Safety alert
date: 8/30/2006
4 warnings on antidepressants: What you can do
Are you trying to make sense of recent news about the safety of antidepressants? We help you sort through the facts so that you can work with your doctor to make the best treatment decisions.
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Antidepressant users have gotten more than their share of disturbing news over the past several months, with reports linking the medications to serious health conditions and increased risk of suicide. Stopping an antidepressant on your own can also be dangerous, so discuss the matter with your doctor. Here’s what you can do to deal with the newly reported risks.
In July 2006 the Food and Drug Administration issued a warning that a potentially life-threatening condition known as serotonin syndrome can result from taking both an antimigraine triptan, such as sumatriptan (Imitrex), and a selective serotonin reuptake inhibitor (SSRI), such as sertraline (Zoloft), or a serotonin-norepinephrine reuptake inhibitor (SNRI), such as duloxetine (Cymbalta). All three types of drugs boost the amount of serotonin in the brain, which can be good up to a point. But when the migraine medication is used in conjunction with a serotonin-raising antidepressant, the body may accumulate too much serotonin, causing side effects such as nausea, diarrhea, and rapid changes in blood pressure and pulse rate.
What you can do: Inform your doctor right away if you take both a triptan and an SSRI or SNRI. Seek medical attention if you experience the symptoms above or loss of coordination, fever, tremor, hallucinations or vomiting. If you have not had problems, don’t stop taking the medications on your own until you talk to a doctor. You may not need to stop using the drugs, says Fred Sheftell, M.D., president-elect of the American Headache Society. Since the incidence of full-blown serotonin syndrome is rare, the benefits of taking the medicines outweigh the risks in some cases. See Consumer Reports Best Buy Drugs for more information on triptans and antidepressants.
In May 2006 GlaxoSmithKline, maker of the antidepressant paroxetine (Paxil), announced that a meta-analysis of clinical trial data found that adults ages 18 to 24 who took Paxil for depression, anxiety or obsessive-compulsive disorder had more than twice the incidence of suicidal behavior as those who took placebo pills. The analysis also found an increase in suicidal behavior among adults up to age 30 who took Paxil for depression. And a separate study, published in the May 2006 American Journal of Psychiatry, found a higher incidence of suicide during the first month of therapy among patients ages 66 and older who took SSRIs compared with those who took other antidepressants.
What you can do: If you, or someone you care about, is starting an antidepressant, be alert to this danger during the first few weeks of treatment or when the dosage changes. Talking or thinking about suicide, giving away possessions, agitation, panic attacks, hostility, and irritability are all important warning signs. Patients with those symptoms should not stop taking their medicine on their own but should call or see their doctor at once.
Researchers reanalyzed data from the 2002 Diabetes Prevention Program, a placebo-controlled study of 3,234 people who were overweight and had high blood glucose, and found that those who took antidepressants had a two to three times greater incidence of diabetes. Participants who did not take antidepressants or took antidepressants but also took the diabetes drug metformin (Glucophage) were not at an increased risk. It’s unclear why metformin provided protection and what the underlying association between antidepressants and diabetes is.
What you can do: The findings, presented at the 2006 American Diabetes Association annual meeting, are preliminary and still need to be shored up by further research and review. Depression and type 2 diabetes, however, have long been suspected to run hand in hand, so if you take antidepressants and are prediabetic, meaning your glucose levels are higher than normal, but not high enough to be diagnostic for type 2 diabetes, have your doctor monitor your blood-sugar levels more closely.
A study in a February 2006 issue of The New England Journal of Medicine found that newborns whose mothers used a selective serotonin reuptake inhibitor (SSRI) during the second half of pregnancy had a sixfold increase in the incidence of persistent pulmonary hypertension, a condition in which a baby’s blood flow bypasses his or her lungs. The risk for the condition was low—about 6 to 12 cases per 1,000 births, but roughly 11 percent of babies with it die and many more suffer brain damage or other lasting health consequences. What’s more, a separate study published that same month found that 30 percent of newborns exposed to SSRIs during gestation had symptoms of drug withdrawal, such as jitteriness, lasting up to four days after birth. Still, simply discontinuing use of the drugs isn’t the solution, according to a study in a February 2006 issue of Journal of the American Medical Association. It found that pregnant women who did had a five times greater likelihood of depression relapse—which could hamper a mother’s ability to bond with her baby and, in extreme cases, cause her to harm her infant.
What you can do: If your depression is mild, talk to your doctor about substituting a nondrug treatment, such as talk therapy, for the duration of your pregnancy. If you do need drug therapy, you may be able to adjust your dosing schedule to reduce risks to your baby. Research suggests that women can use most SSRIs in the first 20 weeks of pregnancy without increasing their baby’s chance of developing persistent pulmonary hypertension. So you may be able to taper off antidepressants and substitute a nondrug therapy for the last 20 weeks. But be sure that the doctors taking care of your depression and your pregnancy confer with each other so you don’t get contradictory advice.
Warning: Certain antidepressants interact dangerously with migraine drugs.
In July 2006 the Food and Drug Administration issued a warning that a potentially life-threatening condition known as serotonin syndrome can result from taking both an antimigraine triptan, such as sumatriptan (Imitrex), and a selective serotonin reuptake inhibitor (SSRI), such as sertraline (Zoloft), or a serotonin-norepinephrine reuptake inhibitor (SNRI), such as duloxetine (Cymbalta). All three types of drugs boost the amount of serotonin in the brain, which can be good up to a point. But when the migraine medication is used in conjunction with a serotonin-raising antidepressant, the body may accumulate too much serotonin, causing side effects such as nausea, diarrhea, and rapid changes in blood pressure and pulse rate.
What you can do: Inform your doctor right away if you take both a triptan and an SSRI or SNRI. Seek medical attention if you experience the symptoms above or loss of coordination, fever, tremor, hallucinations or vomiting. If you have not had problems, don’t stop taking the medications on your own until you talk to a doctor. You may not need to stop using the drugs, says Fred Sheftell, M.D., president-elect of the American Headache Society. Since the incidence of full-blown serotonin syndrome is rare, the benefits of taking the medicines outweigh the risks in some cases. See Consumer Reports Best Buy Drugs for more information on triptans and antidepressants.
Warning: Some antidepressant drugs can increase the risk of suicide for young adults and seniors.
In May 2006 GlaxoSmithKline, maker of the antidepressant paroxetine (Paxil), announced that a meta-analysis of clinical trial data found that adults ages 18 to 24 who took Paxil for depression, anxiety or obsessive-compulsive disorder had more than twice the incidence of suicidal behavior as those who took placebo pills. The analysis also found an increase in suicidal behavior among adults up to age 30 who took Paxil for depression. And a separate study, published in the May 2006 American Journal of Psychiatry, found a higher incidence of suicide during the first month of therapy among patients ages 66 and older who took SSRIs compared with those who took other antidepressants.
What you can do: If you, or someone you care about, is starting an antidepressant, be alert to this danger during the first few weeks of treatment or when the dosage changes. Talking or thinking about suicide, giving away possessions, agitation, panic attacks, hostility, and irritability are all important warning signs. Patients with those symptoms should not stop taking their medicine on their own but should call or see their doctor at once.
Warning: Antidepressant drugs may increase the risk of developing type 2 diabetes in those predisposed to the disease.
Researchers reanalyzed data from the 2002 Diabetes Prevention Program, a placebo-controlled study of 3,234 people who were overweight and had high blood glucose, and found that those who took antidepressants had a two to three times greater incidence of diabetes. Participants who did not take antidepressants or took antidepressants but also took the diabetes drug metformin (Glucophage) were not at an increased risk. It’s unclear why metformin provided protection and what the underlying association between antidepressants and diabetes is.
What you can do: The findings, presented at the 2006 American Diabetes Association annual meeting, are preliminary and still need to be shored up by further research and review. Depression and type 2 diabetes, however, have long been suspected to run hand in hand, so if you take antidepressants and are prediabetic, meaning your glucose levels are higher than normal, but not high enough to be diagnostic for type 2 diabetes, have your doctor monitor your blood-sugar levels more closely.
Warning: Some antidepressants may increase health risks for newborns.
A study in a February 2006 issue of The New England Journal of Medicine found that newborns whose mothers used a selective serotonin reuptake inhibitor (SSRI) during the second half of pregnancy had a sixfold increase in the incidence of persistent pulmonary hypertension, a condition in which a baby’s blood flow bypasses his or her lungs. The risk for the condition was low—about 6 to 12 cases per 1,000 births, but roughly 11 percent of babies with it die and many more suffer brain damage or other lasting health consequences. What’s more, a separate study published that same month found that 30 percent of newborns exposed to SSRIs during gestation had symptoms of drug withdrawal, such as jitteriness, lasting up to four days after birth. Still, simply discontinuing use of the drugs isn’t the solution, according to a study in a February 2006 issue of Journal of the American Medical Association. It found that pregnant women who did had a five times greater likelihood of depression relapse—which could hamper a mother’s ability to bond with her baby and, in extreme cases, cause her to harm her infant.
What you can do: If your depression is mild, talk to your doctor about substituting a nondrug treatment, such as talk therapy, for the duration of your pregnancy. If you do need drug therapy, you may be able to adjust your dosing schedule to reduce risks to your baby. Research suggests that women can use most SSRIs in the first 20 weeks of pregnancy without increasing their baby’s chance of developing persistent pulmonary hypertension. So you may be able to taper off antidepressants and substitute a nondrug therapy for the last 20 weeks. But be sure that the doctors taking care of your depression and your pregnancy confer with each other so you don’t get contradictory advice.
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