October 11th, 2011
By: Madeline Vann, MPH
You’ve started treating your depression with antidepressants, only to find that you’re still wrestling with a number of annoying side effects or tricky-to-treat symptoms.
One in every 10 people in the United States is on some form of antidepressant, with depressant drugs getting prescribed to middle-aged Americans more than any other medication, according to a recent National Health and Nutrition Examination Survey. But each antidepressant-popping adult reacts individually to the drug — its side effects, strength, and efficacy may be drastically different in you than in someone else.
“Some people are exquisitely sensitive to antidepressant side effects,” says psychiatrist Heidi Combs, MD, assistant professor of psychiatry at the University of Washington in Seattle. Others can take just about any medication without running into any problems.
The good news: If you are encountering problems, most of them can be easily managed or reversed. Here are the most common nuisances of antidepressants — and how to solve them.
Problem 1: “I’m still sad.” Of all antidepressant problems, this may be the thorniest to untangle: You still feel blue. In fact, there are a number of possible reasons you’re continuing to experience depression symptoms despite taking an antidepressant:
- You got the wrong diagnosis. “When someone has depression that doesn’t respond to treatment, the first thing you do is step back and make sure you have the right diagnosis,” says Combs. Your psychiatrist might want to do more tests to make sure some important clues weren’t missed the first time around.
- Your medication hasn’t kicked in yet. Sometimes it takes time for antidepressants to become effective. Check with your doctor to find out if you need to wait a bit longer.
- You’re boozing or using drugs. These substances can interfere with your depression treatment — you’ll need to quit if you want complete success.
- You’re not in therapy. It would be nice if medication could solve all depression problems, but you might also need to talk to a therapist to help you figure out how to cope with some of the issues in your life that are legitimately causing you to feel sad or anxious.
- You’re taking the wrong medication. Many people can find relief by switching antidepressants or adding another medication, such as a thyroid drug or lithium.
Problem 2: “I’m not sad — but I’m not happy, either.” Some people who take selective serotonin reuptake inhibitors (SSRIs) experience emotional blunting — a feeling of being depleted of all emotions (including the good ones). But you don’t have to lose your ability to feel joy just to get rid of the pain: Emotional blunting is best resolved by switching to a different class of antidepressants, adding a second medication, or talking to a therapist, says Combs.
Problem 3: “My antidepressant is making me fat.” As many as 25 percent of people taking an antidepressant will see its effect on the scale. While weight gain is a side effect of some depression medications, it’s not a side effect of all — and most people who gain weight because of their depression drugs will only gain five to 10 pounds.
If you have a history of being overweight, you’re more likely to gain while on an antidepressant — “so choose an antidepressant that is weight neutral,” advises Combs. If that’s not an option, she emphasizes getting counseled in diet and exercise. (An added bonus? Both fitness and good-for-you foods have been shown to help ease depression, too).
Problem 4: “Sex tonight? No way!” Many people struggling with depression lose interest in sexual activity — but some antidepressants actually make it difficult to respond sexually. In fact, about 70 percent of people taking certain antidepressants complain of negative sexual side effects. But doctors don’t always warn their patients about this effect, says Dr. Combs, and it can be very frustrating.
Some people are willing to accept it as a temporary trade-off for successful depression treatment — but most people want solutions. Consider switching antidepressants, trying a different dosing schedule, taking other medications to improve sexual response, or experimenting with new ways to increase arousal.
Problem 5: “I’m up all night.” Sleep problems often go hand in hand with depression. And when you can’t get a good night’s sleep, it can make it even harder to treat depression effectively. “Some antidepressants are identified as activating and some are sedating,” explains Combs. Finding the right match for you is key — a sedating antidepressant might be a good bet for someone who is having problems with sleep. It’s also important to look at other lifestyle choices that might be affecting your sleep, like your environment, physical activity (or the lack of it), drinking caffeine late in the day, and alcohol use.
Problem 6: “I want to stop taking my meds — but I’m afraid my depression will come back.” Once you start feeling better, you’ll probably want to quit taking antidepressants — but, naturally, you may worry that your depression symptoms will return or that you’ll experience withdrawal symptoms. Although antidepressants are only temporary for most people, you should never stop taking them (or any prescription medication) without the guidance of a doctor. Usually, the best approach is to reduce the dosage very gradually — stopping “cold turkey” could result in unwanted side effects.
Problem 7: “I want to die.” With depression, there’s always a risk of suicidal thoughts. In fact, having them is actually a rare antidepressant side effect — people taking antidepressants to ease depression may be surprised to find that they are continuing or even beginning to feel suicidal. Call your doctor immediately if you start to experience worsening depression symptoms that include suicidal thoughts.
If you’re running into a problem with your antidepressants, there’s a likely solution — so don’t ignore it. Get to the bottom of it.
Click here for the full report from EverydayHealth.com
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March 21st, 2011
By: Catherine Donaldson-Evans
Men who have taken a popular pill for baldness say they’ve experienced persistent sexual dysfunction for months, or even years, after stopping the drug.
The new study, published in the Journal of Sexual Medicine, found that men who take finasteride, sold under the brand names Propecia and Proscar, may develop an ongoing loss of libido and orgasm, even after they go off the medication.
In some cases, they could have other lasting sexual side effects, including premature ejaculation and erectile dysfunction, according to lead researcher Dr. Michael Irwig of George Washington University’s medical school.
“It’s obviously having some effect on the brain,” Irwig told AOL Health. “It’s messing up different hormonal pathways. Some of these pathways are important for things like libido and sexual function.”
Finasteride, the most common hair-loss pill, has previously been linked to “reversible” sexual impairment, as noted on the drug’s label, said Irwig. But “this is the first series to find that symptoms persisted for at least three months despite stopping finasteride,” he added.
“Three months was the minimum, but some of these guys had sexual symptoms for years, some … for five to 10 years after,” he told AOL Health. “These were young guys with no medical problems, no psychiatric problems, who happened to develop these side effects.”
Irwig and his team interviewed 71 men aged 21 to 46 who had taken Propecia or Proscar and reported new sexual side effects after they started the drugs. None of the participants had a history of sexual dysfunction or other conditions that might have contributed, Irwig said — and some had only been on finasteride for a few days.
Ninety-four percent said they’d experienced low sexual desire, 92 percent reported a dip in sexual arousal and 69 percent had trouble with orgasm, according to the findings. Another 92 percent said they developed erectile dysfunction after taking finasteride.
On average, participants had been on the baldness drug for 28 months and had chronic sexual problems for an average of 40 months, the research showed.
But 10 percent of those studied had used finasteride for less than a month, Irwig told AOL Health.
“It’s scary,” he said. “For the lack of orgasm and libido, there is no treatment.”
Other reported adverse side effects of finasteride are depression, suicidal thoughts and anxiety. Merck is currently fighting a number of lawsuits involving the drug, including one in Canada and another in Connecticut.
The company does not warn of possible psychological or persistent sexual problems in information about finasteride on its website, nor does it mention those symptoms on its U.S. labeling. Irwig said the drug does carry warning labels in the U.K. and Sweden about ongoing sexual impairment.
“Be aware that this is a potential sexual side effect,” he cautioned. “If somebody chooses to take this medicine, there is that risk. They have to make the decision that it’s a risk they’re willing to take.”
Click here for the full report from AOL Health
January 25th, 2010
By Daniel Martin and Jenny Hope
Tens of thousands of patients have been ordered to stop taking a popular fat-busting drug suspected of raising the risk of heart attacks and stroke. The European Medicines Agency last night suspended the licence of the drug Reductil, which was taken by 86,000 Britons last year.
The safety watchdog fears it could threaten the health of the overweight and obese – although it says any side-effects should not be fatal. However, some 17 deaths have been linked to the drug in Britain since 2001 – six of which were caused by heart attacks and strokes.
Some 1,105 suspected adverse reactions have been reported, a third of them serious.
Last night doctors and pharmacists were told to stop handing out Reductil.
And experts urged everyone who takes it to make an appointment with their GP to discuss alternative ways of losing weight.
It is the second popular antiobesity drug to have its licence suspended. Two years ago, the EMA suspended Acomplia over fears it could lead to suicidal thoughts.
The agency came to its decision on Reductil after examining an international clinical trial, which showed that its main ingredient – sibutramine – increases the risk of heart problems. Sibutramine tricks patients’ brains into making them feel full, meaning they eat up to 20 per cent less.Last night, Dr June Raine, of the UK Medicines and Healthcare Products Regulatory Agency, said: ‘Evidence suggests that there is an increased risk of non-fatal heart attacks and strokes with this medicine that outweigh the benefits of weight loss, which is modest and may not be sustained in the long term after stopping treatment.
‘Prescribers are advised not to issue any new prescriptions for Reductil and to review the treatmentof patients taking the drug. Pharmacists are asked to cease dispensing the medicine.
‘There are no health implications if people wish to stop treatment before seeing their doctor.’
The international trial examined by EMA followed 10,000 patients over six years. It found a 16 per cent increased risk of heart attack and stroke. Many of those who took part in the trial had cardiovascular problems – even though one of the listed side effects of the drug is that it can raise blood pressure. The agency said that although the drug was off limits to those with heart problems, those needing it were likely to have undiagnosed cardiac conditions because of their weight.
It pointed to studies which showed that weight loss achieved with Reductil was often modest and may not be maintained after stopping. This meant the benefits did not outweigh the cardiovascular risks.
Reductil is made by Abbott Laboratories and its official side effects are listed as high blood pressure, insomnia, constipation and dry mouth.
It is prescribed to those who have made serious attempts to slim by other means, such as dieting and exercise. Treatments cost the NHS about £45 a month.
Last night, Eugene Sun of Chicago-based Abbott said: ‘Many people benefit from sibutramine and we respectfully disagree with the committee’s opinion and recommendation to suspend the medicine.
‘However we will act promptly to comply with the committee’s recommendations.’
David Haslam of the National Obesity Forum said he was surprised by the decision and knew of no study proving that Reductil had led to a death from a heart attack or stroke.
The EMA’s decision leaves Orlistat as the only anti-obesity drug still freely available in the UK.
Click here for the full report
July 2, 2009
New York Times
by Gardiner Harris & Duff Wilson
WASHINGTON — Federal drug regulators warned Wednesday that patients taking two popular drugs to stop smoking should be watched closely for signs of serious mental illness, as reports mount of suicides among the drugs’ users.
But officials emphasized that fear should not stop patients from taking the smoking-cessation medicines, Chantix, made by Pfizer, and Zyban, made by GlaxoSmithKline, which also sells it under the brand name Wellbutrin, for depression.
“Stopping smoking is a goal we should all be working towards,” said Dr. Curtis J. Rosebraugh, director of a drug evaluation office at the Food and Drug Administration. “We don’t want to scare people off from trying a medication that could help them achieve this goal. You should just be careful.”
Pfizer will add a so-called black box warning — the F.D.A.’s most serious caution — to the packaging information for Chantix.
The Pfizer drug, introduced in 2006, has about 90 percent of the market for prescription smoking-cessation drugs, according to IMS Health, a health care information company. Even so, Chantix sales — $846 million in 2008 — had been less than Pfizer had hoped because of previous warnings of its side effects.
Glaxo will expand its existing black box warning on Wellbutrin, citing suicidal thoughts by patients who use it for depression, to include Zyban, which has had only modest sales in the smoking cessation market.
Both companies will also be required to conduct clinical trials to assess the mental health risks associated with the drugs’ uses. Pfizer is already enrolling schizophrenia patients in a trial.
Because smokers and people trying to quit are statistically more likely to be depressed and suicidal, officials for both companies said it was difficult to identify the specific impact of the drugs on those risks. “Nicotine withdrawal itself can be very difficult for people to endure,” Dr. Steve Romano, a Pfizer vice president, said Wednesday.
Analysts said the F.D.A. action would have little effect on sales because of previous indications of the drugs’ psychiatric risks.
“I think the market and physicians have already been sensitized to this,” said Catherine J. Arnold, an analyst for Credit Suisse.
“I’m not panicking,” said Jami Rubin, an analyst for Goldman Sachs, “Sales are already down a lot. It is and will remain a small niche product.”
Chantix had already experienced a slight sales decline last year from the $883 million achieved in 2007. And this year’s first-quarter sales of $177 million were 36 percent below the corresponding period last year.
Ms. Arnold predicted that sales would probably continue falling to around $740 million for all of 2009, but that demand for smoking-cessation treatments would enable it to grow modestly after that — to perhaps half of the $2 billion in annual sales Pfizer had originally hoped for the drug.
European officials first alerted the F.D.A. in 2007 to problems associated with Chantix. In September of that year, Jeffrey Carter Albrecht, a keyboard player from the pop-music group Edie Brickell and New Bohemians, was killed by a neighbor who had complained that Mr. Albrecht was banging on his door, ranting. Mr. Albrecht’s girlfriend blamed Chantix, which she said had made him hostile.
The widely publicized event led to a cascade of similar reports and scrutiny by F.D.A. safety officials, who have now received 98 reports of suicides and 188 reports of suicide attempts among those taking Chantix.
As officials looked more closely, they found to their surprise that Zyban has similar associated risks. The agency received 14 reports of suicides and 17 reports of suicide attempts among those taking Zyban.
No one knows why the drugs are associated with mental problems. In some cases, patients could be experiencing nicotine withdrawal, but some of the reports involved patients who had yet to stop smoking. And many of the events happened just as patients began or stopped therapy, officials said.
“If this is nicotine withdrawal, it really doesn’t matter,” said Dr. Robert Temple, an F.D.A. official. “You need to pay attention to them.”
The agency’s action requires the drugs’ makers to mention the risk of suicide in advertising, and it prevents the companies from using “reminder” ads, during which consumers are encouraged to talk to their doctors about a health issue but the product’s name is not mentioned.
Click here for the full report from the New York Times.