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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by jb on March 28, 2001, at 10:11:32
I discovered a very informative article which includes a table indicating the side effects of many Antidepressants, including, in many cases, the pharmacological reasons for the side effect. With the exception of MAOI's, the table seems to be relatively complete. The article can be found at http://pharmacy.orst.edu/dur/news/2_3/2_3.htm
Hope this helps.
By the way, a few observations I was able to make from the table in the article:
(1) Sexual dysfunction side effect - attributable to all SSRI's and any other AD, such as Nardil, which inhibit the reuptake of serotonin.(2) No sexual dysfunction side effect - attributable to drugs which either block 5HT2a post-synapse (that is, do not allow the serotonin messenger to pass it's message along), e.g., Serzone. Also for drugs which exhibit little or no 5HT2 effect, such as Bupropion, venlafaxine, Mirtazapine, and Reboxetin
(3) Weight gain side effect - any drug which acts upon 5HT2c, thereby stimulating appetite. These drugs include Mirtazapine and, I suspect, Nardil, as well.
JB
Posted by Ted on March 28, 2001, at 11:03:06
In reply to Table: Side effects of different Antidepressants, posted by jb on March 28, 2001, at 10:11:32
Hi JB,
Thanks much -- this is an excellent article, as well as the one which follows (SJW & drug interactions).
Ted
>The article can be found at
>http://pharmacy.orst.edu/dur/news/2_3/2_3.htm
Posted by PhoenixGirl on March 28, 2001, at 16:22:22
In reply to Re: Table: Wonderful article -- Thanks!, posted by Ted on March 28, 2001, at 11:03:06
It's not good to accept everything on tables like that as the iron-clad truth. People respond so differently to ADs. For example, I had bad sexual dysfunction on Remeron. Tables like that simplify things too much. They may be GENERALLY true, but remember they are generalizations.
> Hi JB,
>
> Thanks much -- this is an excellent article, as well as the one which follows (SJW & drug interactions).
>
> Ted
>
>
> >The article can be found at
> >http://pharmacy.orst.edu/dur/news/2_3/2_3.htm
Posted by Chaston on March 29, 2001, at 7:54:09
In reply to Re: Table: Wonderful article -- Thanks!, posted by PhoenixGirl on March 28, 2001, at 16:22:22
jb -- Thanks for posting the link, and your interesting observations.
While it's true that individuals often have different responses to these meds, it helps to have these average profiles as starting points, since we can't each try every AD.> It's not good to accept everything on tables like that as the iron-clad truth. People respond so differently to ADs. For example, I had bad sexual dysfunction on Remeron. Tables like that simplify things too much. They may be GENERALLY true, but remember they are generalizations.
>
> > Hi JB,
> >
> > Thanks much -- this is an excellent article, as well as the one which follows (SJW & drug interactions).
> >
> > Ted
> >
> >
> > >The article can be found at
> > >http://pharmacy.orst.edu/dur/news/2_3/2_3.htm
Posted by jb on March 29, 2001, at 8:37:15
In reply to Re: Table: -- Thanks!, posted by Chaston on March 29, 2001, at 7:54:09
Hi, Chaston. Had I engaged my brain at the time I posted my note and the table, I would have put a general disclaimer about many individuals having different side effects. However, I'm sure I would not have done so as well as you. So, thanks.
By the way, I, too, am finding it important to understand at least some of the pharmacology of different medications, so I can have a better understanding of side effects, in particular. My feeling is side effects are much more predictable than is therapeutic efficacy. I think the therapeutic predictions are more difficult due to the complex interactions of various neurotransmitters, as well as response differences among individuals due to their particular brain chemistry. However, regarding side effects, I think many, such as sexual dysfunction and weight gain, are quite predictable, particular at specific dosages and assuming monotherapy. For example, 5HT2a agonism will cause sexual side effects. Overly stimulated young males may like this, others may not.
Also, I think the significance of side effects is, for the most part, grossly under-reported in research as well as various literature on the Internet. I'm sure the pharmacologists and neuro-scientists whose research is posted on PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), would not have forgetten to mention the sexual anasthesia of Nardil, if they had taken it for eight weeks before publishing their work. Now, wouldn't that make for an interest criterion in order to publish?????
As you mentioned, I'm sure many patients, in trying different meds, would at least like to know if there is some predisposition to weight gain and sexual dysfunction. And, for many meds, such as Nardil, the side effects apply almost universally. By the way, the part on side effects really hit home when, the other day, my pharmacologist mentioned "well, if you really want to get away from sexual side effects, you should try Serzone, since it antagonizes or blocks 5HT2a, and exhibits only weak reuptake inhibition." I felt like saying, "Why didn't we discuss this little itsy bitty fact before I started playing ring-around-the-rosy with AD's?"
Again, thanks for your thoughtful and well-worded caveat, as well as your remarks about my introductory summary.
JB
> jb -- Thanks for posting the link, and your interesting observations.
> While it's true that individuals often have different responses to these meds, it helps to have these average profiles as starting points, since we can't each try every AD.
>
> > It's not good to accept everything on tables like that as the iron-clad truth. People respond so differently to ADs. For example, I had bad sexual dysfunction on Remeron. Tables like that simplify things too much. They may be GENERALLY true, but remember they are generalizations.
> >
> > > Hi JB,
> > >
> > > Thanks much -- this is an excellent article, as well as the one which follows (SJW & drug interactions).
> > >
> > > Ted
> > >
> > >
> > > >The article can be found at
> > > >http://pharmacy.orst.edu/dur/news/2_3/2_3.htm
Posted by jb on March 29, 2001, at 10:10:48
In reply to Table: Side effects of different Antidepressants, posted by jb on March 28, 2001, at 10:11:32
Here's an informative article, taken from PubMed, regarding sexual dysfunction of AD's. Please note large sample size of 1022. Also please note relative lack of sexual dysfunction with nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Further, various studies suggest an underreporting of sexual dysfunction, particularly when patients believe it is still tolerable or a non-issue. I would suspect the levels of sexual dysfunction noted for many of the AD's, as indicated below, may be still be slightly underreported.
As in any case, your experience may differ, and this is not to suggest that you definitely will have sexual dysfunction with those AD's for which a majority of users have sexual dysfunction. My purpose is to arm you with certain information so that you might have an improved dialogue with you physician.
Regards,
JB
Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.
Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F
University Hospital of Salamanca, Psychiatric Teaching Area, University of Salamanca, School of Medicine, Spain. angelluis.montejo@globalmed.es
BACKGROUND: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed. METHOD: The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction. RESULTS: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. CONCLUSION: The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.
Publication Types:
Clinical trial
Multicenter studyPMID: 11229449
Posted by Daveman on March 29, 2001, at 21:29:51
In reply to Table: Side effects of different Antidepressants, posted by jb on March 28, 2001, at 10:11:32
Thanks, jb, for the link- it was a very interesting article. One thing I noticed is that Celexa is not indicated as causing insomnia (as opposed to Prozac and Zoloft among the SSRI's), in fact it is indicated as causing sedation. Well, then, is it just in my mind (pardon the choice of words) that I'm still having difficulty sleeping? (I'm on Celexa 40 mg. per day.)
Also, Celexa is indicated as having fewer drug interactions than other SSRI's. Does this mean that Celexa is safer to take with a benzo (say Xanax or klonopin) than other SSRI's?
Finally, the article advises a nine-month continuation after full remission of depressive symptoms, which is precisely what my pdoc has advised. Then the article says that responses to AD's are questionable anyway due to a 30 percent placebo response. How would I know if I'm embarking on a long-term treatment based on a placebo response? It seems unlikely, or I would have responded to the Paxil which was tried first , but it's a thought anyway.
Thanks again for the link.
Dave
> I discovered a very informative article which includes a table indicating the side effects of many Antidepressants, including, in many cases, the pharmacological reasons for the side effect. With the exception of MAOI's, the table seems to be relatively complete. The article can be found at Http://pharmacy.orst.edu/dur/news/2_3/2_3.htm
>
> Hope this helps.
>
> By the way, a few observations I was able to make from the table in the article:
> (1) Sexual dysfunction side effect - attributable to all SSRI's and any other AD, such as Nardil, which inhibit the reuptake of serotonin.
>
> (2) No sexual dysfunction side effect - attributable to drugs which either block 5HT2a post-synapse (that is, do not allow the serotonin messenger to pass it's message along), e.g., Serzone. Also for drugs which exhibit little or no 5HT2 effect, such as Bupropion, venlafaxine, Mirtazapine, and Reboxetin
>
> (3) Weight gain side effect - any drug which acts upon 5HT2c, thereby stimulating appetite. These drugs include Mirtazapine and, I suspect, Nardil, as well.
>
> JB
This is the end of the thread.
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