SSRI antidepressant discontinuation symptoms Solutions include increasing the dose and switching to another antidepressant with a different mechanism of action. Loss of antidepressant effectivenessĪny antidepressant may lose its effect after months or years, sometimes because the brain has become less responsive to the drug (tolerance). For that reason, older people do best with rapidly metabolized drugs like sertraline. But liver function is less efficient in older people, so there is a greater risk of drug interactions involving the cytochrome P450 system. SSRIs are safer than tricyclic antidepressants for older people because they do not disturb heart rhythms and rarely cause dizziness that results in falls. Use of SSRI antidepressants in older people The serotonin syndrome has also been reported when an SSRI is combined with lithium, the standard treatment for bipolar disorder. John's wort, monoamine oxidase inhibitors such as phenelzine (Nardil), and clomipramine (Anafranil). In particular, SSRIs should not be mixed with certain other medications, especially the herbal remedy St. If an SSRI is taken along with another drug that enhances serotonin activity, a rare condition called the serotonin syndrome may develop - racing heart, sweating, high fever, high blood pressure, and sometimes delirium. Sometimes only a dose adjustment is necessary, or it may be best to avoid one of the two drugs. Depending on the interaction, there may be a higher or lower blood level of the two drugs. Many other drugs are also metabolized by this same system. SSRIs are broken down in the liver by a group of enzymes known as the cytochrome P450 system. Another solution is adding or substituting bupropion (Wellbutrin), which works by a different mechanism and does not generally cause sexual side effects. Lowering the dose of the SSRI antidepressant may help, although the patient may lose the drug's benefit. In men, SSRIs can delay or inhibit ejaculation, and in women, delay or prevent orgasm. Sexual effects from SSRIsįor many patients, SSRIs diminish sexual interest, desire, performance, satisfaction, or all four. Patients are at slightly increased risk for internal bleeding, especially if they are also taking aspirin or another NSAID, such as ibuprofen or naproxen. A more serious potential problem is reduced blood clotting capacity because of a decreased concentration of the neurotransmitter serotonin in platelets. These problems are usually temporary or mild or both. Some patients taking SSRIs develop insomnia, skin rashes, headaches, joint and muscle pain, stomach upset, nausea, or diarrhea. These types of antidepressants are generally safe, but no medical treatment is without risk. The range of their uses has expanded from depression to anxiety, obsessive-compulsive disorder, eating disorders, and many other psychiatric conditions. These antidepressants - fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro) - are among the world's most widely prescribed medications. Since the late 1980s, America and the world have been enjoying the benefits of the selective serotonin reuptake inhibitors (SSRIs). Though common in use, SSRIs are not without their side effects.
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