners, scientists believe.

In studies, the ‘happy pills’ banished the mood swings, bloating, lethargy and pain that blights the lives of up to three quarters of women in the run-up to their period.

The doses given were around a tenth of that used to treat depression and so should be free of the side-effects that have dogged the drug’s use in psychiatry.

Preliminary experiments on rats have had ‘dramatic’ results and researchers believe low-dose Prozac could be routinely used to prevent PMT – pre-menstrual tension – within two years.

Neuroscientist Thelma Lovick, from the University of Birmingham, said: ‘A lot of women experience PMT and a lot of men are on the receiving end. I can’t say we are going to cure everyone but when taken in conjunction with sensible lifestyle changes we are in with a chance.’ Dr Lovick pinned the symptoms on the sharp fall of progesterone that occurs the week before a women menstruates. Normally, a waste product of progesterone called allopregnanolone, or allo, helps keep a lid on brain circuits involved in controlling emotions.

When progesterone levels fall, amounts of allo also fall, and emotions run riot. Prozac is known to raise allo levels, so Dr Lovick decided to see if it would ease the condition in rats.

Very small doses completely prevented the anxiety and increased sensitivity to pain the creatures normally experience.

Dr Lovick told the British Science Festival: ‘It completely blocked the symptoms – we are amazed.

‘The time is right for a controlled clinical trial in women. The solution for PMT could be as simple as taking a pill for a few days towards the end of your menstrual cycle.’ It is likely women would take a pill at the first signs of PMT and one a day for the following week.

Used alongside lifestyle changes such as controlling stress and cutting out sugary foods, it could have a major impact on millions.

Regular strength Prozac lifts depression by raising levels of ‘feel good’ brain chemical serotonin but can cause problems from loss of libido to suicidal thoughts and selfharm.

Dr Lovick said that using around a tenth of those used to treat depression should not trigger any side-effects.

This is because although very small doses raise levels of allo, they do not have any effect on serotonin.

A daily dose of regular-strength Prozac is already sometimes prescribed to ease PMT, but Dr Lovick believes the way forward is a very small dose taken for a week a month.

Professor Tim Kendall, consultant psychiatrist, said that the idea warranted more research. But he warned that self-medicating with Prozac could be disastrous.

He said: ‘It can make you anxious and wound-up and affect appetite. I don’t know if these side-effects would occur at low doses but it would strike me as unwise to start tipping drugs out of capsules.’

THE TROUBLED ‘QUICK FIX’

ONCE hailed as a miracle cure for depression, Prozac and similar drugs are prescribed to millions around the globe.

Known as selective serotonin reuptake inhibitors, the ‘happy pills’, which include Seroxat and Efexor, keep mood-boosting serotonin in the brain for longer. When introduced in the late 80s, they were seen as safer than previous anti-depressants. But their use has since been linked to suicidal thoughts and self-harm.

This led to advice that patients with mild depression should instead be offered counseling.

It is claimed that many GPs give out tablets rather than condemn patients to a long wait for counseling.

Some GPs say they are pressurised by patients anxious for a ‘quick fix’ to their problems.

SHOULD CHILDREN BE GIVEN PROZAC

// November 4th, 2010 // No Comments » // Antidepressants, Depression

It Can Stunt Growth, Damage Young Brains and Even Trigger Suicide. Yet Now This Most Controversial Antidepressant Is about to Be Prescribed to Youngsters of Just Eight . . .

prozac and children

prozac and children

JAMES was ten when he was first put on the antidepressant Prozac. His mother was an invalid, and after his father left home, the pressure of caring for his mother had become overwhelming.

Sometimes James would sit and stare into the middle-distance, not responding to anything; other times he’d lock himself in his room. He cried a lot.

Increasingly, he refused to go out because he was being bullied at school.

‘He started showing signs of depression,’ says Jude Sellen, a children and adolescent mental health consultant at the charity Young Minds, who was involved with his case.

‘His situation was very difficult and he badly needed psychological help.’

But there was an 18-month wait for therapy, so what he got instead was long-term treatment with an antidepressant.

Two years later he is still on Prozac – even though it causes him stomach problems, including diarrhoea and painful cramps, and makes him feel ‘funny’.

He also suffers from painful headaches.

He wants to stop taking the medication, but when he does, he becomes violent – a potential-side-effect of withdrawal from drugs such as Prozac – and his mother insists that he goes back on the pills.

James is now being seen by a psychologist and his medication is being reduced. But as Sellen points out, his case shows ‘how important it is to monitor patients on the drug carefully – and only use it short-term’.

The tragedy is that stories such as James’s could become increasingly common. Last week, in a controversial move, the European Medicines Agency announced that depressed children as young as eight could be given Prozac.

This is one of a class of drugs known as selective serotonin reuptake inhibitor, or SSRIs – and in America, children as young as three are already being prescribed them.

These drugs have already been linked with a raised risk of suicide and patients becoming dependent on them. But some experts are now concerned about giving these drugs to younger children because almost nothing is known about how these drugs might affect their growing brains.

‘This is ignorance in the broadest sense of the term,’ said Dr Glen R.

Elliott, a child psychiatrist at the University of California at San Francisco. ‘We don’t know if this is a good idea or not.’ The drugs might also stunt growth.

One trial, reported two years ago, found that children given Prozac between the ages of eight and 17 were, on average, 1cm shorter and 1.1kg lighter than those on a placebo.

In fact, we don’t really know exactly how SSRIs work to treat depression in adults or children – we believe they increase the amount of the ‘ feelgood’ chemical serotonin in the brain, but evidence for this theory is surprisingly thin on the ground.

The latest research suggests that they work by encouraging the growth of new brain cells. But whether this is good for a young brain that is already growing fast is also unknown.

What is known is that childhood depression is a growing problem in the UK.

About 1 per cent of children aged five to 11 and 3 per cent of adolescents aged 11 to 18 are thought to suffer from depression in any one year – with 80,000 five to 16-yearolds suffering from serious depression.

Some experts believe that the increase is partly to do with children’s high expectations – they expect life to be rosier than it is.

Others suggest that children are being exposed to increasingly stressful and emotional experiences, such as sex.

Whatever the cause, the difficulty for parents is knowing if their child is depressed or just feeling a bit down.

And giving medication to children who are not seriously depressed is a cause for concern.

The new guidelines from the European Medicines Agency recommend that the first line of treatment for moderate to severe depression should be psychological therapy.

Only after four to six sessions can fluoxetine – the name of the chemical in Prozac – be prescribed, and even then it should be combined with therapy.

HOWEVER, there is a drastic shortage of therapists as the case of James shows. He has been on Prozac for two years without having any counselling.

Provision of psychological services across Britain is notoriously patchy.

A recent report estimated that 10,000 more therapists were needed to provide effective treatment for depression in all age groups. As a result, the problem of medication without counselling is increasing.

David Cottrell, Professor of Child and Adolescent Psychiatry at the University of Leeds, says: ‘Far more prescriptions are written for children than there ought to be, and many GPs are not so good at monitoring the effects.’ But there is a more deep-rooted problem.

In 2003, the Medicines and Health Products Regulatory Authority advised that most SSRIs were not suitable for children, and that only fluoxetine should be given to them.

However, research by the Mail has found that doctors are still prescribing the other SSRIs.

In other words, while we worry about children being given Prozac, many of them might be receiving other antidepressants that the health authorities have said are not suitable for children.

In a written response to a Parliamentary question by Liberal Democrat MP Paul Burstow, the Department of Health revealed that four SSRIs which the drug regulator has said should not be used are still being widely prescribed.

One of these is Venlafaxine (Effexor), which, not only is unlikely to produce any ‘clinically important improvement’ but, astonishingly, has a rate of ‘suicide-related events’ 14 times greater than a placebo, according to a major review published in The Lancet in 2004.

THIS study looked at all the evidence for the safety and effectiveness of the five SSRIs most commonly used to treat children. And its conclusion about one of them, Citalopram (Cipramil, Celexa), was equally worrying: ‘It is unlikely to produce a clinically important reduction in depressive symptoms’ and doubles the risk of suicide.

One of the authors of this study was Professor Cottrell, who at the time explained that the review was unusually reliable because it combined published with unpublished trials. The conclusion of The Lancet review was that only Prozac was suitable, while the others – including Paroxetine (Seroxat) and Sertraline (Zoloft) should be avoided.

The intention of the trial was to provide information to guide doctors.

But, clearly, GPs did not heed the alarm bells – for as the Parliamentary figures reveal, only around 30 per cent of antidepressant prescriptions written for children under 18 in 2004 were for Prozac.

Another 35 per cent were for one or other of the four ‘banned’ drugs (the cost to the NHS for Prozac was [pounds sterling]407,107, and for the other SSRIs, [pounds sterling]1.6 million). The remainder of the prescriptions were for other forms of antidepressants.

‘Doctors do seem to be flouting the guidelines,’ says Professor Cottrell.

‘Doctors are allowed to prescribe drugs that don’t have a licence for that use, and while there will be a small number of cases where these drugs could be relevant – such as anxiety or obsessive compulsive behaviour a large percentage of these prescriptions should not have been written.’ Dr Jim Kennedy, prescribing spokesman for the Royal College of General Practitioners, questions whether doctors are prescribing medication without therapy.

‘But these figures do raise the question: are there any hotspots where more are being prescribed than should be?’ he says.

‘I think we should be looking in detail at how doctors are prescribing, and if we find a problem, we should re-educate GPs in those areas.’ The Department of Health, while noting the guidelines state that antidepressants should ‘be used rarely in the five to 11 age group’, says that ‘it is for clinicians to decide which of these drugs, if any, to prescribe to their patients.

‘It is important to note that some drugs which may be classified as antidepressants are used for other disorders such as nocturnal enuresis [bedwetting], anxiety, obsessive compulsive disorder and phobic states.’ Most clinicians agree that when faced with the pain of a child who is severely depressed, the benefits associated with antidepressants outweigh the risks.

‘Most experts recognise that psychological support is very important and should be tried first, but there are cases where a drug can help,’ says Professor Cottrell.

However, he adds: ‘Prozac has been the only drug recommended for children here since 2003.’ Meanwhile, if children like James are ever to have a real chance in life, much more attention must be paid to providing the kind of psychological support that everyone agrees is needed, and there should be a serious attempt to stop prescribing drugs that are known to be ineffective and dangerous.

The natural alternatives

PARENTS concerned about the use of SSRIs such as Prozac, the natural question is whether there is an effective alternative for children with mild depression.

There is some evidence that the herb St John’s Wort, available over the counter, can be effective in adults. One study suggested it might help children.

However, it can interfere with other drugs, including medications for asthma, epilepsy and migraine, and should not be taken without first consulting a doctor.

In a book published last year, the French neuroscientist Dr David Servan Schreiber claimed the quickest way to deal with depression was via the body.

In Healing Without Freud Or Prozac, he outlined a number of physical approaches for dealing with depression. Some are relatively familiar, such as nutrition and exercise, others more exotic such as ‘circadian therapy’ and ‘EMDR’ (but all, he claims, with evidence supporting their use).

They all capitalise on the mind and brain’s own healing mechanism for recovering from depression, anxiety and stress, he says.

Some experts believe that the key to tackling depression lies in diet.

Even though mainstream psychiatry is highly sceptical of the benefits of the nutritional approach to this, or to any other mental disorder, there are a few professionals who believe it can be valuable and a couple of centres that specialise in it.

According to Dr David Wheatley, a consultant private psychiatrist and previously director of the Maudsley Stress Clinic, it is ‘an infinitely preferable first line treatment option for those who feel mildly to moderately depressed’.

The nutritionist Patrick Holford suggests that parents should move their child onto a low-sugar diet and boost their intake of Omega 3s (found in oily fish and fish oil supplements).

Other options include a chromium supplement.

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) AND SEX

// October 30th, 2010 // No Comments » // Antidepressants, Impotence

An entirely new class of antidepressant drugs — the selective serotonin reuptake inhibitors designated as SSRI — has proven to be extraordinarily effective in alleviating symptoms of depression in both men and women. SSRI antidepressants include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), among others. Drugs in this category were at first thought to have relatively few sexual side effects because only 1.9 percent of those originally treated with fluoxetine described sexual side effects. However, now that SSRIs are increasingly viewed as the antidepressants of choice, prescribing doctors and their depressed patients have gained additional experience with these medications. It is now apparent that SSRIs are not sexually innocuous medications. In one study, 54 of 160 (34 percent) patients noticed new sexual problems during fluoxetine treatment. Diminished libido, inability to acquire an erection, and delayed or absent orgasm were among the side effects reported.

ANTIDEPRESSANT MEDICATIONS

// October 30th, 2010 // No Comments » // Antidepressants, Impotence

Decreased libido and impotence are common in men suffering from depression. Sexual function usually returns to normal when the depression lifts with treatment. Antidepressant medications fall into three general classes of drugs: tricyclic antidepressants (Imipramine, Desipramine, Amitriptyline, Nortriptyline), monoamine oxidase (MAO) inhibitors (Phenelzine, Isocarboxacid, Tranylcypromine), and atypical antidepressants (trazodone). Sexual side effects are common with all these drugs. Even the newest antidepressants, those characterized as selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) have been reported to inhibit sexual desire and potency.The scenario sounds ominously familiar, something like an instant replay of the hypertension-antihypertensive therapy conundrum. There are indeed similarities, but there are also notable differences.

  • Although it is true that compromised sexual function is one of the hallmarks of depression, it is equally apparent that for the sexually dysfunctional man, resurrection of sexual prowess occurs only when his depression is alleviated. Impotent hypertensive men often experience, but cannot depend on, a similar improvement in sexual function when their blood pressure is normalized.
  • The trend in tracking sexual function of hypertensive men before, during, and after therapy has not yet established a strong foothold in psychiatric literature. As a result, most of our information regarding the sexual side effects of psychiatric drugs has been derived from either anecdotal individual case reports or sidebars to scientific papers describing both the effectiveness and adverse effects of new antidepressant medications.
  • The scale of studies exploring antidepressant-induced sexual side effects is not comparable. The experiences of thousands of hypertensive men now provide the foundation for our knowledge of the sexual side effects of antihypertensive medications. The largest single report of psychoactive drug-induced impairment in sexual function is based on interviews of fifty-seven men who were already receiving the antipsychotic medication thioridazine (Mellaril) at the time of the interview. Impaired ejaculation was reported by twentyeight of the men (49 percent).
  • Paradoxically, the most common sexual side effect of psychoactive drugs has proven to be a boon to some men with other specific sexual dysfunctions. We know that antidepressant and antipsychotic medications commonly cause delayed or retarded ejaculation. This side effect is a godsend for men suffering from premature ejaculation. Unfortunately, none of the sexual side effects of antihypertensive medications can be similarly adapted to improve the lot of other sexually dysfunctional men.
  • Priapism is one sexual side effect attributed to psychiatric medications not shared by the antihypertensives. This painful persistent erection has been recognized with increasing frequency in men who take antidepressant medications. Several tricyclic and MAO inhibitor antidepressants have been reported to cause priapism on rare occasions. Trazodone (Desyrel), an atypical antidepressant, has also been implicated as causing priapism.

Paxil and Paxil CR (paroxetine)

// October 23rd, 2010 // No Comments » // Antidepressants

Paxil and Paxil CR (paroxetine)

buy Paxil online
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Paxil and Paxil CR (paroxetine)
Generic name: Paroxetine
Available strengths: 10 mg, 20 mg, 30 mg, 40 mg tablets;
10 mg/5 mL oral suspension; 12.5 mg, 25 mg.
37.5 mg controlled-release tablets (Paxil CR) Available in generic: Yes, except Paxil CR
Drug class: Selective serotonin reuptake inhibitor antidepressant

Paxil (paroxetine) Overdose

Like other SSRIs Paxil is much safer in overdose than the older TCAs and some of the newer antidepressants. There are no reports of fatality following overdose with Paxil alone. However, fatal outcomes have been reported when Paxil was taken in combination with other medications.
Any suspected overdose should be treated as an emergency. The person should be taken to the emergency room for observation and treatment. The prescription bottle of medication (and any other medication suspected in the overdose) should be brought as well, because the information on the prescription label can be helpful to the treating physician in determining the number of pills ingested.

Paxil (paroxetine) Special Considerations

Most cases of major depression can be treated successfully, usually with medication, psychotherapy, or both. The combination of psychotherapy and antidepressants is very effective in treating moderate to severe depression. The medications improve mood, sleep, energy, and appetite while therapy strengthens coping skills, deals with possible underlying issues, and improves thought patterns and behavior.
In general, antidepressants alone help about 60%-70% of those taking them. Although a few individuals may experience some improvement from antidepressants by the end of the first week, most people do not see significant benefits from their antidepressants until after 3-4 weeks, and it can sometimes take as long as 8 weeks for the medication to produce its full effects. Thus it is critical that patients continue to take their antidepressant long enough tor the medication to be beneficial and that patients not get discouraged and stop their medication prematurely if they do not feel better immediately.
In short-term studies, antidepressants were found to increase the risk of suicidal thinking and behavior in children and adolescents with major depression and other psychiatric disorders. The FDA requires the prescriber to warn of this risk in children and adolescents when starting antidepressant therapy. According to the FDA findings, the risk of suicidal thoughts and behaviors associated with antidepressants is age-related. This phenomenon tends to occur in the younger population and is most likely to occur early in the course of treatment. In adults over 24 years of age, there did not appear to be an increased risk of suicidality with antidepressants compared with placebo. In patients over age 65, the findings showed that antidepressants had a “protective effect” against suicidal thoughts and behavior Other studies have found that when more people in a community are taking antidepressants, the suicide rate is lower.

The risk of suicide is inherent in depression and may persist until the individual responds to treatment. Alter starting or changing antidepressant therapy, the person, especially a child or adolescent, should be closely observed for worsening signs of depression, and the family or caregiver should communicate any concerns to the physician.

Warning: Always let your physician or a family member know if you have suicidal thoughts. Notify your psychiatrist or your family physician whenever your  depressive symptoms worsen or whenever you feel unable to control suicidal urges or thoughts.
Do not discontinue Paxil abruptly. Your dosage should be tapered gradually to prevent discontinuation symptoms.
If you miss a dose, take it as soon as possible, within 2-3 hours of the scheduled dose. If it is close to the next scheduled dose, skip the missed dose and continue on your regular dosing schedule. Do not take double doses. Paxil may be taken with or without food.
Swallow tablets of Paxil CR whole, and do not crush or chew the tablet.
Store the medication in its originally labeled, light-resistant container, away from heat and moisture. Heat and moisture may precipitate breakdown of your medication, and the medication may lose its therapeutic effects. Keep your medication out of reach of children.
If you have any questions about your medication, consult your physician or pharmacist.

Paxil (paroxetine) General Information

Paxil (paroxetine) was approved by the U.S. Food and Drug Administration (FDA) for treatment of major depressive disorder, panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder. The use of a medication for its approved indications is called its labelled use. In clinical practice, however, physicians often prescribe medications for unlabeled (“off-label”) uses when published clinical studies, case reports, or their own clinical experiences support the efficacy and safety of those treatments. Paxil may be used to treat other psychiatric disorders, including premenstrual dysphoric disorder and eating disorders such as bulimia nervosa, which is characterized by symptoms of binge eating and vomiting.
Paxil is a serotonin-specific medication that works by blocking the reuptake of the neurotransmitter serotonin back into brain cells, thereby increasing its levels in the brain. Depression and other mental disorders may be caused by abnormally low levels of serotonin. This abnormality may in turn produce changes in affected areas of the brain, resulting in psychiatric symptoms such as depression or anxiety. The presumed action of Paxil and other selective serotonin reuptake inhibitors (SSRIs) is to increase serotonin levels, which may help to restore those areas of the brain to normal functioning.

Dosing Information

For depression, the usual starting dose of Paxil is 20 mg, taken once a day, usually in the morning. With the controlled-release tablet, Paxil CR, the starting dose is 25 mg. taken once a day in the morning. If no improvement is seen after 3-4 weeks, the dosage is incrementally increased to a maximum daily dosage of 50 mg for Paxil and 62.5 mg for Paxil CR. Seniors and people with severe or chronic medical illnesses may require lower starting dosages. Treatment of other psychiatric disorders such as OCD or panic disorder may require initially lower starting dosages of Paxil but require higher ending dosages. For example, in the treatment of panic disorder, the starting dosage is 10 mg/day of Paxil and 12.5 mg/day of Paxil CR, but the maximum dotage for Paxil and Paxil CR is 60mg/day and 75 mg/day, respectively. For patients who cannot take a tablet, Paxil also comes in a liquid form.
Paxil CR is a controlled — release and not a sustained-release, formulation. The controlled — release tablet does not provide a longer duration of action over Paxil but offers a smoother rate of absorption with fewer gastrointestinal side effects, such as nausea. The enteric-coated tablets of Paxil CR should not be chewed, crushed, or cut but swallowed whole, because the tablet structure is what makes the medication controlled — release.
For most people, it may take as long as 3 -4 weeks to experience the optimal effects of the medication. The duration of medication treatment depends on the individual’s personal psychiatric history and family history. For instance, the length of medication treatment will be longer for those who have had two or more previous episodes of major depressive disorder. For most people, the medication may be tapered 6-9 months after their depression responds to treatment.
However, a small percentage of patients will continue to have depressive symptoms after their antidepressant is reduced or stopped. These individuals may benefit from continuing to take Paxil for 1 year or longer.

Common Side Effects

The most frequent complaints reported with Paxil are gastrointestinal side effects, including nausea, vomiting, cramping, diarrhea, and heartburn. These side effects may be dramatically reduced by switching to the controlled — release tablet, Paxil CR. Drowsiness and daytime sedation may be other frequent side effects experienced by individuals taking Paxil. However, a significant number of people taking SSRIs, including Paxil, may experience jitteriness, nervousness, and insomnia, which is common with this class of antidepressants because of its activating properties in the central nervous system.
Paxil is associated with a significant rate of sexual dysfunction in men and women taking the antidepressant. The sexual side effects reported are delayed orgasm in women and retarded ejaculation in men. Some people may experience decreased desire or lack of interest in sexual activity. Occasionally, individuals report headaches, sleepiness, excessive sweating, stomach cramps, diarrhea, and constipation. People taking Paxil may also experience weight gain.
Patients should discuss these side effects with their physician, especially if they continue to be bothersome 3-4 weeks after the medication is started. If a rash or any other severe symptoms develop, patients should contact their physician immediately.

Adverse Reactions and Precautions

Paxil may cause drowsiness in some people. Patients should not drive or operate machinery until they are certain that their alertness or coordination is not affected by the medication. Patients with a known allergy to Paxil or who have experienced a severe reaction after taking it should not take Paxil.

Use in Pregnancy and Breastfeeding: Pregnancy Category C

Paxil has not been tested in women to determine its safety in pregnancy The effects of the medication on the developing fetus in pregnant women are unknown. however, newborn babies exposed to antidepressants such as SSRIs late in the third trimester developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Women who are pregnant or may become pregnant should discuss this with their physician. Some women may experience a recurrence of their depression when they stop their antidepressant. In these circumstances it may be necessary to restart the medication or seek an alternative medication or treatment.
Nursing mothers should not take Paxil because small amounts will pass into breast milk and be ingested by the baby. If stopping the drug is not an alternative, breastfeeding should not be started or should lie discontinued.

Possible Drug Interactions

The combined use or Paxil with certain other medications may result in adverse drug interactions, because one medication may alter the blood levels of the other. The clinically significant drug interactions reportedOther medications, including herbal supplements (such as St. Johns wort), that boost serotonin may result in excessive levels of that neurotransmitter when combined with Paxil and produce a toxic syndrome known as serotonin syndrome. The early signs of serotonin syndrome are restlessness, confusion, tremors, flushing, and involuntary muscle jerks. If the medications are not stopped, the individual may develop more life-threatening complications resulting in muscle disorders, high fever, respiratory problems, clotting problems, and destruction of red blood cells that may lead to acute renal failure. Patients taking Paxil should be alert to the possible signs of serotonin syndrome, which require immediate medical attention and discontinuation of the serotonin-boosting medications.
Antidepressants known as monoamine oxidase inhibitors (MAOIs) should not be taken together with Paxil, because the combination may potentially produce a toxic reaction that includes elevated temperature, high blood pressure, and extreme excitation and agitation. Patients should consult their physician or pharmacist before taking any new medications, including over-the-counter medications and herbal supplements, with Paxil.
Patients taking Paxil should avoid alcohol or should consume it in moderation because the combination may worsen depression.

Lexapro escitalopram tablets

// October 23rd, 2010 // No Comments » // Antidepressants

Lexapro (escitalopram)

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buy Lexapro online

Generic name: Escitalopram

Available strengths: 5 mg, 10 mg, 20 mg tablets;

5 mg/5 mL oral solution

Drug class: Selective serotonin reuptake inhibitor antidepressant

Overdose

Like other SSRIs, Lexapro (escitalopram) is much safer in overdose than the older tricyclic antidepressants and some of the newer antidepressants. In the reported overdoses with Lexapro (escitalopram), the majority of fatalities were in combination with other medications and/or alcohol. However, fatalities were reported in several cases when Lexapro (escitalopram) alone was taken in very high doses.

Any suspected overdone should be treated as an emergency. The person should be taken to the emergency room for observation and treatment. The prescription bottle of medication (and any other medication suspected in the overdose) should be brought as well, because the information on the prescription label can be helpful in the treating physician in determining the number of pills ingested.

Special Considerations

Most cases of major depression can be treated successfully, usually with medication, psychotherapy, or both. The combination of psychotherapy and antidepressants is very effective in treating moderate to severe depression. The medications improve mood, sleep, energy, and appetite while therapy strengthens coping skills, deals with possible underlying issues, and improves thought patterns and behavior.

In general, antidepressants alone help about 60%-70% of those taking them. Although a few individuals may experience some improvement from antidepressants by the end of the first week, most of people do not see significant benefits from their antidepressants until after 3-4 weeks, and it can sometimes take as long as 8 weeks for the medication to produce its full effects. Thus it is critical that patients continue to take their antidepressant long enough for the medication to be beneficial and those patients not get discouraged and stop their medication prematurely if they do not fed better immediately.

In short-term studies, antidepressants were found to increase the risk of suicidal thinking and behavior in children and adolescents with major depression and other psychiatric disorders. The FDA requires the prescriber to warn of this risk in children and adolescents when starting antidepressant therapy. According to the FDA findings, the risk of suicidal thoughts and behaviors associated with antidepressants is age-related. This phenomenon tends to occur in the younger population and is most likely to occur early in the course of treatment. In adults over 24 years of age, there did not appear to be an increased risk of suicidality with antidepressants compared with placebo. In patients over age 65, the findings showed that antidepressants had a “protective effect” against suicidal thoughts and behavior. Other studies have found that when more people in a community are taking antidepressants, the suicide rate is lower.

The risk of suicide is inherent in depression and may persist until the individual responds to treatment. After starting or changing antidepressant therapy, the person, especially a child or adolescent, should be closely observed for worsening signs of depression, and the family or caregiver should communicate any concerns to the physician.

Warning: Always let your physician or a family member know if you have suicidal thoughts. Notify your psychiatrist or your family physician whenever your depressive symptoms worsen or whenever you feel unable to control suicidal urges or thoughts.

Do not discontinue Lexapro (escitalopram) abruptly. Your dosage should be tapered gradually to prevent discontinuation symptoms.

If you miss a dose, take it as soon as possible, within 2-3 hours of the scheduled dose. If it is close to the next scheduled dose, skip the missed dose and continue on your regular dosing schedule. Do not take double doses.

Lexapro (escitalopram) may be taken with or without food.

Store the medication in its originally labeled, light-resistant container, away from heat and moisture. Heat and moisture may precipitate breakdown of your medication, and the medication may lose its therapeutic effects.

Keep your medication out of reach of children.

General Information

Lexapro (escitalopram) is a purified molecule of Celexa (citalopram), a selective serotonin reuptake inhibitor (SSRI) antidepressant. Celexa has two mirror-image forms (designated as S and R forms), much like our left and right hands, which are mirror images hut opposite. Lexapro is made up of only the S form. What is the advantage of Lexapro over Celexa? It is thought that the primarily antidepressant action is from the S form and that the R form has little or no antidepressant activity and may interfere with the active molecule and contribute to side effects. Lexapro, containing only the purified S form, is presumed to provide better antidepressant activity than Celexa and, as reported in clinical trials, produce fewer side effects.

Lexapro approved by the U.S. Food and Drug Administration (FDA) to treat major depressive disorder and general anxiety disorder. The use of a medication for its approved indications is called its labeled use. In clinical practice, however, physicians often prescribe medications for unlabeled (“off-label”) uses when published clinical studies, case reports, or their own clinical experiences support the efficacy and safety for those treatments. Unlabeled uses of Lexapro (escitalopram) include treatment of other psychiatric disorders, including obsessive-compulsive disorder, panic disorder, social anxiety disorder, posttraumatic stress disorder, and premenstrual dysphonic disorder.

Lexapro is a serotonin-specific medication that works by blocking the reuptake of the neurotransmitter serotonin back into brain cells, thereby increasing its levels in the brain. Depression and other mental disorders may be caused by abnormally low levels of serotonin. This abnormality may in turn produce changes in affected areas of the brain, resulting in psychiatric symptoms such as depression or anxiety. The presumed action of Lexapro and other SSRIs is to increase serotonin levels, which may help to restore those areas of the brain to normal functioning.

Dosing Information

For depression and generalized anxiety disorder, the usual starting dosage ot Lexapro (escitalopram) is 10 mg once a day in the morning or evening. If improvement is not seen after 3-4 weeks, the dosage may be increased to 20 mg once a day. Generally, for treatment of depression, most people need a dosage of 10-20 mg/day, but some patients with more severe depression may require higher dosages. Treatment of other mental disorders may also require higher dosages than those used for depression. Seniors and people with severe or chronic medical illnesses may require a lower starting dosage of 5 mg/day as well as a lower maintenance dosage of 10 mg/day. For patients who cannot take a tablet. Lexapro (escitalopram) also comes in a liquid form.

For most people, it may take as long as 3-4 weeks to experience the optimal effects of the medication. The duration of medication treatment depends on the individual’s personal psychiatric history and family history. For instance, the length of medication treatment will be longer for those who have had two or more previous episodes of major depressive disorder. For most people, the medication may be tapered ft months after their depression responds to treatment. However, a small percentage of patients will continue to have depressive symptoms after their antidepressant is reduced or stopped. These individuals may benefit from continuing to take Lexapro (escitalopram) for 1 year or longer.

Common Side Effects

The most frequently reported side effects with Lexapro (escitalopram) are gastrointestinal disturbance, principally nausea, vomiting, indigestion, diarrhea, or loose stools. Nervousness, jitteriness, and trouble sleeping are other commonly reported side effects. Occasionally, individuals may experience headaches, sleepiness, and excessive sweating. Lexapro has very little influence on appetite and weight changes, unlike some of the other SSRIs such as Paxil.

Lexapro may induce sexual dysfunction in both men and women. The sexual side effects reported are delayed orgasm in women and retarded ejaculation in men. Some people may experience decreased desire or lack of interest in sexual activity. However, the adverse effects on sexual function with Lexapro (escitalopram) are generally less frequent than with Prozac or Paxil.

Patients should discuss these side effects with their physician, especially if they continue to be bothersome 3-4 weeks after the medication is started. If a rash or any other severe symptoms develop, patients should contact their physician immediately.

Adverse Reactions and Precautions

Lexapro (escitalopram) may cause drowsiness in some people. Patients should nut drive or operate machinery until they are certain that their alertness or coordination is not affected by the medication. Patients with a known allergy to Lexapro (escitalopram)or who have experienced a severe reaction after taking it should not take Lexapro (escitalopram).

Use in Pregnancy and Breastfeeding: Pregnancy Category C

Lexapro (escitalopram) has not been tested in women to determine its safety in pregnancy. The effects of the mediation on the developing fetus in pregnant women are unknown. However, newborn babies exposed to antidepressants such as SSRls late in the third trimester developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Women who are pregnant or may become pregnant should discuss this with their physician. Some women may experience a recurrence of their depression when they stop their antidepressant. In these circumstances it may be necessary to restart the medication or seek an alternative medication or treatment.

Nursing mothers should not take Lexapro because small amounts will pass into breast milk and be ingested by the baby. If stopping the drug is not an alternative, breastfeeding should not be started or should be discontinued.

Possible Drug Interactions

The combined use of lexapro with certain other medications may result in adverse drug interactions, because one medication may alter the blood levels of the other. Fortunately. Lexapro i has a very low incidence of reported drug interactions than with some of the other SSRIs, such as Prozac, Paxil, or Zoloft.

Other medications, including herbal supplements (such as St. John’s Wort), that boost serotonin may result in excessive levels of that neurotransmitter when combined with Lexapro (escitalopram) and produce a toxic syndrome known as serotonin syndrome. The early signs of serotonin syndrome are restlessness, contusion, tremors, flushing, and involuntary muscle jerks. If the medications are not stopped, the individual may develop more life-threatening complications resulting in muscle disorders, high lever, respiratory problems, clotting problems, and destruction of red blood cells that may lead to acute renal failure. Patients taking Lexapro (escitalopram) should be alert to the possible signs of serotonin syndrome, which require immediate medical attention and discontinuation of the serotonin-boosting medications.

Antidepressants known as monoamine oxidase inhibitors (MAOls) should not he taken together with Lexapro (escitalopram), because the combination may potentially produce a toxic reaction that includes elevated temperature, high blood pressure, and extreme excitation and agitation. Patients should consult their physician or pharmacist before taking any new medications, including over-the-counter medications and herbal supplements, with Lexapro (escitalopram).

Patients taking Lexapro (escitalopram) should avoid alcohol or should consume it in moderation because the combination may worsen depression.

Celexa

// October 13th, 2010 // No Comments » // Antidepressants

Celexa was approved in 1998 as a treatment for depression, and has been well tolerated among the more than 8 million people who have taken it around the world. In addition, it is less expensive than some other SSRIs. Celexa is taken once a day in the morning or evening, with or without food, typically beginning with a 20-mg dose. This can be increased to 40 mg if needed.
Side effects. Side effects with this medication typically are mild and don’t last very long. You may notice dry mouth, diarrhea, tremor, insomnia, or sleepiness. A few people notice low blood pressure, dizziness when standing up, rapid heartbeat, headache, weight loss or gain, confusion, coughing, rash, itching, or taste problems. Celexa also interferes with many aspects of sexual function and interest.
Food and drug interactions. You should not drink and take Celexa, and you should discuss with your doctor any nonprescription medicines you take. Some drugs affect the way Celexa works in the body, including cimetidine (which raises the blood level of Celexa);

antifungal drugs and the antibiotic erythromycin may slow down Celexa’s clearance from the body. Celexa doubles the concentration of a metabolite of the tricyclic antidepressant imipramine, and you should never combine Celexa with any MAOI.
Special concerns. You should tell your doctor if you have mania, seizures, or liver or kidney disease. Celexa stays in the body twice as long in patients with liver problems, so lower doses will probably be recommended if you have this problem.

Desyrel trazodone antidepressant

// October 13th, 2010 // No Comments » // Antidepressants

Desyrel (Trazodone)

buy Desyrel Trazodone

This novel antidepressant is chemically unrelated to tricyclic, tetracyclic, or other antidepressants. How Desyrel works is not fully understood, but it is believed to inhibit serotonin uptake.

Desyrel should be taken with food or shortly after a meal or light snack to lower the risk of dizziness or lightheadedness. You may be more apt to feel dizzy or lightheaded if you take the drug before you have eaten. The recommended initial dose is 150 milligrams daily. This may be increased every few days by 50 milligrams a day to a maximum daily dose of 600 milligrams. Once you have responded well to Desyrel, your doctor may gradually reduce your dose.

Desyrel (Trazodone) Side Effects

Unlike antidepressants such as Prozac that may leave you pacing die floor at night, Desyrel can have you sleeping like a baby. Because of Desyrel’s sedative qualities, it’s often added to other drugs such as Prozac if insomnia becomes problematic.

On the downside, Desyrel may cause a rare but nasty side effect called priapism, a painful erection without sexual arousal. Priapism occurs when blood doesn’t drain from the penis’s spongy tissue, keeping it erect. Urgent treatment is needed in this case because of the risk of permanent damage to the penis. (Some patients have experienced permanent impairment of erection or impotence.) Desyrel has also been linked to some heart problems.

Other side effects include dry mouth (34 percent), dizziness (28 percent), blurred vision (15 percent), and nausea (13 percent).

You may need to undergo blood tests since this drug can reduce your white blood cell count. (White blood cells are an important part of the body’s immune system; low levels could be a problem if you develop an infection, sore throat, or fever.) Because of the link between Desyrel and some heart problems, your doctor may ask you to have blood pressure readings and electrocardiograms.

If you get too sleepy or dizzy, ask your doctor if you can take a larger portion of your total dose at bedtime, dividing the rest into two or three smaller doses during the day. Be extra cautious about driving, using machinery, or engaging in any activities that require alertness, judgment, or physical coordination until you and your doctor feel reasonably confident that the drug does not impair your abilities.

Drug Interactions

If Desyrel is taken with certain drugs, the effects of either may be increased, decreased, or altered. Desyrel may intensify the effects of alcohol, so you should not combine it with alcoholic beverages. It is especially important to check with your doctor before combining Desyrel with any of the following:

  • Barbiturates such as Seconal
  • Central nervous system depressants such as Demerol or Halcion
  • Chlorpromazinc (Thorazine)
  • Digoxin (Lanoxin)
  • Drugs for high blood pressure such as Catapres and Wytensin
  • Other antidepressants such as Prozac and Norpramin
  • Phenytoin (Dilantin)
  • Warfarin (Coumadin)
  • Little is known about the interaction between Desyrel and general anesthetics; therefore, this drug should be discontinued prior to elective surgery.

Pregnancy and Breast-feeding

Because some animal studies have revealed fetal deaths and birth defects, Desyrel is not recommended during the first three months of pregnancy- The effects of Desyrel during human pregnancy have not been adequately stud­ied. You and your doctor should weigh the potential risks to the fetus and to you before deciding whether or not to take antidepressants during pregnancy.

Desyrel may appear in breast milk (it has been found in lactating rats). If this drug is essential to your health, your doctor may advise you to discontinue breast-feeding until your treatment is finished.