![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 43. Go back in thread:
Posted by Phillipa on June 28, 2009, at 12:13:40
In reply to Re: SSRI's and sudden cardiac death, posted by manic666 on June 28, 2009, at 11:51:56
Manic agree so now what's the use of taking an ad. May as well die. I've tried and am trying all the alternative stuff. Why suffer with side effects just to die? And heart disease and strokes are the cause of death in my whole family both sides not to mention autoimmune diseases, diabetes, thyroid, psoriasis, osteroporosis. Cant win so why try? And I was worried about benzos? Silly huh? Phillipa
Posted by bulldog2 on June 28, 2009, at 14:10:48
In reply to Re: SSRI's and sudden cardiac death, posted by Phillipa on June 28, 2009, at 12:13:40
> Manic agree so now what's the use of taking an ad. May as well die. I've tried and am trying all the alternative stuff. Why suffer with side effects just to die? And heart disease and strokes are the cause of death in my whole family both sides not to mention autoimmune diseases, diabetes, thyroid, psoriasis, osteroporosis. Cant win so why try? And I was worried about benzos? Silly huh? Phillipa
Your more likely to die from depression and anxiety than side effects of a drug. You don't seem concerned about getting cancer from your hormones. More anti med hysteria if you ask me. All your bike riding will ruin your joints. I need a hip replacement from bike riding. Also you better stop driving your car. About 50,000 people a year die from car accidents in the US. Better stop breathing the air as you will get lung cancer.
Posted by yxibow on June 28, 2009, at 16:15:05
In reply to Re: SSRI's and sudden cardiac death, posted by bulldog2 on June 28, 2009, at 14:10:48
> > Manic agree so now what's the use of taking an ad. May as well die. I've tried and am trying all the alternative stuff. Why suffer with side effects just to die? And heart disease and strokes are the cause of death in my whole family both sides not to mention autoimmune diseases, diabetes, thyroid, psoriasis, osteroporosis. Cant win so why try? And I was worried about benzos? Silly huh? Phillipa
>
> Your more likely to die from depression and anxiety than side effects of a drug. You don't seem concerned about getting cancer from your hormones. More anti med hysteria if you ask me. All your bike riding will ruin your joints. I need a hip replacement from bike riding. Also you better stop driving your car. About 50,000 people a year die from car accidents in the US. Better stop breathing the air as you will get lung cancer.
Yes -- its a bit cynical, but its also realism.Life is -inherently- dangerous and fatal. But it also has its pleasures to accompany it, and if you don't take advantage of what is an otherwise complex and curious existence that we all live in called life, you won't be able to see any of the beauties that it passes on to us at times.
I think the point here is that reasonable risk taking -- nobody is saying to climb Half Dome or Denali (although if I was fabulously much better physically I might fancy that) -- everything that you ingest, breathe, and do has benefits and detraction.
As with any trial and pursuit down the road of medication (and medicine), everything is a risk - benefit thing, and if the benefits outweigh the risks (anything from becoming a shut-in to suicide), reasonable medication for depression and anxiety is a much better choice I think.
-- Jay
Posted by Larry Hoover on June 28, 2009, at 18:34:43
In reply to SSRI's and sudden cardiac death, posted by linkadge on June 28, 2009, at 10:41:06
> I understand this is a biased site, but it refers to another credable study. Women who took antidepressants had a higher risk of sudden cardiac death which was not accounted for by depression sevarity.
>
> http://www.beforeyoutakethatpill.com/index.php/2009/03/10/theyre-dropping-like-flies-on-their-ssris/
>
> Thoughts?
>
>
> LinkadgeWell, to their credit, they did provide a link to the full-text of the underlying study. http://www.beforeyoutakethatpill.com/2009/3/depression_cardiac_death.pdf
I agree with the article's authors that it is not possible to determine the influence of antidepressants on the risk of sudden cardiac death. It mis-states the results to express anything else.
In the discussion: "Because antidepressant use more significantly correlated with a diagnosis of clinical depression than the MHI-5 score, it is entirely possible that antidepressant use identified participants with more severe depression that was not fully captured by the MHI-5 questionnaire. In addition, these risks need to be put in perspective and balanced against known benefits of these medications on depression. Sudden cardiac death among healthy women is an uncommon event, and although elevated, the absolute risk among women who reported antidepressant use in this study was still very low (46 SCDs/100,000 person-years)."
And I think the very brief 'Conclusions' statement is quite appropriate: "In this prospective cohort of women without baseline cardiovascular disease, we found that symptoms of depression are associated with higher risks of cardiac events, and at least part of this association seems to be explained by differences in coronary risk factors, which might act as causal intermediates in the risk conferred by depression. When we used a proxy for clinical depression, which included antidepressant medication use, we observed a stronger association for SCD, suggesting a possible proarrhythmic mechanism. Although antidepressant medication use might be a marker of worse depression, its specific association with elevated risk of SCD merits further study."
In brief, the study found an association between *depression* and cardiac events, but especially with sudden cardiac death. The specific influence of antidepressant medication in this outcome cannot be determined, because antidepressant use is itself associated with depression.
Lar
Posted by bulldog2 on June 28, 2009, at 18:41:06
In reply to Re: SSRI's and sudden cardiac death » bulldog2, posted by yxibow on June 28, 2009, at 16:15:05
> > > Manic agree so now what's the use of taking an ad. May as well die. I've tried and am trying all the alternative stuff. Why suffer with side effects just to die? And heart disease and strokes are the cause of death in my whole family both sides not to mention autoimmune diseases, diabetes, thyroid, psoriasis, osteroporosis. Cant win so why try? And I was worried about benzos? Silly huh? Phillipa
> >
> > Your more likely to die from depression and anxiety than side effects of a drug. You don't seem concerned about getting cancer from your hormones. More anti med hysteria if you ask me. All your bike riding will ruin your joints. I need a hip replacement from bike riding. Also you better stop driving your car. About 50,000 people a year die from car accidents in the US. Better stop breathing the air as you will get lung cancer.
>
>
> Yes -- its a bit cynical, but its also realism.
>
> Life is -inherently- dangerous and fatal. But it also has its pleasures to accompany it, and if you don't take advantage of what is an otherwise complex and curious existence that we all live in called life, you won't be able to see any of the beauties that it passes on to us at times.
>
>
> I think the point here is that reasonable risk taking -- nobody is saying to climb Half Dome or Denali (although if I was fabulously much better physically I might fancy that) -- everything that you ingest, breathe, and do has benefits and detraction.
>
>
> As with any trial and pursuit down the road of medication (and medicine), everything is a risk - benefit thing, and if the benefits outweigh the risks (anything from becoming a shut-in to suicide), reasonable medication for depression and anxiety is a much better choice I think.
>
>
> -- Jay
>
>
>Very well put...To me it is risk versus benefit...That's how most of us live...Or else why would most of us ever set put in a car...The same is true of meds..I don't understand the hysterical response of some to med side effects..If the med isn't working discontinue it..If it changes the quality of one's life for the better than evelauate risk versus benefit..
Is a long joyless life a better choice than a short life of pleasure?Risk versus benefit..? almost every human activity has some element of risk
Posted by morganpmiller on June 28, 2009, at 20:39:48
In reply to SSRI's and sudden cardiac death, posted by linkadge on June 28, 2009, at 10:41:06
Years on Zoloft and my heart felt stronger than ever. I almost started running triathlons professionally. Had my heart checked a few times during those years and the doctor was always impressed with how healthy and strong my heart was.
I have had 2 doctors tell me that some SSRIs are given to heart patients after heart surgery.
One study says nothing. I highly doubt that people who feel good on SSRIs will ever ever face any heart problems as a result of the SSRI. And, if SSRIs are being given to heart patients, I seriously doubt there is any validity to this proposed risk.
Posted by linkadge on June 28, 2009, at 21:05:53
In reply to Re: SSRI's and sudden cardiac death, posted by bulldog2 on June 28, 2009, at 14:10:48
>Your more likely to die from depression and >anxiety than side effects of a drug.
Well, thats what this not study was suggesting. It suggested that, even when you account for the effect of depression, antidepressant use is still associated with an elevated risk of dying from sudden cardiac death.
Linkadge
Posted by linkadge on June 28, 2009, at 21:14:17
In reply to Re: SSRI's and sudden cardiac death, posted by bulldog2 on June 28, 2009, at 18:41:06
>If it changes the quality of one's life for the >better than evelauate risk versus benefit..
>Is a long joyless life a better choice than a >short life of pleasure?Yes, but I hate when people start to justify everything under the notion that feeling good is the be-all. I could go on a meth binge if all I wanted was to feel good in the short run.
SSRI's don't do enough for me to justify certain significant side effects - expecially as we are starting to know more about what long term effects may exist.
If they really worked, and I felt better, then sure it might be worth it. But to be tranqued away in asexual, apathetic zombie-land I don't really know any more.
Linakdge
Posted by linkadge on June 28, 2009, at 21:20:42
In reply to Re: SSRI's and sudden cardiac death, posted by morganpmiller on June 28, 2009, at 20:39:48
>Had my heart checked a few times during those >years and the doctor was always impressed with >how healthy and strong my heart was.
Sudden cardiac death is not necessarily the result of a weak heart.
>I have had 2 doctors tell me that some SSRIs are >given to heart patients after heart surgery.
Sure they are. New studies are questioning this practice.
>One study says nothing. I highly doubt that >people who feel good on SSRIs will ever ever
>face any heart problems as a result of the SSRI.Oh well then.
>And, if SSRIs are being given to heart patients, >I seriously doubt there is any validity to this >proposed risk.
That logic is so incredably flawed. TCA's were routinely given to depressed cardaic patients back when. We now now that the TCA's do infact pose significant cardaic risks. The presumed safety of SSRI's is exactly that - presumed. There is more than one study.emerging. I have located about 4 or 5 which cast doubt on the cardiac safety of SSRI antidepresants.
Linkadge
Posted by Phillipa on June 28, 2009, at 21:26:45
In reply to Re: SSRI's and sudden cardiac death, posted by linkadge on June 28, 2009, at 21:20:42
TCA's prolong the QT interval which a form of heart block. There are many types of hearts blocks google for complete list. I don't and haven't felt better on any ad so why risk health anymore. Natural is better. Funny has there ever been a study that had dire consequeces for benzos? If used properly. Phillipa
Posted by morganpmiller on June 28, 2009, at 22:06:28
In reply to Re: A similar study, posted by linkadge on June 28, 2009, at 10:55:44
That second study seemed to be more focused on the effects of depression on heart/cardiovascular health and the effects of antidepressants on patients with existing heart problems.
The first study was only done on women. Plus, neither of these studies come close to showing me anything that should concern the average SSRI user.
You seem to be a bit biased as you have not had good experiences with SSRIs.
I am sure we will find all sorts of things wrong with long term health risks of some or all current antidepressants, including SSRIs. I seriously doubt that these long term risks will apply to a significant percentage of those on antidepressants for 10 or 20 or 30 years.
Every SSRI is so distinctly different from one another. I think we need to start studying each individual SSRI instead of SSRIs as a whole.
Do you know about the study on Zoloft giving evidence for it's use in treating melanoma?
Did you know that it is very possible that many antidepressants, including SSRIs, may actually stimulate the immune system?
I am one of millions that have felt fairly normal on SSRIs without extreme sexual side effects or mind numbing side effects. I and many many others have simply felt great on SSRIs. I can only imagine how much better I would have felt on Zoloft over those 8 years if I had not binge drank the way I did. And still, I felt pretty damn good most of the time.
I would suggest that many people who suffer from depression over the years, even after being treated with an SSRI, simply were not doing all of the other things that are necessary to stay in optimal health. Plus, I would like to see similar studies on other antidepressants(not TCAs). Oh Yeah! the use of those antidepressants is virtual non existent relative to the use of SSRIs. People you have been treated with SSRIs are much more likely to have their health suffer due to the ravages of stress and anxiety and depression. Maybe they just didn't do what was necessary to get healthy again, heal, and counter the damage that was done before the started the SSRI. Maybe that damage was irreversible and was already started before the SSRI treatment. There are sooooooo many factors here.
Maybe some or all SSRIs are bad for our hearts. I'm not ruling out the possibility. But given what we know now and the relationship between stress, anxiety,depression and health, I think it is VERY premature to think that SSRIs are causing sudden cardiac death.
That said, I do know that an SSRI overdose can lead to heart failure.
What about Parnate or Nardil? Any long term risks there?
Posted by Larry Hoover on June 28, 2009, at 22:16:37
In reply to Re: SSRI's and sudden cardiac death » bulldog2, posted by linkadge on June 28, 2009, at 21:05:53
> >Your more likely to die from depression and >anxiety than side effects of a drug.
>
> Well, thats what this not study was suggesting. It suggested that, even when you account for the effect of depression, antidepressant use is still associated with an elevated risk of dying from sudden cardiac death.
>
> LinkadgeI disagree that the study says that at all. Two proxy variables for depression, the MHI-5 score, and antidepressant use, were analyzed. The one that correlated more highly with a clinical diagnosis of depression was also correlated more highly with sudden cardiac death. When they adjusted for other cardiac risk factors, the association of SCD with the proxy depression variable remained. That does not indicate that the particular proxy variable, antidepressant use, had anything to do with the outcome.
If variable A causes outcomes B and C, B and C will be correlated despite there being no causal relationship between B and C. In this instance, variable A is depression, which leads to B, antidepressant use, and C, sudden cardiac death.
In fact, this study did not find any increased risk of sudden cardiac death with antidepressant use when not simultaneously correlated with a diagnosis of depression. I'd say that pretty much rules out the antidepressant having any real contribution to sudden cardiac death.
Lar
Posted by yxibow on June 29, 2009, at 4:34:43
In reply to Re: SSRI's and sudden cardiac death » linkadge, posted by Phillipa on June 28, 2009, at 21:26:45
> TCA's prolong the QT interval which a form of heart block. There are many types of hearts blocks google for complete list. I don't and haven't felt better on any ad so why risk health anymore. Natural is better. Funny has there ever been a study that had dire consequeces for benzos? If used properly. Phillipa
I don't know about a study, but of course they all carry risk and one must get used to being on them, and using them properly of course as noted, and judging their attention while doing potentially hazardous tasks such as household repair and driving.
It's your choice and right not to be on an antidepressant -- I mean not to be rude, I can sense some dysthymia in your posts, but if you feel that you can control that on your own, then more power to you.I know you've been through AD trials -- I'm not you so I can't say how long they should have been, but again -- its a side effect versus benefit choice that you have to make yourself.
A number of medications, not just psychotropics labeled for their intended purpose, can potentially interfere with the QTc interval... so having an EKG annually if your insurance can cover it with a physical I think is important if you have medication(s) with that risk.-- Jay
Posted by Larry Hoover on June 29, 2009, at 6:57:34
In reply to Re: A similar study, posted by morganpmiller on June 28, 2009, at 22:06:28
> The first study was only done on women. Plus, neither of these studies come close to showing me anything that should concern the average SSRI user.
You're quite right to question the generalizability of what was reported here.
The study participants are all medically trained, and likely have extraordinary access to doctors and medical care through their work.
It's hard to do a direct comparison on death rates/100,000 (the standard way of expressing cause of death statitistics) between this study and the information compiled by the United States government, because they're reported under different category descriptors......but, even the worst case reported here, sudden cardiac death rate for depressed users of antidepressants, is *better* than rate for women in the U.S. population statistics. And I'm only comparing it to one cause of sudden cardiac death, so the U.S. population statistic understates the rate of death captured in this study because there are other causes of SCD than the one I selected.
I see no evidence that this correlation of sudden cardiac death with antidepressant use should concern anyone. Yes, the gravity of such a severe consequence needs more research to clearly determine if there is a causal link, but the simple and obvious joint cause explanation makes sense on its own. For these medically trained subjects, I'm absolutely certain that depression severity predicts antidepressant exposure. And depression severity is already well know to predict sudden cardiac death.
Lar
Posted by linkadge on June 29, 2009, at 7:43:12
In reply to Re: A similar study, posted by morganpmiller on June 28, 2009, at 22:06:28
>Plus, neither of these studies come close to >showing me anything that should concern the >average SSRI user.
Well, I am not really trying to convince you in particular.
>You seem to be a bit biased as you have not had >good experiences with SSRIs.
My health is number one. I don't care if I fail a drug.
>I am sure we will find all sorts of things wrong >with long term health risks of some or all >current antidepressants, including SSRIs. I >seriously doubt that these long term risks will >apply to a significant percentage of those on >antidepressants for 10 or 20 or 30 years.
Well, thats one speculation.
>Do you know about the study on Zoloft giving >evidence for it's use in treating melanoma?It is an investigational treatment. Just like citalopram was an investigational (failed) tretment for autism.
>Did you know that it is very possible that many >antidepressants, including SSRIs, may actually >stimulate the immune system?
I'm sorry, is that a good thing?
>I would suggest that many people who suffer from >depression over the years, even after being >treated with an SSRI, simply were not doing all >of the other things that are necessary to stay >in optimal health.
Well, thats an interesting hypothesis. Why don't you design a study to make things a little more scientific.
>Oh Yeah! the use of those antidepressants is >virtual non existent relative to the use of >SSRIs.
Yes, that is now. At one point TCA's were all that was available. It was only after the SSRI's came out that doctors started admitting to some of the more disturbing side effects of TCA's. I assume that the same will happen when a new class of AD comes out.
>People you have been treated with SSRIs are much >more likely to have their health suffer due to >the ravages of stress and anxiety and >depression.Not necessarily. You see when the impact of depression is accounted for, they can adjust for the health effects that a certain level of depression should cause. Not everybody who has severe depression takes an antidepressant. When you study this group you can determine the effect of depression itself on cardic function. Then, you can remove this effect from the AD group and determine whether there is still an elevated risk due to the only common independant variable - antidepressant use.
>Maybe they just didn't do what was necessary to >get healthy again, heal, and counter the damage >that was done before the started the SSRI. Maybe >that damage was irreversible and was already >started before the SSRI treatment. There are >sooooooo many factors here.
Or maybe, as the data suggests, SSRI use itself is negatively impacting cardiac function in some way. The way you dismiss the results says to me that you simply don't like to consider this possibility. You like the notion that your SSRI is perfectly safe - and you are willing to fight to retain that notion.
>Maybe some or all SSRIs are bad for our hearts. >I'm not ruling out the possibility. But given >what we know now and the relationship between >stress, anxiety,depression and health, I think >it is VERY premature to think that SSRIs are >causing sudden cardiac death.I don't think you get the notion that *the effect of depression was accounted for in these studies*. Researchers know that depression and anxiety itself cause an elevated risk of cardiac death. That is why they adjusted for these factors.
Linkadge
Posted by linkadge on June 29, 2009, at 7:52:05
In reply to Re: SSRI's and sudden cardiac death » linkadge, posted by Larry Hoover on June 28, 2009, at 22:16:37
>A is depression, which leads to B, >antidepressant use, and C, sudden cardiac death.
Depression doesn't necesarily lead to antidepressant use.
>In fact, this study did not find any increased >risk of sudden cardiac death with antidepressant >use when not simultaneously correlated with a >diagnosis of depression. I'd say that pretty >much rules out the antidepressant having any >real contribution to sudden cardiac death.
Not necessarily. The depression could be the factor that predisposes an individual to cardiac instability. The drug use can be what precipitates the event. Just like cocaine may be *relativley* safe for indivuals without heart disease. But for somebeody with a mild to severe heart problem it could lead to an adverse cardaic event. The cocaine still caused the cardiac event.
Linkadge
Posted by ihatedrugs on June 30, 2009, at 1:16:33
In reply to Re: SSRI's and sudden cardiac death, posted by linkadge on June 29, 2009, at 7:52:05
Hi all,
I just came back from the hospital after having an
transient ischemic attack (mini stroke). I had a previous ischemic incident 3 years ago. This means that I have about a 65% chance of having a major stroke within a year.
I have been on every kind of ADs since I was 33 now 45. I do not smoke, eat well, exercise moderately, and have normal to lower blood pressure, high cholesterol despite eating healthy and no history of heart disease in my family.
I just weaned off Pristiq and started Savella, and have taken every ssri except Paxil.
When I had the attack on Saturday, I was actually telling my husband how much better I was feeling, went shopping and was getting ready to watch a movie when I developed numbness and pain in my left arm and then it went up the left side of the face.
Had I read this post before Saturday, I would have probably dismissed it as just another anti-depressants mudslinging posting, but this was real and it scared the daylights out of me. I have always been a healthy person except for MDD. Since I began taking ADs, I cannot say I have felt great however, they have pulled me out from some dark holes and allowed me to function for which I am greatful. But honeslty, if this research ends up being true, I am going to be fuc...g angry that not only do I have to put up with so many insidious side effects from these semi-efficent meds but now it can actually cost me my life. It would really suck! I have two young daughters a husband and extended family who were scared to death for me this weekend. It is just so not fair.
So I wouldn't be too quick to dismiss Linkadge's post and links. If it is accurate it will really be another slap on the face for a lot of us.
ihatedrugs
Posted by morganpmiller on June 30, 2009, at 3:36:39
In reply to Re: A similar study, posted by linkadge on June 29, 2009, at 7:43:12
>Do you know about the study on Zoloft giving >evidence for it's use in treating melanoma?
>It is an investigational treatment. Just like citalopram was an investigational (failed) tretment for autism.
The antidepressant sertraline downregulates Akt and has activity against melanoma cells
Kalpana K. Reddy 1 , Benjamin Lefkove 1 , Lan Bo Chen 2 , Baskaran Govindarajan 1 , Arkaitz Carracedo 3 , Guillermo Velasco 3 , Carol O. Carrillo 1 , Sulochana S. Bhandarkar 1 , Michael J. Owens 4 , Fatima Mechta-Grigoriou 5 and Jack L. Arbiser 1*
1 Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
2 Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
3 Department of Biochemistry and Molecular Biology I, School of Biology, Complutense University, Madrid, Spain
4 Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
5 Unit of Gene Expression and Diseases, CNRS URA 1644, Pasteur Institute, Paris, France
*Address correspondence to Jack L. Arbiser, e-mail: jarbise@emory.edu
Copyright Journal compilation © 2008 Blackwell Munksgaard
KEYWORDS
sertraline melanoma AKT SSRI signal transduction reactive oxygen
ABSTRACTMelanoma is a common malignancy which is poorly responsive to chemotherapy and radiation. One of the major reasons melanoma responds poorly to these modalities is constitutive expression of Akt, which protects against apoptosis. The antidepressant sertraline was found to be a potent cytotoxic agent against A375 human melanoma. To determine the mechanism by which sertraline kills melanoma cells, Western blot analysis of signaling molecules, including phosphorylated Akt, caspase 9 and phospho-p70 S6 kinase was performed. Finally, the effects of sertraline on A375 xenografts in mice were assessed. Sertaline potently inhibited the phosphorylation of Akt, and caused cell death through induction of endoplasmic reticulum in vitro. Sertraline monotherapy demonstrated activity against A375 xenografts in vivo. Akt is a major cause of resistance of melanoma to current therapy. Antidepressants are commonly used to prevent interferon-induced depression. Use of antidepressants that decrease Akt may improve the efficacy of interferon and other therapies against melanoma. Further studies are needed to elucidate whether sertraline acts as an Akt inhibitor in melanoma.
I don't think you can compare this to celexa and autism treatment
Posted by morganpmiller on June 30, 2009, at 3:42:49
In reply to Re: A similar study, posted by linkadge on June 29, 2009, at 7:43:12
Did you know that it is very possible that many >antidepressants, including SSRIs, may actually >stimulate the immune system?
>I'm sorry, is that a good thing?
You're right, we do not know exactly how SSRIs affect the immune system. And if they do boost immune function, we don't yet know if this is a good thing or a bad thing.
Depression News
Useful Links
Video LibraryPopular Antidepressants May Also Affect Human Immune System
Main Category: Depression
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Find other articles on: "Antidepressants stimulate the immune system"Drugs that treat depression by manipulating the neurotransmitter serotonin in the brain may also affect the user's immune system in ways that are not yet understood, say scientists from Georgetown University Medical Center and a Canadian research institute.
That's because the investigators found, for the first time, that serotonin is passed between key cells in the immune system, and that the chemical is specifically used to activate an immune response. They do not know yet, however, whether these SSRI (selective serotonin reuptake inhibitors) drugs "including the brands Prozac, Zoloft, Paxil and others" could have either a beneficial or a damaging effect on human immunity.
"The wider health implication is that commonly used SSRI antidepressants, which target the uptake of serotonin into neurons, may also impact the uptake in immune cells," said Gerard Ahern, Ph.D., assistant professor of Pharmacology at Georgetown and lead researcher on the study.
He said that while it may be possible that SSRI drugs may restore a healthy immune function in people who are depressed and prone to infections, it is possible that they might also bolster immunity to the point that they trigger autoimmune disease. "At this point we just don't know how these drugs might affect immunity, so we really need to clarify the normal role of serotonin in immune cell functioning," Ahern said.
The surprising finding that serotonin is rapidly passed between immune cells in a manner similar to its transmission between brain neurons was revealed in mid-October, when the research team published the findings in the journal Blood. In December, the discovery was highlighted for the general scientific audience by the journal Nature Reviews Immunology, and now the research team is working to produce an animal model that may help describe the precise nature of this interaction.
"The novelty is that we reveal a potential communication, involving the transmitter serotonin, between immune cells that is normally only found between neurons," Ahern said.
In addition to Ahern, Peta Connell, Ph.D., from the Robarts Research Institute in Canada, was also a co-lead researcher on the study. Scientists from the Robarts Research Institute also contributed to the work.
In the brain, serotonin transmission between neurons is associated with feelings of pleasure, mood, and appetite, and the class of antidepressants known as SSRIs keeps serotonin active within the synaptic spaces between neurons, enhancing the chemical's positive effects. Unlike in the brain, which uses chemical messengers to communicate between nerve cells, the immune system is believed to "converse" through physical contact -- one type of immune cell touches another, setting off a response.
Specifically, "antigen presenting cells" display their antigens (bits of a foreign invader) to T-cells, and a resulting physical coupling between the antigens and the T-cells will prompt the T-cells to divide and expand in population, triggering an immune response designed to destroy the invader. This process may take hours.
What the Georgetown researchers found, however, is that dendritic cells -- the most powerful of the antigen-presenting cells and the ones that can find invaders that have never infected the body and "educate" the immune system to fight them -- also use serotonin to quickly excite a T-cell response. They discovered that these dendritic cells can rapidly secrete serotonin, which activates serotonin receptors on certain types of T-cells.
"In addition to the physical contact, it surprised us to find that these immune cells also have machinery to take up serotonin and to secrete it in an excitatory manner," Ahern said. "The point behind this transmission is not entirely clear, but it appears to be an additional way of stimulating a T cell response."
Drugs that block serotonin reuptake "likely change some of the parameters of T-cell activation, but we don't know yet if it enhances or inhibits the total immune response," Ahern said. "But it is something that should be explored because we really have no idea what SSRIs are doing to people's immune systems."
About Georgetown University Medical Center
Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through our partnership with MedStar Health). Our mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO).
Laura Cavender
lsc6@georgetown.edu
Georgetown University Medical Center
http://gumc.georgetown.edu
Posted by morganpmiller on June 30, 2009, at 3:55:42
In reply to Re: A similar study, posted by morganpmiller on June 30, 2009, at 3:42:49
If SSRIs so far are the safest antidepressants available in terms of heart problems and there is no real proof of SSRIs being the trigger/cause of heart problems, why make such a big deal out of a few very preliminary studies? I understand the need for precaution and education. I just have to think that the millions of healthy people out there feeling pretty damn good on their SSRI, should not be too concerned about this early and fairly flimsy evidence. Until there is some hardcore proof and there are much better safer options, these studies are nothing worth worrying about. Feeling better way outweighs some unproven risk that, even if it is proven, is most likely a slight risk for a small part of the population. Sh*t, every medication carries a risk.
Antidepressants for Patients with Heart Disease
From Nancy Larson, for About.com
Updated November 08, 2008
About.com Health's Disease and Condition content is reviewed by our Medical Review Board
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(LifeWire) - In patients with heart disease, depression is more likely to lead to heart attack, stroke and chest pain than smoking, high blood pressure or even diabetes. But the odds can be evened by taking antidepressants known as selective serotonin reuptake inhibitors (SSRIs), according to a Canadian study published in the 2007 Journal of the American Medical Association.Patients who suffer depression -- around 50% of those hospitalized and as many as one-fifth of others -- are up to five times more likely to die or experience further heart problems within the next year than others.
SSRIs, such as Celexa (citalopram), Prozac (fluoxetine) and Zoloft (sertraline), are thought to improve mood by preventing nerve cells from reabsorbing serotonin, thus increasing the amount of the neurotransmitter in the brain. Having low levels of serotonin is associated with depression, so "reuptake inhibitors," by keeping more serotonin available to the brain, may relieve depression. These medications are safe for heart patients and work well for many.
According to the Journal study, SSRIs are more effective than interpersonal psychotherapy in improving depression in heart patients.
In the first few weeks of taking an SSRI, patients may actually experience increased anxiety until the the drug is fully effective -- usually in 4 to 6 weeks. Side effects that may last throughout the time the medication is taken include sexual difficulties, nausea and headache.
Some SSRIs, when paired with the antibiotic erythromycin, can increase the risk of irregular heartbeat or sudden death. Make sure the doctor who prescribes your antidepressant has a full list of any other medications you are taking.
How Depression Affects the Cardiovascular System
Controlling depression is critical for heart patients because, unchecked, it can keep the body in a chronic state of emergency preparedness. This has several serious implications:
* Increased hormone levels
* Constricted blood vessels
* Elevated heart rateEventually, this constant state of readiness damages blood vessels and desensitizes the heart to indicators that tell it to slow down.
When heart patients conquer depression, it helps decrease their perception of pain, enhances energy, improves socialization and increases their likelihood of quitting smoking, limiting alcohol consumption, exercising and eating right.
Some Harmful Antidepressants
Several antidepressants other than SSRIs can actually be dangerous for those with heart disease:
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs), including Effexor (venlafaxine), may increase blood pressure.
Tricyclics, such as Elavil (amitriptyline), may cause dizziness and elevate heart rate.
Monoamine Oxidase Inhibitors (MAOIs), which include Nardil (phenelzine), can cause irregular heartbeat and sharply elevate blood pressure when paired with certain foods.
Posted by morganpmiller on June 30, 2009, at 4:13:46
In reply to Re: SSRI's and sudden cardiac =(just had a TIA), posted by ihatedrugs on June 30, 2009, at 1:16:33
> Hi all,
> I just came back from the hospital after having an
> transient ischemic attack (mini stroke). I had a previous ischemic incident 3 years ago. This means that I have about a 65% chance of having a major stroke within a year.
> I have been on every kind of ADs since I was 33 now 45. I do not smoke, eat well, exercise moderately, and have normal to lower blood pressure, high cholesterol despite eating healthy and no history of heart disease in my family.
> I just weaned off Pristiq and started Savella, and have taken every ssri except Paxil.
> When I had the attack on Saturday, I was actually telling my husband how much better I was feeling, went shopping and was getting ready to watch a movie when I developed numbness and pain in my left arm and then it went up the left side of the face.
> Had I read this post before Saturday, I would have probably dismissed it as just another anti-depressants mudslinging posting, but this was real and it scared the daylights out of me. I have always been a healthy person except for MDD. Since I began taking ADs, I cannot say I have felt great however, they have pulled me out from some dark holes and allowed me to function for which I am greatful. But honeslty, if this research ends up being true, I am going to be fuc...g angry that not only do I have to put up with so many insidious side effects from these semi-efficent meds but now it can actually cost me my life. It would really suck! I have two young daughters a husband and extended family who were scared to death for me this weekend. It is just so not fair.
> So I wouldn't be too quick to dismiss Linkadge's post and links. If it is accurate it will really be another slap on the face for a lot of us.
> ihatedrugs
I'm sorry to hear that you have not had much luck with SSRIs or other antidepressants.I believe that sometimes it is not one antidepressant that is causing our problems, but the fact that we have been on and off and on and off so many. One thing we have to understand with antidepressants is, if it gives us 70 percent relief and we don't have any unbearable side effect or no noticeable side effects, that is a successful trial. At that point we can do all of the other things to try to get 100 percent relief like working out, yoga, meditation, therapy, improving relationships, etc.
Also, If we are not giving the antidepressant a good 2 month trial, we may never know if it would have worked for us. If the medication is causing unbearable side effects within the firs 4 to 6 weeks and they do not go away with time or dosage adjustment, it is reasonable to stop the medication.
Many times we think a medication is pooping out. Maybe it is, maybe not. I believe we need to give it at least a month and try to make sure that other things in our life are not causing the depression. It is a common misperception that a medication is supposed to relieve all of our depression and anxiety. Unfortunately this is not true. We have to relieve all of our depression and anxiety. A medication will just enable us to do that. Sometimes a medication will nearly wipe out all symptoms. This hardly ever lasts. And if we find ourselves only getting 50 or 60 percent relief, it usually means we have to start doing all the work to get 80 to 100 percent relief.
Not sure if I articulated things well. I guess what I am trying to say is that we may find ourselves hurting our brains and bodies by being on so many different medications. If we had only been on one or two, and did everything we could to make sure we didn't go through too many trials, we may find ourselves feeling better and healthier in the long run.
Then again, some people just do not respond well and have terrible side effects to these medications. To those people I truly have sympathy and compassion.
I do have a theory about medication response. If you are healthy to begin with and eat right and stay in great shape, you may be more likely to respond well to antidepressants. And, you will be less likely to suffer any health issues in the long term.
Posted by linkadge on June 30, 2009, at 7:26:25
In reply to Re: SSRI's and sudden cardiac =(just had a TIA), posted by ihatedrugs on June 30, 2009, at 1:16:33
An excerpt from a discussion on prisiq
http://www.accessmylibrary.com/coms2/summary_0286-32743255_ITM
"In one trial, we observed a total of five cardiovascular events, namely two myocardial infarctions, or heart attacks, and three revascularizations in the Pristiq arms, and none in the placebo arm."
Linkadge
Posted by linkadge on June 30, 2009, at 7:29:21
In reply to Re: A similar study, posted by morganpmiller on June 30, 2009, at 3:36:39
Activity in mouse cells is one things. An actual human anticancer benefit is another.
In mice studies, sertraline has been linked to diabetes. Why would I take a drug that might induce a new disorder to treat melanoma which I don't have.
Linkadge
Posted by linkadge on June 30, 2009, at 7:38:17
In reply to Re: A similar study, posted by morganpmiller on June 30, 2009, at 3:55:42
Well, first of all I don't think SSRI's work all that well. Sure, some people improve on them, but many would improve on placebo too. More than half of all available clinical trial data on SSRI antidepressants fail to show a difference between active drug and the placebo.
Drug companies have worked long and hard to downplay some of the more serious side effects linked to SSRI drugs. They have been reprimanded for such activities of late. Every drug has side effects. If a priliminary study links SSRI therapy to heart attacks we should take it seriously and design safety trials to test the hypothesis. Instead, we sweep the findings under the carpet and blame them on something else. Plus, why would the drug company care? They've already got the drug approved. So long as nothing comes out to get them sued there is no problem.
Linkadge
Posted by Larry Hoover on June 30, 2009, at 8:04:26
In reply to Re: SSRI's and sudden cardiac death, posted by linkadge on June 29, 2009, at 7:52:05
> >A is depression, which leads to B, >antidepressant use, and C, sudden cardiac death.
>
> Depression doesn't necesarily lead to antidepressant use.I didn't say that it did. My meaning was "tends towards", producing a positive correlation with.
> >In fact, this study did not find any increased >risk of sudden cardiac death with antidepressant >use when not simultaneously correlated with a >diagnosis of depression. I'd say that pretty >much rules out the antidepressant having any >real contribution to sudden cardiac death.
>
> Not necessarily. The depression could be the factor that predisposes an individual to cardiac instability. The drug use can be what precipitates the event. Just like cocaine may be *relativley* safe for indivuals without heart disease. But for somebeody with a mild to severe heart problem it could lead to an adverse cardaic event. The cocaine still caused the cardiac event.
>
> LinkadgeOf course not necessarily. Your hypothesis is the most complex one possible. As a scientist, I apply my scientific training, including what has been called Occam's Razor. I'd say it like this: Unless proven otherwise, the simplest explanation is the best explanation. To quote from wiki: 'When competing hypotheses are equal in other respects, the principle recommends selection of the hypothesis that introduces the fewest assumptions and postulates the fewest entities while still sufficiently answering the question. It is in this sense that Occam's razor is usually understood. To quote Isaac Newton: "We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances."'
I can accept that you have both a different opinion, and a concern about the risk. I think it's important to consider the magnitude of the risk or mortality suggested by this study. It's very similar in magnitude to driving in a car.
I've never suggested that psychotropic drugs have no cardiac effects. I spent some time researching the subject before I allowed myself to comment on this study. In some ways, antidepressants may present cardiac risks, and in others, they are cardio-protective. There is no blanket conclusion to be drawn, as individual medical history is the most important variable to consider during drug selection.
I've got a couple of links to some full-text reports that specifically address the cardiac risk side of the yin/yang of psychotropics.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18324881
http://www.anakarder.com/yazilar.asp?yaziid=1057&sayiid=Regards,
Lar
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