Dr. Bob's Psychopharmacology Tips

Disinhibition and SSRIs and venlafaxine

Date: Wed, 17 Apr 1996 17:03:39 -0700 (PDT)
From: "Kenneth W. Steinhoff" <ksteinho@uci.edu>
Subject: Disinhibition from fluoxetine or venlafaxine

On Wed, 17 Apr 1996, Fumio Inoue wrote:

Anyone heard of fluoxetine induced (or exacerbated) kleptomania?

You might look at:

Riddle MA et al. Behavioral side effects of fluoxetine in children and adolescents. Journal of Child & Adolescent Psychopharmacology 1 (3):193-198, 1990-91.

Date: Wed, 17 Apr 1996 20:13:54 -0500
From: gsdavids@niagara.com (George Davidson)
Subject: Disinhibition and fluoxetine

I have heard anecdotes of this on the public radio in Canada, in one of those "what the doctors don't tell you about Prozac" programs. The cases I heard sound like most of the other horror stories one hears about Prozac -- it was given for the worng reasons or to the wrong patient, or was badly supervised, or, most commonly, the doctor didn't listen to the patient, but insisted on the patient doing what the doctor told him or her to do.

On the other hand, I have seen several cases of kleptomania stopping on Prozac in my own practice. The effect seems to be somehow connected to ADHD and occurs with other SSRIs too. It is such an amazing phenomenon that it has prompted me to enquire more closely from my patients what effects the antidepressant has had on any habits they didn't care to tell me about when they first came in. A couple have now mentioned that their compulsive shoplifting has stopped, which was a big relief to them.

I have seen a couple of people who developed a kind of moral lassitude on Prozac or other SSRIs. I think they had passive-aggressive tendencies that were kept in check by anxiety or depression -- feeling better allowed them to express tendencies that were always there.

Date: Sun, 21 Apr 1996 09:53:35 -0400 (EDT)
From: Alan Eppel <eppela@fhs.csu.mcmaster.ca>
Subject: Disinhibition from fluoxetine

I have one patient, a woman in her 30s, with bulimia & anorexia, who while on fluoxetine (Prozac) shoplifted several identical pieces of (uneeded) underwear.

Date: Tue, 9 Jul 1996 19:10:18 -0700
From: "Kenneth W. Steinhoff" <ksteinho@uci.edu>
Subject: Disinhibition from venlafaxine

Theoretically the noradrenergic effect of venlafaxine should be helpful for attention. The problem is that the noradrenergic effect doesn't kick in until higher doses. In prepubertal children this frequently has already led to a serotonergic disinhibition (as occurs with fluoxetine). These kids are very embarrassed and ashamed of all the things they did when they were "under the influence" of the serotonin agent. The disinhibition also can look a lot like ADHD which muddies the waters.

Date: Wed, 22 May 1996 06:22:24 -0700
From: tgarton@ix.netcom.com (Theresa Garton )
Subject: Disinhibition from SSRIs

I attended an excellent program this past weekend on child and adolescent psychopharmacology. The speaker was Charles Popper, MD. In discussing SSRIs, he indicated that he had personally discontinued their use in children due to the frequency he had encountered a "frontal syndrome" characterized by either lack of concern or disinhibition (this despite the prominent Zoloft display in the lobby). He suggested addition of bupropion or some "other noradrenergic agent" to counteract this effect in adults.

Date: Mon, 15 Jul 1996 16:33:15 -0700
From: "Kenneth W. Steinhoff" <ksteinho@uci.edu>
Subject: Disinhibition and SSRIs and venlafaxine

"Serotenergic disinhibition" looks like hypomania, but is primarily in the social arena. I have seen it in at least 4 prepubertal children, 1 with venlafaxine, 3 with Prozac (fluoxetine). It is dose related. Turn it up, they become party animals (talking out in class, doing silly things, not thinking about social consequences, etc.), turn it down, they can't believe how they acted -- scary. It may be related to why SSRIs do well with social phobia.

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