Posts Tagged ‘SSRIs’

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.

Lexapro escitalopram tablets

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

Lexapro (escitalopram)

buy Lexapro online

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.