Posted by SLS on January 12, 2007, at 6:02:55
In reply to Re: pergolide, cabergoline: heart pathology via 5-, posted by linkadge on January 11, 2007, at 20:10:08
> > "Although 5-HT1B receptors mediated the 5-HT–>induced collagen secretion by human cardiac >myofibroblasts, the contribution of this >receptor type to valvulopathy was ruled out >because double-KO mice deficient in both 5-HTT >and 5-HT1B receptors showed the same cardiac >alterations as 5-HTT-KO mice."
> This says that the vulvopathy is not dependant on 5-ht1b receptors. It doesn't say, however, that 5-ht2b receptors might not be involved.Perhaps I misinterpreted it. I thought that since the 5-HT2b KO mice displayed the same pathology, this would indicate that this receptor was not necessary.
> I think the reason that they started to study these mice was because somebody must have been wanting to know whether pharachological manipulation of the human transporter could affect cardaic function.
Well, I hope someone decides to study an SSRI in a similar fashion. I imagine someone has.
I must have missed it, but can you provide the link to the maternal use of SSRI and the congenital heart pathology?
> There are differences, of course, between 5-htt knockout mice, and people treated with SSRI's. Nevertheless, SSRI's can bring a person pretty close to 5-htt knockout. I remember reading that theraputic doses of sertraline inhibed 5-htt by ~80%.
>
> So, I think there is a possability, and I think only time will tell.The evidence you presented is worrisome, though. I spent some time thinking about it last night, and it would indeed be difficult to exclude SSRIs from being a candidate for producing CV adverse effects after long-term use. As you said, time will tell. Hopefully, we haven't missed something obvious, and that the paucity of reported CV effects after 20 years of use reflects a relatively safe CV profile for the SSRIs.
It is unfortunate, but drugs used to treat many different illnesses can display dangerous side effects, even if only rarely. The decision to take these drugs represents a risk versus benefit evaluation. Medicine for many of these other illnesses are almost as archaic as for mental illness (although I would say that the rate of progress is greater for the former), with an incomplete understanding of how the drugs work and a continual discovery of new and serious side effects.
So, what do we do with the SSRIs or any other drug with potent serotonin reuptake inhibition properties? If removed, what else do we have to work with? Is the rate of heart pathology in real life high enough to justify their withdrawal? I guess for now, there is not enough evidence to be able to quantify the risk. I know that for myself, given the severe debilitation and painful existence that my illness produces, at this point in time, I still wouldn't hesitate to take an SSRI.
The decision whether or not to take psychotropic drugs is sometimes difficult and sometimes easy. I guess it becomes easier the more the magnitude of illness drifts towards the mild pole or the severe pole. For those with a moderate depression who remain functional, there is probably more vacillation. Just a guess, though.
Good job putting all of this stuff together, Link.
- Scott
poster:SLS
thread:720797
URL: http://www.dr-bob.org/babble/20070107/msgs/721570.html