Posts Tagged ‘SSRI’

TREATING SSRI-INDUCED SEXUAL DYSFUNCTION

// October 30th, 2010 // 1 Comment » // Impotence

Several different treatment options have been devised to correct SSRIinduced sexual dysfunction. Adjusting SSRI dose, juggling the schedule of SSRI administration, adding yohimbine, or substituting another antidepressant, bupropion (Wellbutrin), have all been reported to provide relief from SSRI-induced sexual dysfunction.

On occasion, increasing amounts of SSRI are required to alleviate depression, and when that happens, the onset of sexual side effects coincides with escalating SSRI doses. Decreasing SSRI dose alone may suffice to restore sexual function without sacrificing any of the mood-elevating benefits brought about with antidepressant therapy.

Dr. Alan Rothschild of Maclean Hospital, Belmont, Massachusetts, has achieved the same effect by giving his patients a “drug holiday.” He instructed thirty patients who experienced sexual side effects while taking either fluoxetine, sertraline, or paroxetine every day to stop taking medication on Friday and Saturday (the drug holiday) and resume their normal dose at 12:00 noon on Sunday. Significant improvement in sexual function was noted by patients who took a weekend holiday from sertraline and paroxetine, but not from fluoxetine. Depression did not worsen during the brief drug holiday, leading the author to conclude that one way to restore sexual function in sexually impaired sertraline- or paroxetine-treated patients was to ease up on the SSRI burden for a brief period of time. Exactly why the same technique was ineffective in fluoxetine-treated patients is not clear.

Another antidepressant medication, bupropion (Wellbutrin), alone or in combination with fluoxetine, has been used to treat men with SSRI-induced sexual dysfunction. Bupropion is an antidepressant medication different in structure and function from SSRI antidepressants and has been touted as being free of sexual side effects, a claim that has been supported to some degree by clinical experience.

Drs. Lawrence Labbate and Mark Pollack described this phenomenon by reporting their experience with a depressed fifty-year-old man who had less depression two months after starting fluoxetine, but after six months of continued treatment noted diminished libido, erectile impotence, and problems achieving orgasm. Fluoxetine therapy was continued and small doses of another antidepressant, bupropion, were added. Libido, normal erections, and satisfactory orgasms returned within ten days of instituting bupropion therapy. When fluoxetine was discontinued, depression returned, and when bupoprion was stopped, sexual function deteriorated, indicating that for this patient a combination of fluoxetine and bupropion was essential to control depression without disrupting sexual function.

Building on this experience, psychiatrists at several medical centers pooled their experience to see what would happen when patients experiencing sexual dysfunction on fluoxetine stopped that medication and instead used bupropion as their only antidepressant. Patients first discontinued fluoxetine and were on no antidepressant medication for two weeks. It was during this interval, off SSRI medication, that sexual function started to improve. Thereafter, bupropion therapy was instituted, and patients’ estimates of their orgasms, libido, and overall sexual function were evaluated in 25 of 39 patients (64 percent) who started and completed the eight-week trial. Orgasm, libido, and sexual satisfaction were said to be significantly improved in the majority of patients who completed the trial. Some failed to complete because when they stopped fluoxetine and went on bupropion, depression returned. Others were excluded from analysis for a variety of reasons. The improvement in sexual function after discontinuing fluoxetine and starting bupropion, while gratifying, must be interpreted cautiously, because the design of the study does not resolve the question: Did SSRI-induced sexual dysfunction improve because fluoxetine was stopped or because bupropion was started? Only a placebo-controlled study will provide the answer. In the absence of such a study, depressed men who develop sexual side effects during SSRI treatment should alert their doctors to the nature of their problem, and working together, they should be able to find a way to control depression without disrupting sexual function.

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.