Tag Archives: antidepressants

Quick Hits: Pregnant Moms and Antidepressants, Deaths Linked to Parkinson’s Drug & More

Mothers-to-be who take common SSRI antidepressants, such as Lexapro (escitalopram) and Prozac (fluoxetine), may unknowingly alter the brain development of their unborn child. Researchers from Columbia University Medical Center examined brain scans of nearly 100 newborns. Some of those babies were born to mothers who took SSRIs (selective serotonin reuptake inhibitors) while pregnant. The scans revealed that babies who were exposed to certain antidepressants while in the womb had alterations in both the gray and white matter of their brains. Researchers indicated that these alterations could ultimately increase the child’s risk of depression and anxiety. Alarmingly, the changes identified were “much greater than the brain changes or abnormalities associated with psychiatric disorders” that the researchers usually detect in children or adults. The study did not demonstrate cause and effect and did not test long-term consequences of the brain changes linked to antidepressant use during pregnancy. Posted April 9, 2018. Via JAMA Pediatrics.

The Parkinson’s disease drug Nuplazid may be responsible for hundreds of deaths. Nuplazid (pimavanserin), manufactured by Acadia Pharmaceuticals in San Diego, was created to regulate Parkinson’s disease psychosis. A CNN article reports that more than 700 patients have died after they started taking Nuplazid. A report from the non-profit Institute for Safe Medication Practices indicated that 244 patients who took the drug died between the drug’s launch in 2016 and March 2017. The FDA approved Nuplazid in 2016, and the agency classified the drug as a “breakthrough therapy” and granted a “priority review,” which sped up the review process. Posted April 9, 2018. Via CNN.

Increasing cigarette prices would curb extreme poverty and poor health around the world. According to an analysis, low-income people would benefit from the price increase the most. After examining 500 million male smokers in 13 countries, researchers discovered that a 50% price increase in cigarettes would lead to 67 million men abandoning cigarettes. Also, the price increase would allow 15.5 million men to dodge catastrophic health spending in the 7 out of 13 countries without universal health coverage. “A higher price would encourage cessation, lead to better health, and save money much more strongly for the poor than the rich,” said lead researcher Prabhat Jha, MD, DPhil, director of the Centre for Global Health Research of St. Michael’s Hospital. Posted April 11, 2018. Via BMJ.

Combining Migraine Meds With Antidepressants Safe

Taking certain migraine medications in combination with antidepressants does not increase the risk of serotonin syndrome, according to a new study published in JAMA Neurology. In 2006, the FDA issued an advisory about triptan migraine drugs being associated with serotonin syndrome when combined with selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), which are both a common class of antidepressants. However, researchers are suggesting that the advisory should be reconsidered based on new findings.

Over the course of 14 years, researchers analyzed over 47,000 people who were prescribed triptan migraine drugs. Out of that demographic, 21% to 29% of people took antimigraine meds and antidepressants at the same time.

The results indicated that serotonin syndrome was rare in patients who took antimigraine drugs in combination with SSRIs and SNRIs. Serotonin syndrome was suspected in 17 patients. Only 2 patients were classified as having definite serotonin syndrome, while 5 patients were classified as having possible serotonin syndrome. Based on the new findings, the researchers believe that the 2006 FDA advisory is invalid.

Is Kratom Really As Dangerous As the FDA Makes It Out to Be?

America is in the midst of one of the worst epidemics in its history over opioids, which may be one of the reasons the FDA recently issued a warning that kratom, a plant-based supplement often used for pain, is potentially addictive since it has opioid-like qualities.

Kratom has also been used by some people to treat withdrawal from opioids. However, the agency stated that there is “no reliable evidence” to support this and “significant safety issues exist.” The FDA also said it has received reports of 44 deaths related to kratom use. However, as a recent Reason.com blog pointed out, in many of these cases, other substances were found along with kratom in the systems of the deceased, making it difficult to prove kratom was the cause of death.

In one of those deaths, a 22-year-old man had a cocktail of drugs in his system that included the antidepressant Prozac (fluoxetine), antipsychotics Seroquel (quetiapine) and Zyprexa (olanzapine), Lyrica (pregabalin), which is used for nerve pain, and several benzodiazepines (tranquilizers) – in addition to kratom. Also, as Jacob Sullum argued in another Reason.com blog, more people have died from prescription and over-the-counter pain relievers than kratom.

So is kratom really as dangerous as the FDA makes it out to be?

It’s hard to say. But it may be harder to get your hands on kratom. The FDA has already blocked importation of the substance. And in 2016, the Drug Enforcement Agency (DEA) ruled to classify kratom as a Schedule 1 drug, putting it in the same class as marijuana, LSD and heroin as substances with no currently accepted medical use and a high potential for abuse. The DEA backpedaled a bit later in the year following outcry from the public. However, the FDA’s warning could make it more likely for kratom’s Schedule 1 designation to go through.

To me, it seems the FDA is making a bit of a rash decision. Although the FDA says it conducted its own medical analysis of kratom, there is a lot of existing research supporting kratom as effective for conditions such as PTSD and depression. Did they consider this before issuing a warning?

Much like the FDA’s and DEA’s position on marijuana, it seems that decisions are being made based on incomplete examinations of the positives and negatives of herbal substances. The FDA and DEA owe it to patients who use kratom and find benefit from it to conduct a more thorough investigation before deeming it unsafe for public consumption.

Quick Hits: Ibuprofen and Male Fertility, Prostate Cancer Treatment Distress & More

Men may have a greater risk of fertility issues if they take high doses of the pain reliever ibuprofen over the longer term. A Danish study analyzed 31 healthy men who were 18 to 35 years old over the course of 6 weeks. Researchers found that ibuprofen lowered the production of testosterone and led to other health issues such as muscle decay, erectile dysfunction and fatigue. Posted January 8, 2018. Via Proceedings of the National Academy of Sciences.

The side effects that stem from prostate cancer treatment can elevate emotional distress for at least 2 years after the treatment is administered. A study included 1,148 men with prostate cancer who received either surgery or radiotherapy. Results indicated that men who experienced side effects such as urinary, sexual and bowel dysfunction induced by prostate cancer therapy typically reported more emotional distress. Posted December 26, 2017. Via The Journal of Urology

The antidepressant Zoloft (sertraline) may not improve symptoms among patients with chronic kidney disease (CKD). A study assessed 201 patients with non-dialysis-dependent CKD and at least moderate depressive symptoms. Over a 12-week time period, researchers discovered that the use of sertraline did not significantly improve symptoms, but instead caused nausea, vomiting and diarrhea more frequently. Posted November 21, 2017. Via JAMA.

5 Meds That Mess With Digestion (Plus 1 Life-Saving Test)

When your stomach gives you trouble, you might naturally think back to your last couple of meals to try to pinpoint the cause. But it could be something else you’ve swallowed that’s giving you gastrointestinal grief –- like your medication.

Numerous drugs can mess with your digestive system in a variety of ways, from irritating your esophagus or stomach lining to causing stomach bleeding and ulcers.

“With over $4 billion in prescriptions dispensed last year, the odds of such adverse drug reactions are high,” notes Ken Sternfeld, RPh, of RXVIP Enterprises, LTD, a company that provides pharmacy services on site at doctors’ offices, and a spokesperson for the American Pharmacists Association.

Here are 5 common offenders and how to reduce your risk of the issues they can cause. Plus, learn about a simple test that could help you sidestep some of the more serious effects.

1. NSAIDs (Nonsteroidal anti-inflammatory drugs)

NSAIDs such as over-the-counter Advil (ibuprofen), aspirin and Aleve (naproxen), as well as prescription NSAIDs like diclofenac and Celebrex (celecoxib), can cause a range of stomach problems. According to research findings, an estimated 1-2% of people who take these will develop serious GI issues, and the risk of developing a peptic ulcer is 4 to 5 times higher among NSAID users compared to nonusers. Other stomach woes related to these meds include stomach bleeding and less severe symptoms like heartburn, bloating and post-meal nausea.

2. Antibiotics

Although these lifesavers are often absolutely necessary, they can cause one of the most distressing gastro symptoms –- diarrhea. It typically occurs about a week into treatment, but may appear days or weeks afterward. Antibiotics disrupt the balance of gut bacteria, which can also lead to infection by a type called C. difficile that may cause loose bowel movements, abdominal pain, nausea and low-grade fever, and it must be treated with another antibiotic.

Ask your doctor or pharmacist whether you should take probiotics –- in the form of food (like yogurt with live and active cultures) or supplements –- while on antibiotics. Studies show they can help balance gut bacteria and reduce diarrhea associated with antibiotics and C. difficile.

3. Birth Control Pills

Oral contraceptives have been linked with different types of inflammatory bowel disease, which is likely due to effects of estrogen on the immune system, blood clotting, and other functions. A 2013 study of over 230,000 US women found almost 3 times the rate of Crohn’s disease in current users than that of never-users, and a 39% higher rate of Crohn’s among past users. An association was also observed between oral contraceptives and ulcerative colitis, though only in patients with a history of smoking, so be upfront about your history.

4. Antidepressants

Studies have shown higher rates of GERD (gastroesophageal reflux disease) among people taking antidepressants –- particularly the older kinds called tricyclic antidepressants. In research published in 2010, rates of GERD were 71% higher in patients taking tricyclic antidepressants, while no connection was found between GERD and selective serotonin reuptake inhibitors (SSRIs), the newer class of antidepressants that is generally associated with fewer side effects than the older ones. If this is a problem for you, your doc may recommend a change in treatment or an additional OTC or prescription medication to manage the GERD.

5. Opioid analgesics

Due to various effects on the central nervous system and gastrointestinal tract, opioids can really slow things down. Constipation is the most common side effect of these meds, with studies showing that 40-95% of people taking them struggle with this problem. If the constipation becomes chronic, more extreme issues can arise, like bowel obstruction and rupture. Opioid-induced constipation is typically treated with lifestyle modifications and laxatives, or more potent drugs called opioid antagonists if needed. Opioids should only be taken for a few days (except in extreme cases), so constipation should be temporary.

Below are general tips to help you avoid these kinds of side effects.

Follow the directions for use on your prescription or product package –- they might make your eyes glaze over, but those tips can prevent or minimize many drug-related stomach problems.

Take your medications at the specified time. Those that can cause nausea may be best to take before bed so you’ll sleep through it.

It is often suggested that meds be taken with food or water –- if that applies to yours, then do it! However, certain drugs should be taken on an empty stomach because food can interfere with absorption of the medication.

Alcohol should be avoided while taking certain medications –- like NSAIDs, for example –- because it can worsen the irritation of the stomach lining and increase the risk of ulcers and GI bleeding.

The point is to take as instructed, and if there is any uncertainty, be sure to ask the experts. Heed the common advice to talk to your pharmacist about your medications and any concerns that may arise. “Consumers often take drugs without proper management from a pharmacist, in my opinion,” states Sternfeld.

A Surprising Test

He has personal experience with the topic at hand. “My father-in-law, a healthy man, suffered a horrific adverse drug reaction that not only impacted his digestion, but in fact shut down his entire excretion system, leading to toxic levels that almost killed him,” he recalls. He looked into ways that the episode might have been prevented, and was surprised at what he found: “I learned that a simple pharmacogenomic (PGx) cheek swab saliva test –- which was covered by his Medicare insurance –- could have advised the physician to not prescribe that drug to him.”

This is a genetic test that determines whether someone is likely to benefit from a certain medication or experience negative effects, and it can also help a physician determine the best dosage level for a specific patient.

“As a pharmacist, my goal now is to raise awareness that this life-saving test is something everyone should take,” says Sternfeld. Though pharmacogenomic testing is becoming more widely available, it is not yet offered by all healthcare facilities and may not be covered by your particular insurance plan. Check with your doc and insurance company to see if this is a current option for you.

Quick Hits: Americans Open to Non-Drug Pain Treatments, Psychiatric Drugs’ Impact on Cognition & More

More than three-quarters of Americans — 78% — say they are willing to try non-drug alternatives for pain before turning to prescription painkillers. Results from the Gallup-Palmer College of Chiropractic Annual Study of Americans show that 40% of Americans consider prescription painkillers such as opioids a “crisis” or “very serious problem.” And 55% of those who know about the nation’s opioid epidemic place some of blame on the drug industry’s encouraging physicians to prescribe opioids. Another 53% place a lot of blame on doctors overprescribing painkillers to patients. About 23% of those polled said prescription pain meds such as opioids are not very safe, and 8% said opioids are not safe at all. In 2015, more than two-thirds of the opioid deaths reported involved prescription opioids such as oxycodone, hydrocodone, morphine and fentanyl. Posted Sept. 13, 2017. Via Gallup.

Taking high doses of antipsychotic drugs over an extended period may be associated with poorer cognition in schizophrenia. However, taking low doses of antipsychotics such as benzodiazepines and antidepressants over a long time doesn’t affect cognition, according to a new study published in the journal European Psychiatry. The research also found that schizophrenia patients who took a long break from using antipsychotic drugs tended to see their cognitive function improve. Posted Sept. 5, 2017. Via EurekAlert/European Psychiatry.

Women who take antiepileptic drugs (AEDs) during pregnancy have a higher risk of having premature babies or babies that have a low birth weight for their age in the womb. Women with epilepsy who took AEDs while pregnant had a 9.3% increased risk of having a premature baby, while women without epilepsy who took an AED had a 10.5% increased risk, according to results published in the Annals of Neurology. Women who did not take a medication and didn’t have epilepsy had only a 6.2% increased risk of a premature baby. Compared to women who didn’t take an AED and didn’t have epilepsy, women with epilepsy who took one of the drugs gave birth to a child with a mean lower birth weight of 3.9 ounces. For women who took an AED and didn’t have epilepsy, the figure was 4.8 ounces. Common AEDs include Lamictal (lamotrigine), Topamax (topiramate), Tegretol (carbamazepine), Keppra (levetiracetam) and Neurontin (gabapentin). Posted Sept. 11, 2017. Via Medical Express/Annals of Neurology.

Can a Pill Prevent Breast Cancer? For Some Women, the Answer May Be Yes

By Jennifer L.W. Fink
Every morning, I swallow a little white pill in the hope that it will keep me from losing my breasts — or my life — to the disease that’s already taken so much from so many women in my family.

The drug is tamoxifen, a selective estrogen receptor modulator that reduces the effects of estrogen in most parts of the body. The disease I’m running from is breast cancer. And the hope is that this pill will alter my destiny. Breast cancer cells need estrogen to grow and tamoxifen works by blocking hormone receptors on those cells so that estrogen doesn’t attach to those receptors.

My maternal grandmother died of breast cancer. So did her mother. My mother and aunt are both alive and well, but not without significant pain and sacrifice. Both had breast cancer and lost both of their breasts. My mother developed ovarian cancer too, 10 years after she beat breast cancer.

That’s when I pushed for genetic testing, and when we learned that the cancer that plagues our family is likely due to inherited BRCA2 mutations. Women who have a BRCA2 mutation (one of the so-called “breast cancer genes”) have a 45% chance of developing breast cancer by age 70, compared to an approximately 8% risk for women in the general population, according to the National Cancer Institute. Women with a BRCA2 mutation also face a significantly higher risk of ovarian cancer — between 11% and 17% by the time they reach 70, compared to 1.3% for women in the general population.

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Weighing Removal of Breasts and Ovaries

I can decrease my risk of both breast and ovarian cancer by having those organs removed. That’s the choice Angelina Jolie famously made a few years ago. A test showed that Jolie had the BRCA1 mutation — which also greatly raises the risk of breast and ovarian cancers — and her mother, grandmother and aunt had all died from cancer.

I watched my mother go through her mastectomy and recovery, and know the process is far from pain-free. Plus, I like my breasts and my ovaries. They’re important components of my sexuality, health and well-being. I don’t want to surrender them if I don’t have to.

Ask Your Doctor About Chemoprevention If:

  • You have a strong family history of breast cancer
  • You have a known genetic mutation that increases your risk of cancer, such as BRCA1, BRCA2 or PALB2
  • You’ve ever had a breast biopsy
  • You’ve ever been diagnosed with atypical ductal hyperplasia (ADH)

But on the other hand, I see the devastation cancer treatment has wreaked on my mother’s body. Some days, it’s hard for her walk because chemotherapy damaged the nerves in her feet. Her lung problems are likely related to the many doses of radiation to her chest. I’d like to avoid all that too, if I can.

A 5-Year Course of Tamoxifen

So I swallow the white pill. I’m 1-1/2 years into a prescribed 5-year course of tamoxifen.

Chemoprevention, or the use of chemical agents to prevent cancer, is one option for women who are at high risk of developing breast cancer. Prophylactic, preventive surgeries — what Angelina Jolie chose — are another. Watching and waiting is yet another.

Chemoprevention is perhaps the option that is least widely discussed. According to a 2015 article in the New England Journal of Medicine, “even though the benefit-risk ratios for chemopreventive agents are favorable for many women… these agents are infrequently prescribed and infrequently used… Studies focusing on high-risk women show that many physicians are reluctant to prescribe these agents… Numerous other studies have documented the reluctance of women — even women who are considered high-risk — to take tamoxifen, mainly because of a fear of side effects.”

Chemoprevention Can Reduce Cancer Risk, But With Side Effects

Studies have shown that chemoprevention with either tamoxifen or raloxifene — the latter is also a selective estrogen receptor modulator — can decrease the risk of cancer by about half in high-risk women. But both drugs carry significant risks. Both drugs can cause menopausal symptoms, including hot flashes, night sweats, vaginal dryness and weight gain. Both also increase the risk of developing blood clots, and tamoxifen increases a woman’s risk of developing uterine cancer.

Shikha Jain, MD, an oncologist at Northwestern Memorial Hospital in Chicago, helps high-risk women weigh the pros and cons of chemoprevention. “In most breast cancer prevention studies, the overall risk of blood clots developing over the years of treatment was less than 1%,” she says. “Now, if you’ve had a serious blood clot in the past, your risk could be higher. In that case, we wouldn’t recommend chemoprevention.”

Similarly, for most women, the risk of developing uterine cancer as a side effect of chemoprevention is very low. “In one study of women who were on tamoxifen for up to 5 years, specifically to lower their risk of breast cancer, less than 1% of those women developed uterine cancer,” Dr. Jain says.

Still, the decision is not an easy one. Here, 2 women share their experiences with chemoprevention.

Laury Watts

Age: 39

Risk Factors: Family history of breast cancer and PALB2 mutation

On Tamoxifen: since May 2017

“Right off the bat, my oncologist threw tamoxifen at me. I was hesitant. I told her, ‘I don’t want it to ruin my bones.’ She was like, ‘Would you rather get cancer, or brittle bones?’ It was like she didn’t have any sympathy for me… I wavered for 2 months before I started taking it.”
Side Effects: Irregular periods, “stiffness in my bones”

The Doctor Says: “I typically recommend vitamin D and calcium supplementation in premenopausal women if there are no contraindications.” – Dr. Jain

Takeaway: “I feel like I shouldn’t have taken it. I felt fine. I didn’t have cancer. But I also understand that I’m lowering the risk as I’m taking it. I’m on it now, so I might as well stick it out.”

Kelly Miller

Age: 51

Risk Factor: Diagnosis of atypical ductal hyperplasia (ADH)

On Tamoxifen: for 2.5 years

“I started on the tamoxifen so I would feel like I was doing something. I didn’t have any other options except the preventive mastectomy.”

Side Effects: Decreased libido, hot flashes, insomnia, night sweats, increased emotional stability

The Doctor Says: “If patients are having severe symptoms that affect their lives on a day-to-day basis, we can use medications to help. Effexor (venlafaxine) is the one I use the most. It’s been shown to be very helpful with hot flashes.” – Dr. Jain

Takeaway: “It’s definitely scary, but isn’t it amazing that science can tell us that we are prone for a certain thing? At least we have the choice of whether or not to take a pill to try and fight it off.”