MinTankesmie

- Hvorfor gjør antidepressiva mer skade enn nytte?

- Antidepressiva gjør mer skade enn nytte
vg.no 4.5.2012
300.000 nordmenn brukte antidepressiva i fjor, men en ny studie konkluderer med at bivirkningene veier tyngre enn effekten. (...)

Forskningsstudien som er publisert i tidsskriftet Frontiers in Psychology, fastslår at antidepressiva forstyrrer en rekke prosesser i kroppen som reguleres av serotonin, skriver avisen. Serotonin er et signalstoff i nervesystemet, og studier har vist lavt serotoninnivå i hjernen hos deprimerte.

En av forskerne bak studien sier man må bli langt mer forsiktig med den utstrakte bruken av slike legemidler. (...)

(Anm: Antidepressiva (nytteverdi) (mintankesmie.no).)

(Anm: Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Front. Psychology 3:117 (Published online: 24 April 2012).)

Greater Risk Of Relapse In Patients Who Use Anti-Depressants (Større risiko for tilbakefall hos pasienter som bruker antidepressiva)
medicalnewstoday.com 20.7.2011
Pasienter som bruker antidepressiva er mye mer sannsynlig å lide av tilbakefall av kraftig depresjon enn de som ikke bruker legemidler i det hele tatt, konkluderer McMaster-forsker. (Patients who use anti-depressants are much more likely to relapses of major depression than those who use no medication at all, concludes a McMaster researcher.)

In a paper that is likely to ignite new controversy in the hotly debated field of depression and medication, evolutionary psychologist Paul Andrews concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression.

Andrews, an assistant professor in the Department of Psychology, Neuroscience & Behaviour, is the lead author of a new paper in the journal Frontiers of Psychology. (...)

(Anm: Blue again: perturbational effects of antidepressants suggest monoaminergic homeostasis in major depression. Front. Psychology 2011;2:159 (Published online: 07 July 2011).)

Why Antidepressants Don't Always Work (Hvorfor antidepressiva ikke alltid virker)
depression.about.com 26.10.2009
Ifølge forskere ved Northwestern University har halvparten av de som får antidepressiva ingen nytte av midlene. Forskningen synes å indikere at det kan skyldes at hva vi tror trigger depresjon er fullstendig feil. (...) (According to background information provided in a new paper by Northwestern University researchers, over half of antidepressants fail to provide relief to depression sufferers. Their research seems to indicate it may be because what we believe about what triggers depression is entirely wrong.)

Konsekvensen av disse resultater? Redei og hennes gruppe konkluderte at stress ikke spiller noen rolle i trigging av genetiske endringer knyttet til depresjon; og, dersom stress ikke spiller noen rolle ved depresjon innebærer dette at antidepressiva, som stort sett er testet på dyr ved å stresse dyrene og så observere hvordan antidepressiva modifisere deres atferd, i virkeligheten behandler stress, ikke depresjon. (The implication of these results? Redei and her team concluded that stress does not play a role in triggering the genetic changes associated with depression; and, if stress does not play a role in depression then this means that antidepressants, which are generally tested on animals by stressing the animals and then observing how the antidepressant modifies their behavior, are actually treating stress, not depression.)

Redei sier at legemiddelutviklere har fokusert på effekten (stress) snarere enn årsaken til depresjon. "Det er derfor det tar så lang tid for midlene å virke og hvorfor de ikke er effektive for mange mennesker," forklarte Redei. De behandler faktisk ikke depresjon i det hele tatt. (...) (Redei says that drug developers have been focusing on the effect (stress) rather than the cause of depression. "That's why it takes so long for them to work and why they aren't effective for so many people," explained Redei. They are not actually treating depression at all.)

(Anm: Antidepressiva (nytteverdi) (mintankesmie.no).)

(Anm: Mitochondria (mitokondrie). (mintankesmie.no).)

(Anm: Antidepressiva - deprimert, litt trist, angst, stresset eller utbrent? (mintankesmie.no).)

Public 'misled' by drug trial claims (Publikum "villedet" av påstander i legemiddelforsøk)
By Michelle Roberts Health reporter, BBC News
bbc.co.uk 13.10.2 010
Drugs need to undergo extensive testing in trials before approval

Doctors and patients are being misled about the effectiveness of some drugs because negative trial results are not published, experts have warned.

Writing in the British Medical Journal, they say that pharmaceutical companies should be forced to publish all data, not just positive findings. (...)

(Anm: Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. BMJ 2010; 341:c4737 (12 October).)

(Anm: reboxetine (Edronax) (felleskatalogen.no).)

Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials.
BMJ 2010; 341:c4737 (12 October)
Objectives To assess the benefits and harms of reboxetine versus placebo or selective serotonin reuptake inhibitors (SSRIs) in the acute treatment of depression, and to measure the impact of potential publication bias in trials of reboxetine.

Design Systematic review and meta-analysis including unpublished data. (...)

Conclusions Reboxetine is, overall, an ineffective and potentially harmful antidepressant. Published evidence is affected by publication bias, underlining the urgent need for mandatory publication of trial data. (...)

Table 4 Examples of publication bias and industry sponsorship bias in trials of antidepressants

In addition to publication bias, outcome reporting bias has been identified as a major problem in the reporting of clinical trials, resulting in a distorted public record of an intervention.^{35 36 37 38} Our review also identified this type of bias—for three reboxetine trials, only results on subpopulations or selected outcomes were available in the published literature (trials 047, 050, 052; table 1).

The more positive benefit-risk ratio in published data compared with unpublished data also affects the content of clinical guidelines. For example, the National Institute for Health and Clinical Excellence (NICE) guideline on the treatment and management of depression in adults is based on published studies of reboxetine, and concludes that “Reboxetine is superior to placebo and as effective as other antidepressants in the treatment of depression.”¹⁰ In our opinion, this conclusion can no longer be upheld.

The ongoing problem of publication bias shows that unbiased decision making in health care requires mandatory public disclosure of all clinical trial data. The US FDA Amendments Act of 2007³⁹ solves the problem in part by requiring protocol information and study results for clinical trials to be made public on the clinicaltrials.gov website (www.clinicaltrials.gov; please see accompanying comment (doi:10.1136/bmj.c4942) for further details). Similar legislation is also being introduced in Europe, with the mandatory public disclosure of data from the clinical trials database EudraCT (eudract.ema.europa.eu),^{40 41} but the date of implementation is not yet clear.

As the full assessment reports on reboxetine prepared by regulatory authorities are not publicly available, it is not clear as to how the comprehensive body of evidence (including that on efficacy outcomes) generated after reboxetine was approved in Europe in the late 1990s has been analysed by these authorities. The reason for the difference in approval status of reboxetine between Europe and the US thus remains unclear.(...)

Tvivl om antidepressiv medicin
videnskab.dk 21.9.2009
En kritisk artikel i det højt ansete, videnskabelige tidsskrift The New England Journal of Medicine har sat spørgsmålstegn ved effekten af 'lykkepiller'. (...)

Kun positive resultater publiceret
Faktisk var der nøjagtig lige mange undersøgelser med positive resultater (36), som med direkte negative resultater (24) samt tvivlsomme resultater (12), der hverken var klart positive eller negative med hensyn til en tydelig virkning af den antidepressive medicin. (...)

Firmaer skjuler negative medicinforsøg
ekstrabladet.dk 13.10.2010
Medicinalfirmaerne vildleder forbrugerne ved kun at offentliggøre de testresultater, som kommer positivt ud, advarer forskere (...)

Læger og patienter bliver ført bag lyset af medicinalfirmaerne, som skjuler negative resultater fra kliniske forsøg, så deres medicin fremstår mere effektiv end den er, advarer eksperter. (...)

Et tysk forskerhold har i det anerkendte tidsskrift British Medical Journal offentliggjort en gennemgang af ikke tidligere offentliggjorte forsøg med antidepressivet reboxetine (Edronax). De konkluderer, at medicinen ikke er blevet fremstillet i et sandfærdigt lys, skriver BBC.co.uk. (...)

'Vores fund understreger det tvingende behov for tvungen offelitggørelse af førsøgsdata' konkluderer undersøgelsens bagmænd ifølge BBC.co.uk. (...)

Undersøgelsen kommer i kølvandet på flere kritiske historier om medicinalindustrien: Medicinalgiganten Glaxo Smith Kline er ligesom Pfizer blevet anklaget for at tilbageholde kritiske resultater i forhold til diabetesmedicinen Avandia og antidepressivet Seroxat.

Tidligere på måneden blev medicinalfirmaerne i bogen 'Sex, lies and Pharmaceuticals' anklaget for at opfinde nye sygdomme og sygeliggøre raske, så de kunne sælge mere medicin. (...)

(Anm: Forskning og ressurser (mintankesmie.no).)

Studier skönmålade antidepressivt läkemedel
dagensmedicin.se 13.10.2010
Läkemedlet Edronax är inte effektivt mot depression och kan möjligen vara skadligt, enligt en ny metaanalys av publicerade och opublicerade studier. (...)

Forskarnas slutsats är att Edronax på hela taget är ett ineffektivt och potentiellt skadligt läkemedel. De anser att resultaten är ett ”slående” exempel på så kallad publikationsbias, där en annars negativ risk-nytta profil för Edronax blir positiv om man tar hänsyn enbart till publicerade data. (...)

Pfizer depression drug ineffective, may be harmful: study (Pfizers legemiddel mot depresjon ineffektivt, kan være skadelig, ifølge studie)
reuters.com 13.10.2010
(Reuters) - Pfizer's antidepressant reboxetine is an "ineffective and potentially harmful" drug and published data on it overestimates the benefits and underplays the risks, a study by German researchers said on Wednesday.

In a review published in the British Medical Journal, researchers from the German Institute for Quality and Efficiency in Health Care (IQWiG) found that nearly three quarters of the data on patients who took part in trials of reboxetine was not published until now -- a factor they said underlined the urgent need for mandatory publication of all clinical trial results.

Reboxetine, sold under the brand name Edronax, has been approved for the treatment of major depressive disorder in many European countries since 1997 but doubts have been raised about its effectiveness on the basis of recent studies and rejection of the application for approval in the United States in 2001.

"It is not a major drug in depression but every patient that is treated with an ineffective drug is one too many," said Beate Wieseler of IQWiG's department of drug assessment, who led the study. "Depression is a severe disease and there are effective drugs available, so if a patient is given an ineffective drug, that is unacceptable."

Reboxetine is one of the first in a class of anti-depressant drugs called selective serotonin re-uptake inhibitors, or SSRIs. (...)

The German team analyzed the results of 13 trials of reboxetine, including eight previously unpublished trials from Pfizer, and concluded that overall the drug was ineffective as a treatment for depression and may have harmful side effects. (...)

(Anm: reboxetine (Edronax) (felleskatalogen.no).)

Northwestern Research Finds Antidepressant Drugs Aim At Wrong Target (Northwestern-forskning viser at antidepressiva bommer på målet)
medicalnewstoday.com 25.10.2009
More than half the people who take antidepressants for depression never get relief.

Why? Because the cause of depression has been oversimplified and drugs designed to treat it aim at the wrong target, according to new research from the Northwestern University Feinberg School of Medicine. The medications are like arrows shot at the outer rings of a bull's eye instead of the center. (...)

Both findings are significant because these beliefs were the basis for developing drugs currently used to treat depression.

Redei, the David Lawrence Stein Professor of Psychiatry at Northwestern's Feinberg School, found powerful molecular evidence that quashes the long-held dogma that stress is generally a major cause of depression. Her new research reveals that there is almost no overlap between stress-related genes and depression-related genes.

"Dette er en stor og statistisk sterk studie," uttalte Redei. "Denne forskningen åpner opp for nye veier for utvikling av antidepressiva som kan være mer effektive. Der har ikke vært et antidepressiva basert på et nytt konsept på 20 år." (...) ("This is a huge study and statistically powerful," Redei said. "This research opens up new routes to develop new antidepressants that may be more effective. There hasn't been an antidepressant based on a novel concept in 20 years.")

Why Antidepressants Don't Work For So Many
northwestern.edu 23.10.2009
CHICAGO --- For more than half the people who take antidepressants, relief from their symptoms never comes.

Why? Because the cause of depression has been oversimplified and drugs designed to treat it aim at the wrong target, according to new research from the Northwestern University Feinberg School of Medicine. The medications are like arrows shot at the outer rings of a bull's eye instead of the center. (...)

Advarsler

January 2009 Safety Labeling Changes (Januar 2009 sikkerhetsendringer pakningsvedlegg (Seroxat (Paxil), Celexa, Cipramil, Zoloft, Cybalta, Efexor, Prozac, Venlafaxine, Pristiq etc.)
fda.gov 6.3.2009
- Summary of safety-related revisions to the BOXED WARNING, CONTRAINDICATIONS, WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS sections of drug Prescribing Information, plus Patient Package Inserts and Medication Guides. (Posted 03/06/2009) (…)

WARNINGS
Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-like Reactions

WARNINGS
The development of a potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions have been reported with SNRIs and SSRIs alone, including Celexa treatment, but particularly with concomitant use of serotonergic drugs (including triptans) with drugs which impair metabolism of serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists (...)

(Anm: Serotonin syndrom (SS), kramper, parkinsonisme osv. (forhøyet kroppstemperatur) (mintankesmie.no).)

- Antidepressiva og risiko for bryst- og eggstokkreft: En gjennomgang av litteratur og forskernes tilknytning til industrien

Possible Link Between SSRIs and Breast, Ovarian Cancer (Mulig link mellom SSRI-er og bryst- og eggstokkreft)
medscape.com 14.4.2011
But Expert Says Results Should Be Interpreted With Caution

April 14, 2011 — A meta-analysis of 61 studies that looked at the relationship between cancer and antidepressant use shows a "small but statistically significant" increase in the risk for breast and ovarian cancer in women who use selective serotonin reuptake inhibitors (SSRIs).

A meta-analysis has its limitations, but still I feel that these results tell us that we really need to study further the use of SSRIs in women and the link to cancer. It's a fascinating question that really begs an answer. (...)

The study also found that researchers with industry affiliations were significantly less likely than researchers without industry ties to conclude that antidepressants increase the risk for breast or ovarian cancer, Dr. Cosgrove noted.

"There was a statistically significant relationship between researchers' industry ties and conclusions regarding antidepressants and cancer, with a P value as per 2-sided Fisher's exact test equal to .0012," she said. (...)

Antidepressants and Breast and Ovarian Cancer Risk: A Review of the Literature and Researchers' Financial Associations with Industry (Antidepressiva og risiko for bryst- og eggstokkreft: En gjennomgang av litteratur og forskernes tilknytning til industrien)
PLoS ONE 6(4): e18210 (April 6)
Antidepressant (AD) use has been purported to increase the risk of breast and ovarian cancer, although both epidemiological and pre-clinical studies have reported mixed results [1]–[6]. Previous studies in a variety of biomedical fields have found that financial ties to drug companies are associated with favorable study conclusions [7].

We searched English-language articles in MEDLINE, PsychINFO, the Science Citations Index and the Cochrane Central Register of Controlled Clinical Trials (through November 2010). A total of 61 articles that assessed the relationship between breast and ovarian cancer and AD use and articles that examined the effect of ADs on cell growth were included. Multi-modal screening techniques were used to investigate researchers' financial ties with industry. A random effects meta-analysis was used to pool the findings from the epidemiological literature. Thirty-three percent (20/61) of the studies reported a positive association between ADs and cancer. Sixty-seven percent (41/61) of the studies reported no association or antiproliferative effect. The pooled odds ratio for the association between AD use and breast/ovarian cancer in the epidemiologic studies was 1.11 (95% CI, 1.03–1.20). Researchers with industry affiliations were significantly less likely than researchers without those ties to conclude that ADs increase the risk of breast or ovarian cancer. (0/15 [0%] vs 20/46 [43.5%] (Fisher's Exact test P = 0.0012).

Both the pre-clinical and clinical data are mixed in terms of showing an association between AD use and breast and ovarian cancer. The possibility that ADs may exhibit a bi-phasic effect, whereby short-term use and/or low dose antidepressants may increase the risk of breast and ovarian cancer, warrants further investigation. Industry affiliations were significantly associated with negative conclusions regarding cancer risk. The findings have implications in light of the 2009 USPSTF guidelines for breast cancer screening and for the informed consent process. (...)

Questions raised about industry influence on anti-depressant studies (Stiller spørsmål ved industripåvirknining og antidepressiva)
southasiamail.com 30.4.2011
For more than two decades, researchers have been unable to settle an important question: Can anti-depressant medications stimulate the growth of breast and ovarian cancers?

Some studies pointed to a link, but others did not.

Now a re-examination of the available evidence has cast a new – and disturbing – light on the previous research. Many studies that seemed to absolve the drugs of blame were carried out by researchers with close ties to the pharmaceutical industry, according to a report published this week in the online journal PLoS (Public Library of Science) One.

“I think that’s an important piece of information,” said the lead author of the paper, Lisa Cosgrove of the Edmond J. Safra Center for Ethics at Harvard University in Boston.

For the review, Dr. Cosgrove and colleagues amassed a total of 61 studies, which included both laboratory and epidemiological research.

They then conducted separate searches on the principal investigators for each of the studies, looking for drug-company connections. “It was a lot of legwork,” said Dr. Cosgrove, noting that, in the past, such ties were not always publicly reported.

A clear pattern emerged. “None of the researchers with industry affiliation reported a positive association” between antidepressants and the risk of cancer, she said.

There were more mixed findings among researchers free of corporate ties. “Approximately 43 per cent of researchers without industry affiliation reported a positive association.”

A closer examination of these studies – using meta-analysis, which pools the data – suggests the risk is real, but not very large. Women with a history of antidepressant use faced an 11-per-cent increased chance of developing breast and ovarian cancer, compared with those who had not taken these medications. In the case of breast cancer, that means taking antidepressants would raise an average woman's lifetime risk to 13.8 per cent from 12.5 per cent, Dr. Cosgrove said. (...)

- Mindre sannsynlig at mødre på antidepressiva ammer

Mothers on Antidepressants Less Likely to Breast-Feed: Study (Mindre sannsynlig at mødre på antidepressiva ammer)
health.yahoo.com 13.3.2012
TUESDAY, March 13 (HealthDay News) -- Women who take selective serotonin reuptake inhibitor antidepressants, or SSRIs, during pregnancy are much less likely to breast-feed their babies, researchers have found.

The new study was conducted by researchers associated with the Connecticut Pregnancy Exposure Information Service (CPEIS), a state-funded service that provides women with information about exposures during pregnancy and breast-feeding.

The study authors analyzed data from 466 pregnant women who contacted the CPEIS' California affiliate over 10 years with questions about a wide variety of exposures.

The results showed that women who took an SSRI at any time during pregnancy were about 60 percent less likely to breast-feed than women who took no antidepressants. (...)

Antidepressants May Complicate Breast-Feeding (Antidepressiva kan komplisere amming)
businessweek.com 27.1.2010
SSRIs appear to delay lactation in new moms, researchers find (...)

"The breasts are serotonin-regulated glands, meaning the breasts' ability to secrete milk at the right time is closely related to the body's production and regulation of the hormone serotonin," study co-author Nelson Horseman, of the University of Cincinnati, said in a news release from the Endocrine Society.

He said this means that SSRIs may "impact serotonin regulation in the breast, placing new mothers at greater risk of a delay in the establishment of a full milk supply." (...)

(Anm: Serotonin Transport and Metabolism in the Mammary Gland Modulates Secretory Activation and Involution. Journal of Clinical Endocrinology & Metabolism 2009 (December 4).)

- Antidepressiva linket til hjertedød

'Lykkepiller' kan give hjertestop
videnskab.dk 24.11.2011
Det populære antidepressive middel Cipramil kan ifølge et nyt studie få hjertet til at slå ude af takt, så det i sjældne tilfælde går i stå. Lægemiddelstyrelsen ændrer nu sine anbefalinger til brugen af 'lykkepillerne'.

(Redaktionel note, 24. november 2011: Nyheden om det amerikanske studie har hurtigt fået mange patienter til at blive bekymrede for, om de skal holde op med at tage deres medicin. Lægemiddelstyrelsen beder i den forbindelse om, at man ikke ringer til styrelsen, men taler med sin egen læge, hvis man er usikker på sin medicin. Lægemiddelstyrelsen understreger samtidig, at det er sundhedsfarligt at holde op med at tage sin medicin uden lægens anbefaling.)

Et nyt amerikansk studie har for nylig afsløret en hidtil ukendt potentiel farlig bivirkning ved Cipramil, som mange depressive danskere for øjeblikket bliver behandlet med. Omkring 178.000 danskere er i behandling med Cipramil og kopiudgaverne af dette lægemiddel, der alle rummer det virksomme stof Citalopram. (...)

Det kan undre, hvorfor man ikke fra begyndelsen undersøgte, om lægemidlet havde denne effekt, men Lundbecks pressechef Mads Kronborg fortæller, at man ikke tidligere har været opmærksom på mekanismen, da indrapporteringerne fra læger og patienter i årenes løb ikke viser nogen tegn på, at der skulle være en forhøjet risiko. (...)

Dansk Psykiatrisk Selskab og Dansk Kardiologisk Selskab har netop behandlet dette spørgsmål og andre problemer med medicinen i en fælles rapport. (...)

Antidepressants linked to cardiac death (Antidepressiva linket til hjertedød)
hospitalpharmacyeurope.com 16.11.2011
People taking anti-psychotic drugs and anti-depressant drugs have a much higher risk of dying during an acute coronary event of a fatal arrhythmia than the rest of the population, according to research published in the European Heart Journal.

The study showed that the combined use of both antipsychotic and antidepressant drugs was associated with an even greater risk of sudden cardiac death (SCD) during a coronary event. (...)

(Anm: Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey. Eur Heart J (2011) 32 (4): 437-442 (November 30).)

Høye doser citalopram kan gi hjertebivirkninger
legemiddelverket.no 8.11.2011
Det er påvist sammenheng mellom høye doser citalopram og hjertebivirkninger. Ny maksimaldose for citalopram er 40 mg.

Citalopram brukes for å behandle depresjoner, panikkangst og tvangslidelse. En gjennomgang av studier og spontanrapporter viser er en sammenheng mellom bruk av høye doser citalopram og forlenget QT-intervall ved EKG. (...)

- Antidepressiva øker risiko for åreforkalkning, erektil dysfunksjon, hjertesykdom og hjerneslag

Erectile Dysfunction May Be Linked With Cardiovascular Trouble (Erektil dysfunksjon kan være linket til kardiovaskulære problemer)
health.yahoo.com 14.9.2011
WEDNESDAY, Sept. 14 (HealthDay News) -- Men who suffer from erectile dysfunction are at increased risk for cardiovascular disease, stroke and death, Chinese researchers suggest.
Although it is well accepted that cardiovascular disease is a risk factor for erectile dysfunction, it has not been clear whether erectile dysfunction is an independent risk factor for cardiovascular disease, the researchers noted.

"Erectile dysfunction significantly increased the risk of cardiovascular disease, and the increase was probably independent of conventional risk factors," said lead researcher Dr. Li-Qiang Qin, from the department of nutrition and food hygiene in the School of Public Health at Soochow University in Suzhou.

As such, "erectile dysfunction may not only contribute to cardiovascular risk prediction, but also serve as a potential target for cardiovascular disease prevention," Qin said.

The report was published in the Sept. 13 online edition of the Journal of the American College of Cardiology. (...)

(Anm: CLINICAL RESEARCH: CARDIOVASCULAR RISK. Erectile Dysfunction and Risk of Cardiovascular Disease. J Am Coll Cardiol, 2011; 58:1378-1385
(September 20).)

FDA Warns Against High-Dose Citalopram (FDA advarer mot høye doser av citalopram (Cipramil; Celexa))
medpagetoday.com 24.8.2011
Citing increased risk of cardiac arrhythmias and a lack of therapeutic benefit associated with high doses of the selective serotonin reuptake inhibitor (SSRI) citalopram hydrobromide (Celexa), the FDA has reduced the recommended maximum to 40 mg/day.

Previously, the agency had approved a 60-mg/day dose of the antidepressant for certain patients.

The new dosing instruction was prompted by postmarketing surveillance reports and a prospective trial linking the 60-mg dose to unacceptable QT interval prolongations and Torsade de Pointes.

The trial -- a randomized, placebo-controlled, crossover study in 119 adults -- examined citalopram's effects on QT intervals at doses of 20 mg and 60 mg, the FDA said. (...)

Kobler antidepressiva til åreforkalkning
dagensmedisin.no 4.4.2011
Brukere av antidepressiva har mer åreforkalkning og dermed økt risiko for hjertesykdom og hjerneslag sammenlignet med ikke-brukere.

Det fremkommer av en tvillingstudie blant 500 mannlige tvillinger med en gjennomsnittsalder på 55 år. Funnene ble lagt frem på den årlige kongressen til American College of Cardiology (ACC) denne uken.

Uavhengig av depresjon
Bruk av antidepressiva førte til 5 prosent økning i tykkelsen på carotis – den store halspulsåren. Selv om tidligere forskning har vist en sammenheng mellom depresjon og økt risiko for hjertesykdom, hadde depresjon i seg selv ingen effekt på åreforkalkning (aterosklerose), skriver Reuters Health.

– Dette styrker argumentet om at det trolig er antidepressiva og ikke depresjon i seg selv som kan forklare sammenhengen med hjertesykdom, uttaler kardiolog Amit Shah, som presenterte resultatene i New Orleans.

Lavere biologisk alder
Økningen i tykkelsen på halspulsåren på grunn av antidepressiva-bruk ble beregnet å utgjøre en forskjell i biologisk alder på fire år. Med andre ord hadde tvillingen som brukte antidepressiva arterier som var fire år eldre enn brorens årer. (...)

(Anm: åreforkalkning (aterosklerose); Arteriene er de blodårene som frakter blod fra hjertet til resten av kroppen. Når du er frisk, har arteriene en glatt innside og de er elastiske nok til å tilpasse seg store blodtrykksvariasjoner, slik at blodet passerer fritt gjennom blodåren. (...) Noen ganger oppstår fettavleiringer på innsiden av arteriene. Disse avleiringene starter ofte på steder der arterien deler seg, eller der karveggen er noe skadet. En slik fettavleiring kalles for aterom. Et plakk er en stor aterom-masse. (...) Utviklingen av et plakk starter med at kolesterol "graver" seg inn i veggen på blodåren. Kroppen forsøker å reparere denne skaden, det dannes arrvev som gjør karveggen tykkere og stivere og blodåren smalere. Ettersom mer kolesterol avleires, blir karveggene tykkere og blodstrømmen inne i karet går saktere. Dette betegnes i medisinsk terminologi for aterosklerose (åreforkalkning) og er blant annet årsaken til trange arterier i hjertemuskelen, det vil si koronar hjertesykdom og hjerteinfarkt. (...) (nhi.no 16.9.2009)

(Anm: Forkalkning i halskar (carotisstenose); Hva er forkalkning i halskar? Forkalkning i halskar (carotisstenose) er en forholdsvis vanlig tilstand hos eldre mennesker. Sykdommen oppstår når kalkavleiringer fester seg i veggen på halskarene og gjør dem trangere. Carotisstenose oppstår først og fremst hos eldre mennesker. Ca 10% av alle 80-åringer har tilstanden. De fleste har ingen plager eller symptomer, og vi kaller dette asymptomatisk carotisstenose. En sjelden gang kan små biter fra forkalkningen løsne og følge blodstrømmen til hjernen. Dette vil kunne forårsake små drypp eller hjerneslag. Dette kalles symptomgivende carotisstenose. Tilstanden forekommer vanligst hos personer som også har forkalkninger i blodkar andre steder i kroppen. Det er beregnet at ca. 20% av alle hjerneinfarkter - den vanligste typen hjerneslag - er forårsaket av blodpropp fra a. carotis. (nhi.no 12.11.2010).)

Antidepressants linked to heart risk: twins study (Antidepressiva linket til hjerterisiko: tvillingstudie)
reuters.com 2.4.2011
(Reuters) - Middle-age men who use antidepressants are more likely to have a narrowing of blood vessels, increasing the risk of heart attacks and strokes, than those who do not use the medications, according to a study presented on Saturday.

A study of twins found evidence of atherosclerosis, as measured by the interior thickness of the carotid artery, regardless of the type of antidepressant taken.

Antidepressant use was found to cause a 37 micron increase in carotid artery thickness, or roughly 5 percent, according to the study of more than 500 male twins with a mean age of 55 which was presented at the American Cardiology scientific meeting in New Orleans.

In 59 sets of twins in which one brother was taking an antidepressant and the other was not, the brother taking the medication had on average a 41 micron thicker inner lining of the artery, the research found.

As each year of life has been associated with a 10 micron increase in carotid artery thickening, the brother taking the antidepressant had arteries that were essentially four years older than those of his non-medicated twin. (...)

Association of Cerebrovascular Events With Antidepressant Use: A Case-Crossover Study (Forbindelser mellom cerebrovaskulære hendelser (f.eks. hjerneslagslag, TIA "drypp") og bruk av antidepressiva, en kasus kontrollstudie (case-control study))
Am J Psychiatry 2011 (Published March 15) (American Psychiatric Association)
OBJECTIVE: The authors sought to assess the risk of cerebrovascular events associated with use of antidepressant medications.

RESULTS: The adjusted odds ratio of stroke risk with antidepressant exposure was 1.48 (95% confidence interval=1.37–1.59) using 14-day time windows. Stroke risk was negatively associated with the number of antidepressant prescriptions reported. Use of antidepressants with high inhibition of the serotonin transporter was associated with a greater risk of stroke than use of other types of antidepressants.

KONKLUSJONER: Disse resultater tyder på at antidepressiva kan være assosiert med en øket risiko for hjerneslag. Imidlertid er de underliggende mekanismer uklare. (...) (CONCLUSIONS: These findings suggest that antidepressant use may be associated with an increased risk of stroke. However, the underlying mechanisms remain unclear.)

(Anm: TIA - "drypp" (...) Plutselig mister du noe av følelsen i høyre arm og ben. Du må støtte deg mot et tre for ikke å falle. (nhi.no).)

(Anm: Hjerneslag (apopleksi) er plutselig innsettende tap av kroppsfunksjoner på grunn av forstyrrelser i hjernens blodsirkulasjon. Hjerneblødning er årsak i 10-15% av tilfellene, mens blodpropp i blodårer i hjernen (trombose) er årsaken i 80-85% av tilfellene. Går symptomene tilbake i løpet av 24 timer, kaller vi det transitorisk iskemisk atakk, TIA - på norsk brukes betegnelsen "drypp". De fleste TIA varer i under en time. (nhi.no).)

(Anm: apopleksi, apoplexia cerebri, hjerneslag, akutte fokale nevrologiske symptomer og utfall som varer i mer enn 24 timer og som skyldes skade av hjernevev enten på grunn av regionalt redusert blodsirkulasjon (hjerneinfarkt) eller på grunn av hjerneblødning. Kilde: Store norske leksikon.)

Antidepressants May Raise Risk for Cardiovascular Disease (Antidepressiva kan øke risiko for kardiovaskulær sykdom ( hjerte- og karsykdomsykdom))
depression.about.com 5.4.2011
New research suggests that antidepressants may raise the risk for cardiovascular disease.

In a study involving more than 500 middle-aged male twins, researchers found that those twins who took antidepressants of any type were more likely to have a thickening of the inner linings of the arteries in the neck than their twin brothers who didn't. This type of thickening has been previously found to be associated with heart attack and stroke.

"There is a clear association between increased intima-media [inner arterial lining] thickness and taking an antidepressant, and this trend is even stronger when we look at people who are on these medications and are more depressed," said lead investigator Dr. Amit Shah, a cardiology fellow at Emory University in Atlanta, in a written statement issued by the American College of Cardiology. "Because we didn't see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that it is more likely the antidepressants than the actual depression that could be behind the association."

Dr. Shah noted that the link between heart health and antidepressants is not well-understood, but it could be that the chemical messengers that are affected by antidepressant use, such as serotonin and norepinephrine, might cause constriction of blood vessels, leading to increased blood pressure, a known risk factor for hardening of the arteries. (...)

Pfizer, Lilly Antidepressants Linked to Narrowed Arteries in Older Men (Pfizer-, Lilly-antidepressiva linket til innsnevring av arteriene (aterosklerose; åreforkalkning) hos eldre menn)
Bloomberg.com 2.4.2011
Antidepressants may narrow the arteries of middle-aged men, potentially putting them at risk for heart attacks and stroke, researchers said.

A study involving 513 male twins, with an average age of 55, found those who took medications like Forest Laboratories Inc. (FRX)’s Lexapro, Eli Lilly & Co. (LLY)’s Cymbalta or Pfizer Inc. (PFE)’s Zoloft had thicker blood vessel walls. The increase, a measure of fatty-plaque buildup linked to atherosclerosis, was seen regardless of what type of antidepressant the men were taking.

Arteries naturally thicken with age, and each 10-micron increase is linked to a 1.8 percent higher risk of heart attack and stroke. Men taking antidepressants had a 41-micron thicker lining than their twin brothers who weren’t on medication, making their arteries appear about four years older. The difference was greatest in men who were depressed while taking the drugs, according to the study presented today at the American College of Cardiology meeting in New Orleans.

“Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that it is more likely the antidepressants than the actual depression that could be behind the association,” said lead researcher Amit Shah, a cardiology fellow at Emory University in Atlanta, in a statement.

The U.S. National Institutes of Health funded the study.

Antidepressants increase levels of brain chemicals including serotonin and norepinephrine, which may cause blood vessels to constrict, Shah said. The narrower opening may limit blood flow and boost hypertension, triggering atherosclerosis and heart disease, he said. Additional studies are needed to confirm whether the medications, the condition or other factors are responsible for the changes, he said. (...)

TIA Doubles Risk for Later Heart Attack (TIA dobler risiko for hjerteinfarkt)
medpagetoday.com 24.3.2011
The occurrence of a transient ischemic attack (TIA) doubles a person's risk for a subsequent myocardial infarction, a population-based study found.

The relative risk for myocardial infarction (MI) among a cohort of patients who had experienced a prior TIA was 2.09 (95% CI 1.52 to 2.81), according to Robert D. Brown Jr., MD, and colleagues from the Mayo Clinic in Rochester, Minn.

The risk was highest for patients whose TIA occurred before age 60 (RR 15.1, 95% CI 4.11 to 38.6), the researchers reported online in Stroke: Journal of the American Heart Association. (...)

Tricyclics Increase CVD Risk (Trisykliske øker risiko for hjerte-kar-sykdom (CVD; Cardiovascular Disease))
medpagetoday.com 30.11.2010
(...) In a prospective cohort study that included 14,784 adults, those using tricyclics had a 35% increased cardiovascular risk after adjustment for potential confounders including symptoms of depression and anxiety, which are known risk factors for cardiovascular disease (HR 1.35, 95% CI 1.03 to 1.77). (...)

Some previous studies have suggested that any association between the use of antidepressants and risk of cardiovascular disease can be attributed to depression, not the drugs.

Hamer and colleagues disagreed. (...)

Further analysis showed that both tricyclic and SSRI users had a higher risk of stroke in age- and sex-adjusted models:

• Tricyclics, HR 2.23 (95% CI 0.85 to 6.39)
• SSRIs, HR 3.32 (95% CI 1.20 to 9.18)

But the researchers cautioned that the findings on risk of stroke should be interpreted with caution.

They pointed out that there were only 78 events and the association with SSRIs was weakened after multivariate adjustment (HR 2.46, 95% CI 0.87 to 6.96). (...)

(Anm: Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey. Eur Heart J 2010 (First published online: November 30, 2010.)

Antidepressants May Raise Women's Stroke Risk (Antidepressiva kan øke kvinners risiko for hjerneslag)
minorityhealth.hhs.gov 14.12.2009
(…) It found that women on selective serotonin uptake inhibitors (SSRIs, which include Celexa, Paxil, Prozac and Zoloft) had a 45 percent increase in risk for stroke and a 32 percent increase in risk for death from any cause, compared to non-users. Similar results were found for women on tricyclic antidepressants. (…)

- Pfizers Zyvoxid (Zyvox) og antidepressiva kan være en dødelig kombinasjon

Zyvox (linezolid): Drug Safety Communication - Serious CNS Reactions Possible When Given to Patients Taking Certain Psychiatric Medications
fda.gov 21.10.2011
(...) ISSUE: FDA has received reports of serious central nervous system (CNS) reactions when the antibacterial drug linezolid (Zyvox) is given to patients taking psychiatric medications that work through the serotonin system of the brain (serotonergic psychiatric medications. A list of the serotonergic psychiatric medications that can interact with linezolid can be found in the Drug Safety Communication. Safety information about this potential drug interaction and important drug usage recommendations for emergency and non-emergency situations are being added to the drug labels for serotonergic psychiatric medications and linezolid.

BACKGROUND: Linezolid is used to treat infections, including pneumonia, infections of the skin, and infections caused by a resistant bacterium (Enterococcus faecium). It is a reversible monoamine oxidase inhibitor (MAOI). Although the exact mechanism of this drug interaction is unknown, linezolid inhibits the action of monoamine oxidase A — an enzyme responsible for breaking down serotonin in the brain. It is believed that when linezolid is given to patients taking serotonergic psychiatric medications, high levels of serotonin can build up in the brain, causing toxicity. This is referred to as Serotonin Syndrome — signs and symptoms include mental changes (confusion, hyperactivity, memory problems), muscle twitching, excessive sweating, shivering or shaking, diarrhea, trouble with coordination and/or fever.

A separate Drug Safety Communication (DSC) is being released today for methylene blue due to similar potential drug interactions with serotonergic psychiatric medications and includes drug usage recommendations. (...)

FDA Warns About Nervous System Reactions from Zyvox, Methylene Blue (FDA advarer om reaksjoner i nervesystemet fra Zyvoxid (Zyvox), Methylene Blue)
aboutlawsuits.com 27.7.2011
Federal drug regulators are warning that there is a risk of serious central nervous system reactions when the drugs Zyvox and methylene blue are used with some antidepressants, including Paxil, Zoloft, Prozac and Cymbalta, among many others.

The FDA issued a drug safety communications for methylene blue and Zyvox on Tuesday, indicating that the agency analyzed adverse event reports that included reports of central nervous system (CNS) toxicity and some deaths. The reactions were due to drug interactions between the two drugs and psychiatric medications that affect the serotonin system of the brain, according to the FDA warning.

Methylene blue and Zyvox are both reversible monoamine oxidase inhibitors (MAOI). Methylene blue is used to treat cyanide poisoning, methemoglobinemia, vasoplegic syndrome and ifosfamide-induced encephalopathy. It is also used as a dye in therapeutic and diagnostic applications. Zyvox (linezolid) is used to treat infections, including pneumonia, skin infections and methicillin-resistant Staphylococcus aureus (MRSA).

The FDA warning includes a full list of serotonergic psychiatric medications that could react with the drugs. The list includes selective serotonin reuptake inhibitors (SSRIs), which are the most common psychiatric drugs on the market, as well as tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs) and other MAOIs and psychiatric drugs. The list includes some of the most prescribed drugs in the world, such as Paxil, Prozac, Zoloft, Celexa, Lexapro, Effexor, Cymbalta, Wellbutrin and Zyban.

Why the interaction between the drugs causes CNS toxicity is unknown, but the FDA states that some experts believe that the Zyvox and methylene blue cause high levels of serotonin to build up in the brain when used with the serotonergic drugs, resulting in toxicity. This is known as serotonin syndrome and can cause confusion, hyperactivity, memory loss, muscle twitching, excessive sweating, shivering and shaking, diarrhea, fever and trouble with coordination.

The agency is recommending that patients prescribed methylene blue and Zyvox should be taken off of any of the listed antidepressants two weeks prior. However, in some cases the drugs are given as an emergency treatment. In those instances, doctors should attempt to find an alternative method of treatment, the FDA recommended.

The antidepressants can be resumed 24 hours after the last dose of methylene blue and Zyvox, the FDA stated.

(Anm: linezolid (antibiotika; Zyvox i USA); Zyvoxid (in Europe), and Zyvoxam (in Canada and Mexico). Generics are also available in India, such as Linospan (Cipla). (en.wikipedia.org).)

(Anm: Serotonin syndrom (SS), kramper, parkinsonisme osv. (forhøyet kroppstemperatur) (mintankesmie.no).)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

Pfizer's Zyvox and Antidepressants May Be Fatal Combination (Pfizers Zyvoxid (Zyvox) og antidepressiva kan være en dødelig kombinasjon)
sfgate.com 26.7.2011
July 26 (Bloomberg) -- Pfizer Inc.'s Zyvox antibiotic can cause potentially fatal central nervous system reactions in patients who also take antidepressants that increase levels of the brain chemical serotonin, U.S. regulators said.

Pfizer's Zoloft and Pristiq, Eli Lilly & Co.'s Cymbalta and GlaxoSmithKline Plc's Paxil and Wellbutrin are among 29 psychiatric drugs that patients may need to stop taking temporarily when they require treatment with Zyvox, the Food and Drug Administration said today in a drug safety communication.

Zyvox, used to treat some types of drug-resistant bacteria including MSRA or methicillin-related Staphylococcus aureus, skin infections and nosocomial pneumonia, can interact with the antidepressants to cause a toxic reaction known as serotonin syndrome in which excess amounts of the chemical build up in the brain, according to the FDA.

Some deaths among patients who suffered such a reaction were reported to the FDA's adverse-event database, the agency said. Pfizer, based in New York, reported $1.18 billion in revenue from Zyvox last year. (...)

(Anm: linezolid (antibiotika; Zyvox i USA); Zyvoxid (in Europe), and Zyvoxam (in Canada and Mexico). Generics are also available in India, such as Linospan (Cipla). (en.wikipedia.org).)

FDA Warns of Serious Drug Interactions in Patients Taking Psychiatric Drugs (FDA advarer mot alvorlige interaksjoner hos pasienter som tar psykiatriske legemidler)
JAMA 2011 (July 27)
Patients taking certain psychiatric drugs may experience serious neurological problems if they are given the antibacterial medication linezolid (sold under the brand name Zyvox) or methylene blue, a drug that is also used as a dye in some diagnostic procedures and for certain other uses, such as treating cyanide poisoning, according to a pair of warnings issued yesterday by the US Food and Drug Administration (FDA).

The warning applies to psychiatric drugs that affect the brain’s serotonin system and includes those used to treat depression such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, and certain other psychiatric drugs. A full list of these drugs is available on the FDA’s Web site. (...)

(Anm: linezolid (antibiotika; Zyvox i USA); Zyvoxid (in Europe), and Zyvoxam (in Canada and Mexico). Generics are also available in India, such as Linospan (Cipla). (en.wikipedia.org).)

FDA: Avoid Methylene Blue or Linezolid With Serotonergics
medscape.com 26.7.2011
July 26, 2011 — Physicians generally should avoid prescribing either methylene blue or linezolid (Zyvox,Pfizer) in combination with serotonergic agents such as paroxetine or duloxetine to avoid a potential drug interaction causing a dangerous condition called serotonin syndrome, the US Food and Drug Administration (FDA) announced today.

Linezolid is an antibacterial agent, and methylene blue is a dye used in diagnostic procedures and in the treatment of conditions ranging from methemoglobinemia to cyanide poisoning.

Through its Adverse Event Reporting System (AERS) database, the FDA has learned of serious central nervous system reactions when either drug has been given to patients taking other drugs that work through the serotonin system of the brain. (...)

Zyvox (linezolid): Drug Safety Communication - Serious CNS Reactions Possible When Given to Patients Taking Certain Psychiatric Medications (Zyvox (linezolid): Sikkerhetskommunikasjon legemidler - Alvorlige CNS-reaksjoner mulig når det gis pasienter som inntar visse psykiatriske legemidler)
fda.gov 26.7.2011
ISSUE: FDA has received reports of serious central nervous system (CNS) reactions when the antibacterial drug linezolid (Zyvox) is given to patients taking psychiatric medications that work through the serotonin system of the brain (serotonergic psychiatric medications. A list of the serotonergic psychiatric medications that can interact with linezolid can be found in the Drug Safety Communication. Safety information about this potential drug interaction and important drug usage recommendations for emergency and non-emergency situations are being added to the drug labels for serotonergic psychiatric medications and linezolid. (...)

RECOMMENDATION: Linezolid should generally not be given to patients taking serotonergic drugs. However, there are some conditions that may be life-threatening or require urgent treatment with linezolid such as when:

• Linezolid is used to treat vancomycin-resistant Enterococcus faecium (VRE) infections.
• Linezolid is used to treat infections such as nosocomial pneumonia and complicated skin and skin structure infections, including cases caused by methicillin-resistant Staphylococcus aureus (MRSA).

Patients should not stop taking their serotonergic psychiatric medicine without first talking to a healthcare professional. Read the Drug Safety Communication for other specific recommendations for Healthcare Professionals and for Patients. (...)

(Anm: linezolid (antibiotika; Zyvox i USA); Zyvoxid (in Europe), and Zyvoxam (in Canada and Mexico). Generics are also available in India, such as Linospan (Cipla). (en.wikipedia.org).)

Methylene Blue: Drug Safety Communication - Serious CNS Reactions Possible When Given to Patients Taking Certain Psychiatric Medications
fda.gov 26.7.2011
ISSUE: FDA has received reports of serious central nervous system (CNS) reactions when the drug methylene blue is given to patients taking psychiatric medications that work through the serotonin system of the brain (serotonergic psychiatric medications). A list of the serotonergic psychiatric medications that can interact with methylene blue can be found in the Drug Safety Communication. Safety information about this potential drug interaction and important drug usage recommendations for emergency and non-emergency situations are being added to the drug labels for serotonergic psychiatric medications. (...)

RECOMMENDATION: Methylene blue should generally not be given to patients taking serotonergic drugs. However, there are some conditions that may be life-threatening or require urgent treatment with methylene blue such as when it is used in the emergency treatment of methemoglobinemia, ifosfamide-induced encephalopathy, or cyanide poisoning.

Patients should not stop taking their serotonergic psychiatric medicine without first talking to a healthcare professional. Read the Drug Safety Communication below for other specific recommendations for Healthcare Professionals and for Patients. (...)

- Bruk av antidepressiva under svangerskapet linket til høyere risiko for autisme

Antidepressants in Pregnancy and Autism: A Possible Link (Antidepressiva i svangerskapet og autisme: En mulig link)
boston.com 13.11.2011
Studies abound that aim to answer both the question "What causes autism?" and "What is the reason for the increase in incidence and prevalence of autism?" A study published in the November issue of the Archives of General Psychiatry, Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders caught my attention. As both the prevalence of autism and the use of SSRI's (selective serotonin reuptake inhibitors) have increased dramatically in recent years, and SSRI's are powerful medications that act on the brain, the findings do seem plausible. (...)

In this population based study done at the Kaiser Permanente Medical Care Program in Northern California, the researchers found

a 2-fold increased risk of ASD (autism spectrum disorder) associated with treatment with selective serotonin reuptake inhibitors by the mother during the year before delivery, with the strongest effect associated with treatment during the first trimester.

They found that there was no increase in risk for ASD if a mother had been treated for mental health problems but did not receive SSRI's. This finding attempts to answer the question of whether it is the depression or the drug that is associated with ASD. Their findings suggest that it is the drug. (...)

Can an increased risk of autism be linked to Paxil? (Kan en øket risiko for autisme linkes til Seroxat (paroxetine)?)
central-pennsylvania.injuryboard.com 15.3.2012
Late last year, a study was published in the Archives of General Psychiatry that suggests a possible link between autism spectrum disorders (ASDs) and maternal use of antidepressant medications during pregnancy. The study—although inconclusive as to a causal link between the two—has gotten quite a bit of attention for the advances it makes in furthering our understanding of what causes ASDs.

The study was aimed at determining whether prenatal exposure to antidepressant medications can be associated with an increased risk of ASD. It was a relatively small study, involving only about 300 children with ASD and 1500 randomly selected children without ASD. The authors concluded that the results suggest that exposure to SSRIs—especially during the first trimester—may “modestly increase the risk of ASD.” The researchers also underscored the need for further studies on this issue, particularly given this study’s small size. (...)

Antidepressant Use During Pregnancy Linked to Higher Risk of Autism (Bruk av antidepressiva under svangerskapet linket til høyere risiko for autisme)
healthland.time.com 5.7.2011 (Time)
Children whose mothers use antidepressants during pregnancy may be more likely to develop autism than kids whose mothers do not, say researchers in California.

In a study involving data on more than 1,800 children — fewer than 300 of whom had an autism spectrum disorder (ASD) — and their mothers, the scientists found that women who were prescribed drugs to treat depression in the year before giving birth were twice as likely to have children with an ASD, compared with women who did not take antidepressants. The risk was even greater for women who were prescribed the drugs in the first trimester: their children were nearly four times more likely to develop autism or a related disorder.

The study focused on one type of antidepressant, selective serotonin reuptake inhibitors (SSRIs), a class of drug that includes fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). These antidepressants work by increasing available levels of the neurotransmitter serotonin surrounding nerve cells in the brain, which helps boost mood. (...)

Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders (Bruk av antidepressiva under svangerskapet og autisme)
Arch Gen Psychiatry 2011 (Published online July 4)
(...) Results Prenatal exposure to antidepressant medications was reported for 20 case children (6.7%) and 50 control children (3.3%). In adjusted logistic regression models, we found a 2-fold increased risk of ASD associated with treatment with selective serotonin reuptake inhibitors by the mother during the year before delivery (adjusted odds ratio, 2.2 [95% confidence interval, 1.2-4.3]), with the strongest effect associated with treatment during the first trimester (adjusted odds ratio, 3.8 [95% confidence interval, 1.8-7.8]). No increase in risk was found for mothers with a history of mental health treatment in the absence of prenatal exposure to selective serotonin reuptake inhibitors.

Conclusion Although the number of children exposed prenatally to selective serotonin reuptake inhibitors in this population was low, results suggest that exposure, especially during the first trimester, may modestly increase the risk of ASD. The potential risk associated with exposure must be balanced with the risk to the mother or fetus of untreated mental health disorders. Further studies are needed to replicate and extend these findings. (...)

SSRI's And Environment Strong Autism Contributing Factors Over Genes
Editor's Choice
medicalnewstoday.com 5.7.2011
New research this week points to a link between the use of selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, and the occurrence of autism in unborn kids. Another study found that among twins, the environment plays a bigger role in the development of autism than genetics which is a game changer considering past investigation into autism cause factors.

Over the past 30 years, the number of children with autism has increased from about 4 in 10,000 to about 40 in 10,000.

First off, research led by Kaiser Permanente Northern California reviewed the medical records of more than 1,600 children, 298 of whom had autism spectrum disorders (ASDs). They found that the risk of having a child with autism spectrum disorder was about twice as high among women who took SSRIs in the year before delivery. That risk was even four times higher in women who took SSRIs during their first trimester. SSRIs include such well-known brands as Prozac, Zoloft, Paxil and Celexa. (...)

Data Confirm Trend of Sharp Rise in ASD Cases (Data bekrefter trend med sterk økning av autismetilfeller)
Psychiatr News 2011;46(14):20 (July 15) (American Psychiatric Association)
Among 388,644 children born in one state from 2001 to 2005, more than 3,000 were enrolled in an early-intervention program for autism spectrum disorders by age 3, and in that period, the numbers rose steeply.

In a reflection of national trends, a recent study of children in Massachusetts reports that diagnoses of autism spectrum disorders (ASDs) are increasing, particularly among boys. The study was published online May 16 in Pediatrics. (...)

They discovered that 1 of every 129 children born in Massachusetts in that five-year period was enrolled in an early intervention for an ASD by age 36 months. Early ASD diagnoses increased linearly from 1 in 178 for the 2001 birth cohort to 1 in 108 for the 2005 birth cohort, an increase of 66 percent. (...)

Serotonin and the Autisms (Serotonin og autisme)
Arch Gen Psychiatry 2011 (Published online July 5)
A Red Flag or a Red Herring?

The struggles to provide mechanistic insight regarding the causes of the autisms (autism spectrum disorder [ASD]) continue as the data mount from the newest population-based studies finding that ASD diagnoses affect 1% to 2% of the population.^1-2 Twin and sibling studies support the highly heritable nature of ASD risk, and at-risk younger siblings may have a recurrence risk of 15% to 20%. The newest estimates concur that rare mutations and copy number variants may account for up to 20% of cases.³ What about the other 80%? The genomecentric emphases have resulted in an opacity regarding the idea that through enhanced risk and/or endophenotype modulation, environmental factors are likely to interact with genetic components to participate at some important level in ASD etiology. Yet, the generation of convincing evidence of specific environmental factors remains a struggle, with the few exceptions of medication (eg, valproate sodium) or prenatal infection. Co-occurrence does not impart guilt, so the many candidates identified based on increases of exposures to a variety of agents that parallel an increase in ASD prevalence remain unsubstantiated. The problem is that even benign environmental elements can affect brain development in experimental systems because the building of well-functioning brain architecture is exquisitely sensitive to both genetic and environmental regulation. So, the field is left with basic findings that implicate a variety of genetic and epigenetic factors, together with associated small to modest increases in odds ratios for ASD due to a lengthening list of investigated environmental factors. (...)

Perhaps it is a coincidence that the odds ratio for ASD risk in the study by Croen and colleagues increases when first-trimester exposure to SSRIs is the sole factor. However, it is exactly that time of human brain development during which cortical and subcortical neuronal populations are being produced, migrating to their final destinations and beginning the long process of wiring. While much occurs later, the establishment of a strong foundation developmentally may be an essential component of healthy brain development. Croen and colleagues note more than once in their article that the study should not be taken as carte blanche for withholding SSRI treatment from pregnant mothers who are suffering the stress of depression and related disorders. Altered neurochemistry and stress response systems during pregnancy may affect the fetus as well. New basic neurobiology studies that focus on the importance of 5-HT in brain development and further advances in analyzing prospectively collected clinical data and outcomes will lead to a sound evidence-based approach to the clinical management of individuals who are suffering during a period that should be among the most joyous in their life. (...)

Is Autism, at Least in Part, a Disorder of Fetal Programming?
Arch Gen Psychiatry 2011 (Published online July 5)
The year 1977 marked an important milestone in the history of autism. In this year, the first twin study in autism was published by Folstein and Rutter¹; it demonstrated a striking difference in concordance rates between monozygous (MZ) and dyzgyous (DZ) twins. The studies that followed reported even higher MZ concordance rates, up to 90%, for a broader phenotype resembling what is currently labeled as autism spectrum disorder (ASD)^2-4 and DZ concordance rates at or close to 0%. This resulted in heritability estimates greater than 90%, suggesting that almost all of the variance in phenotypic expression could be attributed to inherited genetic factors.

There was an important need to revisit those early heritability estimates given that there have been significant improvements in the diagnosis of ASD and that the prevalence rates on which the original models were based are now much greater. In addition, the fact that the concordance for DZ twins was so close to 0% has always been a puzzling finding largely ascribed to the imprecision of the estimates. Family studies of nontwin siblings have suggested that the recurrence risk is closer to 5%, or even 10%, once stoppage rules are taken into account.⁵ Even so, based on these twin studies, ASD was often described as the most heritable of psychiatric disorders. It must be admitted, though, that the field has been frustrated by the difficulty in identifying the specific inherited genetic mechanisms for the etiology of ASD. Even the recent genome-wide association studies have not given us any smoking guns, and the top hits have been difficult to replicate. (...)

- Økt dødsrisiko dødsrisiko for psykotrope legemidler

Concern over elderly antidepresssant use (Bekymringer over eldres bruk av antidepressiva)
irishhealth.com 3.8.2011
The prescribing of antidepressants to older people needs to be carefully considered, as newer antidepressants may not be as safe for this population as previously thought, a new study suggests.

According to recent research, depression remains a significant public health problem across all parts of the world, affecting 121 million people, including up to 400,000 people in Ireland.

The condition is common among older people due to a number of specific risk factors, such as changes in roles and/or lifestyle, illness and hormonal changes triggered by the menopause.

UK researchers noted that there is very little known about the safety of new generation antidepressants in older people. These drugs are known as SSRIs (selective serotonin reuptake inhibitors) and include Seroxat and Prozac. (...)

The participants were monitored until the end of 2008. During that time, almost nine in 10 received at least one prescription for an antidepressant. Just over half of these prescriptions were for SSRIs, while one in three were for older antidepressants, known as tricyclic antidepressants (TCAs). The rest were prescribed other types of antidepressants.

The study then looked at the link between antidepressant use and a number of adverse outcomes, such as heart attack, stroke, attempted suicide, attempted self-harm, falls, fractures and epilepsy.

After taking into account other factors which may have influenced the results, the study found that SSRIs increased the risk of a number of adverse outcomes compared to TCAs.

This increased risk was also found among people who took other types of antidepressants.

Overall, SSRIs appeared to increase the risk of all-cause mortality, stroke, epilepsy or seizures, falls, fractures and hyponatraemia (high salt levels in the blood) when compared with TCAs.

Meanwhile the other antidepressants appeared to increase the risk of all-cause mortality, stroke, epilepsy or seizures, attempted suicide or self harm and fractures.

The researchers found that depressed people who were not taking any antidepressants had a 7% risk of dying during the next year. This risk rose to just over 8% for those taking TCAs. However, for those taking SSRIs, the risk increased to almost 11%, while those on other antidepressants had the greatest risk of dying during the following year, at just over 11%.

In terms of suffering an adverse outcome, the most risky time appeared to be during the first 28 days of antidepressant use, as well as the first 28 days after stopping the medication. (...)

Some Psychotropics Risky in Older Patients (Noen psykotrope legemidler utgjør en risiko for eldre pasienter)
medpagetoday.com 28.3.2011
Psychotropic drugs are often used to control behavioral symptoms in nursing-home residents, but data on almost 11,000 older patients found a significantly increased risk of death and other adverse outcomes in those treated with conventional antipsychotic drugs, antidepressants, and benzodiazepines, compared with atypical antipsychotic drugs.

Treatment with conventional antipsychotics increased the relative risk of death by 47% and femur fractures by 61%, reported Krista F. Huybrechts, PhD, of Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues.

Benzodiazepines were associated with a 54% increased risk of heart failure, while antidepressant users had a 20% to 30% increased risk of death and femur fracture, Huybrechts and co-authors wrote online in CMAJ. (...)

(Anm: Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes. CMAJ 2011 (Published online ahead of print March 28).)

Antidepressant Use and Risk of Incident Cardiovascular Morbidity and Mortality Among Postmenopausal Women in the Women's Health Initiative Study
Arch Intern Med. 2009;169(22):2128-2139 (Dec 14/28)
(...) Background Antidepressants are commonly prescribed medications, but their effect on cardiovascular morbidity and mortality remains unclear. (...)

Conclusions In postmenopausal women, there were no significant differences between SSRI and TCA use in risk of CHD, stroke, or mortality. Antidepressants were not associated with risk of CHD. Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality, and SSRIs with increased risk of hemorrhagic and fatal stroke, although absolute event risks are low. These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression. (...)

Antidepressants May Raise Risk for Cardiovascular Disease (Antidepressiva kan øke risiko for kardiovaskulær sykdom ( hjerte- og karsykdomsykdom))
depression.about.com 5.4.2011
New research suggests that antidepressants may raise the risk for cardiovascular disease.

In a study involving more than 500 middle-aged male twins, researchers found that those twins who took antidepressants of any type were more likely to have a thickening of the inner linings of the arteries in the neck than their twin brothers who didn't. This type of thickening has been previously found to be associated with heart attack and stroke.

"There is a clear association between increased intima-media [inner arterial lining] thickness and taking an antidepressant, and this trend is even stronger when we look at people who are on these medications and are more depressed," said lead investigator Dr. Amit Shah, a cardiology fellow at Emory University in Atlanta, in a written statement issued by the American College of Cardiology. "Because we didn't see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that it is more likely the antidepressants than the actual depression that could be behind the association."

Dr. Shah noted that the link between heart health and antidepressants is not well-understood, but it could be that the chemical messengers that are affected by antidepressant use, such as serotonin and norepinephrine, might cause constriction of blood vessels, leading to increased blood pressure, a known risk factor for hardening of the arteries. (...)

Antidepressants May Raise Women's Stroke Risk (Antidepressiva kan øke kvinners risiko for hjerneslag)
minorityhealth.hhs.gov 14.12.2009
(…) It found that women on selective serotonin uptake inhibitors (SSRIs, which include Celexa, Paxil, Prozac and Zoloft) had a 45 percent increase in risk for stroke and a 32 percent increase in risk for death from any cause, compared to non-users. Similar results were found for women on tricyclic antidepressants. (…)

Fosterskader

Antidepressiv medicin kan svække hjernens vækst hos fostre
dagenspharma.dk 13.3.2012
Hos gravide kvinder, der tager SSRI-præparater, vokser fostrenes hoveder langsommere, mens deres kroppe udviklede sig i et normalt tempo. (...)

Moms' Antidepressants May Affect Babies' Head Size: Study (Mors antidepressiva kan ifølge studie påvirke babyers hodestørrelse)
health.msn.com 5.3.2012
Pregnant women may want to try alternatives to treat depression, experts say

MONDAY, March 5 (HealthDay News) -- Pregnant women taking certain antidepressants may be more likely to deliver infants with reduced head growth, a new study suggests.

The researchers also found that although selective serotonin reuptake inhibitors (SSRIs) such as Paxil and Prozac relieved depression in these women, they appeared to be associated with a higher risk of preterm birth.

"Fetal body growth is a marker of fetal health and fetal head growth is a marker for brain development," said lead researcher Hanan El Marroun, a postdoctorate fellow in the department of child and adolescent psychiatry at Sophia Children's Hospital and Erasmus Medical Center in Rotterdam, the Netherlands. "We found prenatal exposure to SSRIs was associated with decreased growth of the head, but not decreased growth of the body."

In mothers with untreated depression, the babies had smaller growth in both the body and head, the investigators found.

"If the depression is untreated, it affected the whole body; but if the mother used SSRIs, the head growth of the fetus was affected," El Marroun noted. "This may mean that smaller head growth is not explained by depression, but by the SSRIs."

Dette tyder på at ubalanse i hjernens serotonin -- etn kjemikalie som hjelper hjernen å sende signaler fra et område til et annet -- ikke er bra for spedbarns hjerneutvikling, uttalte hun. SSRI-er er spesielt målrettet serotonin. (...) (This suggests that imbalance in the brain's serotonin -- a chemical that helps the brain send signals from one area to another -- is not good for infants' developing brains, she said. SSRIs specifically target serotonin.)

Antidepressants in pregnancy: weighing benefits and risks
news-medical.net 5.3.2012
(...) Most of the mothers (7,027, or 91.3%), who had few depressive symptoms and did not use SSRIs, formed the control group. Another 570 mothers (7.4%) had clinically relevant depressive symptoms but did not use SSRIs, while the remaining 99 mothers (1.3%) used SSRIs during pregnancy. Mean depression scores on the depression scale of the Brief Symptom Inventory were 0.10 in the control group, 1.45 in the women with depressive symptoms but no SSRIs, and 0.74 for the women taking SSRIs.

They found that the untreated, depressed women were more likely to have babies with reduced body growth, including reduced fetal head size, while depressed women taking SSRIs were more likely to have babies with reduced fetal head size but a normal fetal body growth. It's unclear how significant reduced fetal head growth is. It has been linked to later behavioral and psychiatric problems in other studies.

Fetal head growth is “one of the best prenatal markers of brain volume,” and reduced head growth has been linked to poor cognitive performance, behavioral problems, and psychiatric disorders later in life. “Nonetheless, we must be careful not to infer an association of SSRI use in pregnancy with future developmental problems. ... [M]ore long-term drug safety studies are needed before evidence-based recommendations can be derived,” the investigators noted. (...)

(Anm: SSRIs During Pregnancy Linked to Reduced Fetal Head Growth (Video) (insidermedicine.ca 5.3.2012).)

Maternal Use of Selective Serotonin Reuptake Inhibitors, Fetal Growth, and Risk of Adverse Birth Outcomes
Arch Gen Psychiatry. 2012 (Published online March 5)
(...) Context Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed to pregnant women, but knowledge about their unintended effects on child health is scarce. (...)

Conclusions Untreated maternal depression was associated with slower rates of fetal body and head growth. Pregnant mothers treated with SSRIs had fewer depressive symptoms and their fetuses had no delay in body growth but had delayed head growth and were at increased risk for preterm birth. Further research on the implications of these findings is needed. (...)

SSRI-antidepressiva til gravide øker risikoen for høyt blodtrykk i lungene hos barnet
fhi.no 13.1.2012
Kvinner som behandles med antidepressive legemidler av typen SSRI under siste del av graviditeten har en økt risiko for å føde barn med vedvarende høyt blodtrykk i lungene. Det viser en ny studie utført av forskere fra de fem nordiske landene. Fra Norge har forskere ved Folkehelseinstituttet deltatt.
Studien er en såkalt kohortstudie og har vært koordinert av Karolinska Institutet i Stockholm med aktivt bidrag fra forskere ved Folkehelseinstituttet i Oslo. Artikkelen publiseres i det vitenskapelige tidsskriftet British Medical Journal (BMJ). (...)

(Anm: Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries. BMJ 2012;344:d8012 (12 January).)

Nordisk studie bekräftar tidigare känt samband mellan SSRI-behandling och ökad risk för högt blodtryck i lungorna hos det nyfödda barnet
lakemedelsverket.se 13.1.2012
En ny nordisk studie omfattande 11 000 barn bekräftar tidigare studieresultat att behandling av kvinnor med depression med SSRI-läkemedel i senare delen av graviditeten kan leda till ökad risk att föda barn som drabbas av högt blodtryck i lungornas blodkärl. (...)

SSRI till gravid ökar risken för högt blodtryck i lungorna hos barnet
ki.se 13.1.2012
[PRESSMEDDELANDE 2012-01-13] Nyfödda barn till kvinnor som behandlas med antidepressiva SSRI-läkemedel under senare delen av graviditeten har en ökad risk att drabbas av kvarstående högt blodtryck i lungornas blodkärl, så kallad persisterande pulmonell hypertension. Det visar en ny samnordisk studie som letts från Karolinska Institutet och som publiceras i den vetenskapliga tidskriften British Medical Journal (BMJ). (...)

Mødre kræver depressionspille-erstatning
politiken.dk 23.12.2011
ANTIDEPRESSIVT. Præparatet Cipramil har været i søgelyset flere gange på grund af uheldige bivirkninger.

Sager om mødres brug af antidepressions-piller under graviditeten strømmer ind.

Nye sager i forbindelse med mødres brug af piller mod depression under graviditeten er det seneste år strømmet ind hos Patientforsikringen.

Alene i 2011 har Patientforsikringen fået syv nye sager om aborter, misdannelser, problemer i udviklingen og andre alvorlige symptomer. Det skriver Ekstra Bladet.

Sagerne er kommet ind efter avisens afsløringer af, at myndighederne har reageret alt for langsomt i forhold til at advare gravide om depresisonspiller, hvilket har fået kvinderne og deres familier til at søge forsikringen om kompensation for skader på deres børn. (...)

Nye alvorlige lykkepiller-sager: Baby uden kranium
ekstrabladet.dk 23.11.2011
Nye choktal fra Lægemiddelstyrelsen: Dødfødt baby, stribevis af aborter og foster uden kranium (...)

Før Ekstra Bladet i foråret satte fokus på sagen havde Styrelsen modtaget 51 indberetninger over en periode på over 10 år. Nu her fem måneder efter Ekstra Bladets første artikler har Lægemiddelstyrelsen pr. 28. september modtaget 35 nye indberetninger om alvorlige bivirkninger, så man i alt er oppe på 86.

Læs også: Gravide proppet med livsfarlige lykkepiller

- De nye tal bestyrker mistanken om, at antidepressiv medicin under graviditeten kan give alvorlige bivirkninger, siger Lektor Lise Aagaard fra Institut for Farmakologi og Farmakoterapi på Københavns Universitet

Bivirkninger kan ramme børn senere i livet
Hos Lægemiddelstyrelsen har man særligt fokus på de bivirkninger, der rammer børn senere i livet:

- Det som vi lægger ekstra mærke til, er rapporterne om forsinket psykomotorisk udvikling. Altså det, at børn flere år efter de har været eksponeret for den her medicin under graviditeten, måske udvikler sig unormalt.

- Det emne vil vi se nærmere på og blandt andet undersøge om andre lande har set det samme og tage kontakt til danske læger, der arbejder med disse patienter, siger overlæge Doris Stenver. (...)

Paxil Plaintiff Settles Birth Defects Lawsuit (Seroxat-saksøker forliker fødselsdefekt-søksmålsøksmål)
lawyersandsettlements.com 20.10.2010
Watertown, SD: A woman who recently settled her Paxil birth defects lawsuit ended a legal ordeal that began with the 2004 death of her newborn son. The woman's Paxil lawsuit alleged her son suffered from Paxil birth defects, including persistent pulmonary hypertension of the newborn (PPHN). (...)

READ MORE [ PAXIL ARTICLES ] (...)

Use of antidepressants during pregnancy and the risk of spontaneous abortion (Bruk av antidepressiva under svangerskapet og risiko for spontanabort)
CMAJ 2010; 182 (10) (July 13)
(...) Interpretation: The use of antidepressants, especially paroxetine, venlafaxine or the combined use of different classes of antidepressants, during pregnancy was associated with an increased risk of spontaneous abortion. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Plaintiffs Hoping for More Paxil Birth Defects Settlements (Saksøker håper på flere flere forlik i saker om fødselsdefekter utløst av Seroxat (Paxil))
lawyersandsettlements.com 5.7.2010
Boston, MA: Although very little information has been released concerning the settlement of Paxil birth defects lawsuits, news reports indicate that approximately 190 cases have been settled while another 100 are in various stages of settlement.

At issue in the lawsuits is whether or not Paxil caused the birth defects of infants whose mothers took the antidepressant while pregnant. Scientific studies concerning the link between Paxil and other selective serotonin reuptake inhibitors (SSRIs) to birth defects have returned mixed results. Further studies have suggested a link between SSRIs and behavioral problems, withdrawal symptoms and developmental delays.

GlaxoSmithKline, however, has defended its drug and its own actions regarding Paxil. A spokeswoman for GlaxoSmithKline, Sarah Alspach, said in an e-mail statement that the company agreed to settle to avoid the costs and uncertainties of ongoing litigation

"GSK believes it acted properly and responsibly in conducting its clinical trial program for Paxil, in marketing the medicine, in monitoring its safety once it was approved for use and in updating pregnancy information in the medicine's label as new information became available," Alspach wrote, as published in the Legal Intelligencer on 6/23/10.

Plaintiffs, however, disagree. They argue that GlaxoSmithKline failed to adequately warn physicians and patients about the risks of birth defects when babies are exposed to Paxil prior to birth. They allege those birth defects include Persistent Pulmonary Hypertension of the Newborn (PPHN) and atrial or septal defects—holes in the heart. (...)

Adverse drug reactions from psychotropic medicines in the paediatric population: analysis of reports to the Danish Medicines Agency over a decade (Uheldige legemiddelreaksjoner fra psykotrope medisiner i barnebefolkningen: analyser av rapporter til Lægemiddelstyrelsen i en tiårsperiode)
BMC Research Notes 2010, 3:176 (23 June)
(...) Background The prescribing of psychotropic medicines for the paediatric population is rapidly increasing. In attempts to curb the use of psychotropic medicine in the paediatric population, regulatory authorities have issued various warnings about risks associated with use of these products in childhood. Little evidence has been reported about the adverse drug reactions (ADRs) of these medicines in practice. As spontaneous reports are the main source for information about previously unknown ADRs, we analysed data submitted to a national ADR database. The objective was to characterise ADRs reported for psychotropic medicines in the Danish paediatric population over a decade. (...)

Konklusjon Det høye antall alvorlige ADRer (Adverse Drug Reactions) rapportert for psykotrope medisiner i barnbefolkningen bør skape bekymringer for helsepersonell og leger. Tatt i betraktning det høye antall fødselsdefekter som er rapportert bør større omsorg utvises når disse legemidler forskrives til gravide kvinner. (...) (Conclusion The high number of serious ADRs reported for psychotropic medicines in the paediatric population should be a concern for health care professionals and physicians. Considering the higher number of birth defects being reported greater care has to be given while prescribing these drugs for pregnant women.)

More Questions About Paxil Side Effects (Flere spørsmål om Seroxats (Paxils) sideeffekter)
lawyersandsettlements.com 29.5.2010
Chicago, IL: En ny artikkel i ScienceNews reiser spørsmål om risiko for Seroxats (Paxils) sideeffekter og fødselsdefekter hos barn eksponert for antidepressiva før fødselen. Artikkelen referer til studier som antyder udefinerbare forandringer i hjernene til babyer eksponert for antidepressiva av typen selektive serotoninreopptakshemmere (SSRIer). Seroxat (Paxil) er et av legemidlene i SSRI-klassen. (Chicago, IL: A new article in ScienceNews raises questions about the risk of Paxil side effects and Paxil birth defects in children exposed to the antidepressant prior to birth. The article cites studies that suggest subtle changes in the brains of babies exposed to Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants. Paxil is one of the drugs in the SSRI class.)

According to the author of the ScienceNews (06/05/10) article, Susan Gaidos, studies conducted in the past few years indicate that mice and rats exposed to antidepressants either just before or just after birth grew up anxious and depressed. A more recent study, according to Gaidos, suggests that children exposed to antidepressants while in the womb are more likely to appear sad or withdrawn at three years old than those not exposed to antidepressants.

Serotonin is produced naturally in the brain and is released into the spaces between the person's neurons. The neuron that releases the serotonin then takes it back almost immediately. This is called reuptake. Selective Serotonin Reuptake Inhibitors work by preventing serotonin's reuptake. The longer serotonin remains in the space between neurons (known as the synapse), the better the person feels. People who are depressed may feel less so because the serotonin remains in the synapse for longer. (...)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

Common antidepressants 'increase miscarriage risk' (Vanlige antidepressiva "øker risiko for abort")
telegraph.co.uk 1.6.2010
Taking common antidepressants while pregnant significantly increases the chances of suffering a miscarriage, a new study warns.

The risk rose by more than two thirds if expectant mothers were taking the drugs, researchers found.

Previous studies have also found a link between antidepressants and birth defects.(...)

Dr. Anick Berard, from the University of Montreal, who led the research, said: "These results, which suggest an overall class effect of selective serotonin re-uptake inhibitors, are highly robust given the large number of users studied.

Overall, the increased risk was 68 per cent. (...)

Antidepressants during pregnancy increase risk of sponaneous abortion, study finds (Antidepressiva i løpet av svangerskapet øker risikoen for spontanaborter, ifølge studie)
latimes.com 31.5.2010
(...) In the new study, Dr. Anick Berard, director of the University of Montreal's Research Unit on Medications and Pregnancy at University Hospital Center Sainte-Justine used information from the Quebec Pregnancy Registry to identify 5,124 women who had a spontaneous abortions between 1998 and 2003 -- before warnings about the risks of the drugs became more common -- and compared them with about 10 times that many carefully matched women who did not have abortions. A separate database provided information about prescriptions the women had filled.

The researchers reported in the Canadian Medical Assn. Journal that 5.5% of the women who had spontaneous abortions had taken antidepressants, compared with 2.7% of those who did not have a spontaneous abortion. Controlling for other factors, that amounted to a 68% increase in risk. The biggest effects were found with paroxetine (brand names Paxil and Seroxat) and venlafaxine (Effexor) or when combinations of drugs from different families were used. (...)

Use of Antidepressants, Nicotine in Pregnancy Linked to Childhood Difficulties (Bruk av antidepressiva, nikotin i svangerskapet linket til vanskeligheter i barndommen)
medscape.com 10.5.2010
May 4, 2010 — Prenatal nicotine exposure may increase the risk of sleep problems in children through adolescence, whereas prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) may increase the risk of behavior problems at the age of 3 years, although the risk may be moderated by the serotonin transporter promoter gene, SLC6A4.

These are the findings of 2 studies appearing in the May issue of Archives of Pediatrics and Adolescent Medicine.
These 2 studies, note the coauthors of an accompanying editorial, focus on compounds that are "at the eye of the storm of current concerns" regarding potential adverse effects of drug and chemical exposure on the developing fetus.

"In both instances, the new studies offer refined methods to further our understanding of these complex questions," write Gideon Koren, MD, and Irena Nulman, MD, of the Division of Clinical Pharmacology, Hospital for Sick Children, Toronto, Ontario, Canada. (...)

Antidepressant tied to risk of newborn heart defect (Antidepressiva knyttet til risiko for hjertedefekter hos nyfødte)
reuters.com 4.5.2010
NEW YORK (Reuters Health) - Women who use the antidepressant bupropion during early pregnancy may have an increased risk of having a baby with a particular type of heart defect, a new study suggests.

Researchers caution that it is not clear whether the medication, marketed as Wellbutrin, is the cause. And even if it is, they say, the absolute risk of the heart defect would be small -- affecting just 2 out of every 1,000 infants born to women who used bupropion during the first trimester.
But the findings, published in the American Journal of Obstetrics & Gynecology, do add to questions about the risks of using antidepressants during early pregnancy.

Some studies have already linked other antidepressants -- including some of the commonly used selective serotonin reuptake inhibitors (SSRIs) -- to higher-than-average, though small, risks of certain birth defects.

A study last year, for example, found that among nearly half a million Danish children born between 1996 and 2003, the risk of heart defects was elevated among those whose mothers had used SSRIs such as fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa) during early pregnancy. (...)

Antidepressants May Impact Infant Development (Antidepressiva kan ha følger for spedbarns utvikling)
lawyersandsettlements.com 28.2.2010
Denmark: A new study suggests that babies who are exposed to antidepressants prior to birth are slower to reach certain developmental milestones. The study will likely add to the growing controversy about whether or not SSRI antidepressants are safe for pregnant women to use. (...)

Mom's Antidepressant Use May Delay Baby's Development
depression.about.com 26.2.2010
If a mother takes an antidepressant during pregnancy, her child may experience delays in certain aspect of his development, according to Dr. Lars Henning Pederson and his research team at Aarhus University Hospital in Denmark.

Pederson's team identified 400 women who had taken antidepressants during pregnancy, as well as 500 women who were depressed but took no medication. Based upon the women's own reports, they then compared how many children hit specific developmental milestones - such as sitting up, following the direction of sounds with their eyes, expressing irritation and walking. (...)

Glaxo Said to Have Paid $1 Billion in Paxil Suits (Update2) (Glaxo hevdes å ha betalt 1 milliard dollar i forbindelse med Seroxat-søksmål)
Bloomberg.com 14.12.2009
Dec. 14 (Bloomberg) -- GlaxoSmithKline Plc has paid almost $1 billion to resolve lawsuits over Paxil since it introduced the antidepressant in 1993, including about $390 million for suicides or attempted suicides said to be linked to the drug, according to court records and people familiar with the cases.

As part of the total, Glaxo, the U.K.’s largest drugmaker, so far has paid $200 million to settle Paxil addiction and birth-defect cases and $400 million to end antitrust, fraud and design claims, according to the people and court records.

The $1 billion “would be worse than many people are expecting,” said Navid Malik, an analyst at Matrix Corporate Capital in London. “I don’t think this is within the boundaries of current assumptions for analysts.” (...)

GlaxoSmithKline Reportedly Paid $1 Billion for Paxil Lawsuits (GlaxoSmithKline har angivelig betalt én milliard dollar for Seroxat-søksmål)>
lawyersandsettlements.com 14.12.2009
Philadelphia, PA: According to reports, Paxil-maker GlaxoSmithKline may have paid almost $1 billion to settle Paxil lawsuits alleging serious side effects, including birth defects, addiction and suicides or attempted suicides. (...)

With 600 birth defects lawsuits still waiting in the wings, a $2.5 million settlement for each lawsuit could leave GlaxoSmithKline on the hook for $1.5 billion in birth defect lawsuits alone.

According to Bloomberg, approximately 150 suicide-related lawsuits were settled for an average of $2 million and 300 suicide attempt cases were settled for an average of $300,000. Meanwhile, 10 birth defect lawsuits were settled for an average of $4 million. (...)

GSK to Pay $2.5 Million to Family in Birth Defects Lawsuit (GSK betaler 2,5 millioner dollar til familie for Seroxat-fødselsdefekter)
lawyersandsettlements.com 13.10.2009
(...) Interne GSK-e-poster indikerer at de visste (Internal GSK Emails Suggest They Knew)

Under rettssaken ba dommeren GSK om å overlevere e-poster skrevet av GSK-ledere, og en slik e-post, et notat skrevet av Bonnie Rossello i 1997, som var spesielt belastende, inneholdt uttalelsen, "Dersom negative, resultater kan begraves." Rosello refererte til hva den farmasøytiske giganten burde gjøre dersom det ble nødvendig å utføre dyrestudier på Seroxat (Paxil), kjent som paroxetine (paroksetin). Ifølge resultater utført av danske utviklere av den kjemiske forbindelsen, tok lave doser av paroxetine livet av unge rotter. (During the court case the judge ordered GSK to hand over emails written by GSK executives, and one such email, written by Bonnie Rossello in a 1997 memo, was particularly incriminating, including the statement, "If neg, results can bury." Rosello was referring to what action the pharmaceutical giant should take if it became necessary to do animal studies with Paxil, known generically as paroxetine. According to results of a study done by the Danish developers of the compound, low-dose paroxetine killed young rats.)

Under rettssaken, fortalte Tracey jurymedlemmene at Food and Drug Administration (FDA) ikke ba om ytterligere sikkerhetsstudier for selektive serotoninreopptakshemmere (SSRIer) - den klasse antidepressiva som Seroxat tilhører - før i 2003. På dette tidspunkt erkjente angivelig GSK at Seroxat var assosiert med en økt risiko for fødselsdefekter. (...) (During the trial, Tracey reportedly told jurors that the Food and Drug Administration (FDA) did not order additional safety studies on selective serotonin reuptake inhibitors (SSRIs)- the class of antidepressants to which Paxil belongs - until 2003. At that point, GSK allegedly acknowledged there was an increased risk of birth defects associated with Paxil.)

Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study (Selektive serotoninreopptakshemmere i svangerskap og medfødte misdannelser: befolkningsbasert kohortstudie)
BMJ 2009;339:b3569 (23 September)
(...) Konklusjon Der er en økt forekomst av defekter i hjerteskillevegger hos barn av mødre forskrevet SSRI tidlig i svangerskapet, spesielt sertraline og citalopram. Den sterkeste forbindelsen ble påvist hos barn av kvinner som innløste forskrivninger på mer enn én type SSRI. (...) (Conclusion There is an increased prevalence of septal heart defects among children whose mothers were prescribed an SSRI in early pregnancy, particularly sertraline and citalopram. The largest association was found for children of women who redeemed prescriptions for more than one type of SSRI.)

(Anm: Antidepressiva (REM-søvn). (mintankesmie.no).)

(Anm: Fosterskader (legemiddelinduserte) (mintankesmie.no).)

Selective serotonin reuptake inhibitors and congenital malformations
Editorials
BMJ 2009;339:b3525 (23 September)
(...) In the linked population based cohort study from Denmark (doi:10.1136/bmj.b3569), Pedersen and colleagues confirm a previously reported doubling of risk for septal heart defects after early exposure in pregnancy to SSRIs (odds ratio 1.99, 95% confidence interval 1.12 to 3.53).⁴ (...)

Lack of consistency across these studies with respect to specific malformations and specific drugs makes it difficult to translate the findings into clinical practice. (...)

One explanation for this inconsistency, assuming that SSRIs do cause specific birth defects, is differences in study designs. For example, although Pedersen and colleagues linked records for 496 881 singleton live born infants, they identified only 1370 mothers who redeemed multiple prescriptions for an SSRI in the perinatal period. Therefore, the study may have been insufficiently powered to detect the previously suggested twofold to threefold increased risk for anencephaly, omphalocele, craniosynostosis, or right ventricular outflow tract defects, all of which occur at least an order of magnitude less frequently than septal defects. (...)

Strong Link Found Between Two Antidepressants and Infant Heart Problems (Sterk link funnet mellom to antidepressiva og spedbarns hjerteproblemer)
depression.about.com 25.11.2008
Women who took the antidepressants Prozac (fluoxetine) or Paxil (paroxetine) in their first trimester were significantly more likely to give birth to babies with heart problems than women who did not take them, according to a new study published in the November issue of the British Journal of Clinical Pharmacology. (...)

(Anm: British Journal of Clinical Pharmacology. Paroxetine and fluoxetine in pregnancy: a prospective, multicentre, controlled, observational study 2008;66: 695-705.)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

ANTIDEPRESSANTS MAKE FOR SAD FISH (Antidepressiva bidrar til trist fisk)
SCIENCENEWS.ORG 25.11.2008
The drugs are becoming more common in river waters and can play dangerous head games with fish

UBEKVEM POSITUR Noen stripede hybride abborer utsatt for Prozac begynte til slutt å henge vertikalt i vannet — en høyst avvikende stilling — og sluttet å spise. (...) (AWKWARD POSE Some hybrid striped bass exposed to Prozac eventually began hanging vertically in the water — a highly anomalous pose — and stopped eating.)

Tons of medicine ends up in the environment each year. Much has been excreted by patients. Leftover pills may also have been flushed down the toilet. Because water treatment plants were never designed to remove pharmaceuticals, water released into rivers by these plants generally carries a broad and diverse array of drug residues.

In 2006, a pair of chemists reported that antidepressants downstream of water treatment plants were making it into the brains of fish. (...)

Soldater dør og ikke bare grunnet våpen

Soldiers are dying and not just from guns (Soldater dør og ikke bare grunnet våpen)
romeobserver.com 3.6.2010
(...) When soldiers return from Iraq or Afghanistan, and they have suffered either emotional or physical wounds, especially Traumatic Brain Injury (TBI), they are sent to Warrior Transition Units (WTU’s). Some shocking news has come to light concerning the large numbers of deaths in these WTU’s. For example, an article in the Chicago Tribune in February of 2008 has the Army Surgeon General stating that there has been a "series, a sequence of deaths" in the WTU’s. Many of these deaths were attributed to suicide, but an Army Times article which appeared in April of this year stated that "more than 70 soldiers died while assigned to the 36 WTU’s," but that "suicide is not the major cause of death." That honor belongs to something being referred to as "sudden cardiac arrest." Now, these soldiers may be as young as 20, so we would not expect to see this rate of cardiac arrest in those so young. What is going on? And, further, the wife of a veteran did some basic research and found that 128 veterans had died under similarly strange circumstances, such as "in barracks," "at work station," and none of them were found in a coma. They simply dropped dead.

For some insight into this horrible phenomenon, we can turn to the musings of another psychiatrist, Grace Jackson, who is distinguished in the field of psychopharmatoxicology, or, the ability of psychiatric drugs to poison those who take them. In studying these military deaths, Dr. Jackson has come up with several hypotheses as to the mechanisms of action. Her theories are quite complicated and technical, but I will try to sum them up.

• The psychiatric drugs these soldiers were taking, many of them involving the neurotransmitter serotonin, could have caused a massive dysregulation of the autonomic nervous system, which, by the way, is a possible explanation for Sudden Infant Death Syndrome.

• Legemidler som Seroquel og Seroxat (Paxil) kan ha fremtvunget uoppdagede hjernestammeeffekter, slik som slag, anfall eller forstyrrelser i hjerneaktivitet. (The drugs Seroquel and Paxil may have precipitated undetected brainstem effects, such as stroke, seizure or other disruption of brain activity.)

• Those soldiers with TBI may have sustained endocrine anomalies associated with pituitary damage, and drugs such as Seroquel and Paxil exacerbate these pre-existing deficiencies. These drugs could contribute to sudden cardiac death in these cases, as well.

• Sleep apnea is also associated with TBI (I can attest to this from personal experience counseling returning veterans: They ALL had sleep apnea!) The drugs the soldiers are receiving disrupt lung function, and disrupt the electrochemical processes of which contribute to regular sleep, and produce heart arrhythmia, leading to sudden cardiac death. (...)

(Anm: Serotonin syndrom (SS), kramper, parkinsonisme osv. (forhøyet kroppstemperatur) (mintankesmie.no).)

Daily Mail: - Liv ødelagt av lykkepiller

Lives destroyed by happy pills: As our use of antidepressants DOUBLES in a decade, experts say thousands are being given dangerous drugs they don't need (Liv ødelagt av lykkepiller: Idet vårt forbruk av antidepressiva DOBLES på et tiår, sier eksperter at tusener er gitt legemidler de ikke trenger)
dailymail.co.uk 29.6.2010
(...) After about six weeks she went to see her doctor, who diagnosed depression and anxiety. 'I asked him if he was sure, because there were other symptoms such as diarrhoea, weight-loss and vomiting. But he confirmed his diagnosis and prescribed an antidepressant.' (...)

Unfortunately this only made her feel worse; she developed the shakes as well as suicidal thoughts. In an attempt to remedy this, her GP changed the medication three weeks later. But nothing changed.
And after mentioning her suicidal thoughts to her doctor, she was put under the supervision of a mental health team.

Six weeks later, Clare was put on yet another antidepressant, along with a tranquilliser and an anti-psychotic drug. She was now sleeping 14 hours a day; unable to work, she had to rely on her boyfriend for support.

'I was zombified, but still felt the anxiety and the terror, and that didn't seem right. However, my doctor simply increased my dose.' (...)

'The only good part was a brilliant nurse, who took me seriously when I said I'd always felt that something physical had caused my symptoms and put me in touch with a sympathetic private doctor,' she says.

A year-and-a-half after her symptoms began, Clare was diagnosed with an overactive thyroid and a problem with her adrenal glands. 'That was why I had been so bizarrely agitated, had diarrhoea and had lost weight.' (...)

Clare's story is extreme, but it is far from unique. Increasing numbers of Britons are taking antidepressant drugs, with prescriptions doubling over the past ten years, according to a report this month. In 2000, there were 20 million prescriptions - this rose to 39 million last year.

While this rise is partly being blamed on the recession, experts are concerned that misdiagnosis is a major factor. Indeed, a study published recently in The Lancet found that the average GP will wrongly diagnose 16 out of every 100 patients they see with depression and anxiety. (...)

Dyskinesi linket til serotonin

Some PD Dyskinesia Linked to Serotonin (Dyskinesi linket til serotonin hos enkelte med parkinsons sykdom (PD))
medpagetoday.com 30.6.2010
Fetal tissue transplants for Parkinson's disease initially seemed promising, but after a period of improvement, most patients began experiencing involuntary movements. Now British and Swedish researchers think they've worked out the paradoxical cause of that so-called "graft-induced dyskinesia" and in the process identified ways to prevent and treat it, according to Marios Politis, MD, of Imperial College London, and colleagues.

The key is an excess of serotonin-producing neurons in the grafted striatum, Politis and colleagues said in the June 30 issue of Science Translational Medicine.

Dyskinesias in Parkinson's disease are thought to be a result of dopamine, not serotonin, stimulation, but the graft-induced dyskinesias occur in the absence of dopaminergic medication. Politis and colleagues thought that the explanation might lie in the ability of the serotonin neurons to switch to a different neurotransmitter -- to use dopamine as a so-called "false transmitter."

To test the idea, they used brain imaging techniques on two patients who had been given fetal tissue transplants, 12 Parkinson's patients who had not been transplanted, and 12 healthy volunteers.

Positron emission tomography radioactive tracers that bind to dopaminergic neurons and to the dopamine receptor showed that, in the two patients, the grafts had restored the dopamine neurons that decay during Parkinson's disease.

In both patients, the neurons and the amount of dopamine they released returned to normal values after the transplant, Politis and colleagues found.

But in both, there were more serotonin neurons than usual. Specifically:

•In one patient, the ratio of serotonin to dopamine neurons in the grafted region increased by a factor of 2.3 compared with the ratio in normal controls -- at 356 versus 108.
•In the second patient, the ratio was also increased, by a factor of 1.46 -- at 266 versus 108.

The findings suggested that blocking the action of the serotonin neurons might improve the symptoms, Politis and colleagues said. To test the idea, they treated both patients with 15 milligrams of the 5-HT1A agonist buspirone (BuSpar), given in three doses of five milligrams at 30-minute intervals.(...)

(Anm: dyskinesi; dyskinesi. (av dys- og gr. 'sette i bevegelse'), forstyrrede kroppsbevegelser. (...) mer eller mindre permanent art, oftest ved langvarig bruk av nevroleptika. (...) Typisk er stereotype, rytmiske bevegelser i ansikt, tunge og kjevemuskulatur. En viss samtidig muskulær urofølelse kan forekomme (akathisi). Kilde: Store norske leksikon.)

(Anm: akatisi; manglende evne til å sitte stille, sterk rastløshet og trang til å vandre rundt. Akatisi skyldes oftest utilsiktede og uønskede forandringer i sentralnervesystemets funksjon. De er fremkalt av medisiner og er bivirkninger. Akatisi er oftest fremkalt av nevroleptika, spesielt såkalte lavdosenevroleptika, vanligvis ved behandling av alvorlige psykiske lidelser (se psykose). Kilde: Store norske leksikon.)

(Anm: dystonia; dystoni; endring i muskulaturens spenningstilstand, ofte i form av ufrivillige muskelsammentrekninger (f.eks. i nakkemuskulaturen og svelgmuskulaturen. Dystoni kan være symptom ved indremedisinske og nevrologiske sykdommer, men kan også opptre som bivirkning av legemidler som blokkerer signalsubstansen dopamin. Akutte dystonier sees hos yngre menn noen dager etter at vedkommende har begynt på relativt høye doser med nevroleptika. (...) Ved akutte dystonier på grunn av legemidler er behandlingen tilførsel av antiparkinsonmidler. Kilde: Store norske leksikon.)

- Antidepressiva linket til betydelig risiko for hjerneslag, fall og benbrudd

Do Antidepressants Raise the Risk of Stroke?
Am J Psychiatry 2011; 168:511-521 ( May 2011)
(...) Previous studies have had conflicting results, though some have suggested a link between antidepressant use and stroke. For example, in the large Women's Health Initiative study of postmenopausal women, those receiving treatment with selective serotonin reuptake inhibitors (SSRIs) had a 45% relative increased risk of stroke compared with women not receiving antidepressant treatment (4). In addition, SSRI use was associated with a doubling of the risk of hemorrhagic and fatal stroke (4). (...)

Association of Cerebrovascular Events With Antidepressant Use: A Case-Crossover Study (Forbindelser mellom cerebrovaskulære hendelser (f.eks. hjerneslagslag, TIA "drypp") og bruk av antidepressiva, en kasus kontrollstudie (case-control study))
Am J Psychiatry 2011 (Published March 15) (American Psychiatric Association)
OBJECTIVE: The authors sought to assess the risk of cerebrovascular events associated with use of antidepressant medications.

RESULTS: The adjusted odds ratio of stroke risk with antidepressant exposure was 1.48 (95% confidence interval=1.37–1.59) using 14-day time windows. Stroke risk was negatively associated with the number of antidepressant prescriptions reported. Use of antidepressants with high inhibition of the serotonin transporter was associated with a greater risk of stroke than use of other types of antidepressants.

KONKLUSJONER: Disse resultater tyder på at antidepressiva kan være assosiert med en øket risiko for hjerneslag. Imidlertid er de underliggende mekanismer uklare. (...) (CONCLUSIONS: These findings suggest that antidepressant use may be associated with an increased risk of stroke. However, the underlying mechanisms remain unclear.)

(Anm: TIA - "drypp" (...) Plutselig mister du noe av følelsen i høyre arm og ben. Du må støtte deg mot et tre for ikke å falle. (nhi.no).)

(Anm: Hjerneslag (apopleksi) er plutselig innsettende tap av kroppsfunksjoner på grunn av forstyrrelser i hjernens blodsirkulasjon. Hjerneblødning er årsak i 10-15% av tilfellene, mens blodpropp i blodårer i hjernen (trombose) er årsaken i 80-85% av tilfellene. Går symptomene tilbake i løpet av 24 timer, kaller vi det transitorisk iskemisk atakk, TIA - på norsk brukes betegnelsen "drypp". De fleste TIA varer i under en time. (nhi.no).)

(Anm: apopleksi, apoplexia cerebri, hjerneslag, akutte fokale nevrologiske symptomer og utfall som varer i mer enn 24 timer og som skyldes skade av hjernevev enten på grunn av regionalt redusert blodsirkulasjon (hjerneinfarkt) eller på grunn av hjerneblødning. Kilde: Store norske leksikon.)

TIA Doubles Risk for Later Heart Attack (TIA dobler risiko for hjerteinfarkt)
medpagetoday.com 24.3.2011
The occurrence of a transient ischemic attack (TIA) doubles a person's risk for a subsequent myocardial infarction, a population-based study found.

The relative risk for myocardial infarction (MI) among a cohort of patients who had experienced a prior TIA was 2.09 (95% CI 1.52 to 2.81), according to Robert D. Brown Jr., MD, and colleagues from the Mayo Clinic in Rochester, Minn.

The risk was highest for patients whose TIA occurred before age 60 (RR 15.1, 95% CI 4.11 to 38.6), the researchers reported online in Stroke: Journal of the American Heart Association. (...)

Tricyclics Increase CVD Risk (Trisykliske øker risiko for hjerte-kar-sykdom (CVD; Cardiovascular Disease))
medpagetoday.com 30.11.2010
(...) In a prospective cohort study that included 14,784 adults, those using tricyclics had a 35% increased cardiovascular risk after adjustment for potential confounders including symptoms of depression and anxiety, which are known risk factors for cardiovascular disease (HR 1.35, 95% CI 1.03 to 1.77). (...)

Some previous studies have suggested that any association between the use of antidepressants and risk of cardiovascular disease can be attributed to depression, not the drugs.

Hamer and colleagues disagreed. (...)

Further analysis showed that both tricyclic and SSRI users had a higher risk of stroke in age- and sex-adjusted models:

• Tricyclics, HR 2.23 (95% CI 0.85 to 6.39)
• SSRIs, HR 3.32 (95% CI 1.20 to 9.18)

But the researchers cautioned that the findings on risk of stroke should be interpreted with caution.

They pointed out that there were only 78 events and the association with SSRIs was weakened after multivariate adjustment (HR 2.46, 95% CI 0.87 to 6.96). (...)

(Anm: Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey. Eur Heart J 2010 (First published online: November 30, 2010.)

Older antidepressants linked to heart risk
irishhealth.com 2.12.2010
People who use older generation antidepressant drugs may be at an increased risk of developing heart disease, the results of a new study indicate. (...)

Secondly, people taking the antidepressants are also more likely to smoke, be overweight, and do little or no physical activity. By giving up smoking, losing weight, and becoming more active, a person can reduce their risk of CVD by two to three-fold, which largely outweighs the risks of taking the medications in the first place. In addition, physical exercise and weight loss can improve symptoms of depression and anxiety," Dr Hamer said.

He pointed out that the majority of previous work in this area has focused on patients who already had heart problems, however this one looked at a healthy population. (...)

Antidepressants linked with significant risk of stroke and fracture (Antidepressiva linket til betydelig risiko for hjerneslag og benbrudd)
pulsetoday.co.uk 3.8.2010
Forskrivning av antidepressiva er assosiert med en betydelig økt risiko for slag, fall og benbrudd hos eldre pasienter ifølge analyser av data fra primærhelsetjenesten utført av britiske forskere. (Antidepressant prescribing is associated with a significantly increased risk of stroke, falls and fractures in older people, according to analyses of primary care data by UK researchers.)

Two analyses by the same team of researchers from the University of Nottingham of the QResearch database – a network of 602 practices in England – found antidepressants increased the stroke rate by up to half, the rate of falls by more than three quarters and the fracture rate by 87% compared with no antidepressant use.

Figures from the NHS information Centre show antidepressants are the 10th most commonly prescribed class of drugs in primary care, with 39 million prescriptions issued in England in 2009.

Although depression is common in older people, clinical trials for antidepressants often under-represent the elderly population so little is known about the risks of adverse events in older patients and the relative safety of individual drugs in this class. (...)

Serotonerg ubalanse? (Svindelen som aldri tar slutt)

Study Undermines Case For Antidepressants (Studie undergraver bevis for antidepressiva)
forbes.com 5.1.2010
(...) Såkalte selektive serotoninreopptakshemmere (SSRIer) slik som Seroxat, Prozac og Zoloft, er utstrakt brukt på bakgrunn av teorien om at deprimerte mennesker lider av mangel på hjernekjemikaliet serotonin. Men få harde data støtter det populære konseptet, ifølge Kirsch. "Hele idéen med serotoninmangel er en myte." (...) (So-called selective serotonin reuptake inhibitors such as Paxil, Prozac and Zoloft, gained widespread use on the theory that depressed people suffer from a deficit of the brain chemical serotonin. But little hard data supports the popular concept, Kirsch says. "This whole idea of serotonin deficiency is a myth.")

Det er ikke eksakt kjent hvor mange pasienter med mild depresjon som tar antidepressiva. Men en undersøkelse sitert av forskerne fant at 71 % av alle pasienter som søker behandling for depresjon faller i den mildere kategori, hvor det er sannsynlig at placebo virker like bra. (...) (It is unknown exactly how many patients taking antidepressants have milder cases of depression. But one survey cited by the researchers found that 71% of all patients seeking treatment for depression fall in the milder category, where placebos are likely to do as well.)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

(Anm: Svindelen som aldri tar slutt (forskning.no 17.4.2004).)

(Anm: Antidepressant Drug Effects and Depression Severity A Patient-Level Meta-analysis. JAMA. 2010;303(1):47-53 (January 6).)

Ads for SSRI antidepressants are misleading, say researchers (Reklamer for SSRI-antidepressiva er villedende, ifølge forskere)
medicalnewstoday.com 12.11.2005
Reklamer for en klasse antidepressiva kalt SSRI-er påstår ofte at depresjon skyldes kjemisk ubalanse i hjerne, og at SSRI-er korrigerer denne ubalansen, men disse påstander er ikke støttet av vitenskapelig bevis, uttaler forskere i PLoS Medicine. (Consumer ads for a class of antidepressants called SSRIs often claim that depression is due to a chemical imbalance in the brain, and that SSRIs correct this imbalance, but these claims are not supported by scientific evidence, say researchers in PLoS Medicine.)

Selv om forskere på 1960-tallet antydet at depresjon kan være linket til lavt nivå av serotonin (den såkalte "serotonin-hypotese"), sier de at forskning hittil har mislykkes å bekrefte hypotesen. (Although scientists in the 1960s suggested that depression may be linked to low brain levels of the chemical serotonin (the so-called "serotonin hypothesis"), contemporary research has failed to confirm the hypothesis, they say.)

Forskerne--Jeffrey Lacasse, doktorgradkandidat Florida State University og dr. Jonathan Leo, professor i neuroanatomi ved Lake Erie College of Osteopathic Medicine--gransket amerikansk forbrukerreklame for SSRI-er publisert i trykte medier, fjernsyn, og internett. De fant mange påstander om at SSRI-er gjenoppretter serotoninbalansei hjernen. "Men likevel er der ikke etablert noe vitenskapelig som tilsier at "balanse" av serotonin korrigeres," ifølge forfatterne. (...) (The researchers--Jeffrey Lacasse, a doctoral candidate at Florida State University and Dr. Jonathan Leo, a neuroanatomy professor at Lake Erie College of Osteopathic Medicine--studied US consumer advertisements for SSRIs from print, television, and the Internet. They found widespread claims that SSRIs restore the serotonin balance of the brain. "Yet there is no such thing as a scientifically established correct 'balance' of serotonin," the authors say.)

(Anm: Serotonin and Depression: A Disconnect between the Advertisements and the Scientific. PLoS Medicine 2005;2:0101-0106 (December 2005). (PDF).)

Debate Simmers Over Popular Antidepressant Ad Claims (healingwell.com) (Debatten koker grunnet reklamepåstander om populær antidepressiva)
healthfinder.gov 28.2.2006
Der er ingen bevis for at depresjon stammer fra en kjemisk ubalanse i hjernen, hevder kritikere. (There's no evidence depression stems from a chemical imbalance in the brain, critics say.)

-- Mange amerikanere har sett TV-reklamer for Pfizers reseptbelagte antidepressiva Zoloft. (...) (-- Many Americans have seen the television ad for Pfizer Inc.'s prescription antidepressant Zoloft.)

Denne type utsagn er formidlet i reklamekampanjer så ofte overfor forbrukere av selektive serotoninreopptakshemmere (SSRI) at kritikere sier at disse påstander nå tilsynelatende oppfattes som en slags vitenskapelig sannhet. (Statements like these have been repeated so often in direct-to-consumer ad campaigns for selective serotonin reuptake inhibitor (SSRI) antidepressants that critics say they now have the ring of scientific truth.)

Derfor kan mange amerikanere "bli svært overrasket over at ikke en eneste artikkel kan fremvises som direkte påviser at depresjon er et resultat av mangel på serotonin," sa Jeffrey Lacasse, en doktorgradsstudent ved Florida State University's College of Social Work. (...) (That's why many Americans "might be particularly surprised that not a single article can be produced which directly demonstrates that depression is the result of a serotonin deficiency," said Jeffrey Lacasse, a doctoral student at Florida State University's College of Social Work.)

New Strategy For Developing Antidepressants
medicalnewstoday.com 10.12.2007
Researchers may be able to develop an antidepressant which takes effect almost immediately by directly targeting novel molecules in the brain instead of taking a less direct route, which can lead to longer times for medication to take effect, according to a new study presented at the American College of Neuropsychopharmacology (ACNP) annual meeting. The antidepressant is also thought to be effective in people for whom previous treatments have been ineffective. This human and rodent research is among the first to examine the effects of rapid antidepressant strategies. (...)

Onset of action of antidepressants
BMJ 2007;334:911-912 (5 May)
(...) A meta-analysis of 76 double blind placebo controlled trials of antidepressant treatment for depression in 2005 found that 60% of overall improvement occurred during the first two weeks and that half of all patients who respond to a six week trial respond in the same period.¹⁰ More recently, a meta-analysis of placebo controlled trials of selective serotonin reuptake inhibitors suggested that therapeutic response is greatest in the first week, with a gradual decline in the size of benefit over successive weeks of treatment.¹¹ One third of the total effect seen at six weeks was apparent in the first week.¹¹ As the studies were placebo controlled trials, this improvement was unlikely to be a placebo effect. (...)

Widow to testify at Senate committee hearing on drug safety
expertclick.com 14.3.2007
Kim's husband, Timothy (Woody) Witczak, was a 37-year-old dynamic and upbeat, happily married man who was prescribed Zoloft because he was having difficulty sleeping due to job-related stress. He was on Zoloft for about five weeks with an increased dose before he committed suicide (by hanging himself from the rafters in his garage). He had no history of mental illness or suicidality.

His symptoms after Zoloft and before his death included profuse sweating, worsened insomnia, horrible nightmares, headaches, agitation and an odd feeling in his head (he told his wife that he felt like his head was "detached from [his] body.") This phenomenon has been acknowledged by Pfizer in internal company documents to be a side effect of Zoloft.

Kim Witczak has become an influential victim advocate for drug safety. As a result of Woody’s death, Kim established www.woodymatters.com. The website serves as an information clearing house on antidepressant risks and a forum for other victims. FDA reform has become an increasingly important goal of woodymatters.com. Kim has traveled to Washington D.C. over 20 times to advocate for antidepressant warnings as well as FDA reform. Kim has, on numerous occasions, testified before the FDA, US Congress, and Minnesota legislature concerning these issues. Kim’s story has been featured in a number of news reports, including the November 2005 issue of Fortune Magazine and in an I-Team feature on WCCO TV in Minneapolis. She has also been on NPR regarding drug advertising.

See: WCCO TV I-Team Report: www.wcco.com/iteam/local_story_142142535.html
Star Tribune article “The Battle for Woody”: www.baumhedlundlaw.com/media/ssri/Zoloft/Witczak/Battle-for-Woody.pdf (...)

SSRIs start to relieve depression soon after the start of treatment
BMJ 2006;333 (9 December)
Abstract
Research question Do selective serotonin reuptake inhibitors take weeks to work?

Answer Probably not. Symptoms of depression improve during the first week of treatment (...)

UM study links genetic mutations to depression
sun-sentinel.com 26.9.2006
University of Miami researchers reported new evidence Monday that clinical depression appears to be caused by inborn genetic mutations. (...)

New Depression Findings Could Alter Treatments
nytimes.com 8.8.2006
The results of two new studies may signal a substantial shift in the way psychiatrists and researchers think about treatment for severely depressed patients. (...)

Clinical & Research News Brain Protein Could Be Treatment Breakthrough
Psychiatr News 2006;41:45 (April 21)
American Psychiatric Association
The finding that substance P is implicated in depression and posttraumatic stress disorder should boost efforts to see whether substance P antagonists can counter the disorders.

It looks as though a small protein discovered in horses' brains 75 years ago, and since dubbed substance P, may play a role in depression and posttraumatic stress disorder (PTSD). (...)

Hjerneskader årsag til depression
netdoktor.com 7.4.2006
Er man over 50 år og får sin første depression, kan det skyldes blodpropper i hjernen. Delresultater fra et forskningsprojekt under den nyoprettede neuropsykiatriske enhed i Risskov viser nemlig, at fire ud af ti patienter har læsioner i hjernen.

Hjerneskader og depressioner ser derfor ud til at være tæt forbundet, men det er svært at sige, hvad der opstår først. Overlæge Poul Videbech fra Center for Psykiatrisk Grundforskning håber, at den nye viden fra undersøgelsen kan være med til at fjerne det sociale stigma ved depression.

Formålet med undersøgelsen er at fastslå årsagen til hjerneskaderne og at forhindre, at de udvikler sig og forårsager demens. (...)

Depression kan måles i hjernen
netdoktor.com 20.10.2005
Depression kan måles i hjernen, da den ser anderledes ud hos personer, der lider af en svær depression end hos raske personer.

Depressive personer har nemlig en væsentligt forhøjet blodgennemstrømning i hippocampus området i hjernen. Det område har blandt andet betydning for følelser, drifter og hukommelse ligesom det regulerer kroppens respons på stress.

Det viser en ny stor undersøgelse af deprimerede patienters hjerner fra Center for Psykiatrisk Grundforskning i Århus. Man undersøgte 42 svært deprimerede og 47 raske personer med både PET- og MR-scanninger af hjernen kombineret med psykologiske test.

”For patienterne vægter det tungt, at vi er i stand til at finde noget i hjernen, som er anderledes end hos raske mennesker. Depression er jo en sygdom, som stadig er forbundet med skyld og skam”, siger overlæge Poul Videbech, der har stået i spidsen for forskningen.

Undersøgelsen bliver præsenteret i en doktorafhandling ved Århus Universitet fredag den 21. oktober. (...)

Mulig granskning av GSK/Seroxat

GlaxoSmithKline faces US scrutiny over Paxil suicide link (GlaxoSmithKline står overfor amerikansk granskning av Seroxats selvmordslink)
guardian.co.uk 12.6.2008
(...) The senator also pointed to a report recently unsealed by a US court that found GSK knew as early as 1989 that Paxil carried a heightened suicide risk in adults as well as children.

The report, by Harvard University psychiatrist Joseph Glenmullen, was based on internal GSK documents and intended for use in ongoing US court cases against the company. (...)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

(Anm: Grassley seeks FDA scrutiny of Paxil and suicide risk (finance.senate.gov).

(Anm: Sen Grassley investigates GlaxoSmithKline and Paxil/Seroxat (seroxatsecrets.wordpress.com).)

Parlamentsmedlem kritiserer legemidler under avhør om dødsårsak

MP takes war on drugs to inquest (Parlamentsmedlem kritiserer legemidler under avhør om dødsårsak)
torontosun.com 18.6.2010
Oakville MP Terence Young started a relentless campaign to prevent tragedies linked to prescription drugs when his teenaged daughter died after taking a since-banned drug Prepulsid for bloating in 2000.

He used a coroner’s inquest Friday to champion a host of changes aimed at protecting Canadians by making them aware of the dangerous side effects of prescription drugs.

The 57-year-old MP testified at the inquest examining the May 6, 2007 suicide of athlete-scholar Sara Carlin after the 18-year-old took an anti-depressant drug called Paxil.

Her parents are blaming the drug for her death.

Sara hanged herself in the basement of her parents’ Oakville home after taking Paxil for 14 months.

Young emphasized that patients must be educated about the dangerous side effects of drugs and the possibility of using alternate non-drug treatments. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

The National Association for Premenstrual Syndrome (NAPS)

Drug warning for PMT sufferers (Legemiddeladvarsel for PMS-pasienter)
bbc.co.uk 18.6.2008
Many young women are being told they are experiencing depression
There's been a rise in the number of young women being told they've got depression, when they're actually experiencing hormonal problems, according to the only UK-wide charity for people with PMT.

National Association for Premenstrual Syndrome (NAPS) opplyser at flere og flere kvinner kontakter dem fordi de anser at de feilaktig er blitt forskrevet antidepressiva inklusive Prozac og Seroxat. (...) (The National Association for Premenstrual Syndrome (NAPS) says more and more women are contacting them because they reckon they've wrongly been prescribed anti-depressants including Prozac and Seroxat.)

(Anm: National Association for Premenstrual Syndrome (NAPS).)

- SSRI-er øker risiko for fall hos demenspasienter

Antidepressiva medel fick gamla på fall
dagensmedicin.se 23.1.2012
Personer som lider av demens har ökad risk för fallskador om de använder antidepressiva SSRI-preparat. Och risken ökar med dosen, konstaterar nederländska forskare.

Risken ökade ju högre dosen av läkemedlet var. Personer som tog en låg dos, motsvarande en kvarts definierad dygnsdos, hade 31 procents ökad risk. Bland dem som åt motsvarande en definierad dygnsdos var risken trefaldigad. Personer som också fick lugnande medel hade ytterligare ökad risk för fall.

Forskarnas slutsats är att även låga doser SSRI är förenade med en ökad risk för fallskador hos personer med demens och att risken ökar med dosen. De anser att nya behandlingsprotokoll behöver ta med detta i beräkningen. (...)

(Anm: Dose-response relationship between Selective Serotonin Reuptake Inhibitors and Injurious Falls: A study in Nursing Home Residents with Dementia. British Journal of Clinical Pharmacology 2012 (Accepted, unedited articles published online for future issues).)

SSRIs Boost Risk of Falls in Dementia Patients (SSRI-er øker risiko for fall hos demenspasienter)
medscape.com 19.1.2012
January 19, 2012 – Nursing home residents with dementia who use selective serotonin reuptake inhibitors (SSRIs) have an increased risk of having a fall that causes injury compared with those who do not use SSRIs, new research shows.

Further, the risk is dose-dependent, with those using average doses having 3 times the risk compared with nonusers, the authors, led by Carolyn S. Sterke, MSc, from Erasmus University Medical Center, Rotterdam, the Netherlands, report.

"Even at low doses, SSRIs are associated with increased risk of an injurious fall in nursing home residents with dementia," the authors write.

The use of an SSRI with a hypnotic or sedative increases the risk even further, they add.

The study is published online January 18 in the British Journal of Clinical Pharmacology. (...)

The study showed that the risk of a fall resulting in injury increased with age (hazard ratio [HR], 1.05, 95% confidence interval [CI] 1.01 - 1.09), and use of antipsychotics (HR 1.76, 95% CI 1.18 - 2.63).

Increased risk of falls was seen only with the SSRIs, the authors report. Overall, the HR associated with the use of SSRIs was 2.50 (95% CI, 1.50 - 4.19).

(Anm: Dose-response relationship between Selective Serotonin Reuptake Inhibitors and Injurious Falls: A study in Nursing Home Residents with Dementia. British Journal of Clinical Pharmacology 2012 (Accepted, unedited articles published online for future issues).)

Antidepressiva ødelegger ansiktsmuskulatur, og gir økt aldring

Divorce, Antidepressants, Or Weight Gain/Loss Can Add Years To Your Face (Skilsmisse, antidepressiva, eller vektøkning/vekttap kan legge år til ditt ansikt)
medpagetoday.com 4.2.2009
Your mother's wrinkles -- or lack there of, may not be the best predictor of how you'll age. In fact, a new study claims just the opposite. The study, involving identical twins, suggests that despite genetic make-up, certain environmental factors can add years to a person's perceived age. Results just published on the web-based version of Plastic and Reconstructive Surgery(R), the official medical journal of the American Society of Plastic Surgeons (ASPS), reveal that factors like divorce or the use of antidepressants are the real culprits that can wreak havoc on one's face. (...)

During the study, Dr. Guyuron and his colleagues obtained comprehensive questionnaires and digital images from 186 pairs of identical twins. The images were reviewed by an independent panel, which then recorded the perceived age difference between the siblings.

Results showed that twins who had been divorced appeared nearly 2 years older than their siblings who were married, single or even widowed. Antidepressant use was associated with a significantly older appearance and researchers also found that weight played a major factor too. In those sets of twins who were less than 40 years old, the heavier twin was perceived as being older, while in those groups over 40 years old, the heavier twin appeared younger. (...)

I tillegg mistenker forskerne at den vedvarende avslapping av ansikstmuskler som antidepressiva forårsaker, kan forklare årsaken til at ansiktet faller sammen (henger) (...) (Additionally, researchers suspect that continued relaxation of the facial muscles due to antidepressant use, could account for sagging.)

(Anm: Plastic and Reconstructive Surgery. Factors Contributing to the Facial Aging of Identical Twins (Note: This study is appearing in a raw, publish-ahead-of-print format and will be published in final form in the April 2009 issue of PRS.) (February 2009).)

Trikset for å unngå rynker
dinside.no 4.2.2009
Forskning viser at du selv kan påvirke.

Det er langt fra bare alder og genetiske faktorer som avgjør om du blir rynkete i ansiktet. Det kommer fram i en fersk studie publisert i tidsskriftet Plastic and Reconstructive Surgery. (...)

Stress er synderen
Testpersoner som hadde brukt antidepressiva eller som hadde gått kraftig opp og ned i vekt også så eldre ut enn tvillingen sin. (...)

Antidepressiva kan dessuten føre til at ansiktshuden henger mer, fordi medisinen gjør at ansiktsmuskulaturen blir mer avslappet. (...)

What happens when minnows take a chill pill? (Hva skjer når småfisk tar en avslapningspille)
startribune.com 22.12.2008
Meghan McGee, a graduate student at St. Cloud State University, tested minnow larvae reaction time to vibrating movement.

St. Cloud State University research found that minnows exposed to antidepressants, whose residues end up in local waters, are more laid back - which is not so great for survival. (...)

FIKK 2,2 MILL. etter ansiktskramper (PDF)
Av JORUN SOFIE F. AARTUN og MAY LINN GJERDING
VG 22.05.2006 (Side: 9. Emne: Helse. Kategori: HELSE OG MEDISIN)
En 51 år gammel kvinne fikk utbetalt hele 2,2 millioner kroner i erstatning, etter at «lykkepiller» ga henne kroniske rykninger i ansiktet. Informasjonssjef Torill Svoldal Stæhr i Norsk Pasientskadeerstatning (NPE) ser svært alvorlig på saken.

- Kvinnen har fått store skader. I tillegg til de kroniske muskeltrekningene i ansikt, hals og mellomgulv har kvinnen store pustebesvær, sier Svoldal Stæhr i NPE.

Hun mener det er overveiende sannsynlig at kvinnen fikk de lumske skadene som følge av såkalte SSRI-preparater, som «lykkepillene» heter på fagspråket.

- Store smerter
- Kvinnen har store smerter og er delvis eller helt ufør etter å ha tatt preparatet Fontex, sier Svoldal Stæhr.

Fontex, bedre kjent som Prozac, skal virke mot depresjon, angst, spiseforstyrrelser, narkolepsi og andre psykiske lidelser.

Det foreligger en potensiell risiko for kramper ved behandling med antidepressive legemidler. (...)

- Psykiatriske legemidler kan øke risiko for hjertedød

Antipsykotika kan gi økt risiko for venøs tromboembolisme
Tidsskr Nor Legeforen 2010; 130:2330 (2.12.2010)
Økt risiko for venøs tromboembolisme var mest markant hos nye brukere av antipsykotiske legemidler og ved bruk av atypiske antipsykotika.

Studier har vist at antipsykotiske legemidler gir økt risiko for venøs tromboembolisme, men studiene har vært små eller ikke omfattet nye atypiske antipsykotika. Nå har forskere undersøkt risikoen for venøs tromboembolisme ved bruk av ulike typer antipsykotiske legemidler i det britiske pasientregisteret til allmennleger (1). (...)

– Studien viser hvor viktig det er å følge opp somatisk helse hos pasienter som behandles med antipsykotika, og man må være bevisst økt risiko for venetrombose, sier professor Ole A. Andreassen ved Oslo universitetssykehus. (...)

(Anm: tromboembolisme; Etymologi: av trombo-, og embolos, 'propp' tromboembolisme, tilstand med blodpropp der en del av blodproppen løsner og følger blodstrømmen inntil dimensjonen på blodkaret ikke lenger tillater videre passasje, og proppen setter seg fast som en embolus. Kilde: Store norske leksikon.)

(Anm: Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ 2010; 341:c4245 (21 September).)

Antipsykotika kan gi økt risiko for venøs tromboembolisme
Tidsskr Nor Legeforen 2010; 130:2330 (2.12.2010)
Økt risiko for venøs tromboembolisme var mest markant hos nye brukere av antipsykotiske legemidler og ved bruk av atypiske antipsykotika.

Studier har vist at antipsykotiske legemidler gir økt risiko for venøs tromboembolisme, men studiene har vært små eller ikke omfattet nye atypiske antipsykotika. Nå har forskere undersøkt risikoen for venøs tromboembolisme ved bruk av ulike typer antipsykotiske legemidler i det britiske pasientregisteret til allmennleger (1). (...)

– Studien viser hvor viktig det er å følge opp somatisk helse hos pasienter som behandles med antipsykotika, og man må være bevisst økt risiko for venetrombose, sier professor Ole A. Andreassen ved Oslo universitetssykehus. (...)

(Anm: tromboembolisme; Etymologi: av trombo-, og embolos, 'propp' tromboembolisme, tilstand med blodpropp der en del av blodproppen løsner og følger blodstrømmen inntil dimensjonen på blodkaret ikke lenger tillater videre passasje, og proppen setter seg fast som en embolus. Kilde: Store norske leksikon.)

(Anm: Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ 2010; 341:c4245 (21 September).)

Psychiatric Drugs Might Raise Cardiac Death Risk (Psykiatriske legemidler kan øke risiko for hjertedød)
wrongdiagnosis.com 14.5.2010
(...) THURSDAY, May 14 (HealthDay News) -- Foreløpig forskning indikerer at mennesker som dør av hjertesvikt var mer sannsynlig å ha tatt antidepressiva eller psykiatriske legemidler enn de som overlevde hjertesvikt. (...) (-- Preliminary research suggests people who suffered fatal cardiac arrest were more likely to have taken antidepressants and other psychiatric drugs than those who survived heart attacks.)

A variety of conditions can cause sudden cardiac death, including the clogging of arteries caused by coronary heart disease.

And, "despite many years of intensive research we still don't know how to identify people who are at risk for sudden cardiac death," Honkola said.

In the new study, the Finnish researchers examined the medications taken by 321 victims of cardiac death compared with those taken by 609 patients who survived heart attacks. (...)

Combination Of Depression With Heart Disease Can Be A Lethal Mix (Kombinasjon av depresjon og hjertesykdom kan være en dødelig miks)
medicalnewstoday.com 17.9.2010
Having depression or heart disease is bad enough, but having a combination of the two can be significantly more lethal than either one of them on their own, researchers wrote in an article published in the medical journal Heart. According to previous research, people who were diagnosed with depression but were otherwise healthy had a higher risk of developing coronary heart disease, regardless of what other risk factors they had. (...)

Antipsykotika kopplas till blodpropp
lakemedelsvarlden.se 22.9.2010
Personer som behandlats med antipsykotiska läkemedel löper en högre risk att drabbas av blodpropp. Det visar en studie som publicerats i British Medical Journal. (...)

(Anm: tromboembolisme; Etymologi: av trombo-, og embolos, 'propp' tromboembolisme, tilstand med blodpropp der en del av blodproppen løsner og følger blodstrømmen inntil dimensjonen på blodkaret ikke lenger tillater videre passasje, og proppen setter seg fast som en embolus. Kilde: Store norske leksikon.)

Antipsychotics and the risk of venous thromboembolism (Antipsykotika og risiko for venøs tromboembolisme)
BMJ 2010; 341:c4216 (21 September)
(...) In the linked study (doi:10.1136/bmj.c4245), Parker and colleagues report a large population based case-control study that included primary care patients aged over 16 who were taking antipsychotics.⁵ (...)

Den høyeste risiko var for quetiapine (nesten firedoblet økt risiko) og for lavpotente antipsykotika snarere enn høypotente antipsykotika. Nye brukere av antipsykotika synes å ha større risiko enn brukere som står på medikamentene, og effekten ble ikke registrert hos de som avsluttet bruken. Disse resultatene indikerer at VTE er direkte linket til bruken av antpsykotika, og at riskoen for VTE øker tidlig etter oppstarten med legemidlet. (...) (The highest risks were for quetiapine (nearly fourfold increased risk) and for low potency antipsychotics rather than high potency ones. New users of antipsychotics seemed at greater risk than continuing users, and the effect was not seen in those who stopped taking the drug. These findings indicate that VTE is directly linked to the use of an antipsychotic, and that the risk of VTE increases early after starting the drug.)

(Anm: tromboembolisme, tilstand med blodpropp der en del av blodproppen løsner og følger blodstrømmen inntil dimensjonen på blodkaret ikke lenger tillater videre passasje, og proppen setter seg fast som en embolus. Eksempler på tromboembolisme er dyp venetrombose i lårvenen med lungeembolisme eller blodpropp i venstre hjertehalvdel med hjerneembolisme. Kilde: Store norske leksikon.).)

(Anm: Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ 2010; 341:c4245 (21 September).)

Psychiatric Drugs Might Raise Cardiac Death Risk (Psykiatriske legemidler kan øke risiko for hjertedød)
healthfinder.gov 14.5.2009
But other medical factors could also be at play, researchers note. (...)

The study doesn't reveal specifically which psychiatric drugs were examined, but it does say that those who died of cardiac death were more likely to have taken one of three types.

Almost 11 percent of those who suffered sudden cardiac death took antipsychotics, compared to 1.4 percent of those who survived heart attacks.

The numbers for antidepressants were 7.4 percent and 3 percent, respectively, and 18.4 percent and 5 percent for benzodiazepines, which include drugs such as Xanax. (...)

- Antidepressiva kan fremkalle eller forsterke seksuell dysfunksjon

Serotonin sex bomb: How to make a mouse bisexual or just really horny (Serotonerg sexbombe: Hvordan gjøre mus biseksuelle eller bare virkelig kåte)
cbsnews.com 24.3.2011
(CBS) Scientists aren't sure whether they have figured out how to make mice bisexual or just so horny that they will mount whatever happens to saunter in their cage, but a fascinating study out of China sheds new light on the role of serotonin in sexual behavior.

Serotonin is a brain chemical long known to affect sex drive in humans. People who take anti-depressants like Prozac and Zoloft, drugs which increases serotonin in the brain, often have lower libidos.

For mice, the problem is particularly acute - give them too much serotonin and they have trouble gaining erections and ejaculating. But take it away and it's game on.

Researchers at Beijing's National Institute of Biological Sciences did just that. Working with male mice that lack a gene which makes serotonin, they introduced mice of both genders into their cages and sat down to watch the sex show.

Turns out the serotonin-deprived mice were quite the performers, mounting both male and female partners about 80 percent of the time. By comparison, normal male mice got funky with females between 60 and 80 percent of the time and didn't have much taste for their more macho counterparts - mounting them only 20 to 30 percent of the time. (...)

(Anm: Molecular regulation of sexual preference revealed by genetic studies of 5-HT in the brains of male mice. Nature 2011 (Published online 23 March).)

Molecular regulation of sexual preference revealed by genetic studies of 5-HT in the brains of male mice
Nature 2011 (Published online 23 March)
Although the question of to whom a male directs his mating attempts^1,2 is a critical one in social interactions, little is known about the molecular and cellular mechanisms controlling mammalian sexual preference. Here we report that the neurotransmitter 5-hydroxytryptamine (5-HT) is required for male sexual preference. Wild-type male mice preferred females over males, but males lacking central serotonergic neurons lost sexual preference although they were not generally defective in olfaction or in pheromone sensing. A role for 5-HT was demonstrated by the phenotype of mice lacking tryptophan hydroxylase 2 (Tph2), which is required for the first step of 5-HT synthesis in the brain. Thirty-five minutes after the injection of the intermediate 5-hydroxytryptophan (5-HTP), which circumvented Tph2 to restore 5-HT to the wild-type level, adult Tph2 knockout mice also preferred females over males. These results indicate that 5-HT and serotonergic neurons in the adult brain regulate mammalian sexual preference. (...)

Seksuelle bivirkninger av antidepressive legemidler
Tidsskr Nor Legeforen 2010; 130:1930-1 (7.10.2010)
Seksuell dysfunksjon er vanlig hos pasienter med depresjon. Samtidig kan antidepressive legemidler fremkalle eller forsterke seksuell dysfunksjon som bivirkning. Hvilke antidepressiver er særlig assosiert med seksuell dysfunksjon, og hvilke mekanismer ligger til grunn for slike bivirkninger? Hvordan skal bivirkningene håndteres i klinisk praksis? (...)

Forekomst
Alt i alt er forekomsten av seksuelle bivirkninger anslagsvis 40 % ved bruk av SSRI-preparater, mot 10 % ved placebo (2). Det finnes få studier som har sammenliknet frekvensen av seksuelle bivirkninger hos ulike SSRI-preparater. En gjennomgang fra 2008 konkluderte med at det ikke foreligger sikre holdepunkter for at noe SSRI-preparat har færre seksuelle bivirkninger enn andre, selv om det finnes visse data som antyder at slike bivirkninger er vanligere ved paroksetin enn ved andre midler i gruppen (4). (...)

Effect of medication on some causes concern (Legemiddeleffekt gir grunn til litt bekymring)
kansan.com 22.9.2010
In June, Kate Hardy, a junior from Kansas City, Kan., stopped spending as much time with her friends and family. Some days, her interests consisted solely of lying around and sleeping. She dropped out of one of her summer classes and her grades plummeted in the others. Her nights became cloaked with insomnia and often sleep didn’t come until 5 a.m.

Hardy wasn’t suffering the symptoms of any anxiety disorder, however. She was being treated for one. Her side effects came from an antidepressant called Celexa, which doctors prescribed when she reported having hopeless thoughts and experiencing frequent panic attacks. Steve Ilardi, professor of abnormal psychology, says Hardy isn’t alone.

Ifølge en artikkel skrevet av lege Simon Sobo, kan selektive serotoninreopptakshemmere eller SSRI-er som Celexa, forårsake et psykisk fenomen kalt “emosjonell avstumpethet,” som kan medføre at pasienter blir ubekymret, en “angår ikke meg” innstilling til livet. (According to an article written by Simon Sobo, M.D., selective serotonin reuptake inhibitors, or SSRIs, like Celexa can cause a mental phenomenon called “emotional blunting,” which can make patients have a carefree, “well whatever” attitude toward life.)

Ilardi said emotional blunting could lead to two particular types of potentially life-altering side effects: emotional numbing and reduced error detection.

For some patients emotional numbing is a good thing. But for others the degree to which they experience positive emotions such as love and affection goes down as well. Ilardi said he has known many individuals on SSRIs who have reported falling out of love with their significant others, and they never considered that it could be because of the medications.

“People were making irreversible lifetime decisions, like divorcing their partners or leaving their longtime boyfriend or girlfriend,” Ilardi said. “They never once considered it could be the medications that was doing it. That’s just not how we reason about it.” (...)

Prozac inhibits sex drive in fish: study (Prozac hemmer seksualdriften til fisk, ifølge studie)
cbc.ca 21.9.2010
The popular antidepressant drug Prozac inhibits sexual activity in fish by interfering with sperm production and pheromone transmission, which raises environmental concerns, according to a study by University of Ottawa researchers.

The study, published in the Aquatic Toxicology journal on Tuesday, found that male goldfish exposed to water treated with Prozac experienced decreases in sperm production of up to 50 per cent. They also reacted less to the pheromones released by female fish. (...)

(Anm: Waterborne fluoxetine disrupts feeding and energy metabolism in the goldfish Carassius auratus. Aquat Toxicol. 2010 Oct 1;100(1):128-37.)

New targets for old drugs
Nature 2009 doi:10.1038/news.2009.1047 (1 November)
A computer program predicts thousands of previously unknown drug-target associations. (...)

For example, the antidepressants Prozac and Paxil, which work by boosting serotonin levels in the brain, also bound the β-adrenergic receptors, the researchers showed. This β-blocking activity could explain some of the drugs' side effects which include nausea and decreased libido.

Trip or treatment?
"The pharmaceutical industry should take note of this work," says Jeremy Jenkins, a chemoinformatician at the Novartis Institutes for BioMedical Research — the drug company's research arm — in Cambridge, Massachusetts, who was not involved in the new work. "This could really help us improve on preventing safety issues, which are one of the major contributors to drugs failing." (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Sex and Psych Drugs - Young Couples Beware
By Evelyn Pringle
lawyersandsettlements.com 2.6.2009
Although the adverse effects of women taking psychiatric drugs while pregnant related to birth defects and infant withdrawal syndrome are often discussed or reported, the serious adverse effects on the sex lives and reproductive systems of millions of young couples are rarely mentioned.

Whatever the reason, due to the ever widening marketing campaigns by the psycho-pharmaceutical industry, young people need to be warned before they get conned into taking psychiatric drugs.

Sexual dysfunction, including lack of libido, orgasmic dysfunction and delayed ejaculation, are common side effects of using SSRI antidepressants, according to the May 2005 report, “The Marketing of Depression: The Prescribing of SSRI Antidepressants to Women,” by Dr Janet Currie. The report warns:

“There are concerns that not all sexual dysfunction may fully resolve after termination of treatment. Since SSRIs are prescribed more often for women, women are more frequently affected by SSRI-induced sexual dysfunction. Because SSRIs can also lead to a worsening of depression, paradoxical effects, emotional blunting or detachment, reduced emotional activity, memory loss and confusion, these effects, in conjunction with sexual dysfunction, can negatively affect intimate relationships.” (...)

Antidepressants may damage more sex lives (Antidepressiva kan skade mange menneskers sexliv)
boston.com 15.12.2008
Sexual "numbness." Lack of libido. Arousal that stalls. (...)

Current warnings on the labels of selective serotonin reuptake inhibitors, or SSRIs, cite early studies in which the prevalence of sexual side effects was lower: 4 percent for Prozac, for example, and ranging from 0 to 28 percent for Paxil.

But more recent studies, in which patients were more likely to be asked about specific sexual side effects and thus more likely to report them, suggest that the ballpark range of those affected by SSRIs is between 30 percent and 50 percent, said researchers including Dr. Richard Balon, a psychiatry professor at Wayne State University who studies the symptoms.

That would translate into millions of affected sex lives among the estimated 1 in 8 American adults who have tried these antidepressants in the past decade or so. Some studies have found the range still higher. (...)

Balon and other researchers agree that the issue is complex and the science imperfect: Mental illness can often impair sexuality, and the studies on SSRI-related sexual dysfunction have been small. "The [pharmaceutical] industry, understandably, has no interest in funding this," Balon noted. (...)

For example, Dr. Cigdem Tanrikut a Massachusetts General Hospital urologist, reported last month at the annual meeting of the American Society for Reproductive Medicine that when 35 normal, healthy men were put on Paxil for five weeks, up to 35 percent of them reported new problems with erections and up to 47 percent reported difficulty ejaculating while on the medication. (...)

But in a small number of patients, it appears, the symptoms continue after stopping the drugs. Based on recent case reports of persistent effects, an article earlier this year in the Journal of Sexual Medicine said patients should "be told that in an unknown number of cases, the side effects may not resolve with cessation of the medication." (...)

Legger antidepressiva en demper på kjærlighetslivet?

Sexgale ældre bliver kastreret med lykkepiller
bt.dk 9.3.2008
Gamle kan være så demente, at de mister hæmningerne og får ustyrlig lyst til sex. Lægerne giver dem lykkepiller og anden medicin, som kan lægge låg på lysterne. (...)

(Anm: Effect of citalopram in treating hypersexuality in an Alzheimer's Disease case. Neurol Sci. 2008 Sep;29(4):269-70. Epub 2008 Sep 20.)

Are antidepressants taking the edge off love? (Legger antidepressiva en demper på kjærlighetslivet?)
latimes.com 30.7.2007
Sure, we know about the sexual side effects of SSRIs. But researchers now wonder if that's the only aspect of romance the drugs can influence. (...)

Any drug that has sexual side effects, Thomson says, could well blunt other chemicals the brain uses to intently focus on one person or to work up the obsession necessary to fall in love in the first place.

Then there was the 42-year-old single woman who had not been on a date in the eight years she had been taking an antidepressant. "She had not felt any desire [to date] for at least that period of time," he says. (...)

At that time, reports were that only about 6% of patients suffered sexual side effects, but the low rate is now understood to have resulted because doctors failed to ask questions about sex and patients were reluctant to bring it up. A later analysis put that figure at about 30%, and a 2001 study at as high as 73%. It is one of the top reasons that people stop taking the drugs. (...)

(Anm: Love is blue. (magicvalley.com 13.8.2007).)

Shrimp On Prozac Are None Too Cheerful (Ingen reker på Prozac er spesielt glade)
npr.org 9.8.2010
Think about all the bottles in your medicine cabinet — things you take every day, like aspirin, antihistamines, prescription drugs. What happens to those medications once they leave your body?

Eventually, they end up in our water supply, where they can have unfortunate effects on wildlife. Birth control, for example, is known to disrupt the development of frogs and alligators.

Nå sier forskere at Prozac i vann påvirker visse typer reker. Nei, antidepressiva gjør dem ikke rolige og glade. I virkeligheten kan disse rekene, når de blir eksponert for Prozac, være mer tilbøyelige til å utsette seg for dødelige farer. (...) (Now, scientists say Prozac in the water is affecting certain kinds of shrimp. No, the antidepressant doesn't make them calm and cheerful. In fact, these shrimp, when exposed to Prozac, may be more likely to put themselves in mortal danger.)

"We bought the chemical fluoxetine, which is the active ingredient in Prozac, and we looked at the research which indicated what concentrations these drugs were being found in the environment," Ford says. He tested different concentrations of the drug on tanks of shrimp, and found that shrimp exposed to the fluoxetine were five times more likely to swim into the light. (...)

(Anm: Miljø og legemiddel. (mintankesmie.no).)

Dette dreper de unges sexlyst
dinside.no 5.5.2008
Hasj kan ødelegge sexlysten for unge.

Det er én ting som tar knekken på selv tenåringenes potens. (...)

- Mange som bruker hasj, blir sløve, tiltaksløse og får ikke hverdagen til å fungere, verken med jobb eller skole. Mange får etter hvert nedbrutt selvbilde, noe som kan resultere i depresjon og angst. At de som går på antidepressiva, også kan få potensproblemer, er noe vi kjenner til. Men dette er problemer som først kommer frem etter noen ganger med behandling, sier han. (...)

5 Questions for 'Doctor of Love' Researcher Helen Fisher
popularmechanics.com 13.2.2008
(...) Are there certain advancements in, say, new drugs or antidepressants that can have an adverse on this quest you’re speaking about?
Yes. I think we’ve evolved through distinctly different brain systems involved for mating and reproducing. One is the sex drive, one is romantic love, and the third is attachment—that sends the sense of calm and security you can feel with a long-term partner. And when you take the serotonin-enhancing antidepressants like Prozac, Paxil, Zoloft, etc., what you’re doing is driving up serotonin in the brain, and we know that that affects the sex drive. In almost 75 percent of people it kills the sex drive. (...)

Paedophiles offered 'happy pills' to curb their sex drive (Pedofile tilbudt "lykkepiller" for å dempe sexlyst)
dailymail.co.uk 14.11.2007
Det er kommet frem at pedofile tilbys gratis Prozac som alternativ til "kjemisk kastraksjon". (Paedophiles are to be offered free Prozac as a softer alternative to 'chemical castration', it has emerged.)

The Government secured headlines this summer when it promised offenders would be given - on a voluntary basis - strong medication to curb their sex drive.

However, these drugs, which amount to chemical castration by making it difficult to have sex, have a number of side-effects which could deter potential users. (...)

Brain Chemical Could Spur Lovesickness
healthfinder.gov 15.10.2008
A monogamous rodent could shed light on romantic loss. (...)

Examination of the brains of the lovesick voles revealed heightened activity of a chemical messenger called corticotropin releasing factor (CRF) in an area of the hypothalamus, a center for emotions in the brain.

When the researchers administered a drug that blocked CRF activity, voles who'd been separated from their mate began to perform just as vigorously in the stress tests as all the other voles tested. It seemed the drug "switched off" the mechanism -- and their lovesickness, as well. (...)

(Anm: Pharmacologic differences among the SSRIs: focus on monoamine transporters and the HPA axis. CNS Spectr. 2004 Jun;9(6 Suppl 4):23-31.)

- Etter noen få måneder så skiftet rottene fra å være unormalt vennlige til å være mer antisosiale enn de var før de fikk midlet

Love rats reveal agony of ecstasy (Kjærlige rotter får agoni av ecstasy)
smh.com.au 7.4.2007
(...) Iain McGregor, professor i psykofarmakologi ved University of Sydney, uttalte i går at det lenge har vært kjent at ecstasy øker nivået av serotonin, et hormon involvert i kontroll av appetitt, humør og angst. Men mange andre midler, inklusive Prozac, aktiverer også serotoninnivåer uten at folk ønsker å omfavne hverandre. For å finne mekanismen bak "kjærlighetsmidlet" ga hans team rotter ecstasy. (...) (Iain McGregor, professor of psychopharmacology at the University of Sydney, said yesterday it had long been known that ecstasy boosted serotonin, a hormone involved in controlling appetite, moods and anxiety. But many other drugs, including Prozac, also activated serotonin levels without making people want to hug each other. Seeking the mechanism that makes it the "love drug" his team fed rats ecstasy.)

Imidlertid bemerket hans team, ut fra resultater publisert tidsskriftet journal Neuroscience, at ecstasys "sosiale" effekt på rotter raskt gikk over.
Etter noen få måneder så skiftet rottene fra å være unormalt vennlige til å være mer antisosiale enn de var før de fikk midlet. Og de plagsomme humørsvingningene synes å være "en permanent forandring" (...) (However, his team, whose results have been published in the journal Neuroscience, also noted ecstasy's "sociable" effect on rats wore off quickly. After a few months the rats turned from being unusually friendly to being more anti-social than before they took the drug. And the ugly mood swing seemed to be "a permanent change".)

- Antidepressiva kan skade menns sædceller (DNA)

Data fra dyreforsøg vedrørende SSRI og nedsat sædkvalitet
lmst.dk
På baggrund af publicerede studier (1,2) har Den Europæiske Bivirkningskomité, PhVWP, gennemgået de tilgængelige data vedrørende effekten af selektive serotonin genoptagshæmmere (SSRI’er) på sædkvaliteten og vurderet, om behandling med SSRI kan have indflydelse på fertiliteten hos mænd.

I den forbindelse har dyrestudier vist, at SSRI-præparater, bortset fra sertralin, i højere doser end de almindeligt anbefalede til mennesker, kan påvirke sædkvaliteten. Endvidere foreligger kasuistiske meddelelser om, at visse SSRI’er har en negativ effekt på sædkvaliteten hos mænd, og at effekten er reversibel ved behandlingsophør. Effekten på fertiliteten er ukendt.

Produktinformationen for SSRI’er bliver opdateret med den nye information
PhVWP har konkluderet, at produktresumeer og indlægssedler for alle SSRI-præparater i EU, der indeholder citalopram, escitalopram, fluoxetin, fluvoxamin, paroxetin og sertralin skal opdateres. Fremover skal produktinformationen, i henhold til data for de aktive indholdsstoffer – indeholde information om, at dyrestudier har vist, at SSRIer kan påvirke sædkvaliteten, at effekten er reversibel hos mennesker, samt at nedsat fertilitet hos mænd ikke er påvist. Læs mere i PhVWP’s månedsrapport marts 2012.

Referencer
1 Tanrikut C, Schlegel PN. Antidepressant-associated changes in semen parameters. Urology. 2007; 69: 185.e5-7.
2 Safarinejad MR. Sperm DNA damage and semen quality impairment after treatment with selective serotonin reuptake inhibitors detected using semen analysis and sperm chromatin structure assay. J Urol. 2008; 180: 2124-2128. (...)

Anti-depressants can damage men's sperm (Antidepressiva kan skade menns spermie)
chicagotribune.com 12.6.2009
Add anti-depressants to the list of substances that can damage men’s sperm and potentially impair their fertility.

In a new study, New York researchers report that as many as half of men taking the anti-depressant paroxetine (brand names, Seroxat and Paxil) have higher levels of sperm fragmentation.

The study was published online today by the journal Fertility & Sterility.

“It’s fairly well known that SSRI anti-depressants negatively impact erectile function and ejaculation. This study goes on step further, demonstrating that they can cause a major increase in genetic damage to sperm,” said Dr. Peter Schlegel, the study’s senior author and professor of reproductive medicine at Weill Cornell Medical College in New York.

“Although this study doesn’t look directly at fertility, we can infer that as many as half of men taking SSRIs have a reduced ability to conceive. These men should talk with their physicians about their treatment options,” he added. (...)

Dr. Cigdem Tanrikut speculated that the anti-depressant caused mens’ sperm to slow down as it makes its way through the male reproductive tract. Sperm gets “hung up,” she said in a statement, allowing it to age and become damaged.

The amount, concentration and motility of sperm were not significantly changed by the medication.

Though men may not know it, sperm can be damaged by various substances, including smoking, alcohol, heat, anabolic steroids, drug abuse, sexually transmitted diseases and some environmental exposures. (...)

The Bad Daddy Factor
miller-mccune.com 10.12.2010
Drinking, smoking, taking prescription meds or failing to eat a balanced diet can influence the health of men’s future children. (...)

Drugs can also interfere with sperm transport. A 2009 study revealed that a standard dose of paroxetine — the active drug in the antidepressant marketed as Paxil — causes a fivefold increase in the number of men who show evidence of “sperm fragmentation,” which can increase the chances of miscarriage. Researchers have known that certain antidepressants can influence ejaculatory response; it turns out that they seem to slow the transportation of sperm through the male reproductive system, causing the cells to age prematurely. “Sperm are being damaged because they’re not traveling properly through the body,” says Peter Schlegel, who led the study and is a urologist at New York’s Weill Cornell Medical College. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Urovekkende dårlig sædkvalitet hos norske menn
aftenposten.no 22.6.2010
(...) Instituttet mener det er urovekkende at en av fem norske menn har en spermiekvalitet under grensen som Verdens Helseorganisasjon, WHO, mener er assosiert med redusert fruktbarhet. (...)

- Det er åpenbart at spermier kan ha DNA-skader som har stor betydning for både fertilitet og det fødte barnet, samtidig som slike skader kan være vanskelige å oppdage. Vi kjenner oftest ikke årsakene til at spermiene er skadet, sier avdelingsdirektør Gunnar Brunborg og stipendiat Ville Sipinen ved Folkehelseinstituttet. (...)

Adverse effect of paroxetine on sperm (Uheldig virkning av Seroxat (paroxetine) på sædceller)
Fertility and Sterility (American Society for Reproductive Medicine)
published online 10 June 2009.
Objective
To assess the effects of a selective serotonin reuptake inhibitor on semen parameters. (...)

Patient(s)
Thirty-five healthy male volunteers, 18–65 years old.
Intervention(s)
Paroxetine administration for 5 weeks. (...)

Conclusion(s)
In men with normal semen parameters, paroxetine induced abnormal sperm DNA fragmentation in a significant proportion of subjects, without a measurable effect on semen parameters. The fertility potential of a substantial number of men on paroxetine may be adversely affected by these changes in sperm DNA integrity. (...)

Anti-Depressant-Associated Changes In Semen Parameters
medpagetoday.com 28.11.2008
SAN FRANCISCO, CA, USA (UroToday.com) - The authors previously reported an effect of antidepressants on semen parameters. The current study was designed to assess/confirm their prior report of the effects of an SSRI, paroxetine (Paxil), on semen parameters. (...)

As opposed to prior report, semen parameters (volume, concentration, motility, morphology) were not significantly altered during SSRI treatment. However, mean DNA fragmentation TUNEL score was significantly higher on SSRI (30.3%) versus baseline (13.8%). Multivariate logistic regression, correcting for age and body mass index, confirmed that SSRI treatment was significantly correlated with increased DNA fragmentation Up to 35% of men noted significant changes in erectile function and up to 47% of subjects reported ejaculatory difficulties while on paroxetine. (...)

Svårare bli pappa med antidepressiva
sr.se 26.9.2008
(...) Antidepressiva läkemedel kan göra det svårare för män att få barn. Det tycks bero på att spermierna drabbas av skador i sitt DNA, visar en första, mindre undersökning från Cornell Medical Centre i New York. (...)

Paxil could make men infertile, researchers suggest (Seroxat kan gjøre menn sterile)
pharmatimes.com 25.9.2008
US scientists have claimed that one of the most commonly used selective serotonin re-uptake inhibitors, GlaxoSmithKline's Seroxat/Paxil, causes serious DNA damage in sperm cells, according to the report in New Scientist. (...)

Paxil could make men infertile, researchers suggest
pharmatimes.com 25.9.2008
US scientists have claimed that one of the most commonly used selective serotonin re-uptake inhibitors, GlaxoSmithKline's Seroxat/Paxil, causes serious DNA damage in sperm cells, according to the report in New Scientist. (...)

Antidepressants may damage male fertility: study (Antidepressiva kan skade menns fruktbarhet, ifølge studie)
reuters.com 24.9.2008
LONDON (Reuters) - Common antidepressant drugs may reduce some men's fertility by damaging the DNA in their sperm, according to scientists.

A study of 35 healthy men given paroxetine -- sold as Paxil or Seroxat by GlaxoSmithKline -- found that, on average, the proportion of sperm cells with fragmented DNA rose from 13.8 percent before treatment to 30.3 percent after just four weeks.

Similar levels of sperm DNA damage have been linked to problems with embryo viability in couples trying to have children. (...)

Allan Pacey, Senior Lecturer in Andrology at the University of Sheffield, said the apparent increase in sperm DNA damage was "alarming," although he noted the level at which damage becomes clinically significant was open to debate. (...)

Being Overweight Does Not Result In Decreased Sperm Production, Study Shows
sciencedaily.com 17.6.2008
(...) Santoro and her coworkers plan to further study a trend they saw toward reduced sperm motility in the six men who were taking an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class. This class of drugs includes Prozac, Celexa, Lexapro, Paxil and Zoloft.

“We know that SSRIs affect sex drive, but there aren’t much data on their effect on fertility,” she said.

The results will be presented at The Endocrine Society’s 90th Annual Meeting in San Francisco. (...)

Antidepressants may make men infertile (Antidepressiva kan gjøre menn sterile)
guardian.co.uk 24.10.2006
Bestselling antidepressant drugs may be making some men infertile, research reported yesterday suggested.

The warning follows a study of two men at Cornell Medical Centre in New York whose sperm counts dropped to almost zero while taking the drugs but recovered to healthy levels whenever their medication was suspended.

The men were tested over a two-year period while being treated with the selective serotonin reuptake inhibitors (SSRIs) Citalopram (Cipramil) or Sertraline (Lustral), which belong to the same class of drugs as Prozac and Seroxat, Britain's biggest selling antidepressants. (...)

"These were men with normal sperm counts that went to nearly zero when they were on these antidepressants but returned to normal when they were off them," Prof Schlegel said.

"It's a dramatic effect and it has never been described before. We believe that while it has had a profound effect on these two men, it could be having a significant but more subtle effect on many more." (...)

Antidepressants Linked to Male Infertility
newsinferno.com 24.10.2006
Researchers at New York’s Cornell Medical Center have found a major correlation between use of antidepressants and sperm count. Men who take selective serotonin reuptake inhibitors (SSRIs) are being urged to consult closely with their doctors in order to determine a proper course of action in light of the new study, the first of its kind. Cornell’s Peter Schlegel announced the results this week at the 62nd annual meeting of the American Society for Reproductive Medicine (ASRM) in New Orleans. (...)

Dr. Schlegel believes that the problem may be connected to damage of the nerves in the vas deferens, the tube trusted with the task of delivering sperm to semen just before ejaculation. For male SSRI patients who may be considering starting or continuing a family, the results may have major ramifications. (...)

(Anm: vas deferens; ductus deferens; jf ev kongenital bilateralt manglande vas deferens EN vas deferens. Kilde: Norsk medisinsk ordbok.)

(Anm: vas deferens; wikipedia.org.)

Prozac is linked to low sperm count (Prozac linket til dårlig sædkvalitet)
timesonline.co.uk 24.10.2006
ANTIDEPRESSANT drugs could lower men’s sperm count, the first investigation of their effect on male fertility has found. (...)

SSRI-er utsetter utløsningen

Första läkemedlet mot för tidig utlösning godkänt
dagensmedicin.se 10.2.2009
Det första läkemedlet mot för tidig utlösning har godkänts i Sverige. Preparatet fördröjer utlösningen i mellan en och drygt två minuter.
Det nya läkemedlet ska säljas som tabletter under namnet Priligy och är godkänt på indikationen prematur ejakulation, för tidig sädesavgång. (...)

Ny pille utsetter utløsningen
Mari Rian Hanger
dagensmedisin.no 11.2.2009
Det første legemiddelet mot for tidlig utløsning er godkjent i Sverige. – Mange flere vil tørre å stå fram med problemet hvis dette blir godkjent i Norge, sier urolog Ole Martin Høeg. (...)

Ifølge det svenske Läkemedelsverket er den eneste dramatiske bivirkningen at det finnes en risiko for at følsomme personer svimer av på grunn av blodtrykksfall. (...)

(Anm: Priligy (Dapoxetine) (wikipedia.org).)

SSRI-preparater og mulige MS-liknende hjerneskader

Reversal of SSRI-Associated Apathy Syndrome by Discontinuation of Therapy
Ann Pharmacother. 2012 Mar;46(3):e8. Epub 2012 Feb 21.
(...) OBJECTIVE : To report 6 cases of selective serotonin reuptake inhibitor (SSRI)-associated apathy syndrome. CASE SUMMARIES : In all 6 cases, the patient reported loss of motivation while being treated with an SSRI. Loss of motivation was of new onset and temporally associated with the use of the SSRI. A trial of discontinuation of the SSRI was performed in all 6 patients and 2 were started on bupropion while cross-tapering from the SSRI. During the treatment trials, depression and apathy were monitored in all patients. Each case was assessed using the Apathy Evaluation Scale, Clinician version (AES-C), and by evaluating how the patient responded to discontinuation of the SSRI. DISCUSSION : Scores on the AES-C improved significantly in all 6 cases after the SSRI was discontinued. Improvement was also seen in the motivation, novelty, and persistence subdomain scores of the AES-C. A pretreatment AES-C score was available only in the first case. Based on the Naranjo probability scale, there was a probable cause of apathy syndrome with SSRI therapy in the first case and a possible association in the rest of the cases. CONCLUSIONS : In some patients SSRIs may cause an apathy syndrome that can be reversed through discontinuation of the agent. When evaluating patients being treated with an SSRI, clinicians should have a high degree of suspicion and specifically inquire for this iatrogenic form of apathy syndrome. (...)

Antidepressant linked to worsening white matter in elderly (Antidepressiva linket til forverring av hvit substans hos eldre)
rehabpub.com/reuters_article.asp 17.3.2008
NEW YORK (Reuters Health) - The results of a study employing serial cranial MRI suggest that elderly adults who use tricyclic antidepressants may be at increased risk for progression of white matter lesions, which have been linked with late-life depression by previous studies. (...)

The use of an antidepressant from any class during the study period hastened the progression of white matter disease, according to the report in the March issue of Stroke.

Contrary to what the investigators had hypothesized, SSRI use did not reduce, but slightly increased the risk of worsening white matter on multivariate analysis. Still, the 36% increased risk seen with these agents was not statistically significant.

The use of a tricyclic antidepressant, however, was associated with a significantly elevated risk of worsening white matter lesions. Compared with those who used no antidepressants, patients receiving an agent in this drug class had an increased risk of 77%. (...)

(Anm: Antidepressant Treatment and Worsening White Matter on Serial Cranial Magnetic Resonance Imaging in the Elderly. Stroke 2008;39:857-862.)

(Anm: hvit substans; hvit substans, margkledde nervefibrer, utløpere fra nervecellene i hjerne og ryggmarg. Den hvite fargen skyldes myelin, et fettholdig stoff som danner margskjeder omkring nervefibrene. Kilde: Store norske leksikon.)

(Anm: white matter (hvit substans); Multiple Sclerosis (MS) is one of the most common disease which affects white matter (wikipedia.org).)

(Anm: Magnetic resonance imaging MRI findings in white matter disease of brain. J Pak Med Assoc. 2008 Feb;58(2):86-8.)

Selective serotonin reuptake inhibitor use associates with apathy among depressed elderly: a case-control study (Bruk av selektive serotoninreopptakshemmere er assosiert med apati blant deprimerte eldre: en case-control studie)
Annals of General Psychiatry 2007, 6:7
Background (Bakgrunn)
Det er det siste ti år rapportert at bruk av selektive serotoninreopptakshemmere (SSRI-er) kan være assosiert med forekomst av apati. (...) (It has been reported for over the past decade that the use of selective serotonin reuptake inhibitors (SSRI's) may associate with the emergence of apathy.)

Conclusion (Konklusjon)
Selv om depresjon ble bedre hos eldre pasienter som fikk antidepressiva, opptrådte apati oftere hos pasienter som ble behandlet med SSRI enn hos pasienter som ikke ble behandlet. Dysfunksjon i frontal lobe på grunn av serotonerge endringer er ansett som en av mulighetene. (...) (Even though depression was improved in elderly patients receiving antidepressants, apathy appeared to be greater in patients who were treated with SSRI than that found in patients who were not. Frontal lobe dysfunction due to alteration of serotonin is considered to be one of the possibilities.)

(Anm: apati (av gr. nektende a og 'affekt'), psykologisk og psykiatrisk begrep som betyr mangel på sjelelige følelser (affekter). Som regel ledsaget av interesseløshet. Sees særlig ved svære depressive og schizofrene tilstander.

(Anm: pannelappen; lobus frontalis, hjernens frontallapp; jf frontallappssyndromet EN frontal lobe.

frontallappssyndromet; eit særleg huglag (sinnelag) som kan koma etter skade i ein pannelapp i hjernen, t d etter lobotomi; pasienten får eit grunt kjensleliv, vert urimeleg overflatisk og lett til sinns, likesæl og godtruande; også kalla frontal psyke; jf Witzelsucht (ty.) EN frontal lobe syndrome. Kilde: Norsk medisinsk ordbok.)

Vanlige utfall etter ervervet hjerneskade
sunnaas.no 26.2.003
(...) Det er rapportert at noen pasienter blir passive og apatiske. Noen er det fordi de har blitt deprimerte, mens det for andre er et direkte resultat av skaden. Noen blir også urolige og kritikkløse. Ofte er slike endringer i oppførsel det de pårørende synes er vanskeligst å forholde seg til. (...)

THE PEOPLE'S PHARMACY
infoweb.newsbank.com 14.7.2007 (The Dallas Morning News)
Serotonin has become a household word, thanks to Prozac. Millions of people take this popular antidepressant or related drugs such as Zoloft and Paxil every day.

These medications are known scientificallyas SSRIs: selective serotonin reuptake inhibitors. They allow serotonin to accumulate between nerve endings. This brain chemical helps to regulate mood and appears to be important for sleep, learning, appetite, sexual behavior, pain, perception and movement.

But although serotonin is essential for good health, it has a darker side. Too much serotonin can cause bizarre behavior, and some people taking these medications might be at risk of life-threatening drug interactions.

Serotonin syndrome can cause a range of problems, from anxiety, agitation and muscle twitches to nausea, sweating, confusion, convulsions and even coma. (...)

"...forstyrret følesans og opplevelser av "elektriske støt" i hodet" (...) "...følelse av elektriske støt i hodet, andre blir svimmel og psykisk urolig"

Hva er antidepressivt nedtrappingssyndrom?
pasienthandboka.no/ 17.4.2007
Stans i behandlingen med antidepressiv medikasjon (antidepressiva) er noen ganger forbundet med utvikling av et såkalt "antidepressivt nedtrappingssyndrom" (syndrom betyr samling av mange symptomer). Symptomene kan være forkjølelsesliknende, søvnproblemer, kvalme, svimmelhet, forstyrret følesans og opplevelser av "elektriske støt" i hodet. Alle typer antidepressiva er rapportert å kunne gi slike reaksjoner, enten som følge av brå stans eller for rask nedtrapping av behandlingen. De mest brukte antidepressiver betegnes SSRI (Fluoxetin, Fontex, Citalopram, Cipramil, Paroxetin, Seroxat, Sertralin, Zoloft, Fevarin, Cipralex), trisykliske antidepressiver (Klomipramin, Anafranil, Surmontil, Sarotex, Noritren, Sinequan) og MAO-hemmere (Moklobemid, Aurorix). Atypiske antidepressiver er Mianserin, Tolvon, Mirtazapin, Efexor, Edronax, Cymbalta, Yentreve.
Kjennskap til antidepressivt nedtrappingssyndrom er viktig fordi selv om symptomene ofte er milde, kan tilstanden gi mye ubehag, fravær fra jobb, andre psykososiale problemer og unntaksvis kreve sykehusinnleggelse. (...)

SSRI mot depresjon
pasienthandboka.no 27.2.2008
(SSRI betyr selektiv, serotonin reopptaks inhibitor) (...)

Mange er redd for avhengighet ved bruk av nervemedisiner. Medikamentene som brukes ved depresjoner gir ingen ruseffekt eller umiddelbar lykkefølelse, og heller ikke avhengighet (derfor er tilnavnet lykkepiller misvisende). Derimot kan man oppleve ubehag når man slutter med medisinene. Mange beskriver en følelse av elektriske støt i hodet, andre blir svimmel og psykisk urolig. Dette kan være skremmende dersom man ikke vet om det. Denne bivirkningen kan man unngå eller betydelig redusere ved å trappe langsomt ned dosene når man slutter. (...)

Hvilke symptomer ser vi ved MS?

Hvilke symptomer ser vi ved MS?
MS.NO 4.12.2002
SYMPTOMER
MS omfatter inflammasjon i sentralnervesystemet som etterfølges av tap av de beskyttende myelin skjedene som omgir nervefibrene [demyelinisering]. Myelinet virker som isolasjonsmateriale som omgir og beskytter elektriske ledninger. Når myelinet tar skade vil ikke nerveimpulsene kunne overføres så hurtig og effektivt som de skal. Som et resultat av den inflammatoriske prosessen vil det oppstå skadde områder [lesjoner eller plaques] i hjerne og ryggmarg som i sin tur gir ulike nevrologiske symptomer.

Vanlige symptomer kan være synstap, nummenhet og vissenhet, kraftsvekkelse, ustø gange, dobbeltsyn, økt trøttbarhet, varmeintoleranse, delvise eller fullstendige lammelser og en fornemmelse av elektrisk støt langs ryggsøylen ved bøyning i nakken. Symptomene kan forsvinne etter et akutt attakk, men kan også bli værende. (...)

Brain-damaged people give insights into morality (Hjerneskadede mennesker gir innblikk i moral)
reuters.com 22.3.2007
WASHINGTON (Reuters) - Det er krigstid, og en lege hos fienden utfører smertefulle/dødelige eksperimenter på barn. (- It's wartime, and an enemy doctor is conducting painful and inevitably fatal experiments on children.)

Du har to barn som er 8 og 5 år. You can surrender one of them within 24 hours or the doctor will kill both. What is the right thing to do? (You have two kids, ages 8 and 5. You can surrender one of them within 24 hours or the doctor will kill both. What is the right thing to do?)

For de fleste mennesker er dette scenariet, som er hentet fra en novelle av William Styrons, "Sophie's Choice", nesten et umulig dilemma. Men for en gruppe mennesker med skade i en del av hjernens frontal lobe, som hjelper å styre følelser, er beslutningen mye klarere. De ville velge ut et barn som skulle dø. (For most people, this scenario based on one in William Styron's novel "Sophie's Choice" is almost an impossible dilemma. But for a group of people with damage in a part of the brain's frontal lobe that helps govern emotions, the decision was far more clear. They would choose one child for death.)

Scientists said on Wednesday a study involving these people has produced unique insights into the brain mechanics of moral decision making and showed that in some key situations emotions play a fundamental role in moral judgments.

The new findings highlighted the role of a region in the front part of the brain below the eyes called the ventromedial prefrontal cortex.

Earlier research had pegged this area -- one of the more recently evolved parts of the human brain -- as playing a role in generating social emotions. In fact, the people with damage in this region due to stroke or other causes experienced severely diminished empathy, compassion and sense of guilt.

The new findings published in the journal Nature seem to confirm its central role in guiding certain moral judgments like life-or-death scenarios. (...)

Another wartime scenario involved enemy troops searching for civilians to kill. The people in the study were asked about their willingness to kill their own infant whose crying was drawing the attention of enemy soldiers who would then kill the parent, the baby and people hiding with them.

Again, the people with this brain damage were far more willing to judge killing the baby as the right moral choice. (...)

Vanlige utfall etter ervervet hjerneskade
sunnaas.no 26.2.003
(...) Det er rapportert at noen pasienter blir passive og apatiske. Noen er det fordi de har blitt deprimerte, mens det for andre er et direkte resultat av skaden. Noen blir også urolige og kritikkløse. Ofte er slike endringer i oppførsel det de pårørende synes er vanskeligst å forholde seg til. (...)

THE PEOPLE'S PHARMACY
infoweb.newsbank.com 14.7.2007 (The Dallas Morning News)
Serotonin has become a household word, thanks to Prozac. Millions of people take this popular antidepressant or related drugs such as Zoloft and Paxil every day.

These medications are known scientificallyas SSRIs: selective serotonin reuptake inhibitors. They allow serotonin to accumulate between nerve endings. This brain chemical helps to regulate mood and appears to be important for sleep, learning, appetite, sexual behavior, pain, perception and movement.

But although serotonin is essential for good health, it has a darker side. Too much serotonin can cause bizarre behavior, and some people taking these medications might be at risk of life-threatening drug interactions.

Serotonin syndrome can cause a range of problems, from anxiety, agitation and muscle twitches to nausea, sweating, confusion, convulsions and even coma. (...)

Andre teorier

Protein avgjør hvor godt du takler motgang
vg.no 25.10.2007
(VG Nett) Et protein i hjernen styrer hvor godt du takler motgang, viser ny forskning. (...)

Nå hevder forskere i en ny studie at det er mengden av proteinet Brain-derived neutrophic factor (BDNF) som styrer hvor godt vi takler påkjenninger, og nivået er merkbart lavere hos personer som ikke takler det så godt.

Tidligere studier har vist at deprimerte har et lavere nivå av hjerneproteinet sammenliknet med ikke-deprimerte. (...)

- Tren og spis sunt
- Både aktivitet og diett kan ha god effekt på produksjon av BDNF og andre funksjoner i hjernen. Det å være i fysisk aktivitet har vist seg å øke BDNF, og stimulering av miljø har også god effekt. Stress over lengre tid kan være med på å redusere mengde BDNF i enkelte deler av hjernen, sier hun, og gir følgende råd:

- Tren, spis sunt og ikke utsett deg for stress over lengre tid. (...)

(Anm: Fysisk trening (aktivitet / løping / jogging).)

Protein kan ligga bakom depression
dn.se 9.1.2006
Den svenska neurofarmakologen Per Svenningsson har funnit en koppling mellan två funktioner i hjärnan som kan vara ett forskningsgenombrott i förståelsen av sjukdomen depression.

Depression är en mycket vanlig sjukdom som drabbar varannan kvinna och var fjärde man någon gång under en livstid.

Läkemedelsbehandlingen av depression enbart i Sverige kostar över en miljard kronor varje år. Men forskarna vet fortfarande väldigt lite om hur utvecklingen av sjukdomen egentligen går till inne i kroppen.

Nu kan den svenska neurofarmakologen docent Per Svenningsson vid Karolinska institutet i Stockholm vara depressionens mekanism på spåren. Hans forskning har just publicerats i vetenskapliga tidskriften Science. (...)

Det finns fortfarande mycket forskning kvar att göra innan depressionens gåta är löst. Och det är också troligt att det är flera proteiner och gener som är involverade vid utvecklingen av depression. Det kommer därför att ta tid innan någon ny behandling finns att tillgå.

- Men jag tror att min strategi att specifikt studera mekanismerna bakom sjukdomen kommer att leda till att vi i framtiden kommer att kunna behandla depression på ett bättre sätt, säger Per Svenningsson. (...)

Implant eases depression with zaps of happiness
seattletimes.nwsource.com 8.1.2006
Implant eases depression with zaps of happiness

For two decades, Meir Samel was severely depressed. Ultimately, he said, his prolonged sadness and feelings of worthlessness cost him his job and his marriage.

"It just messed up my whole life. I really couldn't function," said the 66-year-old biochemist, who took an early retirement at age 49.

Today, Samel feels better than he has in years, thanks to a pacemakerlike device implanted in his chest three months ago.

The implant was approved by the government in July for people with treatment-resistant depression — that is, the kind that does not respond to multiple medications or other psychiatric therapies.

The implant works by delivering mild, intermittent electrical pulses to the left vagus nerve in the neck, one of a dozen cranial nerves that serve as the body's "information highway." The nerve then activates areas of the brain believed to regulate mood. (...)

Genes may indicate likelihood of depression
netdoctor.co.uk 6.1.2006
A gene which regulates a vital brain chemical may indicate whether or not an individual is likely to suffer from depression, US scientists have said.

A team from the Rockefeller University said the p11 gene, which regulates the levels of the brain chemical serotonin, could also be used to develop treatments for mental disorders such as depression.

The team of researchers, led by Professor Paul Greengard, found decreased levels of p11 in the brain were associated with the development of depression.

Professor Greengard said: "We have shown that a gene called p11 is involved in the multiple complex changes that underlie depression. (...)

Antidepressiva, fettceller, benskjørhet, hjertesykdommer og immunsystem

Neuroleptic malignant syndrome: a neuroimmunologic hypothesis
CMAJ 2010;182 E834-E838 (December)

Selective Serotonin Reuptake Inhibitors Linked to Bone Loss in Older Men: Presented at ASBMR
docguide.com 22.10.2010
TORONTO -- October 22, 2010 -- Men taking selective serotonin reuptake inhibitors (SSRIs) experience greater bone loss than men who do not take SSRIs, according to data from the Osteoporotic Fractures in Men (MrOS) Study presented here at the American Society of Bone and Mineral Research (ASBMR) 2010 Annual Meeting.

The analysis, presented here at a poster session on October 18, found that use of SSRIs was associated with rising loss of bone mineral density (BMD) at the total hip and subregions, according to lead investigator Elizabeth Haney, MD, Oregon Health Sciences Center, Portland, Oregon. (...)

Statistical analyses revealed that patients who took SSRIs had greater loss of BMD at the total hip and subregions, and there was no statistically significant difference between the 2 groups at the total spine.

They also found that SSRI users had lower grip strength, lower physical activity scores, and a greater history of falls compared to nonusers. (...)

Breaking into bone biology: serotonin's secrets
Nature Medicine 2009;15, 145-146 (1 February)
Bedside to Bench Selective serotonin reuptake inhibitors (SSRIs) have been the cornerstone of treatment for depression for over a decade. However, two recent studies have shown that patients who are prescribed SSRIs have lower bone mineral density (BMD) than those taking older, tricyclic antidepressants such as amitriptyline. (...)

Sick and down (Syk og nedfor)
sciencenews.org 4.7.2008
To fight off an infection or illness, the body shifts into a slow-down mode that mirrors some symptoms of depression. In fact, scientists now think the immune response itself may even cause the mood disorder.

From Sick to DownImmune cells secrete cytokines (shown as red dots in this simplified drawing, click on image to see larger version) that trigger inflammatory responses. But when cytokine levels in the brain stay high fo too long, people susceptible to mood disorders may develop depression. Cytokines released in the body may enter the brain directly, by passing through leaky areas in the blood-brain barrier, or indirectly by initiating a chain reaction of "middlemen" that lead to brain cells called microglia releasing cytokines. Cytokines may alter mood by changing brain processes and levels of brain chemicals such as serotonin and dopamine. Synthetic version of interferon-alpha and interferon-beta, used to treat cancers, hepatitis C and multiple sclerosis, may engage the same pathway. (...)

Psykiske lidelser og hjertesykdom
Tidsskr Nor Lægeforen 2007; 127: 2126-7
(...) Det er i flere studier vist at også antidepressive medisiner fører til signifikant økning av lipidnivået i blodet. Derfor bør pasienter som behandles med antipsykotiske, antidepressive og stemningsleiestabiliserende midler få blodlipidnivået kontrollert regelmessig. (...)

Overraskende om skjelettet
forskning.no 13.8.2007
(...) - Regulerer stoffskiftet
- Jeg var overrasket over hvor omfattende funnene var. Det ser ut til at skjelettet er en reostat som regulerer stoffskiftet, sier Gerard Karsenty til Nature. (...)

Karsenty er entusiastisk, men nøye med å påpeke at man må forske mer for å finne ut akkurat hvor mye disse hormonene har å si for kroppen. (...)

Newtonsk premiss
Bakgrunnen for oppdagelsen er at Karsenys forskning tidligere hadde vist at fettceller påvirket stoffskiftet i benbygningen. (...)

Lipidmetabolismen reguleres av immunsystemet
Tidsskr Nor Lægeforen 2007; 127 (31.5.2007)
Hyperlipidemi er ofte forbundet med inflammasjon. Ny forskning på mus har vist at de proinflammatoriske cytokinene lymfotoksin og LIGHT (homolog til lymfotoksin), hovedsakelig produsert i T-lymfocytter, regulerer nøkkelenzymer i lipidmetabolismen (Science 2007; 316: 285 - 8). (...)

Antidepressive medikamenter påvirker kroppens fettproduksjon
NY DOKTORGRAD
uib.no (23.9.2006)
Cand. med. Maria Barøy Ræder disputerer fredag 29. september for PhD graden ved Universitet i Bergen med avhandlingen:

”Lipid-related effects of antidepressant and antipsychotic drugs: A molecular and epidemiological study”

Medikamenter som brukes i behandlingen av depresjon er i hyppig og økende bruk i Norge. Denne økningen har særlig kommet etter at en ny medikament-gruppe mot depresjon ble introdusert, de såkalte SSRI-medikamentene (”lykkepiller”). Avhandlingen handler om medisiner brukt ved depresjon og hvordan disse påvirker fettproduksjonen i kroppen, både på et klinisk- og på et molekylært plan.

På det kliniske planet benyttet Ræder data fra Helseundersøkelsen i Hordaland (HUSK) og viste at pasienter som brukte SSRI-medikamenter oftere hadde økt risko for hjerte-karsykdom. Særlig viktig var det at personer som brukte antidepressive legemidler hadde høyere forkomst av de disponerende risikofaktorene overvekt og forhøyete kolesterolverdier. Tidligere har man vist at antipsykotiske medisiner disponerer for overvekt. (...)

På det molekylære planet tok Ræder i bruk cellestudier og moderne genteknologiske metoder for å vise at de store gruppene av psykiatriske medisiner (antipsykotika og antidepressiva, inkludert SSRI-medikamenter) virker på fettomsetningen i kroppen gjennom en transkripsjonsfaktor kalt SREBP (steroid reseptor-element bindende protein). SREBP er meget viktig for å regulere produksjon både av kolesterol og av ulike fett-stoffer i kroppens celler. Kolesterol og andre fett-stoffer er viktig for at nevroner skal utvikle seg og fungere normalt, men har også en rolle i utviklingen av hjerte- og karsykdom. (...)

Nurse 'shocked to death' by alarm
bbc.co.uk 28.4.2006
Lisa Browne died suddenly in her bed in 1998
A nurse died from heart failure brought on by the shock of her alarm clock going off, an inquest has heard.

Lisa Browne, who was originally from Stoke-on-Trent, died suddenly in her bed in 1998. She was 27. (...)

Heart specialists in London, who investigated the case last year, confirmed the paediatric nurse was suffering from Long QT Syndrome. (…)

The attorney general ordered a fresh inquest and the original verdict, given in August 1998, to be quashed. (...)

She complained on a number of occasions to her GP, who prescribed her a low dose of an antidepressant which she took for a few months from October 1996.

The antidepressant should not be taken by anyone suffering from Long QT syndrome, the inquest heard. (…)

SSRI-preparat kan ge förlängd QTc-tid
lakartidningen.se 4.4.2006
Selektiva serotoninåterupptagshämmare (SSRI) har visats kunna ge hjärtbiverkningar, främst QTc-förlängning, som disponerar för ventrikulära arytmier av typ ”torsade de pointes”. SSRI kan därför inte längre betraktas som riskfria från hjärtsynpunkt. Vid behandling med dessa medel bör patientens hjärtstus, EKG och eventuella riskfaktorer uppmärksammas. Nyligen antagna internationella riktlinjer kan öka den kardiovaskulära säkerheten vid läkemedelsbehandling.

Läkemedelsutlöst arytmi svårfångad biverkan

Citalopram inte riskfritt från hjärtsynpunkt (...)

Antidepressants Boost Heart Patients' Death Risk (Antidepressiva øker hjertepasienters dødsrisiko)
healthfinder.gov 5.3.2006
Overraskende resultat, trenger ytterligere granskning, ifølge eksperter. (Finding surprising, needs further study, experts say.)

Menn og kvinner med koronararteriesykdom som tar antidepressiva synes å ha en høyere dødsrisiko, antyder overraskende ny forskning. (Men and women with coronary artery disease who take antidepressants appear to be at a higher risk of dying, surprising new research suggests.)

Der er ingen enkel forklaring på resultatene, som motsier tidligere studier. (There was no ready explanation for the finding, which contradicts previous studies.)

"Dette var et uventet funn," sa medforfatter av studien, James Blumenthal, professor i medisinsk psykologi ved Duke University Medical Center. "Der er ingen åpenbar forklaring." ("This was an unexpected finding," said study co-author James Blumenthal, a professor of medical psychology at Duke University Medical Center. "There is no obvious explanation.")

Men, han la til, "det er uriktig å konkludere at antidepressiva forårsaket pasientenes død." (But, he added, "it is improper to conclude that antidepressants caused the patients to die.")

"Det strider imot hva vi hadde håpet>," tilla dr. Nieca Goldberg, sjef for hjertebehandling av kvinner ved Lenox Hill Hospital i New York City og talsmann for American Heart Association. "Men vi kan ikke bevise det på den ene eller annen måte." ("It contradicts what we were hoping," added Dr. Nieca Goldberg, chief of women's cardiac care at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association. "But we can't prove it one way or the other.")

Forskningen, presentert lørdag på møte til American Psychosomatic Society i Denver, viste at, selv etter justering for ulike faktorer, fant forskerne at hjertepasienter som tok antidepressiva hadde 55 prosent høyere dødsrisiko enn de som ikke tok antidepressiva. Der var ingen statistisk signifikant forskjell mellom de som tok selektive serotoninreopptakshemmere (SSRI-er) og de som tok andre typer av antidepressiva. (...) (The research, presented Saturday at the American Psychosomatic Society meeting in Denver, showed that, even after adjusting for a variety of factors, the researchers found heart patients taking antidepressants had a 55 percent higher risk of dying than those not taking antidepressants. There was no statistical significant difference between those taking selective serotonin reuptake inhibitors (SSRIs) and those taking other types of antidepressants.)

Effects of paroxetine on cardiovascular response to mental stress in subjects with a history of coronary artery disease and no psychiatric diagnoses. (Effekter av paroxetine på kardiovaskulær respons til mentalt stress hos personer med en historie av koronararteriesykdom og ingen psykiatrisk diagnose.)
Psychopharmacology (Berl) 2005;;182(3):321-6.)
(...) RESULTATER: Mens på paroxetine, var systolisk blodtrykk og diastolisk blodtrykk 10-15 % lavere (p < 0.005) i løpet av stressoren, i forhold til målinger oppnådd på placebo. Puls og plasma norepineprin-konsentrasjoner i løpet av stress tenderte å være lavere i løpet av paroxetine behandling men nådde ikke statistisk signifikans. (...) (RESULTS: While on paroxetine, systolic blood pressure and diastolic blood pressure were 10-15% lower (p < 0.005) during the stressor, relative to measures obtained while on placebo. Pulse and plasma norepinephrine concentrations during stress trended lower during paroxetine treatment but did not reach statistical significance.)

Antidepressiver øger risiko for hjertedød
dagensmedicin.dk 10.3.2006
Hjertepatienter, der tager antidepressiv medicin, har tilsyneladende en højere risiko for at dø. Det viser de foreløbige resultater af en undersøgelse, som i sidste uge blev fremlagt på en konference i USA.

Det er forskere fra det amerikanske Duke University Medical Center, der har fremlagt de overraskende resultater fra en undersøgelse af hjerte-kar-patienter. Undersøgelsen viste, at personer, der havde fået udført en koronararteriografi (KAG) og brugte antidepressive lægemidler, havde en signifikant forhøjet risiko for at dø, sammenlignet med patienter, der havde fået den samme undersøgelse, men ikke brugte disse lægemidler. Forskellen vedblev, efter at data var renset for forskelle i alder, køn, hjertets pumpeevne, rygevaner, andre sygdomme og uddannelse. (...)

Forskare hittade samband mellan antidepressiva och dödlighet
dagensmedicin.se 5.3.2006
Personer som har hjärt-kärlsjukdom och äter antidepressiva läkemedel verkar löpa en högre risk att dö, enligt preliminära forskningsresultat som presenterades i går.

Det är forskare vid Duke University Medical Center i USA som vid en konferens i går, lördagen den 4 mars, presenterade förvånande resultat från en studie av hjärt-kärlsjuka patienter. Det visade sig att personer som genomgått kärlröntgen och använde antidepressiva medel löpte en signifikant ökad risk att dö, jämfört med patienter som också genomgått kärlröntgen, men inte tog sådana läkemedel.

Skillnaden kvarstod när forskarna rensade för bland annat ålder, kön, hjärtats pumpningsförmåga, rökvanor, andra sjukdomar och utbildning. Det verkade också finnas en skillnad mellan så kallade SSRI-preparat och andra antidepressiva - SSRI-preparaten ledde till ökad dödlighet - men den var inte signifikant.

I den prospektiva studien analyserade forskarna data från 921 patienter som tagits in på sjukhus för kärlröntgen. Knappt en femtedel av dessa personer tog antidepressiva läkemedel.

Patienterna fick svara på ett test som användes för att avgöra om de led av depression eller inte. Sedan följdes patienterna i genomsnitt i tre år. Under denna tid avled 21,4 procent av de personer som tog antidepressiva medel, jämfört med 12,5 procent i gruppen som inte behandlades med sådana preparat.

Sedan andra faktorer rensats bort, hade gruppen som fick antidepressiva en 55 procent högre risk för att dö.

Forskarna vid Duke University förbereder nu en randomiserad studie för att undersöka vilken påverkan motion och SSRI-preparat kan ha på olika markörer för hjärt-kärlsjukdom. (...)

(Anm: Anti-Depressant, Heart Risk Association Needs Further Study.
dukemednews.org 4.2.2006.)

Cardiovascular Side Effects of New Antidepressants and Antipsychotics: New Drugs, old Concerns?
Current Pharmaceutical Design 2004;10(20)
The cardiovascular toxicity of older generation of tricyclic antidepressants (e.g. imipramine, desipramine, amitriptyline, clomipramine) and neuroleptics (e.g. haloperidol, droperidol, thioridazine, pimozide) is well established. These drugs inhibit cardiovascular Na+, Ca2+ and K+ channels often leading to life-threatening arrhythmia.

To overcome the toxicity of old generation of antidepressants and antipsychotics, selective serotonin reuptake inhibitor antidepressants (SSRIs: fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, venlafaxin) and several new antipsychotics (e.g. clozapine, olanzapine, risperidone, sertindole, aripiprazole, ziprasidone, quetiapine) were introduced during the past decade. Although these new compounds are not more effective in treating psychiatric disorders than older medications, they gained incredible popularity since they have been reported to have fewer and more benign side effect profile (including cardiovascular) than predecessors. (...)

SSRIer forårsaker blødninger

Recent findings from University of Southern Denmark highlight research in selective serotonin reuptake inhibitor
behavioralhealthcentral.com 5.3.2010
Investigators publish new data in the report 'An association between selective serotonin reuptake inhibitor use and serious upper gastrointestinal bleeding.' "In vitro studies have shown that selective serotonin reuptake inhibitors (SSRIs) inhibit platelet aggregation. It is controversial whether use of SSRIs is a cause of clinically important bleeding; results from observational studies have been equivocal," researchers in Denmark report (see also Selective Serotonin Reuptake Inhibitor). "A population-based case-control study was conducted in Denmark. The 3652 cases all had a first discharge diagnosis of serious upper gastrointestinal bleeding (UGB) from 1995 to 2006. Controls (n=36,502), matched for age and sex, were selected by risk-set sampling. Data on drug exposure and medical history were retrieved from a prescription database and the county's patient register. Confounders were controlled for by conditional logistic regression and the case-crossover design. The adjusted odds ratio (OR) of UGB among current, recent, and past users of SSRIs was 1.67 (95% confidence interval [CI], 1.46-1.92), 1.88 (95% CI, 1.42-2.5), and 1.22 (95% CI, 1.07-1.39). The adjusted OR for concurrent use of SSRI and nonsteroidal anti-inflammatory drugs (NSAIDs) was 8.0 (95% CI, 4.8-13). The adjusted OR for the concurrent use of NSAID, aspirin, and SSRI was 28 (95% CI, 7.6-103). Of the UGB cases, 377 were current users of SSRI; the adjusted OR for UGB in the case crossover analysis was 2.8 (95% CI, 2.2-3.6). The adjusted OR among users of proton pump inhibitors was 0.96 (95% CI, 0.50-1.82). Use of SSRI was associated with UGB, consistent with its antiplatelet effects," wrote M. Dall and colleagues, University of Southern Denmark.

The researchers concluded: "SSRIs should be prescribed with caution for patients at high risk for UGB." (...)

(Anm: An Association Between Selective Serotonin Reuptake Inhibitor Use and Serious Upper Gastrointestinal Bleeding. Clinical Gastroenterology and Hepatology, 2009;7(12):1314-21) (December).)

Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study (Bruk av selektive serotoninreopptakshemmere og risiko ved reoperasjon grunnet blødning etter operasjon hos brystkreftpasienter: en dansk befolkningsbasert kohortstudie)
BMC Surgery 2010, 10:3doi:10.1186/1471-2482-10-3 (24.1.2010)
Background
Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association. (...)

Results
389 of 14,464 women (2.7%) were re-operated. 1592 (11%) had a history of SSRI use. Risk of re-operation was 2.6% among never users, 7.0% among current SSRI users, and 2.7% among former users. Current users thus had an increased risk of re-operation due to post-operative bleeding (adjusted relative risk=2.3; 95% confidence interval (CI)=1.4, 3.9) compared with never users. There was no increased risk of re-operation associated with former use of SSRI (RR=0.93, 95% CI= 0.66, 1.3). (...)

Anti-depressants And Painkillers Combined Linked To Gastrointestinal Bleeding
sciencedaily.com 9.10.2007
Science Daily — New research shows that selective serotonin reuptake inhibitors (SSRIs), a group of drugs commonly used to treat depression, may double the risk of gastrointestinal bleeding, according to researchers from Wake Forest University School of Medicine and colleagues. When the drugs are taken with aspirin and other similar pain medications, the risk is more than 600 percent higher. (...)

SSRIs and gastrointestinal bleeding (SSRI og gastrointestinal bløding)
BMJ 2005;331:529-530 (10 September)
Der er teoretiske grunner til å tro at selektive serotoninreopptakshemmere (SSRIs), mye brukt til å behandle depresjon, kan øke risikoen for gastrointestinal bløding. (...) (There are theoretical reasons for believing that selective serotonin reuptake inhibitors (SSRIs), widely used to treat depression, might increase the risk of gastrointestinal bleeding.)

Serotonin er frigjort fra blodplater (trombocytter) som respons på vaskulær skade og aktiverer vasokonstriksjon (sammentrekning av blodårene) og en forandring i formen på blodplatene som fører til aggregasjon (sammenklumping av blodplater til tromber (blodpropper)).¹ Blodplater kan ikke selv syntetisere serotonin. SSRI-er hemmer serotonintransporten, som er ansvarlig for opptaket av serotonin i blodplatene. Det kunne således forutsis at SSRi-er ville tømme blodplatene for serotonin, som fører til redusert evne å danne klumper med påfølgende økning i risikoen for blødning. (Serotonin is released from platelets in response to vascular injury and promotes vasoconstriction and a change in the shape of the platelets that leads to aggregation.¹ Platelets cannot themselves synthesise serotonin. SSRIs inhibit the serotonin transporter, which is responsible for the uptake of serotonin into platelets. It could thus be predicted that SSRIs would deplete platelet serotonin, leading to a reduced ability to form clots and a subsequent increase in the risk of bleeding.)

Vi har gjennomgått de publiserte databasestudier på sammenhengen mellom bruk av SSRI og gastrointestinal blødning. Fire av disse studier sammenliknet risikoen for en blødning i øvre delen av mage-tarm-kanalen hos de som er forskrevet SSRi-er med de som ikke er det. Oddsratioer for en blødning hos en SSRI-behandlet pasient varierte fra 1,38 til 3,6: 3,0 (95% konfidensintervall 2,1 til 4,4),² 3,6 (2,7 til 4,7),³ 2,1 (0,6 til 8,3),⁴ og 1,38 (0,82 to 2,34).⁵ Denne omtrent tredoble økning i risiko kan også gjede for andre typer blødninger. Movig et al rapporterte at pasienter som tar SSRI-er var 3,71 (1,35 til 10,18) ganger mer sannsynlig å kreve blodtransfusjon under ortopedisk kirurgi enn pasienter som ikke tar dem.⁶ Meijer el al rapporterte at kvinner som tar SSRIs med en høy affinitet til serotonin transport var 3,0 (0,8 til 4,9) ganger mer sannsynlig å erfare uvanlig livmorblødning enn kvinner som tok antidepressiva med lav affinitet.⁴ (We have reviewed the published database studies on the relation between SSRI use and gastrointestinal bleeding. Four of these studies compared the risk of an upper gastrointestinal bleed in those prescribed SSRIs with those who were not. The odds ratios of a bleed in an SSRI-treated patient ranged from 1.38 to 3.6: 3.0 (95% confidence interval 2.1 to 4.4),² 3.6 (2.7 to 4.7),³ 2.1 (0.6 to 8.3),⁴ and 1.38 (0.82 to 2.34).⁵ This roughly threefold increase in risk may also hold for other types of bleeding. Movig et al reported that patients taking SSRIs were 3.71 (1.35 to 10.18) times more likely to require a blood transfusion during orthopaedic surgery than patients not taking them.⁶ Meijer el al reported that women taking SSRIs with a high affinity for the serotonin transporter were 3.0 (0.8 to 4.9) times more likely to experience abnormal uterine bleeding than women who took antidepressants with low affinity for this transporter.⁴)

En forbindelse mellom risikoen for blødning og økende affintitet for serotonin transportering har vært bemerket i flere studier,^{2 4 7} selv om konfidensintervaller for de siterte oddsratioer overlapper betraktelig. (...) (An association between the risk of bleeding and increasing affinity for the serotonin transporter has been noted in several studies,^{2 4 7} although the confidence intervals around the quoted odds ratios overlap considerably.)

Rapid Responses
Bortsett fra gastrointestinal blødning, økte SSRI-er også risikoen for livmorsblødning, hjerneblødning, unormal blødning i ledd, neseblod, og blødning i urinblære. Dette kan være et resultat av følgende mekanismer. Blodplatefaktor 4 og beta-tromboglobulin er to trombogeniske proteiner frigitt i blodet når blodplater er aktivert. Serotonin potensierer blodplateaktivering. SSRI-er reduserer serotoninopptak fra blod til blodplater. Siden blodplater ikke fremstiller serotonin, er SSRi-er forbundet med økninger i blødningsepisoder. (...) (Apart from gastrointestinal bleeding,SSRIs also increase the risk of uterine bleeding, brain hemorrhages, abnormal bleeding in joints, nose bleeds, and bleeding within the bladder. This may result due to following mechanisms. Platelet factor-4 and beta-thromboglobulin are two thrombogenic proteins released into the blood when platelets are activated. Serotonin potentiates platelet activation. SSRIs decrease serotonin uptake from blood to platelets. Since platelets do not synthesize serotonin, SSRIs are associated with increases in bleeding episodes.)

(Anm: gastrointestinal bleeding; gastrointestinal bløding; «g.i.bløding», bløding frå øsofagus, magesekk eller tarm; kan gi synleg blod i avføringa, gjerne som svart farge (melena) eller positiv kjemisk prøve for blod utan synleg endring (okkult bløding); stundom brukast uttrykka øvre- eller nedre g.i. bløding; jf tarmbløding, okkult bløding. EN gastrointestinal bleeding. BM gastrointestinal blødning. Kilde: Norsk medisinsk ordbok.)

(Anm: platelet; trombocytt; thrombocytt, blodplate; små plateliknande kjernelause lekamar i blodet som er viktige for blodlevringa; dei kan hefta seg til kvarandre, til årevegger eller sårvev og desse samanklumpingane kan dekka skadar i endotel og tena som pluggar som stansar småblødingar, og dei kan frisetja koagulasjonsfaktorar; dei vert danna ved avsnøringar frå megakaryocyttane i beinmargen; dei inneheld alfa-granula som lagrar fibrinogen, PDGF, TGFb, faktor V, Willebrandfaktor m v, og delta-granula (dense granules)som inneheld serotonin og ADP og har på overflata reseptorar (P2Y) for ADP, sjå også trombospondin, glykoproteinkompleks og PDGF; trombocyttane kan vera med i framveksten av arteriosklerose og ved blodproppsjukdommar; jf trombopoetin, tromboksan, viskøs metamorfose. EN platelet; thrombocyte. ET [gr thrombos blodlevre + kytos holrom, celle]. Kilde: Norsk medisinsk ordbok.)

SSRI-er og mulig lungeemboli (PE)

Thoracic Ultrasound for Diagnosing Pulmonary Embolism: A Prospective Multicenter Study of 352 Patients. (Ultralyd av bryst for diagnostisering av lungeemboli: En prosoektiv multisenterstudie av 352 pasienter.)
Chest 2005;128(3):1531-1538 (September 2005)
BAKGRUNN: Lungeemboli (PE) fortsetter å være en stor diagnostisk utfordring, som vist ved det faktum at mange pasienter dør udiagnostisert og/eller ubehandlet. Målet for denne multisenterstudie var å bestemme nøyaktigheten av ultralyd av thorax (TUS) ved diagnosen av PE (TUSPE). (...) (BACKGROUND: Pulmonary embolism (PE) continues to be a major challenge in terms of diagnosis, as evidenced by the fact that many patients die undiagnosed and/or untreated. The aim of this multicenter study was to determine the accuracy of thorax ultrasound (TUS) in the diagnosis of PE (TUSPE).)

Resultater: PE ble diagnostisert hos 194 pasienter. Ved TUS, hadde 144 pasienter samlet 333 subpleurale lesjoner (middelverdi, 2,3 lesjoner per pasient) gjennomsnittlig 15,5 x 12,4 mm i størrelse. I tillegg ble en snever pleural effusjon funnet hos 49 % av paientene. TUS ga følgende resultater ved bruk av de strenge kriterier 1 og 2: PE sann-positiv, n = 144; PE falsk positiv, n = 8; PE sann-negativ, n = 150; og PE falsk-negativ, n = 50. Sensitiviteten var 74%, spesifisitet var 95 %, positiv prediktiv verdi var 95 %, negativ prediktiv verdi var 75 %, og nøyaktighet var 84 %, med en prevalens på 55 %. Sensitiviteten hos pasienter med criterion 1 var 43 % og en spesifisitet på 99 %. Fortolkning: TUS er en ikke-invasiv metode for å diagnostisere perifer PE. I fraværet av CTPA, er TUS et egnet verktøy til å påvise PE ved sykesengen eller akuttsituasjoner. (...) (Findings: PE was diagnosed in 194 patients. On TUS, 144 patients had a total of 333 subpleural lesions (mean, 2.3 lesions per patient) averaging 15.5 x 12.4 mm in size. Additionally, a narrow pleural effusion was found in 49% of the patients. TUS yielded the following results under application of the strict criteria 1 and 2: PE true-positive, n = 144; PE false-positive, n = 8; PE true-negative, n = 150; and PE false-negative, n = 50. The sensitivity was 74%, specificity was 95%, positive predictive value was 95%, negative predictive was value 75%, and accuracy was 84%, at a prevalence of 55%. The sensitivity in patients with criterion 1 was 43% and a specificity of 99%. Interpretation: TUS is a noninvasive method to diagnose peripheral PE. In the absence of CTPA, TUS is a suitable tool to demonstrate a PE at the bedside and in the emergency setting.)

(Anm: pulmonary embolism (PE); lungeemboli; embolia arteriae pulmonalis; blodpropp til lungene, d e til lungepulsåra, kan ha opphav i årebetennelse i bein, armar eller i vena cava, har lett for å koma i dagane etter ein operasjon; små lungeemboliar treng ikkje gi plager, store emboliar kan gi brått innsettande brystsmerter, hoste, av og til med blodig oppspytt, tung pust, gjerne takykardi m v; kan føra til brå død; i tillegg til ein trombosetendens (s d) kan røyking og høgt blodtrykk disponera for lungeemboli; jf pulmonal angiografi, Q-skanning, V-skanning. EN pulmonary embolism. Kilde: Norsk medisinsk ordbok.)

(Anm: subpleural; subpleuralis; som er under eller like innanfor brysthinna (pleura). EN subpleural. Kilde: Norsk medisinsk ordbok.)

Fatal venous thromboembolism associated with antipsychotic therapy (Dødelig venøs tromboembolisme assosiert med antipsykotisk terapi)
Ann Pharmacother 2004;38(9):1435-8 (September 2004)
(...) CASE-SAMMENDRAG: En 47 år gammel kvinne behandlet med clozapine og paroxetine ble innlagt på sykehus med dyspné og hevelse i leggene. Pasienten ble diagnostisert med PE og ble behandlet intravenøst med heparin. Pasienten utviklet på dag 7 på sykehuset plutselig akutt åndedrettssvikt og døde. Obduksjon bekreftet eksistensen av massiv PE. (CASE SUMMARY: A 47-year-old woman treated with clozapine and paroxetine was admitted to the hospital with dyspnea and swelling of the leg. The patient was diagnosed as having PE and was treated with intravenous heparin. On hospital day 7, sudden acute respiratory failure developed and the patient died. Postmortem examination confirmed the existence of massive PE.)

(Anm: SSRI-en paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

(Anm: pulmonary embolism (PE); lungeemboli, se forklaring ovenfor.)

DISKUSJON: Kvinnen hadde ingen andre identifiserbare risikofaktorer enn inntak av en kombinasjon av clozapine og paroxetine, med en påvist forhøyet konsentrasjon av clozapine i blod. Bruk av Naranjo-sannsynlighetsskala viste en mulig sannsynlighet for at den uheldige reaksjonen var legemiddelrelatert. (DISCUSSION: The woman had no identifiable risk factors other than receiving a combination of clozapine and paroxetine, with a demonstrated elevated clozapine blood concentration. Use of the Naranjo probability scale revealed a probable likelihood that the adverse reaction was drug related.)

KONKLUSJONER: Forbindelsen mellom antipsykotiske legemidler og venøs blodproppsjukdom er tidligere blitt beskrevet, men er fremdeles et sjeldent funn. Dette tilfellet understreker viktigheten av overvåking og mulig avbrytelse av behandling når venøs trombose er mistenkt. Det bør grundig overvåkes, spesielt hos pasienter med risikofaktorer for trombose. Til slutt kan antidepressiva-antipsykotika kombinasjoner øke risikoen for sjeldne uheldige effekter, slik som venøs blodproppsjukdom, selv med fravær av andre risikofaktorer. (...) (CONCLUSIONS: The association of antipsychotic drugs and venous thromboembolism has been previously described, but is still a rare finding. This case highlights the importance of monitoring and possibly discontinuing treatment when venous thrombosis is suspected. There should be careful monitoring, especially in patients with risk factors for thrombosis. Finally, antidepressant-antipsychotic drug combinations can increase the risk of rare adverse effects, such as venous thromboembolism, even in the absence of other risk factors.)

(Anm: dyspné; tung pust, andpust, kort pust, vanskeleg andedrett, pustevanskar; kjensla av dyspné skal vera utløyst av impulsar frå pustemusklane og senene deira, impulsar frå hjerneborken og visstnok også frå kjemoreseptorar ved blodgassendringar. EN dyspnea ET [gr dyspnoia]. Kilde: Norsk medisinsk ordbok.)

(Anm: tromboembolisme; blodproppsjukdom, d e tiltetting av blodårer av blodlevrer, blodplateklumpar eller andre faste emne som vert førde med blodstraumen; jf trombose, emboli. EN thromboembolism. Kilde: Norsk medisinsk ordbok.)

SSRI-indusert benskjørhet (osteoporose) og hjertesykdom

Hazards: Antidepressant Linked to Fractures in Older People
nytimes.com 30.1.2007
Daily use of a common class of antidepressant may double the risk of fracture in people older than 50, a Canadian study reports. (...)

Depression and Inflammation may go Hand-in-Hand
ivanhoe.com 1.9.2006-- People who are depressed are more likely to have exaggerated inflammatory responses to stressful situations, according to the results of a study released this week. Now, researchers want to know if that inflammation is behind the link between depression and heart disease ... or if it's the actual cause of depression. (...)

Ny mekanism funnen bakom inflammation vid åderförkalkning
dagensmedicin.se 9.5.2006
En forskargrupp vid Karolinska institutet i Solna har upptäckt mekanismer kring den inflammatoriska processen vid bland annat åderförkalkning, något som kan bana väg för nya läkemedel.

Forskarna från Solna har upptäckt att ämnen som bildas vid en inflammatorisk process, som till exempel cytokiner, bidrar till att förstärka inflammationen i blodkärlen ytterligare på ett sätt som tidigare inte beskrivits.

De inflammatoriska substanserna får celler i blodkärlens väggar att uttrycka receptorer för leukotrien B4, LTB4, ett ämne som i sig är starkt inflammatoriskt. När cellerna sedan reagerar på LTB4 förstärks inflammationen ytterligare.

Det har tidigare inte varit känt att cellerna i blodkärlens väggar kan reagera på LTB4. Upptäckten ökar förståelsen för den inflammatoriska processen, och bidrar till utvecklingen av läkemedel som på sikt kan få användning för flera sjukdomar med kroniska inflammationer, som till exempel ledgångsreumatism, astma och åderförkalkning, enligt ett pressmeddelande från Karolinska institutet.

Forskarna har publicerat sin studie i senaste numret av den vetenskapliga tidskriften Pnas. (...)

(Anm: Cannabis smokers 'at risk of brittle bone disease' (Cannabis røkere “løper risiko for beinskjørhet”.) Independent 23.5.2005.)

Cannabis hämmar immunförsvaret
svt.se 29.11.2010
Cannabis kan ge ökad risk för cancer och infektioner.

Marijuanarökning kan utlösa en dämpning av kroppens immunförsvar. Nu har forskarna funnit varför brukare av cannabis är mer mottagliga för vissa typer av cancer och infektioner.

Cannabis är en av de mest använda missbruksdrogerna i världen. Man har länge misstänkt att en av effekterna är en försvagning av immunförsvaret. Nu tror forskarna att orsaken till dämpningen är en nyligen upptäckt typ av immunceller, kallade MDSC. (...)

(Anm: Marihuana (marijuana) (mintankesmie.no).)

(Anm: cannabis, eller cannabispreparater, fellesnavn for de narkotiske stoffene som utvinnes av en underart av hamp (...) Det er toppskuddene og hunnblomsterstanden som gir de forskjellige produktene: marihuana, hasjisj, hasjolje og andre cannabispreparater. Kilde: Store norske leksikon.)

Lykkepiller kan øke risiko for beinskjørhet
forskning.no 28.11.2005
400 000 nordmenn bruker i dag såkalte lykkepiller. Pillene kan gi varige skader på skjelettet. (...)

- Lykkepillen hemmer nemlig aktiviteten til de beinbyggende cellene. Samtidig øker den produksjonen av signalstoffer som stimulerer til økt nedbryting av beinmassen.

Det sier Björn I. Gustafsson, stipendiat ved NTNU og overlege ved St. Olavs Hospital. Han har påvist denne medisinske sammenhengen ved cellestudier, som en del av sitt doktorgradsarbeid.

Endrer kjemi, bryter ned bein
Ved bruk av lykkepiller (også kalt SSRI-medikamenter) økes mengden serotonin lokalt i hjernen. Serotonin er et viktig signalstoff i hjernen. Mesteparten av kroppens serotonin produseres av bestemte celler i kroppens mage- og tarmsystem.

Økt mengde av serotonin i hjernen har positiv effekt på depresjoner og andre psykiske lidelser. Men lykkepiller påvirker også nivået og funksjon av serotonin i resten av kroppen. (...)

Fin balanse
Ved normal beindannelse i en menneskekropp er det balanse mellom de beinproduserende osteoblastene og beinnedbrytende osteoklastene. Lykkepillene ser ut til å forrykke denne balansen.

Forskerne har funnet ut at kroppens serotonin stimulerer osteoblastene slik at det foregår en sunn reproduksjon av beinceller. Dette kan være en av mekanismene som hindrer de fleste i å utvikle beinskjørhet.

Trolig permanente skader
Skader på skjelettet er generelt permanente. Det finnes ikke legemidler som kan reversere skader forårsaket av andre medikamenter. Man vet at lykkepiller ”bygges inn” i beinmassen. Studier viser at mengden av pillens ulike substanser i kroppen øker lang tid etter at pasienten har sluttet med legemiddelet.

Barn på lykkepiller opplever hemmet vekst, noe som også er skjelettrelatert.

Helsebombe?
Nordmenn har i utgangspunktet en svært høy forekomst av beinskjørhet. Og nå tar i tillegg hele 400 000 av oss lykkepiller. Vi kan i verste fall sitte på en helsebombe, der forekomsten av beinskjørhet øker betraktelig i årene som kommer.

Det er ikke forsket på langtidsvirkninger for beinmassen av SSRI-medikamenter. Ingen vet ennå hvor store skader lykkepiller kan medføre, eller hvor mange som kan være i faresonen. Men forskere i Nederland og i USA arbeider nå med å framskaffe slike data.

Skader på hjerteklaffene
NTNU-forskningen har også påvist en sammenheng mellom serotonin i blodet og skader på hjerteklaffene. Dette kalles det carcinoide syndrom. Gustafsson viser for første gang at overproduksjon av serotonin er direkte årsak til at skade oppstår på hjerteklaffene.

Hjerteklaffene sørger for at blodet går den riktige veien gjennom hjertet, og skade på disse medfører hjertesvikt. Halvparten av alle med det carcinoide syndrom – hvis de ikke opereres – dør av denne skaden på hjertet.

Oppdagelsen vil ha stor betydning for utvikling av nye behandlingsformer. (...)

(Anm: osteopetrose sjeldsynt arveleg sjukdom der beinvevet er for tett, men likevel skjørt pga sviktande osteoklastfunksjon; marghola og andre beingangar kan smalna inn slik at det kjem blodmangel, nerveutfall m v; ein autosomal recessiv type fører til døden i barnealder, ein dominant type kan vera harmlaus; til grunn kan liggja mutasjon i gen for karboanhydrase; andre namn: Albers-Schønbergs sjukdom, marmorbeinsjukdommen. EN osteopetrosis ET [gr osteon bein + petra stein + -osis].

osteoblast; bindevevscelle som modnar til beindannande celle, blir etterkvart til osteocytt ved at ho blir innebygd i det beinvevet ho lagar; cella deltar i mineraltransporten i beinvev, ho stammar frå stroma i beinmargen, dannar kollagen som er hovuddelen av matrix i bein, alkalisk fosfatase som fremjar nedslag av kalsiumsambindingar, dessutan interleukin-6 og -11, GM-CSF m v; blir påverka av PHTrP, kalsitonin og kalsitriol. EN osteoblast. ET [gr osteon bein + blastos spire]

osteoklast; 1 ei stor, mangekjerna celle som fortærer beinvev (med surgjering og proteolytisk fordøying), ho stammar frå makrofagar i beinmargen og blir påverka av dei same vekstfaktorane og cytokinene som bloddannande celler; jf osteoklast-aktiverande faktor; 2 reiskap brukt ved oppattbryting av beinbrot. EN osteoclast. ET [gr osteon bein + klan bryta]

karsinoid; gulfarga, oftast godarta svulst av argentaffine celler i tarmkanal eller andre innvolar; svulsten skil ut serotonin og kan vera årsak til rier med hjartebank, varmeflager med raudning i huda (flushing), stundom diaré, høgresidig endokardfibrose, bronkokonstriksjon m v, d e karsinoid-syndromet; andre namn: argentaffinom, Kulkitsky-celletumor; jf serotonin og bradykinin som også kan verta utskilt frå svulsten. EN carcinoid; carcinoid tumor. ET [gr karkinos krabbe + eidos form].

syndrom; syndroma; eit sett av plager eller teikn som kjem i lag og høyrer til ein viss sjukdom eller tilstand; symptomkompleks. EN syndrome. ET [gr syndrome samløp].

endokard; årehinna (endotelet) inne i hjartet og bindevevslaget under årehinna, indre hjartehinne. EN endocardium. ET [gr endon inne i + kardia hjarte]. Kilde: Norsk medisinsk ordbok.)

Lykkepiller kan øke risiko for benskjørhet
aftenposten.no 28.11.2005
Rundt 400.000 nordmenn bruker i dag såkalte lykkepiller. Nå viser ny forskning at pillene kan gi varige skader på skjelettet.

Barn på lykkepiller opplever hemmet vekst, som også har sammenheng med pillenes innflytelse på skjelettet.

- Lykkepiller- også kalt SSRI-medikamenter- hemmer aktiviteten til de benbyggende cellene. Samtidig øker den produksjonen av signalstoffer som stimulerer til økt nedbryting av benmassen, sier overlege Bjørn I. Gustafsson ved St. Olavs Hospital i Trondheim til forskning.no.

Han har påvist den medisinske sammenhengen ved cellestudier som en del av sitt doktorgradsarbeid.

Gustafssons studie dreier seg om medikamentet Prozac, men andre lykkepiller virker på samme måte. (...)

(Anm: osteopetrose sjeldsynt arveleg sjukdom der beinvevet er for tett, men likevel skjørt pga sviktande osteoklastfunksjon; marghola og andre beingangar kan smalna inn slik at det kjem blodmangel, nerveutfall m v; ein autosomal recessiv type fører til døden i barnealder, ein dominant type kan vera harmlaus; til grunn kan liggja mutasjon i gen for karboanhydrase; andre namn: Albers-Schønbergs sjukdom, marmorbeinsjukdommen. EN osteopetrosis ET [gr osteon bein + petra stein + -osis]. Kilde: Norsk medisinsk ordbok.)

Serotoninåterupptagshämmare misstänks öka risken för osteoporos
Läkartidningen 2005;102:2746-9
Sammanfattat
Skeletal remodellering kontrolleras inte bara av osteotropa hormoner utan också av signalsubstanser i nervsystemet. Sålunda härbärgerar benbildande osteoblaster och benresorberande osteoklaster bland annat receptorer för serotonin (5-HT).

Bencellerna uttrycker också det protein som svarar för serotoninåterupptag (5-HTT). Studier in vitro och in vivo visar att serotonin kan reglera bencellernas aktivitet. Merparten av tillgängliga data tyder på att hämning av 5-HTT, antingen genom att genen slagits ut hos möss eller genom farmakologisk inhibition med selektiva serotoninåterupptagshämmare (SSRI) hos möss eller människa, leder till minskad benmassa.

Även om det ännu inte har klarlagts om effekterna av SSRI på skeletal remodellering beror på en direkt eller en indirekt effekt på skelettet så antyder dessa observationer möjligheten att patienter som behandlas med SSRI kan ha ökad risk för sekundär osteoporos och skeletala frakturer. Det saknas dock för närvarande data från stora, välkontrollerade kliniska studier för att detta med säkerhet skall kunna fastslås. (...)

Sally Field Brings Osteoporosis to Center Stage
healthfinder.gov 21.4.2006
'Norma Rae' star takes on another fight, this time for bone health.

According to the Foundation for Osteoporosis Research and Education (FORE), 44 million Americans -- 80 percent of them women -- now face the prospect of serious bone loss. Ten million patients are already diagnosed with the illness, while another 34 million suffer from low bone density, which can lead to osteoporosis.

If left unchecked, this progressive and initially painless disease leads to increasing bone fragility that can ultimately result in fractures -- most commonly of the hip, spine and wrist. Height loss, severe back pain and long-term disability can result, often requiring hospitalization and surgery. (...)

D-vitamin hjelper mot benskjørhet
dagbladet.no 27.12.2005
Åsa Rytter Evensen Bydelsoverlege
I Norge finnes ca. 250 000 benskjøre kvinner. De færreste vet selv om det. På en konferanse i Dublin var det full enighet om at en daglig dose D-vitamin er et enkelt tiltak i forebyggelse av brudd og bedring av livskvalitet.

SAMMEN MED EKSPERTER fra hele Europa har jeg deltatt på en konferanse i Dublin der hensikten var å komme til enighet om betydningen av D-vitamin i forebyggelse og behandling av osteoporose/benskjørhet. I sitt foredrag sa lederen for den irske osteoporoseforeningen, professor O% Brien, at «benskjørhet er en sykdom som, når den fører til brudd, representerer en enorm medisinsk, sosial og økonomisk belastning for ethvert samfunn. Pasienter med osteoporose belegger til enhver tid akuttsenger på landets sykehus.»

I Norge er gjennomsnitts liggetid for benbrudd på grunn av benskjørhet 12,7 dager. Det betyr at minst 250 sykehussenger er belagt av en osteoporosepasient til enhver tid. Lårhalsbrudd alene koster årlig 1,3 milliarder kroner i Norge. (...)

SSRIer linket til dårlig sædkvalitet

Anti-Depressant-Associated Changes In Semen Parameters
medpagetoday.com 28.11.2008
SAN FRANCISCO, CA, USA (UroToday.com) - The authors previously reported an effect of antidepressants on semen parameters. The current study was designed to assess/confirm their prior report of the effects of an SSRI, paroxetine (Paxil), on semen parameters. (...)

As opposed to prior report, semen parameters (volume, concentration, motility, morphology) were not significantly altered during SSRI treatment. However, mean DNA fragmentation TUNEL score was significantly higher on SSRI (30.3%) versus baseline (13.8%). Multivariate logistic regression, correcting for age and body mass index, confirmed that SSRI treatment was significantly correlated with increased DNA fragmentation Up to 35% of men noted significant changes in erectile function and up to 47% of subjects reported ejaculatory difficulties while on paroxetine. (...)

Being Overweight Does Not Result In Decreased Sperm Production, Study Shows
sciencedaily.com 17.6.2008
(...) Santoro and her coworkers plan to further study a trend they saw toward reduced sperm motility in the six men who were taking an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class. This class of drugs includes Prozac, Celexa, Lexapro, Paxil and Zoloft.

“We know that SSRIs affect sex drive, but there aren’t much data on their effect on fertility,” she said.

The results will be presented at The Endocrine Society’s 90th Annual Meeting in San Francisco. (...)

Antidepressants Linked to Male Infertility
newsinferno.com 24.10.2006
Researchers at New York’s Cornell Medical Center have found a major correlation between use of antidepressants and sperm count. Men who take selective serotonin reuptake inhibitors (SSRIs) are being urged to consult closely with their doctors in order to determine a proper course of action in light of the new study, the first of its kind. Cornell’s Peter Schlegel announced the results this week at the 62nd annual meeting of the American Society for Reproductive Medicine (ASRM) in New Orleans. (...)

Dr. Schlegel believes that the problem may be connected to damage of the nerves in the vas deferens, the tube trusted with the task of delivering sperm to semen just before ejaculation. For male SSRI patients who may be considering starting or continuing a family, the results may have major ramifications. (...)

(Anm: vas deferens; ductus deferens; jf ev kongenital bilateralt manglande vas deferens EN vas deferens. Kilde: Norsk medisinsk ordbok.)

(Anm: vas deferens; wikipedia.org.)

Prozac is linked to low sperm count (Prozac linket til dårlig sædkvalitet)
timesonline.co.uk 24.10.2006
ANTIDEPRESSANT drugs could lower men’s sperm count, the first investigation of their effect on male fertility has found. (...)

Populær antidepressiva linket til overdoser

Popular antidepressant linked to overdoses (Populær antidepressiva linket til overdoser)
msnbc.msn.com 25.10.2006
FDA urges doctors to prescribe smallest possible amounts of Effexor

- The Food and Drug Administration on Wednesday urged doctors to prescribe the popular antidepressant Effexor in the smallest possible quantities to reduce the risk of overdose.

Wyeth, the maker of Effexor or venlafaxine HCI, and the FDA had reports of overdoses occurring in some patients, mostly in combination with alcohol or other drugs, the agency said in a statement.

“Health care professionals are advised to prescribe Effexor and Effexor XR in the smallest quantity of capsules consistent with good patient management to reduce the risk of overdose,” the FDA said.

The reported overdoses resulted in death or symptoms such as rapid heartbeat, coma, seizures, vomiting and vertigo, Wyeth said in a letter it sent to doctors and health care providers.

Prozac (fluoxetine) linket til benskjørhet

Lykkepiller kan gi benskjørhet
nrk.no 26.6.2007
Moderne antidepressiva kan trolig føre til benskjørhet, viser en studie utført blant både kvinner og menn.

Det er to nye studier i medisintidsskriftet Archives of Internal Medicine som viser at bruken av såkalte SSRI-preperater, populært kalt lykkepiller, kan medføre benskjørhet.

Medisinene hemmer et protein som produserer nye benceller.

Derfor tror forskerne at moderne antidepressiva, såkalte SSRI-preparater, kan forårsake benskjørhet. (...)

Prozac linked to osteoporosis (Prozac linket til benskjørhet)
telegraph.co.uk 26.6.2007
Common anti-depressants may increase the risk of osteoporosis in the elderly, new research suggests.

Two separate American studies found that people who used Prozac and Seroxat developed thinner bones than those who did not take them. (...)

(Anm: Use of Antidepressants and Rates of Hip Bone Loss in Older Women: The Study of Osteoporotic Fractures. Arch Intern Med 2007;167 1240-1245.)

Association of Low Bone Mineral Density With Selective Serotonin Reuptake
Inhibitor Use by Older Men Bliziotes; for the Osteoporotic Fractures in Men Study Group. Arch Intern Med 2007;167 1246-1251.)

Boning Up on Antidepressants
sciencemag.org 18.10.2006
(...) To find out if fluoxetine could protect against bone loss, the team injected the drug, along with lipopolysaccharride (LPS), directly into skull bone. LPS induces inflammation and subsequent bone turnover. About twice as much new bone was seen in animals that received both the drug and LPS versus those given no fluoxetine or those given LPS alone, the team reports in an upcoming issue of the Journal of Cellular Biochemistry.

The results contradict a 2005 finding by a group led by endocrinologist Michael Bliziotes at Oregon Health and Science University in Portland, who showed that twice as much fluoxetine as used in this study lowered overall bone mass in a different strain of mice. "At this point, we can say it's possible that we get different responses to Prozac in the bone," says Bliziotes, adding that a genetic explanation would be a "very exciting." Understanding the genetic underpinnings of why fluoxetine helps bone in some circumstances and not in others could lead to better treatment plans, Bliziotes says. (...)

Prozac May Protect Against Osteoporosis (Prozac kan beskytte mot benskjørhet)
healthfinder.gov 13.10.2006
The depression drug boosted bone mass in animal study. (...)

-- Could a widely used treatment for depression be a remedy for osteoporosis?

Researchers have discovered that the drug Prozac also increases bone mass, at least in adult mice.

"Treating animals for six weeks with Prozac resulted in an increase in trabecular bone mass," said study lead author Ricardo Battaglino, assistant member of the staff in the department of cytokine biology at the Forsyth Institute in Boston. "It was a pretty significant 60 percent increase." (...)

Serotoninets effekter på hjerte og benvev

Serotoninets effekter på hjerte og benvev
ntnu.no 5.11.2005
Hormonet serotonin produseres i hovedsak av de enterochromaffine (EC) cellene i mage/tarm-slimhinnen. I doktoravhandlingen sin ved Norges teknisk-naturvitenskapelige universitet NTNU beskriver overlege Björn I. Gustafsson (40) fra Lund i Sverige utseendet til disse cellene, belyst ved en nyutviklet metode. Han viser at EC-cellene har et utseende som er likt de serotoninproduserende nevroner som finnes i hjernen.

Overproduksjon gir alvorlig hjerteklaffsykdom
Ved det carcinoide syndrom produseres store mengder serotonin fra svulster som utgår fra EC-cellene. Symptomer som ses ved det carcinoide syndrom er diaré, rødme i huden og alvorlig hjerteklaffsykdom. Gustafsson viser for første gang at overproduksjon av serotonin er direkte årsak til at skade oppstår på hjerteklaffene. Det vises også at rotter som behandles med serotonin får økt benmasse og stivere ben.

«Lykkepiller» påvirker serotoninbalansen i hele kroppen
Dette er av stor betydning med tanke på det omfattende bruket av såkalte «lykkepiller» ved behandling av depresjon. Når slike medisiner brukes, endres mengden serotonin lokalt i hjernen, men serotoninbalansen påvirkes også i resten av kroppen. I cellestudier viser Gustafsson at serotonin synes å ha en positiv effekt på benomsetningen i motsetning till lykkepiller som synes å ha en negativ virkning.

Resultatene øker forståelsen for EC-cellenes funksjon i mage/tarm-kanalen. De åpner også for nye muligheter i utviklingen av medikamenter for å behandle pasienter med carcinoid hjertesykdom og benskjørhet. (...)

Legemiddelindusert pankreatitt

Läkemedelsutlöst akut pankreatit
Läkemedelsverket 22.11.2005
Resultat från en epidemiologisk studie av läkemedelsutlöst akut pankreatit som Läkemedelsverket genomfört i samarbete med regionala biverkningscentra i Umeå, Uppsala, Stockholm och Lund, har nyligen publicerats i webbupplagan av den vetenskapliga tidskriften Pharmacoepidemiology and Drug Safety.
Biverkningsinformation.

Den huvudsakliga slutsatsen i artikeln är att de magsyrahämmande läkemedelsgrupperna H2-antagonister (ranitidin, famotidin och cimetidin) samt protonpumpshämmare (omeprazol och lansoprazol) kan medföra en ökad risk för att utveckla akut pankreatit (1). H2-antagonisterna har alla diagnosen ”pankreatit” listad som sällsynt biverkning i produktinformationen. (...)

(Anm: pancreatitis acuta; akutt pankreatitt; brå bukspyttkjertelbetennelse med magesmerter, kvalme, oppkast, gjerne stram bukvegg og luftutspiling i magesekken, ofte ein alvorleg sjukdom, stundom ei forverring av pancreatitis chronica (s d); startar i feittvevet omkring kjertelen og kjertellappane med ødem og flekkar av feittnekrose (s d), kan også øydeleggja parenkym og etterlata pankreascystar (s d), ev nekrose og pankreasabscess, grunnlag er aktivering av proenzym i kjertelen pga årsaker som er opprekna under kronisk panreatitt der også blodprøver er nemnde; infeksjon er særs sjeldan årsak, men nekrosar blir sekundærinfiserte, dei blir stundom fjerna ved endoskopi, operasjon e a; jf trypsinogen. EN acute (necrotizing) pancreatitis. Kilde: Norsk medisinsk ordbok.)

Legemiddelindusert hyperprolaktinemi

Antipsykotikaindusert hyperprolaktinemi
Erik Johnsen Hugo A. Jørgensen Tidsskr Nor Lægeforen 2006; 126: 179-80
Innen behandling med antipsykotika blir hyperprolaktinemi i økende grad sett på som en undervurdert og alvorlig bivirkning. I en del tilfeller kan forhøyet prolaktinnivå utgjøres av en fraksjon kalt makroprolaktin som har liten eller ingen biologisk aktivitet. Gode data på forekomst av denne tilstanden ved antipsykotikaindusert hyperprolaktinemi foreligger ikke. Ved antipsykotikaindusert hyperprolaktinemi bør derfor inntil videre makroprolaktintesting gjennomføres før eventuelle medikamentjusteringer vurderes. (...)

Prolaktin er et polypeptidhormon som utskilles fra adenohypofysen, og sekresjonen er under innflytelse av en rekke både stimulerende og inhibitoriske faktorer (1). Hos mennesket fremmer prolaktin melkesekresjon og inhiberer effekten av gonadotropiner. I tillegg er flere hundre andre effekter av hormonet beskrevet hos mennesker og dyr (2). Både normalfysiologiske og patologiske forhold kan gi forhøyede prolaktinnivåer, og ramme 1 gir en oversikt over de vanligste differensialdiagnostiske muligheter ved hyperprolaktinemi. Av rammen fremgår at en rekke farmaka kan føre til prolaktinforhøyelse. (...)

• Medikamentutløst hypersekresjon
• Dopamin D2-reseptorantagonister (første- og noen annengenerasjons antipsykotika, metoklopramid)
• Antidepressiver (spesielt serotonerge preparater)
• Antihypertensiver (metyldopa, verapamil)
• Histamin H2-reseptorantagonister (cimetidin, ranitidin)
• Hormonpreparater (østrogener, antiandrogener)
• Andre (opioider, amfetamin)

Prolaktin og antipsykotika
I den senere tid har antipsykotikaindusert hyperprolaktinemi vært trukket frem som en undervurdert og alvorlig bivirkning. I nyere litteratur peker man på at forhøyet prolaktinnivå kan medføre en rekke symptomer som gynekomasti, galaktoré, seksuell dysfunksjon og akne, og hos kvinner i tillegg hirsutisme, menstruasjonsforstyrrelser og infertilitet (3).

Seroxat og teratogene effekter

Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data.
Psychol Med. 2010 Jan 5:1-11. [Epub ahead of print]
(...) CONCLUSIONS: Women using antidepressants during pregnancy and their newborns have increased pathology. It is not clear how much of this is due to drug use or underlying pathology. Use of TCAs was found to carry a higher risk than other antidepressants and paroxetine seems to be associated with a specific teratogenic property. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

(Anm: teratogen; som skaper misfoster, som er årsak til lyte hos foster; særleg brukt om visse kjemiske stoff eller medikament. EN teratogenic. ET [gr teras misfoster + gennan skapa]. Kilde: Norsk medisinsk ordbok.)

Paroxetine and congenital malformations: meta-Analysis and consideration of potential confounding factors
Clin Ther. 2007 May;29(5):918-26
BACKGROUND: Antidepressants have been commonly used by women of childbearing age. Recent studies suggest that paroxetine, a selective serotonin reuptake inhibitor (SSRI), might specifically increase teratogenic risk. (...)

CONCLUSIONS: Based on the results of this metaanalysis, first-trimester exposure to paroxetine appears to be associated with a significant increase in the risk for cardiac malformation. However, a detection bias cannot be ruled out as contributing to the apparent increased detection of cardiovascular malformation of children exposed in utero to paroxetine. A significantly greater number of women were using paroxetine for anxiety or panic when compared with women using other SSRIs. (...)

Paroxetine (Paxil) and congenital malformations
PRACTICE
HEALTH AND DRUG ALERTS
CMAJ 2005; 173 (11) (22.11.2005)
Paroxetine (Paxil) and congenital malformations
Reason for posting: Selective serotonin reuptake inhibitors (SSRIs) have not previously been demonstrated, as a group, to be teratogenic.¹ However, the results of an unpublished study² by GlaxoSmithKline (GSK) has led the US Food and Drug Administration and Health Canada to warn that one SSRI, paroxetine, may increase the risk of major congenital malformations.^{3 (...)}

What to do: This study is limited by its retrospective design, its post hoc secondary analyses, the limited clinical details available in an insurance database, and its lack of controls. However, it is one of the first reasonably large epidemiologic studies to suggest possible teratogenicity of an SSRI. Why paroxetine may have this effect is not clear, and the results conflict with other epidemiologic studies performed to date.³ Although the relative risk increase of malformations is about twofold, the absolute risk increase over baseline malformation rates appears to be about 1% (i.e., about 100 pregnant users would be needed before additional harm would come to one infant). Any woman of childbearing age being treated with paroxetine should be counselled on these absolute and relative risks. If pregnancy is a real possibility, consideration should be given to switching medications. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

(Anm: teratogen; som skaper misfoster, som er årsak til lyte hos foster; særleg brukt om visse kjemiske stoff eller medikament. EN teratogenic. ET [gr teras misfoster + gennan skapa]. Kilde: Norsk medisinsk ordbok.)

SSRI-induserte lungesykdommer

Cases of Fen-Phen and SSRI-Related Lung Disorder Rise
By Evelyn Pringle
lawyersandsettlements.com 16.4.2007
Washington, DC: In the fall of 1997, American Home Products Corporation, which became Wyeth in 2002, withdrew the drugs Pondimin (fenfluramine), and Redux (dexfenfluramine), which were prescribed together with phentermine for weight loss, in a combination called "fen-phen," for short.

Fen-phen causes the life-threatening lung disorder known as primary pulmonary hypertension, or PPH. According to the Pulmonary Hypertension Association, PPH is a rare blood vessel disorder of the lung in which the pressure in the pulmonary artery rises above normal levels and can become life threatening.

As the blood is pumped through the arteries in the lungs, it receives oxygen; this oxygenated blood returns to the heart where it is then transported to the rest of the body through the aorta and other arteries. Changes to the pulmonary artery can cause the vessel to tighten, limiting the passage of blood, and increasing the pressure in the artery, according the Lung Disorder web site. (...)

According to the Lung Disorder educational information web site, PPH is difficult to study because it is so rare. Of the estimated 300 cases diagnosed each year in the US, the majority occur in women between the ages of 21 and 40. (...)

SSRIs sold in the US include Prozac, Zoloft, Paxil, Celexa, Lexapro, and the various generic versions of the drugs.

Babies with PPHN, the FDA says, have abnormal blood flow through the heart and lungs, do not get enough oxygen to their bodies and can become very sick and die. (...)

The FDA warning was based on a study in the February 9, 2006, New England Journal of Medicine, led by Dr Christina Chambers, at the University of California in San Diego, which found a 6-fold increased risk of PPH in infants exposed to SSRIs after the 20th week of pregnancy. (...)

Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn
New England Journal of Medicine (NEJM) 2006;354:579-587 (February 9)
(...) Conclusions These data support an association between the maternal use of SSRIs in late pregnancy and PPHN in the offspring; further study of this association is warranted. These findings should be taken into account in decisions as to whether to continue the use of SSRIs during pregnancy. (...)

(Anm: pulmonal hypertensjon; for høgt blodtrykk i lungepulsåra – arteria pulmonalis, kan gi tung pust ved pårøyning, brystsmerter, synkopetendens m v; kan skuldast mitralstenose eller andre slags, gjerne medfødde hjartesjukdommar, lungeemboliar (ev i form av kronisk tromboembolisk pulmonal hypertensjon), visse medikament (jf aminorex, fenfluramin), kollagene åresjukdommar m v; jf primær pulmonal hypertensjon og endotelin 1. EN pulmonary hypertension. Kilde: Norsk medisinsk ordbok.)

Antidepressiv medicin kan skada foster
Östersunds-Posten 9.2.2006
Blivande mödrar som äter antidepressiva så kallade SSRI-preparat sent under graviditeten löper ökad risk att föda barn med allvarliga lungproblem, enligt en studie i New England Journal of Medicine.

Enligt forskarna kan ett intag av antidepressiva medel som Zoloft och Prozac efter den 20:e graviditetsveckan ge en liten men tydligt ökad risk för kvardröjande pulmonell hypertension (PPHN) hos det nyfödda barnet. Det är ett allvarligt tillstånd som försvårar syresättningen av blodet och andningen hos barnet, och kräver omedelbar behandling.

Normalt drabbas en till två nyfödda per tusen av besvären, men hos mödrar som åt SSRI-preparat efter 20:e veckan ökade risken till sex-tolv barn per tusen. (...)

Cautions Issued on Use Of Psychiatric Drugs
washingtonpost.com 9.2.2006
Antidepressants, ADHD Medications Cited
Expectant mothers who took antidepressants like Prozac late in their pregnancy were significantly more likely to give birth to an infant with a rare but serious breathing problem, doctors are reporting today.

The lung disorder, called persistent pulmonary hypertension, strikes 1 to 2 newborns in 1,000, on average, and can be fatal. In babies exposed to antidepressants during the last few months of pregnancy, the study found, the rate was six times as high: 6 to 12 newborns in 1,000.

In a news conference yesterday, Dr. Sandra L. Kweder, an official at the Food and Drug Administration, which was not involved in the research, said that the study results were "very worrisome," and that the agency planned to search its own database of adverse events for further evidence of risk. She said the F.D.A. would consider whether to require manufacturers to make labeling changes and conduct postmarketing studies to clarify the risk. (...)

Antidepressants May Harm Infants' Lungs, Report Says
New York Times 9.2.2006
Expectant mothers who took antidepressants like Prozac late in their pregnancy were significantly more likely to give birth to an infant with a rare but serious breathing problem, doctors are reporting today. (...)

But studies have found that up to one-third of babies exposed to antidepressants in the womb suffer temporary withdrawal symptoms like agitation. The F.D.A. has warned that one popular depression drug, Paxil, from GlaxoSmithKline, may increase the risk of rare heart problems in newborns exposed to the medication in utero. (...)

SSRIs late in pregnancy linked to neonatal respiratory problems
reutershealth.com 8.2.2006
- The use of a common class of antidepressant -- selective serotonin-reuptake inhibitors (SSRIs) -- during late pregnancy is associated with an increased risk of persistent pulmonary hypertension of the newborn (PPHN), investigators report.

A cause of severe respiratory failure, PPHN occurs when pulmonary arterial pressure remains high after birth and poorly oxygenated blood continues to be shunted to the systemic circulation, Dr. Christina D. Chambers and her associates point out. Up to 20% of affected infants will not survive.
Previous work by Dr. Chambers' group suggested that the SSRI fluoxetine in late pregnancy may be a risk factor for transient neonatal complications, including PPHN. (...)

Echoing these recommendations in a related editorial, Dr. James L. Mills, from the National Institute of Child Health and Human Development in Bethesda, Maryland, observes that the study is based on a small number of cases, and that a mother's untreated depression can also adversely affect the fetus.
"There is a pressing need," he writes, "for experts to compare SSRIs with other forms of treatment to determine which are the safest, the most effective, and the best tolerated by pregnant women." (...)

(Anm: Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn. N Engl J Med 2006;354:579-587, 636-638.)

SSRI-induserte fødselsdefekter hos nyfødte

Effect of exposure to selective serotonin reuptake inhibitors in utero on fetal growth: potential role for the IGF-I and HPA axes. (Effekt av selektive serotoninreopptakshemmere (SSRI) i livmor på fostervekst; mulig rolle for IGF-I og HPA axes)
Pediatr Res. 2009 Feb;65(2):236-41.
To investigate the possible effect of fetal exposure to selective serotonin reuptake inhibitors (SSRIs) on somatic growth and on hormones of the hypothalamic-pituitary-adrenal (HPA) and insulin-like growth factor (IGF)-I axes, we compared the anthropometric parameters and hormonal profile of 21 SSRI-exposed infants and 20 matched controls. The SSRI group was characterized by lower crown-heel length (p < 0.01), smaller head circumference (p = 0.08), and higher percentage of infants with birth weight, birth length, and head circumference below the 10th percentile (p < 0.045, p = 0.08, p < 0.04, respectively), in addition to a significantly lower cord blood level of cortisol (p < 0.03) and higher level of thyroid-stimulating hormone (TSH) (p < 0.004). Infants exposed to citalopram had a lower cord blood IGF-I level than infants exposed to paroxetine (p < 0.001) and controls (p < 0.003). Placental IGF-I receptor (IGF-IR) expression was significantly higher in the SSRI group than in controls (p < 0.01). Urine 5-hydroxyindoleacetic acid (5-HIAA) level was negatively correlated with birth weight (r = -0.71, p < 0.025) and with dehydroepiandrosterone (DHEA) level (r = -0.71, p < 0.025). The Finnegan score was correlated with dehydroepiandrosterone sulfate (DHEAS) (r = 0.8, p < 0.005) and cortisol (r = 0.62, p = 0.05). Fetal exposure to SSRIs causes impaired intrauterine growth accompanied by alterations in the IGF-I and HPA axes. The findings may raise concern regarding maternal use of SSRIs during pregnancy. (...)

(Anm: IGF-I; Insulin-like growth factor 1; Almost every cell in the human body is affected by IGF-1, especially cells in muscle, cartilage, bone, liver, kidney, nerves, skin, and lungs. In addition to the insulin-like effects, IGF-1 can also regulate cell growth and development, especially in nerve cells, as well as cellular DNA synthesis. (wikipedia.org).)

(Anm: HPA axes; The hypothalamic-pituitary-adrenal axis (HPA or HTPA axis), also known as the limbic-hypothalamic-pituitary-adrenal axis (LHPA axis), is a complex set of direct influences and feedback interactions among the hypothalamus (a hollow, funnel-shaped part of the brain), the pituitary gland (a pea-shaped structure located below the hypothalamus), and the adrenal (or suprarenal) glands (small, conical organs on top of the kidneys). The interactions among these organs constitute the HPA axis, a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure. A wide variety of species, from the most ancient organisms to humans, share components of the HPA axis. It is the common mechanism for interactions among glands, hormones, and parts of the midbrain that mediate the general adaptation syndrome (GAS). (wikipedia.org).)

Experts Say Birth Defect Risks Outweigh Benefits of SSRIs
opednews.com 5.9.2007
Drug makers looking to increase profits with the sale of selective serotonin reuptake inhibitor antidepressants to pregnant women claim that untreated depression poses a grave risk to the unborn fetus, but a new study reports that the use of antidepressants, and not the depression itself, increases the risk of lower fetal age and preterm birth.

The study in the August 2007 American Journal of Psychiatry examined the effects of depression and antidepressant use on fetal age and risk of preterm birth in 90 women who were divided into three groups: (1) forty-nine women treated with antidepressants for more than 50% of their pregnancy; (2) twenty-two briefly treated or not treated with the drugs during pregnancy; and (3) a comparison group of 19 healthy pregnant women. (...)

SSRI treatment for maternal depression may affect neonate
reutershealth.com 25.8.2006
- Women who take selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy appear to be at increased risk of having offspring with low birth weight and respiratory distress, Canadian researchers report in the August issue of Archives of General Psychiatry. (...)

Birth weight and gestational age were also significantly less in SSRI-exposed infants and a significantly greater proportion was born before 37 weeks.

"Disse resultater er i strid med forventninger om at behandling av mødre med SSRI-er under svangerskap ville være assosiert med færre uheldige neonatale konsekvenser assosiert til depresjon hos mor," uttalte dr. Oberlander. (...) ("These findings are contrary to an expectation that treating depressed mothers with SSRIs during pregnancy would be associated with lessening of the adverse neonatal consequences associated with maternal depression," Dr. Oberlander said.)

Antidepressiva kan skade fosteret
vg.no 9.2.2006
Gravide som tar antidepressiva i siste del av svangerskapet kan risikerer at barnet utvikler en sjelden og livstruende lungesykdom som følge av medisineringen. (...)

Dette kommer fram i en forskningsrapport, publisert i siste nummer av New England Journal of Medicine.

Den type antidepressive midler det er snakk om er såkalte SSRI-preparater, (selective serotonin reuptake inhibitors) som blant annet Prozac, Paxil og Zoloft. Ifølge Annlaug Johnsen i Statens legemiddelverk er Zoloft et velkjent preparat i Norge. Prozac går under navnet Fontex, mens Paxil ikke selges her i landet.

Ifølge forskerne kan bruk av Zoloft og Fontex etter 20. gravidititsuke gi en liten men likevel økt risiko for persistant pulmonell hypertention (PPHN) hos det nyfødde barnet.

(Anm: Paxil; Seroxat (generisk navn paroxetine; paroksetin i Norge), som fikk markedsføringstillatelse i Norge den 1. april 1993, var mestselgende legemiddel på midten av 1990-tallet, og omsettes fortsatt i Norge under flere ulike handelsnavn. (jf. Legemiddelnavn som årsak til feilmedisinering.)

Legemiddelindusert impulsivitet

Science fair in Rockland encourages high school science students
thejournalnews.com 4.4.2006
— High school students from across the state had their scientific projects scrutinized by judges yesterday at the New York State Science and Engineering Fair, which sends finalists to the Intel International Science and Engineering Fair.

The 310 participants, including students from Suffern, John Jay, Fox Lane, Yorktown, Ossining, Scarsdale and Edgemont high schools, submitted individual or team projects to one of three divisions — the Intel Division to be considered for the international fair; the Andromeda Division to be considered for state and local awards; or the Galaxy Division, which is for ninth-graders only.

"These types of science fairs are the best forum for students to present the work they've been doing for the past year," Paul Lichtman, New York fair director, said.

The fair at Rockland Community College's fieldhouse was one of hundreds worldwide affiliated with the annual Intel fair, the largest pre-college science competition in the world, according to Science Service, the fair's administrator since its inception in 1950.

Jane Kurtzman, a 17-year-old senior at Suffern High School, said she was excited her project was one of 12 to make it to the final round in the fair's Intel Division.

She had five minutes to tell a panel of judges about her research, which looked at how fluoxetine, or Prozac, affects impulsivity in juvenile rats.
Her research found that the anti-depressant did affect impulse action in rats, which may have implications for adolescent humans.

"It's the first to do what I did. It's preliminary, but it's important," she said. "If anti-depressants are causing suicide in adolescents, impulsivity is perhaps an underlying cause."

Alexandria Ocasio-Cortez, a 16-year-old junior at Yorktown High School, also made it to the final round.

She studied the effects of antioxidants on the life span of C. elegans, a roundworm species, and said she was elated with the outcome.
Her research found the antioxidant dimethyl sulfoxide extended C. elegans lifespan from the average 12 to 17 days to 51 days.

"That's really significant," she said. "It was really rare to have an extension that huge. It extended life span more than 300 percent."

The final 12 projects were narrowed down to the four that are sent to the 57th Intel international fair, which is May 7 to 13 in Indianapolis. The names of the four winners were not available last night.

Students will compete for more than $3 million in scholarships, tuition grants, scientific equipment and scientific trips. (...)

Abstinenser eller forgiftninger?

How one woman got hooked on happy pills (Hvordan en kvinne ble avhengig av lykkepiller)
independent.co.uk 13.2.2007
(...) I started to see a psychiatrist who diagnosed me with post- traumatic stress disorder (PTSD). (...)

Health checkup Stopping antidepressants
democratandchronicle.com 5.7.2006
— Abruptly stopping the use of antidepressants — by missing a dose, forgetting to get a prescription refilled or deciding on your own to stop the medication — may trigger unpleasant physical and psychological symptoms. This can happen with the newer classes of selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, and the older class of tricyclic antidepressants. (...)

But suddenly stopping the medication can lead to a constellation of symptoms.

Patients most typically experience gastrointestional distress; headaches or lethargy; sleep disturbances such as insomnia and excessive dreaming or nightmares; and anxiety, agitation and low mood.

Studies have shown that discontinuation symptoms are common among users of tricyclic antidepressants. About 55 percent of patients who stop Tofranil, 80 percent who stop Elavil and 33 percent who discontinue Anafranil will experience these symptoms.

In addition, patients who suddenly stop taking SSRIs (Prozac, Zoloft, Paxil, Celexa, Lexapro and Luvox) or SNRIs (Cymbalta and Effexor) can experience balance and sensory abnormalities. Dizziness and a feeling of disorientation can sometimes impair coordination to the point where a person can't drive.
Sensory abnormalities include numbness and the unusual sensation of electric shocks, particularly in the head, neck and upper limbs. (...)

Paroxetine Toxicity in a Newborn After In Utero Exposure: Clinical Symptoms Correlate With Serum Levels.
Ther Drug Monit. 2006;28(1):5-7.
There are several case reports and case series that have examined the acute effects of selective serotonin reuptake inhibitors (SSRIs) on the newborn. There is considerable controversy whether the reported symptoms represent withdrawal from the SSRI or toxicity caused by the SSRI. A case of an infant who was exposed to paroxetine during pregnancy is presented. This case supports the notion of serotonin toxicity and is believed to be the first report that substantiates clinical symptoms with serum levels of the offending SSRI. (...)

Neonatal Abstinence Syndrome After In Utero Exposure to Selective Serotonin Reuptake Inhibitors in Term Infants
Arch Pediatr Adolesc Med. 2006;160:173-176.
(...) Conclusions Neonatal abstinence syndrome occurs in 30% of neonates exposed to SSRIs in utero. These neonates should be monitored for at least 48 hours after birth. The long-term effects of prolonged exposure to SSRIs, particularly in neonates who develop severe symptoms, have yet to be determined. (...)

Språkproblemer?

Läkemedelsverket ser över påstådd felöversättning
Läkemedelsvärlden 23.9.2005
Läkemedelsverket ska nu ompröva den kritiserade översättningen av EMEA:s varningstext för antidepressiva läkemedel till barn och ungdomar.

ANTIDEPRESSIVA I en utredning från EMEA i våras fastslogs att antidepressiva läkemedel av SSRI- och SNRI-typ inte bör användas av barn och unga annat än på godkänd indikation.

Läkemedelsverkets översättning av varningstexten lyder ”läkemedlen är inte godkända för behandling av depression hos barn och ungdomar. Av det skälet kan de ej generellt rekommenderas vid detta tillstånd”.

– Det är inte klokt att Läkemedelsverket inte följer det europeiska pressmeddelandet, som är så pass tydligt, sa Lena Westin vid konsumentorganisationen Kilen i LMV 5/05.

– Det blir förmildrande, en mjukare övergång, ungefär som att det går bra ändå, bara man är noggrann med uppföljningen.

Läkemedelsverket, som tidigare tillbakavisat kritiken, backar nu delvis.

– Vi kommer att göra ytterligare en bedömning av översättningen och med utgångspunkt från den vidta eventuella åtgärder, skriver Christina Wik vid Läkemedelsverket i ett e-postmeddelande som Läkemedelsvärlden tagit del av. (...)

Varning för SSRI tonades ned
Läkemedelsvarlden 25.5.2005
Läkemedelsverket mildrar EMEA:s varning om antidepressiva till barn, anser företrädare för konsumenter.

DEPRESSION Antidepressiva läkemedel av SSRI- och SNRI-typ ”bör inte användas av barn och unga annat än på godkänd indikation”, står det i en EMEA-utredning som nyligen offentliggjordes (se länk till höger).

Läkemedelsverket hänvisar till utredningen och skriver ”läkemedlen är inte godkända för behandling av depression hos barn och ungdomar. Av det skälet kan de ej generellt rekommenderas vid detta tillstånd”.

– Det är inte klokt att Läkemedelsverket inte följer det europeiska pressmeddelandet, som är så pass tydligt, säger Lena Westin på konsumentorganisationen Kilen.

Läkemedelsverket tillbakavisar kritiken.
– Vi har gjort en korrekt sammanfattning och dessutom länkat till det europeiska dokumentet. Där står ”should not”, should översättes med bör och vi har skrivit ”kan ej generellt rekommenderas vid detta tillstånd. I särskilt utvalda fall kan behandling ändå bli aktuell. I dessa fall rekommenderas omsorgsfull uppföljning av patienten”, vilket väl speglar innehållet i dokumentet, säger Jane Ahlqvist Rastad som är läkare på Läkemedelsverket.

Lena Westin på Kilen håller inte med.
– Det blir förmildrande, en mjukare övergång, ungefär som att det går bra ändå bara man är noggrann med uppföljningen.
I den europeiska versionen står också att myndigheten rekommenderar att man inkluderar en kraftfull varning för riskerna till läkare och patienter.
Motsvarande text finns inte på Läkemedelsverkets hemsida. (...)

Økt selvmordsfare

- Også farlig for voksne
Dagsavisen 26.04.2005
- Legemiddelverket bør lage nye anbefalinger også for bruken av lykkepillen til voksne, sier Ivar Aursnes.

Han er professor ved Institutt for farmakoterapi Universitetet i Oslo. Aursnes har gått igjennom alt underlagsmaterialet på lykkepillen Seroxat, som GlaxoSmithKline (GSK) la fram da de søkte om godkjenning.

- Det er vanskelig å kartlegge selvmordstanker. Her er dataene dårlige. Men da jeg gikk igjennom de kliniske studiene fant jeg ut at både antall selvmord og antall selvmordsforsøk økte i den gruppen som brukte Seroxat sammenlignet med den som fikk placebo, altså sukkerpiller, sier Aursnes.

I gruppen på rundt 3.000 som fikk Seroxat, var det fem selvmord. I kontrollgruppen på 550 var det ingen.

- Når jeg så på de samme gruppene når det gjaldt selvmordsrelaterte handlinger, var det henholdsvis 40 selvmordsforsøk av dem som fikk Seroxat og én i kontrollgruppen, sier Aursnes.

- Jeg har sett på selvmordsfaren de første seks ukene. Det er vanlig å hevde at faren øker de første to til fire ukene før medisinene begynner å virke skikkelig. Jeg så ingen forskjell på ukene, sier Aursnes, som tror selvmordsfaren er like stor under hele behandlingsperioden. (...)

The Risk of Suicide With Selective Serotonin Reuptake Inhibitors in the Elderly
American Journal of Psychiatry 2006;163:813-821 (May 2006)
OBJECTIVE: The authors explored the relationship between the initiation of therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants and completed suicide in older patients. METHOD: The authors linked population-based coroner’s records with patient-level prescription data, physician billing claims, and hospitalization data for more than 1.2 million Ontario residents 66 years of age and older from 1992 to 2000. For each suicide case, four closely matched comparison subjects were selected using propensity score methods. The authors determined the odds ratio for suicide with SSRIs versus other antidepressant treatment, calculated at discrete monthly intervals from the start of treatment. RESULTS: Of 1,329 suicide cases, 1,138 (86%) were each fully matched to four comparison subjects using propensity scores. During the first month of therapy, SSRI antidepressants were associated with a nearly fivefold higher risk of completed suicide than other antidepressants (adjusted odds ratio: 4.8, 95% confidence interval=1.9–12.2). The risk was independent of a recent diagnosis of depression or the receipt of psychiatric care, and suicides of a violent nature were distinctly more common during SSRI therapy. Numerous sensitivity analyses revealed consistent results. No disproportionate suicide risk was seen during the second and subsequent months of treatment with SSRI antidepressants, and the absolute risk of suicide with all antidepressants was low. CONCLUSIONS: Initiation of SSRI therapy is associated with an increased risk of suicide during the first month of therapy compared with other antidepressants. The absolute risk is low, suggesting that an idiosyncratic response to these agents may provoke suicide in a vulnerable subgroup of patients. (...)

Lykkepille koblet til økt selvmordsfare
Dagbladet 22.8.2005
Kontroversiell norsk studie ryster legemiddelbransjen.

Et av de mest utbredte antidepressivaene, Seroxat, har blitt koblet til økt selvmordsfare i en norsk studie. Studien publiseres i dag i det anerkjente medisinske tidsskriftet BMC Medicine.

Funnene omtales i dag av en lang rekke store internasjonale medier, deriblant The Times, og regnes for å kunne brukes i søksmål mot produsenten av Seroxat, legemiddelgiganten GlaxoSmithKline.

De norske forskerne har opplevd svært stor pågang fra internasjonale medier i dag, bekrefter en av medforfatterne bak studien, Bent Natvig, ved Universitetet i Oslo, overfor Dagbladet.no.

- Økt risiko for selvmord
Den norske studien er en analyse av tidligere data som ikke har vært tilgjengelig før nå, som er gjort rundt effektene av antidepressivaet Seroxat i forkant av at legemiddelet ble godkjent.

Analysen har tatt for seg randomiserte dobbeltblinde studier, hvor verken leger eller pasienter visste hvem som fikk seroxat og hvem som fikk placebo (narrepiller). Den viser at det i gruppa pasienter som tok Seroxat ble gjort sju selvmordsforsøk, mot bare ett i gruppa som fikk placebo. 1500 pasienter var med i datamaterialet.

- Vi fant at forholdet var alarmerende, sier Natvig til Dagbladet.no.

Kontroversielt
Funnene i studien vakte tidligere i år sterke reaksjoner fra GlaxoSmithKline, da de ble gjengitt i helsemagasinet Puls på NRK i vår. Legemiddelgiganten mente at forskerne hadde gjort metodiske feil og at studien ikke var til å stole på.

Bent Natvig mener imidlertid at dagens publisering av studien deres i BMC Medicine, bekrefter at han selv, forskningsleder Ivar Aursnes og medforfatterne Ingunn F. Tvete og Jørund Gåsemyr ved Universitet i Oslo har gjort en solid jobb.

- Selv om vi har ett lite datamateriale er det et veldig grundig og sikkert datamateriale, sier Natvig. Han viser til at de blant annet har tatt hensyn til hvor lenge pasientene har gått på medisinene, og at antallet pasienter i de to gruppene var forskjellig.

GlaxoSmithKline hevder i en melding i dag at det later til at de norske forskerne har vært selektive i sitt valg av studier, men at de vil studere rapporten for å se nærmere på hva slags data og forskning som er benyttet.

Rundt 160.000 nordmenn bruker daglig såkalte SSRI-preparater, en gruppe medisiner hvor blant annet Seroxat inngår.

• Debatten rundt de norske forskernes funn, slik de ble gjengitt av helsemagasinet Puls, har tidligere gått i flere omganger i Aftenposten. Du kan lese debattinnleggene her.
• Rapporten fra de norske forskerne kan leses hos BMC Medicine.

BMC Medicine 2005, 3:14
Suicide attempts in clinical trials with paroxetine randomised against placebo
(...) Conclusions
Our findings support the results of recent meta-analyses. Patients and doctors should be warned that the increased suicidal activity observed in children and adolescents taking certain antidepressant drugs may also be present in adults. (...)

Norsk lykkepille-artikkel vekker oppsikt utenlands
NTBtekst 22.08.2005
Oslo (NTB-Bodil Stein): En undersøkelse som en norsk professor i klinisk farmakologi offentliggjorde her i landet for flere måneder siden, har nå vakt enorm interesse både i Storbritannia og USA.

Det dreier seg om et av Storbritannias mest solgte antidepressiva, legemiddelet Seroxat, som ifølge den norske undersøkelsen kan gi økt risiko for selvmord.

- Vi fikk tilgang til undersøkelsene som legemiddelprodusentene selv hadde gjort, før de søkte om tillatelse til å selge medikamentet i Norge. Vi fant da en studie der en gruppe pasienter som hadde fått middelet, hadde sju tilfeller av selvmordsforsøk. I kontrollgruppen som fikk narremedisin, var det bare ett tilfelle, sier professor i klinisk farmakologi Ivar Aursnes ved Universitetet i Oslo til NTB.

Selvmordstanker var også vanligere blant dem som tok middelet enn blant kontrollgruppen
Aursnes har skrevet om undersøkelsen, der 1.500 pasienter deltok, i British Medical Journal. Men trykketiden i medisinske tidsskrifter er lang, og artikkelen kom på trykk i siste nummer som kom ut i Storbritannia mandag.

Invitert i britisk TV
- Tidsskriftet sendte ut en pressemelding om vår artikkel mandag, og dermed grep britiske medier saken. Den har også vakt stor oppsikt i USA, sier Aursnes.
Både nettutgaven av avisen Times og det franske nyhetsbyrået AFP omtalte undersøkelsen mandag.

Selv ble den norske professoren bedt om å delta i et britisk fjernsynsprogram mandag kveld, men hadde ikke anledning til å reise.

- Tallene er muligens ikke helt statistisk signifikante, men andre undersøkelser med andre typer SSRI-preparater (mot depresjon) peker i samme retning. Det er en økt fare for selvmordsforsøk, sier Aursnes.

Tallene fra Seroxat-undersøkelsen ble lagt fram i NRKs helsemagasin «Puls» i februar og førte til en heftig debatt her i landet. Det er denne debatten som nå har blusset opp for fullt i Storbritannia.

- Må få vite
Aursnes mener brukerne skal få vite om risikoen og bivirkningene ved antidepressiva.

- Jeg leste forleden en artikkel der en lege hevdet at preparatene reduserte selvmordsrisikoen. Det er det ingen grunn til å si, tvert imot, advarer han.
Etter debatten i Norge i vinter gikk det i ut råd til norske leger om ikke å foreskrive preparatene til barn og unge.

- Jeg mener også at man bør vise større forsiktighet med voksne pasienter, Det er uheldig med høye doser, og man behøver heller ikke å gi medikamentet til så mange mennesker, påpeker Aursnes.

Legemiddelverket krevde i april at Seroxat og andre såkalte «lykkepiller»skal merkes med at de kan føre til selvmord. Pasientene skal også informeres om den mulige selvmordsfaren, ikke bare legene, slik praksis hadde vært inntil da. Det europeiske legemiddelkontoret advarte samtidig mot lykkepiller til barn og unge.

Mest solgt
Seroxat er et av de mest solgte antidepressiva i Storbritannia. Den britiske organisasjonen for mental helse, Mind, uttalte mandag at de mener resultatene er svært bekymringsfulle, og at preparatet bør trekkes fra markedet. Det britiske legemiddelverket og produsenten GlaxoSmithKline (GSK) mener fordelene langt oppveier bivirkningene ved preparatet.

GSK sier de vil gå igjennom den norske undersøkelsen nøye.
- Men konklusjonen gjenspeiler på ingen måte det bildet som er bygd opp om fordeler og risiko hos voksne gjennom et omfattende klinisk utprøvingsprogram med 24.000 pasienter, sier produsenten. (©NTB)

Antidepressant Seroxat linked to suicide attempts among adults
Independent 22.8.2005
The antidepressant Seroxat has been linked to an increase in suicide attempts among adults. Researchers suggest that patients and doctors should be warned of the propensity to suicidal thoughts while on the drug.

Experts have already warned that Seroxat is not suitable for children and adolescents due to an increased risk of self harm.

In the new study of 916 adults on the drug, seven attempted to take their own life. Dr Ivar Aursnes and colleagues at the University of Oslo compared these findings with 550 patients taking a placebo, of whom one tried to commit suicide. Their conclusions are published in the journal BMC Medicine.

They say: "We conclude that the recommendation of restrictions in the use of paroxetine (Seroxat) in children and adolescents ... should include usage in adults."

Seroxat has been taken by about 20 million people around the world since being licensed in 1990. Like Prozac, it is a Selective Serotonin Re-uptake Inhibitor (SSRI). (...)

GlaxoSmithKline (GSK) sier at selvmordsstudie er feilaktig og villedende

Glaxo says Paxil suicide study flawed, misleading (GlaxoSmithKline (GSK) sier at selvmordsstudie er feilaktig og villedende)
Reuters Health 22.8.2005 (indiadaily.com 22.5.2005)
LONDON (Reuters) - GlaxoSmithKline Plc fordømte mandag i sterke ordelag en studie fra norske forskere, som antyder at antidepressivaet Seroxat (Paxil) er linket til økt suicidal risiko hos voksne, og hevder at forskningen er feilaktig og villedende. (GlaxoSmithKline Plc on Monday slammed a study from scientists in Norway suggesting its antidepressant Paxil was linked to an increased suicide risk in adults, arguing that the research was flawed and misleading.)

GlaxoSmithKlines Seroxat (Paxil) og andre liknende legemidler er tidligere linket til selvmordsrisiko hos barn, og leger er på verdensbasis blitt advart at de ikke generelt bør brukes på de under 18 år. (GlaxoSmithKline's Paxil and other similar drugs have previously been linked to suicide risk in children, and doctors around the world have been warned they should not generally be used among under-18s.)

Men forskerne ved Universitetet i Oslo skrev i BMC Medicine journal at legemidlet synes å påvirke voksne på samme måte. (But researchers at Oslo University wrote in the BMC Medicine journal that the drug also seemed to affect adults in the same way.)

Deres analyse av forsøk involverer mer enn 1 500 pasienter fant syv selvmordsforsøk blant de som tok legemidlet og bare ett blant de som tok placebo. (Their analysis of trials involving more than 1,500 patients found seven suicide attempts among those taking the drug and only one among those taking a placebo.)

I en kunngjøring fra GSK, heter det i svært sterke ordelag at GSK anser analysen som villedende og at den fokuserer på feilaktige og selekterte data, innsamlet for 15 år siden da GSK søkte godkjenning for legemidlet, som også er kjent som Seroxat og paroxetine. (In a strongly worded statement, GSK said the analysis was misleading as it focused on incorrectly selected data, collected 15 years ago when GSK was seeking approval for the medicine, which is also known as Seroxat and paroxetine.)

"Det tjener bare til å skape forvirring og unødvendige bekymringer hos pasienter som bruker en SSRI (selektiv serotoninreopptakshemmer), slik som paroxetine, for behandling av depresjon," uttalte GSK. ("It serves only to cause confusion and unnecessary concern for patients using an SSRI (selective serotonin reuptake inhibitor), such as paroxetine, for treatment of depression," GSK said.)

"Sub-analysen mislykkes også å godta de nåværende samlede datamengde, som er betydelig mer omfattende og som nylig er blitt gjennomgått at EU-myndighetene." ("The sub-analysis also fails to erkjenne de nåværende data, which is significantly more extensive and which has been recently reviewed by EU authorities.")

Eksperter ved European Medicines Agency bekreftet tidligere i år på nytt den positive nytte-risiko for Paxil i behandlingen av voksne med angst og depresjon. (...) (Experts at the European Medicines Agency earlier this year reaffirmed the positive benefit-risk for Paxil in the treatment of adult anxiety and depression.)

(Anm: Suicide attempts in clinical trials with paroxetine randomised against placebo. 2005, 3:14.)

Jack Modell (03 October 2005) GlaxoSmithKline. Comments on this article (1). Paroxetine Association with Suicide Attempts Overstated. BMC Medicine (03 October 2005).

GlaxoSmithKline (GSK) har senere måtte innrømme at Aursnes og kollegers resultater er korrekte, og at de i 17 år (bevisst?) har feilinformert pasienter, leger og publikum.)

Prescription: Suicide?

Welcome to the official website for the film Prescription: Suicide?
prescriptionsuicide.com (2007)
Prescription: Suicide? is an unprecedented feature documentary built around intimately-told personal stories of six American families, their hopes and experiences with anti-depressant drugs prescribed to their children. As the film unfolds, we meet a range of individuals - some shy, some outspoken. Many have experienced tragedies and their pain is undeniable, yet with strength, humor and resilience, they love, care, struggle and speak for those who are no longer with us. (...)

Seponeringssymptomer

Medscape General Medicine (MedGenMed) 2005;7(3)
Venlafaxine and Serious Withdrawal Symptoms: Warning to Drivers.
As discussed, withdrawal symptoms occur in patients who have received both low and high doses of venlafaxine and result in a discontinuance syndrome with several manifestations, especially severe dizziness and disorientation, that are incompatible with driving a car or using heavy or dangerous machinery. Although standard warnings are given that taking the drug may affect those abilities, and patients are also generally advised not to stop the medication abruptly, severe withdrawal symptoms, such as confusion, impaired coordination, sensory disturbances, vertigo, delirium, strokelike symptoms, and depersonalization, may occur only hours after reduction or cessation and should warrant a specific "warning to drivers." Whenever venlafaxine is not taken at the usual time or in the usual quantity, special caution is warranted. Even when the dosage is being tapered, the physician should instruct the patient to beware of these symptoms, because the recommended tapering period of 2 weeks is not necessarily sufficient. Cases have been documented in which even tapering over a period of 3 months was insufficient. [16] (...)

As discussed, withdrawal symptoms occur in patients who have received both low and high doses of venlafaxine and result in a discontinuance syndrome with several manifestations, especially severe dizziness and disorientation, that are incompatible with driving a car or using heavy or dangerous machinery. (...)

(Anm: seponering; det å stansa ei behandling, slutta med eit legemiddel, vanleg forkorting: sep. EN cessation of medication; withdrawal. ET [lat. seponere setja til side] Kilde: Norsk medisinsk ordbok.)

Spasmer og dystoni?

Kan Cipralex gi spasmer og dystoni?
3.6.2005
RELIS har mottatt bivirkningsmelding om en 40 år gammel mann som de siste årene har brukt antidepressiva i lange perioder. Han hadde vært medikamentfri omtrent 9 måneder da behandling med Cipralex (escitalopram) ble startet opp. Etter ca. to ukers bruk fikk pasienten spasmodisk torticollis, og medikamentet ble seponert. Pasienten ble forbigående bedre, men etter vel tre uker fikk han kraftigere kontraksjoner igjen. Han ble henvist til nevrolog som antok at lidelsen var forårsaket av Cipralex. Det ble forsøkt med botoxbehandling, uten at dette ga sikker bedring. Det videre forløpet er ikke kjent. (...)

(Anm: Bevegelsesforstyrrelser - hva bør gjøres? Tidsskr Nor Legeforen 2008; 128:2162. (9.10.2008).)

(Anm: dystonia; dystoni; endring i muskulaturens spenningstilstand, ofte i form av ufrivillige muskelsammentrekninger (f.eks. i nakkemuskulaturen og svelgmuskulaturen. Dystoni kan være symptom ved indremedisinske og nevrologiske sykdommer, men kan også opptre som bivirkning av legemidler som blokkerer signalsubstansen dopamin. Akutte dystonier sees hos yngre menn noen dager etter at vedkommende har begynt på relativt høye doser med nevroleptika. (...) Ved akutte dystonier på grunn av legemidler er behandlingen tilførsel av antiparkinsonmidler. Kilde: Store norske leksikon.)

Falske prøvesvar

Toxicol Clin Toxicol. 2003;41(7):999-1002.
Massive venlafaxine overdose resulted in a false positive Abbott AxSYM urine immunoassay for phencyclidine. (...)

Negative legemiddelstudier publiseres ikke, ifølge rapport

Unfavorable drug studies don't see print: report (Negative legemiddelstudier publiseres ikke, ifølge rapport)
reuters.com 17.1.2008
BOSTON (Reuters) - Nearly a third of antidepressant drug studies are never published in the medical literature and nearly all happen to show that the drug being tested did not work, researchers reported on Wednesday.

And in some of the studies that are published, unfavorable results have been recast to make the medicine appear more effective than it really is, said the research team led by Erick Turner of the Oregon Health & Science University. (...)

The idea that unfavorable test results get quietly tucked away so nobody will see them -- sometimes call the "file drawer effect" -- has been around for years. (...)

They could see which experiments approved by the FDA between 1987 and 2004 were ultimately publicized in the medical literature and the main criteria the researchers planned to measure success.

"It tells you where they placed their bets before they saw the data," Turner said in a telephone interview. (...)

REWRITTEN STUDIES
However, when it came to the 36 studies with negative or questionable results, as assessed by the FDA, only three were published and another 11 were turned around and written as if the drug had worked.

"Not only were positive results more likely to be published, but studies that were not positive, in our opinion, were often published in a way that conveyed a positive outcome," said the team.

For example, of the seven negative studies done on GlaxoSmithKline's Paxil, five were never published. The researchers found three studies for GSK's Wellbutrin SR, but the two negative ones never reached print. (...)

"There's an expectation that if you get a positive result, that's what you're supposed to do, and if you get a negative result you have failed," said Turner. "The first impulse is to say, 'I was wrong. Maybe I should move on to something more interesting'" so the results may never get written up. (...)

Lyver om negative legemiddelstudier
helserevyen.no 23.1.2008
I en gjennomgang har den amerikanske legemiddelmyndigheten, FDA, funnet at legemiddelindustrien underslår negative tester på antidepressive midler.

Undersøkelsen tyder på at effekten av antidepressive legemidler er sterkt overdrevet i forhold til testresultatene.

Grunnen er at negative resultat aldri blir offentliggjort, eller at de blir presentert som positive istedenfor negative, ifølge The Wall Street Journal. (...)

One Third Of Antidepressant Studies Never Published
consumerist.com 18.1.2008
A new study—"the most thorough to date," writes the New York Times—shows that about a third of the studies for some of the market's most successful antidepressants (Paxil, Prozac, Zoloft, Effexor) were never published because they didn't have favorable results. (...)

Juks med forskning på lykkepillen
Underslo negative resultater
Tror du lykkepillen virker?
dagbladet.no 18.1.2008
Vel - du må kanskje tro om igjen.

BARE POSITIVE RESULTATER: En ny gjennomgang av forskning på antidepressiva viser at negative forskningsresultater ikke blir publisert. (...)

Researchers Find a Bias Toward Upbeat Findings on Antidepressants
nytimes.com 17.1.2008
The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs’ true effectiveness, a new analysis has found. (...)

Web Link
Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy (NEJM)

In published trials, about 60 percent of people taking the drugs report significant relief from depression, compared with roughly 40 percent of those on placebo pills. But when the less positive, unpublished trials are included, the advantage shrinks: the drugs outperform placebos, but by a modest margin, concludes the new report, which appears Thursday in The New England Journal of Medicine. (...)

Antidepressants Less Effective Than Doctors Have Been Led to Believe: Study
therapeuticsdaily.com 17.1.2008
TORONTO - Antidepressants are far less effective than doctors have been led to believe, a new study has found.

That's because 88 per cent of clinical trials that showed the drugs didn't work either weren't published in medical journals or were presented as positive findings, says the study in the New England Journal of Medicine. (...)

Snedvriden publicering om antidepressiva
lakemedelsvarlden 17.1.2008
Studier som visar negativa resultat för antidepressiva läkemedel publiceras inte i den vetenskapliga litteraturen. Det visar en jämförelse som forskare gjort mellan de studier som amerikanska läkemedelsverket har tillgång till och de studier som är offentliggjorda i medicinska tidskrifter. (...)

Antidepressant Trials Are Selectively Reported, Study
medicalnewstoday.com 17.1.2008
(...) Specifically, the results showed that:

• 31 per cent of 74 FDA-registered studies (accounting for 3,449 participants) were not published.
• 37 of the studies seen by the FDA as having a positive outcome were published, and 1 study viewed as positive was not.
• Studies viewed by the FDA as having a negative outcome were, except in 3 cases, either not published (22 studies), or published in such a way that the outcome was presented as positive (11 studies). These 33 studies accounted for a total of 5,212 participants.
• Collectively, according to the published literature, it appeared that 94 per cent of the trials conducted were positive.
• This contrasted sharply with the FDA view, which showed that only 51 per cent of the trials were positive.
• The meta-analysis revealed that the increase in effect size from FDA to journal data sets ranged from 11 to 69 per cent for individual drugs and came to 32 per cent across all 12 drugs.

Turner and colleagues concluded that: (...)

Antidepressants Under Scrutiny Over Efficacy (Effekt av antidepressiva granskes)
wsj.com 17.1.2008
Sweeping Overview Suggests
Suppression of Negative Data
Has Distorted View of Drugs

The effectiveness of a dozen popular antidepressants has been exaggerated by selective publication of favorable results, according to a review of unpublished data submitted to the Food and Drug Administration.

ACCENTUATE THE POSITIVE

A review of research submitted to the FDA:
• Of 74 studies reviewed, 38 were judged to be positive by the FDA. All but one were published, researchers said.
• Most of the studies found to have negative or questionable results were not published, researchers found.
Source: The New England Journal of Medicine (...)

Five Trials
For example, Pfizer submitted five trials on its drug Zoloft to the FDA, the study says. The drug seemed to work better than the placebo in two of them. In three other trials, the placebo did just as well at reducing indications of depression. Only the two favorable trials were published, researchers found, and Pfizer discusses only the positive results in Zoloft's literature for doctors. (...)

The average effect size of the antidepressant Zoloft rose 64% by the failure to publish negative or questionable data on the drug, the researchers found. (...)

Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy (Selektiv publikasjon av forsøk på antidepressiva og dets innflytese på angivelig effektivitet)
NEJM 2008; 358:252-260 (January 17)
Background Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio. (...)

According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. Separate meta-analyses of the FDA and journal data sets showed that the increase in effect size ranged from 11 to 69% for individual drugs and was 32% overall.

Conclusions We cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, from decisions by journal editors and reviewers not to publish, or both. Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients. (...)

Antidepressant Studies Unpublished
nytimes.com 17.1.2008
Eli Lilly, manufacturer of Prozac, was among those criticized.

The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs’ true effectiveness, a new analysis has found. (...)

Antidepressant Trial Results Exaggerated (Forsøksresultater på antidepressiva overdrevet)
ivanhoe.com 16.1.2008
(Ivanhoe Newswire) – A new study shows a problem with past reporting of antidepressant research. The analysis finds selective publication in reporting exaggerates the effectiveness of antidepressants. (...)

Turner’s team found that whether and how the studies were published depended on how they turned out. They found 94 percent of the studies had positive results, but the FDA data showed only half of the study were positive. All but one of the positive studies was published. Most of the studies that were not positive were not published or they were published with a positive spin.

“Selective publication can lead doctors and patients to believe drugs are more effective than they really are, which can influence prescribing decisions,” says Turner. “Doctors and patients must have access to evidence that is complete and unbiased when they are weighing the risks and benefits of treatment.” (...)

BMJ 2005;331;155-157 (15 july)
Education and debate
Efficacy of antidepressants in adults
Most people with depression are initially treated with antidepressants. But how well do the data support their use, and should we reconsider our strategy? (…)

Although the NICE meta-analysis of placebo controlled trials of selective serotonin reuptake inhibitors found significant differences in levels of symptoms, these were so sl that the effects were deemed unlikely to be clinically important.¹

Longitudinal follow-up studies show very poor outcomes for people treated for depression both in hospital14 and in the community,15 and the overall prevalence of depression is rising despite increased use of antidepressants.16

Summary points
Recent meta-analyses show selective serotonin reuptake inhibitors have no clinically meaningful advantage over placebo

Claims that antidepressants are more effective in more severe conditions have little evidence to support them

Methodological artefacts may account for the sl degree of superiority shown over placebo

Antidepressants have not been convincingly shown to affect the long term outcome of depression or suicide rates

Given doubt about their benefits and concern about their risks, current recommendations for prescribing antidepressants should be reconsidered

Conclusions.
The NICE review data suggest that selective serotonin reuptake inhibitors do not have a clinically meaningful advantage over placebo, which is consistent with other recent meta-analyses. (...)

Rapid Responses to:
BMJ 2005; 331: 155-157 [Full text]
EDUCATION AND DEBATE:
Joanna Moncrieff and Irving Kirsch
Efficacy of antidepressants in adults. (...)

Authors Response 16 August 2005
We are glad that we have generated so much discussion. Firstly we want to respond to the accusation by the authors of the NICE guidelines that our paper contained “inaccuracies” (Pilling et al, rapid responses). In response to the first substantial point, the authors contend that they based their conclusions on mean endpoint data. We quote from the full guideline itself:

“There is evidence to suggest that there is a statistically significant difference favouring SSRIs over placebo on reducing depression symptoms as measured by the HRSD but the size of this difference is unlikely to be of clinical significance.” P. 186-7. In the conclusions to this section entitled “Clinical Summary” they again state that “there appears to be no difference between SSRIs and placebo on mean endpoint or change scores.” P 189 (1)

Therefore if NICE’s recommendations are based on endpoint data, as they say they are in their response, they should have recommended that SSRIs are not used at all. (...)

BMJ 2005;331:155-157 (16 July)
Re-examining SSRIs for depression
In a clinical review on page 155, Moncrieff and Kirsch take a close look at available evidence for and against the use of selective serotonin reuptake inhibitors (SSRIs) in treating depression. Current approaches to depression should be re-evaluated, they say, and alternatives to drug treatment should be developed further. Since antidepressants have become society's main response to distress, the authors say that expectations raised by decades of use will also need to be addressed. (...)

SSRI-utløst aggresjon?

'Involuntary intoxication' defense introduced in 2004 murder case
dailyregister.com 4.3.2011
A murder case with a lot of twists and turns since 2004 has at least one more twist in store.

James Burns, accused of murder in connection with the December 2004 death of Thomas Condon, plans to argue he was involuntarily intoxicated by the prescription drug Paxil at the time of the incident.

Burns' attorney, Hugh Richard Williams of Carbondale, served notice of "affirmative defense" on the court at a hearing Wednesday. The defense depends upon a medical expert reviewing the case and medical records of the defendant. (...)

(Anm: Paxil (Seroxat; generisk navn paroxetine; paroksetin i Norge). )

Kan legemidler utløse voldshandlinger?
relis.no 10.2.2011
Om legemidler kan utløse voldshandlinger er sjeldent studert og en nylig publisert studie av Moore og medarbeidere omtales.

Vold er sjeldent studert som en mulig bivirkning av legemidler. Imidlertid har det jevnlig vært diskutert legemidler og selvmordrisiko (jf. antidepressiva). I den nasjonale bivirkningsdatabasen for spontanrapportering er det kun enkelte rapporter hvor melder har mistenkt en assosiasjon mellom legemidler og voldsutøvelse og lignende (1). Imidlertid er flere legemidler som antidepressiva, vareniklin og montelukast assosiert med aggressiv adferd (2). (...)

(Anm: Prescription Drugs Associated with Reports of Violence Towards Others (Reseptbelagte legemidler med rapporter om vold mot andre)
PLoS ONE 2010;5(12): e15337.)

Several Medications Linked to Violent Acts (Flere legemidler linket til voldelige handlinger)
Psychiatric News, 2011;46(3):16 (February 4) (American Psychiatric Association)
A psychiatrist with a particular interest in violence believes that psychiatrists should become aware that the antismoking medication varenicline and antidepressants have been linked with violent behavior.

A link between several types of psychotropic medications and violent behavior toward others has been documented in a recent study.

The medications most strongly linked to violent behavior were the smoking-cessation aid varenicline and antidepressants, regardless of class. (...)

(Anm: Prescription Drugs Associated with Reports of Violence Towards Others (Reseptbelagte legemidler med rapporter om vold mot andre)
PLoS ONE 2010;5(12): e15337.)

Prescription Drugs Associated with Reports of Violence Towards Others (Reseptbelagte legemidler med rapporter om vold mot andre)
PLoS ONE 2010;5(12): e15337
Context Violence towards others is a seldom-studied adverse drug event and an atypical one because the risk of injury extends to others.

Objective To identify the primary suspects in adverse drug event reports describing thoughts or acts of violence towards others, and assess the strength of the association. (...)

Conclusions Acts of violence towards others are a genuine and serious adverse drug event associated with a relatively small group of drugs. Varenicline, which increases the availability of dopamine, and antidepressants with serotonergic effects were the most strongly and consistently implicated drugs. Prospective studies to evaluate systematically this side effect are needed to establish the incidence, confirm differences among drugs and identify additional common features. (...)

Fresno Mom In Child Drowning Case Sentenced (Fresno-mor dømt for drukning av sitt barn)
kmph.com 18.10.2010
A Fresno mother, who admitted to drowning her seven–month–old daughter, was sentenced on Monday.

Lisa Brown was sentenced to 15 years in prison for drowning her baby daughter Jillian.

Brown pleaded no contest in the case back in August. According to court records, Brown told several investigators her daughter was "possessed" on Christmas Eve of 2007.

Brown fortalte detektiver at det var djevelen som ba henne om å gjøre det. Hun fortalte også detektiver at hun selvmedisinerte seg med marihuana, og hadde tatt antidepressivaet Seroxat (Paxil). (Following the incident, Brown told detectives the devil made her do it. She also told detectives she had been self-medicating with marijuana, and had taken the anti-depressant, Paxil.)

Stay with KMPH and KMPH.com as we continue to follow this story. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

He Killed His Own Son While on Paxil (Han drepte sin sønn mens han tok Seroxat (Paxil))
lawyersandsettlements.com 22.10.2010
Huntsville, ON: Anyone who ever felt that antidepressants are generally safe need only know the story of David Carmichael, a Canadian who lost his son to Paxil side effects. That's because Carmichael, while taking Paxil, strangled his 11-year-old son in a hotel room. It was 2004, and Carmichael was severely depressed and taking Paxil at the time. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Neb. inmate loses appeal in lawsuit blaming Zoloft
action3news.com 17.12.2009 (Associated Press)
LINCOLN, Neb. (AP) - A Nebraska inmate serving time for his girlfriend's murder likely won't be able to pursue his lawsuit against the makers of Zoloft.

Randall Robbins II filed his lawsuit against Pfizer Inc. and his former doctor in June, blaming the widely prescribed antidepressant for influencing his behavior.

Pfizer defends Zoloft as a safe and effective drug that has helped millions. (...)

Doctor’s doubts on antidepressant treatment (Leges tvil om antideperessivabehandling)
gazettelive.co.uk 5.6.2009
DRUGS given to a psychiatric patient who died after cutting his throat with a razor blade could have made his condition worse, an inquest has heard.

Jason Walker, who was being treated in the Stephenson ward of the University Hospital of North Tees, was given a high dose of Prozac to treat a severe form of Obsessive Compulsive Disorder.

But the antidepressant may have had the opposite effect, his psychiatrist told Teesside Coroners’ Court.

Mr Walker, who was 34 and from Yarm, died in May 2007.

Speaking during yesterday’s hearing, consultant psychiatrist Dr Stephen Humphries said increased serotonin as a result of the large Prozac dose could have worsened Mr Walker’s anxiety.

“The unintentional results could be side-effects such as over stimulation,” he told the jury. “Jason was quite a tortured man. He was tortured by his thoughts.

“I’m beginning to wonder whether the anxiety was actually being generated by the Prozac rather than resolving it.” (...)

Japan Revises SSRI Warnings--Hostility, Violence
medpagetoday.com 28.5.2009
In Japan reports of violence linked to SSRI antidepressants have raised public awareness to the danger these drugs can pose. A Japanese psychiatrist acknowledges: "To say that being able to tell the difference between depressives and mild manic-depressives is the test of a psychiatrist's true skill is no exaggeration."

The absence of any empirically valid diagnostic tool in psychiatry puts patients at risk of trial and error --i.e., Russian roulette--diagnostic and treatment methods. (...)

No need to fear antidepressants if patients, doctors team up on diagnosis, treatment
mdn.mainichi.jp 21.5.2009
"Is the antidepressant I'm taking safe?" I am hearing this question from my patients more and more. The reason? The media has recently reported that among antidepressant users, some develop increased feelings of hostility or anxiety, and have even committed sudden acts of violence against others.

The Ministry of Health, Labor and Welfare has investigated the side-effects of antidepressants and has decided to revise the warnings on the medication, stating, "There are cases where we cannot rule out a causal relationship with the medication."

When patients taking antidepressants hear news like this, it's little wonder they feel uneasy and think things like, "I guess there are some harsh side-effects," or, "Will I end up like that, too?" (...)

Link between violence, antidepressants debated
eveningsun.com 14.4.2009
In 2001 when he was 12 years old, Christopher Pittman killed his grandparents with a shotgun.

Christopher was taking a daily dose of 200 mg of Zoloft, an antidepressant, at the time of the killing and his defense became known as the "Zoloft Defense" - that the drug had provoked his homicidal rage. (...)

Stamford attorney who went on rampage sues psychiatrist
stamfordadvocate.com 3.3.2009
Lawyer was not guilty by reason of mental disease

STAMFORD -- A Stamford attorney who went on a rampage in 2007, shooting at a van driver then breaking into his ex-wife's home, has filed a lawsuit against his psychiatrist.

Eric Witlin, 41, was found not guilty by reason of mental disease or defect in May. In July, he was committed to serve 20 years in the Whiting Forensic Institute after psychiatrists testified that he had a psychotic episode induced by a prescription drug.

The suit was filed Feb. 26 in state Superior Court in Stamford against Dr. Simon Epstein. (...)

The psychiatrists who testified in court said the prescription drugs Adderall and Prozac led to Witlin's state, and one of the psychiatrists said he believed Witlin was misdiagnosed when he was prescribed them.

The psychiatrists and police officers testified that Witlin's Manhattan co-workers noticed increasingly odd behavior immediately. (...)

Teenager bludgeoned his father to death after GP prescribed him Prozac (Tenåring slår sin far til døde etter at allmennpraktiserende lege forskrev ham Prozac)
dailymail.co.uk 6.2.2009
Edward Belben bludgeoned his father to death and attempted to murder his mother
A teenager bludgeoned his father to death with a hammer and crowbar weeks after a GP prescribed him the controversial anti-depressant Prozac. (...)

'Prozac killing' claim boy guilty
bbc.co.uk 6.2.2009
A 17-year-old boy from Essex has been found guilty by a jury of killing a 59-year-old man and attempting to murder a 43-year-old woman.

Tanya Belben, 43, and husband Gry, 59, were attacked in their Colchester home in December 2007.

The boy, then aged 15, denied murder and said at Chelmsford Crown Court his personality was changed after taking the anti-depressant drug Prozac.

Mr Justice Tugendhat said the boy would be sentenced at a later date. (...)

Drug 'could have led boy to kill' (Legemiddel "kan være årsaken til at gutt drepte")
bbc.co.uk 26.1.2009
A 15-year-old boy may have battered a man to death because his personality was changed by an antidepressant drug, a specialist doctor has told a court.
The boy killed Gary Belben, 59, with a hammer and attempted to kill his wife, Tanya, in Essex after being prescribed Prozac, Chelmsford Crown Court heard.
The boy, who cannot be identified and who denies murder and attempted murder, was given the drug for depression.

Lawyers representing him argue the drug caused a "mental abnormality".
His lawyers contend the boy is not guilty of murder but guilty of manslaughter on the grounds of diminished responsibility. (...)

Clinically Depressed Poodle Mauls Former French President Chirac (Klinisk deprimert puddel skamferer tidligere fransk president Chirac)
foxnews.com 22.1.2009
Former French First Lady Bernadette Chirac walks Sumo in this undated photo.

Former French President Jacques Chirac was rushed to a hospital after being mauled by his pet dog who is being treated for depression, in a dramatic incident that rattled the ex-president's wife.

Parets hvite malteser-puddel, kalt Sumo, har en historie med ville innfall og fikk stadig oftere en tendens til mer "ustyrlige", uprovoserte angrep, til tross for at den gikk på antidepressiva, ifølge hans kone Bernadette. (The couple's white Maltese poodle, called Sumo, has a history of frenzied fits and became increasingly prone to making "vicious, unprovoked attacks" despite receiving treatment with anti-depressants, Chirac's wife Bernadette said.)

"If you only knew! I had a dramatic day yesterday," she told VSD magazine. "Sumo bit my husband!"

Mrs. Chirac, 74, did not reveal where the former president was bitten, but said, "the dog went for him for no apparent reason." (...)

Killer who beat man suffering side effects from anti-depressants
mirror.co.uk 15.1.2009
A boy of 15 who beat a man to death was suffering side effects from anti-depressants he had been prescribed against medical guidelines, a court heard yesterday. (...)

Schoolboy who killed man and attacked his wife 'blames Prozac' (Skolegutt som drepte mann og angrep hans kone "legger skylden på Prozac")
dailymail.co.uk 13.1.2009
A 15-year-old boy battered a man to death and tried to kill a woman after claims his personality changed a month after he began taking Prozac, a court heard.

Defence lawyers for the unnamed boy will argue that he was driven to club the man more than 30 times after taking the popular anti-depressant.

Chelmsford Crown Court in Essex will hear scientific evidence in an attempt to prove the drug, also known as Fluoxetine, can cause 'violent impulses' which can drive someone to kill. (...)

Prozac 'caused boy, 15, to kill' (Prozac "får gutt på 15 til å drepe")
bbc.co.uk 13.1.2009
A 15-year-old boy whose personality had been changed by the anti-depressant Prozac beat a man to death and tried to kill his wife, a court has heard.
He denies murdering Gary Belben, 59, and trying to murder Tanya Belben in Colchester, Essex, in December 2007.

The teenager's lawyers say their client is only guilty of manslaughter on the grounds of diminished responsibility.

Chelmsford Crown Court heard how the hammer attacks happened a month after the boy was prescribed the drug.

He cannot be identified for legal reasons.

'Mental abnormality'
Jurors heard that the boy had been prescribed the medication by a doctor after he complained of feeling depressed.

Lawyers representing him argue that the drug caused a "mental abnormality". (...)

Crawford man sentenced in father’s shooting (Mann fra Crawford dømt for å skyte sin far)
goerie.com 1.11.2008
MEADVILLE -- A Townville-area man will serve at least five years in prison for intentionally shooting his father in the legs during a domestic dispute in the spring. (...)

Maine fortalte Miller at det å slutte med antidepressiva medførte at "jeg ble ekstremt sint." (Maine told Miller that coming off the antidepressant put him in situations where "I was extremely angry.")

"Denne type raseri har jeg aldri erfart tidligere i mitt liv," sa Maine, som tilla at han var glad i sin far. ("This kind of rage, I never experienced in my life," said Maine, adding that he loves his father.)

"I just want to let you know that I'm sorry that this happened to him," he added. (...)

Retrial planned for Mansfield man, 85, in wife’s death
nwanews.com 1.11.2008
GREENWOOD — Prosecutors said Friday they will retry 85-year-old Autry Basham after a jury was unable to reach a verdict in his first-degree murder trial. (...)

Fayetteville psychiatrist Robin Ross testified during the trial she concluded Basham suffered from delirium the morning he killed his wife. She said the delirium was triggered by pneumonia he was suffering from at the time, obstructive sleep apnea, his taking depression and anxiety drugs Paxil and Xanax, and his advanced age. (...)

Kvinner biter og slår politiet
vg.no 30.10.2008
Bergen (NTB): Unge kvinner er blitt politifolkenes store mareritt. Flere kvinner enn menn tiltales nå for vold mot politiet i Bergen, skriver Bergensavisen.

Kvinnene både biter, slår, sparker og skaller politifolkene. (...)

Voldsforsker Ragnhild Bjørnebekk ved Politihøgskolen er ikke så sikker på om tallene er representative, men advarer likevel mot å bagatellisere kvinnevolden. (©NTB) (...)

Looking for answers to shootings
blog.nj.com 8.12.2007
The shooting at the mall in Omaha, Nebraska Wednesday is just another in a very long list of senseless violence with seemingly no answer as to why.

Maybe there is an answer, or a series of answers. I wonder if this kid, Robert Hawkins, was on anti-depressants, or off them. I kept this article by Dr. Julian Whitaker which appeared in the November, 1999 edition of Health and Healing (seven months post Columbine). He states that in virtually all of the gun related massacres over the last decade, the shooters were taking Prozac, Zoloft, Luvox, Paxil or a related antidepressant drug. Coincidence? I doubt it. In addition to the suicide warning on some of these drugs, perhaps there should be a homocide warning also.

The doctor goes on to say that the overuse of drugs is not even part of the national debate, probably because of the FDA's close ties to the multi-billion dollar drug industry. It's impossible to watch TV without being bombarded with drug commercials promoting this pill or that (side effects included). (...)

Fish on Prozac: a simple, noninvasive physiology laboratory investigating the mechanisms of aggressive behavior in Betta splendens
TEACHING IN THE LABORATORY
Advan. Physiol. Edu. 31: 358-363, 2007 (© 2007 American Physiological Society)
The neuromodulator serotonin is an important regulator of aggressive behavior in vertebrates. (...)

Some antidepressants may cause adolescent aggression
paktribune.com 18.10.2007
ISLAMABAD: Some antidepressant drugs could cause irritability and other abnormal behaviour in teenagers and more research is required to study their effect on children, say scientists. (...)

New Mexico Prozac Murder-Suicide Case Takes Another Twist
law.lexisnexis.com 9.10.2008
Mark Gilbert Rimbert’s case against Prozac maker Eli Lilly & Co. just keeps heating up, but this time the turmoil involves Judge James O. Browning, who was taken off the case today after informing attorneys that his son recently attempted suicide after his psychiatrist prescribed Prozac to him. (...)

Drugs might breed violence
thenewstribune.com 28.5.2007
Attacks on staff rise at Western State Hospital

Violence has been a growing problem at Western State Hospital for years.
If present trends continue, one in four of the Lakewood mental hospital’s more than 1,700 workers can expect to be assaulted by a patient in 2007, according to the state Department of Labor and Industries.

For years, hospital administrators have blamed the violence on familiar causes: not enough staff members, not enough money and increased societal violence that leads to the admission of more-violent patients. But they don’t have the data to back up those assertions.

A News Tribune analysis of drug-prescribing trends at Western since 1999 finds another possible factor: Western is giving more patients psychiatric drugs with side effects that can include extreme agitation and aggression.

The drugs include newer antidepressants and newer anti-psychotics dubbed atypical anti-psychotics.

The newer drugs, which are expensive compared with older, generic alternatives, have been heavily promoted at the hospital by the pharmaceutical companies that make them. Sales representatives for those companies have logged about 1,200 visits to Western since late 2003, when administrators began tracking their activity.

Concerned about their influence on prescribing patterns, the hospital in March banned all drug company representatives from visiting the campus to meet with doctors.

Randy Burkholder, an associate vice president for Pharmaceutical Research and Manufacturers of America, the Washington, D.C.-based drug industry lobby group, acknowledged The News Tribune analysis, saying it’s a “great idea” to discover more about the impact of pharmaceuticals through original investigation.

“There may be something there, there may not be,” he said about the findings. But he cautioned that the analysis doesn’t prove cause and effect. Instead, it just hints at a possible association. Only additional research can make that determination, Burkholder said.

The link between changes in drug use at Western and recent increases in violence “is very plausible,” said Dr. Stefan Kruszewski, a Harvard-trained psychiatrist and an expert on the side effects of anti-psychotic drugs who is on the faculty at Eastern University, outside Philadelphia.

“There is a significant relationship between restlessness and agitation induced by medicine and the propensity for violence,” Kruszewski said.

Western has never studied the idea that changes in drug use could contribute to increased violence, said Dr. Roger Jackson, the hospital’s acting medical director and an employee there since 1993. (...)

Anmeldte lovbrudd, 2007
ssb.no 16.5.2008
(...) Voldskriminalitet anmeldt, etter type voldslovbrudd. 1993-2007. (...)

Teen Who Shot Grandparents Gets Support
cfnews13.com 9.4.2007
Supporters are rallying around a teenager who killed his grandparents and blamed the antidepressant drug Zoloft. Every week, Janet Sisk rises as early as 5 a.m. and drives nearly 100 miles to spend her Sundays with the boy who was just 12 when he murdered his grandparents in their sleep. (...)

Medication blamed for 'rock row'
bbc.co.uk 29.3.2007
(...) She claimed events were prompted "by a reaction to an imbalance in medications used to treat my bipolar disorder". (...)

The Plummer defense
rockymountainnews.com 11.6.2006
Jake Plummer, take note. A new psychiatric "finding" suggests that drivers who cut people off in traffic may not be behaving badly after all. Perhaps they're just sick and need medication.

The study, partially funded by drug companies that involved researchers from Harvard Medical School and the University of Chicago, identified a cause for road rage: a mental illness the authors call "intermittent explosive disorder." The malady reportedly afflicts 16 million Americans, mostly men, and is presumably more prevalent than schizophrenia or bipolar disorder.

But the "study" sounds less like a scientific breakthrough than a marketing gimmick by pharmaceutical companies - and an open invitation for trial lawyers to absolve dangerous "jerks" in court from taking responsibility for their actions.
After all, Dr. Emil Coccaro, chairman of psychiatry at the University of Chicago, and his colleagues did not conduct physical examinations, perform brain scans or analyze clinical data. Instead, they asked 9,000 adults if they ever became angry enough to destroy something or hit or threaten another person.
Between 5 percent and 7 percent of those surveyed said they had "lost control" more than three times, making them likely IED patients.

Fear not, however. The disorder can be treated with therapy and medications, including Prozac and Zoloft, which just happen to be made by two of the four drugmakers that helped underwrite the study for the National Institutes of Mental Health.

Frequent, uncontrolled outbursts of anger can indeed indicate psychological or physiological problems. But claiming that garden-variety hotheads may be mentally ill and not fully responsible for their actions reinforces the worst stereotypes of the psychiatric profession.

And for prestigious institutions to tout such "findings" without conducting original physical research smacks of desperation . . . or worse. (...)

IT'S NOT YOU—IT'S THE PROZAC
SEEDMAGAZINE.COM 24.10.2006
BRAIN & BEHAVIOR
Click on the image to watch hamsters on fluoxetine tussle in their cage.

Courtesy of Kereshmeh Taravosh-Lahn. Image Credit: Marsha Miller
When hamsters tussle, the altercation might be one animal's attempt to establish social dominance over the other. Or, maybe it's the Prozac. (...)

‘King Kong' talked to car
blackburncitizen.co.uk 25.9.2006
A 24-year-old Darwen man who mixed prescribed medication with drink was later seen talking to a parked car pretending to be King Kong.

Blackburn magistrates heard that Leon Paul Wilkinson also shouted at the top of his voice that he was King Kong before kicking the wing mirror off a car.

Wilkinson, of Holden Fold, Darwen, pleaded guilty to criminal damage. (...)

Risk Of Violent Behavior With Selective Serotonin Reuptake Inhibitors And Antidepressants
medicalnewstoday.com 14.9.2006
(...) The authors note that "Some regulators, such as the Canadian regulators, have also referred to risks of treatment-induced activation leading to both self-harm and harm to others" and the "United States labels for all antidepressants as of August 2004 note that 'anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric'". (...)

A summary of placebo controlled trials in children and adults showed that 60 of 9219 (0.65%) patients given paroxetine, compared with 20 of 6,455 given placebo (0.31%) had what was called a "hostility event". (...)

(Anm: Healy D, Herxheimer A, Menkes DB. Antidepressants and Violence: Problems at the Interface of Medicine and Law. PLoS Med. 2006 Sep 12;3(9). (PDF).)

Study links antidepressants to violence risks (Studie linker antidepressiva til risiko for vold)
msnbc.msn.com 12.9.2006
Adults taking Paxil should be closely monitored, researchers say

- Newer antidepressants, already suspected of raising the risk of suicide, may also cause a few people to become violent, researchers reported Monday.

They found that people who took GlaxoSmithKline’s antidepressant Paxil were twice as likely to have what was called a “hostility event” as those given a placebo.

Paxil, known generically as paroxetine, is in a class of drugs called selective serotonin reuptake inhibitors or SSRIs.

They came under scrutiny when some doctors reported that teenagers taking the drugs might be more likely to commit suicide.

In 2004, the U.S. Food and Drug Administration concluded there was a higher risk of suicidal behavior among children and teenagers and ordered strong label warnings on several SSRI drugs. It has urged close monitoring of adults.

David Healy and David Menkes from Cardiff University in Britain and Andrew Herxheimer from the Cochrane Centre used several sources of information to see what the risk of violent behavior was among people taking SSRIs. (...)

They found that 60 out of 9,219 people who took Paxil or 0.65 percent, had “a hostility event,” compared to 20 of 6,455 given a placebo, or 0.31 percent.

Writing in the online journal Public Library of Science-Medicine, the researchers said, however, that such violence was likely to be rare.

“The new issues highlighted by these cases need urgent examination jointly by jurists and psychiatrists in all countries where antidepressants are widely used,” they wrote. (...)

(Anm: Healy D, Herxheimer A, Menkes DB. Antidepressants and Violence: Problems at the Interface of Medicine and Law. PLoS Med. 2006 Sep 12;3(9). (PDF).)

Hostility Events Dog Small Minority of SSRI Users
psychiatrictimes.com 12.9.2006
-- Selective serotonin reuptake inhibitors (SSRI) can have a rare paradoxical effect, sparking aggressive or violent behaviors in otherwise placid patients.
So reported three researchers here who concluded from an odd mix of studies and reports on the antidepressants, including e-mail responses to a TV documentary, that Paxil (paroxetine) and other SSRIs can trigger what they called "hostility events."

The three study authors have all served as expert witnesses in legal cases revolving around antidepressants and violence or suicide. Their findings have legal implications, they reported in the September issue of the online journal PLoS Medicine, because "many jurisdictions appear not to have considered the possibility that a prescription drug may induce violence."

"Our main finding is that unselected sets of placebo-controlled trials of antidepressants show evidence for an increased relative risk of aggressive behaviors on treatment, although such outcomes apply to only a small subset of patients," wrote psychologist David Healy, Ph.D., of Cardiff University here, and colleagues.

The investigators reviewed data on the SSRIs Paxil, Prozac (fluoxetine), and Zoloft (sertraline), looking at controlled trials and other sources. They found in a pooled analysis of studies of children and adults treated with Paxil, 0.65% had a "hostility event," versus 0.31% of patients on placebo (odds ratio [OR]: 2.10; 95% confidence interval [CI]: 1.37-3.48). (...)

(Anm: Healy D, Herxheimer A, Menkes DB. Antidepressants and Violence: Problems at the Interface of Medicine and Law. PLoS Med. 2006 Sep 12;3(9). (PDF).)

Antidepressiv medicin kan öka aggressivitet
netdoktor.passagen.se 1.10.2006
I ett djurförsök med unga hamstrar som fick SSRI-läkemedlet Fontex (Prozac) såg man att de blev mer aggressiva. Detta kan förklara den ökade suicidrisken hos tonåringar som behandlas med antidepressiv medicin. Fontex är idag det enda preparat av typen som EU godkänner för att behandla barn och ungdomar från åtta års ålder. (...)

Animal Study Links Teen Aggression With Prozac
forbes.com 16.10.2006
-- Scientists have uncovered clues as to why children and adolescents may get more aggressive or even suicidal while taking the widely prescribed antidepressant Prozac. (...)

For the new study, which was published in the October issue of Behavioral Neuroscience, researchers at the University of Texas at Austin injected hamsters with either high or low doses of Prozac. (...)

UpHill Battle - Warning Pharma Customers About Dangers of SSRIs
by Evelyn Pringle
opednews.com 2.10.2006
(...) Professors David Healy and David Menkes from Cardiff University in Britain, and Andrew Herxheimer from the Cochrane Centre, conducted the study to determine the risk of violent behavior in people taking SSRIs. (...)

(Anm: Healy D, Herxheimer A, Menkes DB. Antidepressants and Violence: Problems at the Interface of Medicine and Law. PLoS Med. 2006 Sep 12;3(9). (PDF).)

Sjukt sinte sjåfører
nettavisen.no 7.6.2006
Aggressive sjåfører er ikke dumme, de er syke, mener amerikanske forskere. Og det kan helbredes. (...)

Kostbart
Mellom fem og syv prosent av de testede hadde sykdommen, og det skulle tilsi omtrent 16 millioner amerikanere, og gjennomsnittlig hadde de som var med i undersøkelsen 43 anfall i løpet av livet, som ifølge forskningen beløper seg til 1.359 amerikanske dollar per person for ting som skades.

Ronald Kessler, som publiserte resultatene i Archives of General Psychiatry, sier at det er nytt både for folk flest og spesialister innen mental helse at det er så store deler av folket som lider av disse sinne-utbruddene.

Dr Coccaro sier at sykdommen skyldes feil ved produksjon og funksjonen av serotonin, som er et stoff i hjernen som regulerer humør og oppførsel, og han mener at det i stor grad kan behandles med antidepressiva og terapi. (...)

Derfor går sjåfører amok
aftenposten.no 6.6.2006
Aggressive bilførere sliter ifølge forskere med en psykisk sykdom.

Amerikanske forskere mener at rundt 16 millioner amerikanere lider av intermittent explosive disorder - eller "midlertidig eksplosiv atferd".
Sykdommen karakteriseres ved hyppige raseriutbrudd - som ofte inkluderer trusler og vold, skriver The Telegraph.

Ofte er også reaksjonen langt kraftigere enn situasjonen skulle tilsi.
Årsaken til de plutselige utbruddene skal være utilstrekkelig produksjon av stoffet serotonin i hjernen.

- Folk tror at det skyldes dårlig oppførsel, og at man bare behøver å justere seg inn. Men det folk ikke vet, er at det er biologiske forklaringer på dette, sier professor i psykiatri ved Universitetet i Chicago, Emil Coccaro. (...)

Mellom fem og syv prosent av de 9.282 personene som ble undersøkt, hadde lidelsen, ifølge The National Institute of Mental Health.

Diagnosen ble tatt inn i psykiatriske fagbøker for mange år siden, men forskerne trodde den rammet langt færre enn den faktisk gjør.

Sykdommen kan ifølge forskerne behandles med antidepressiva. (...)

Jury clears diplomat of being drunk on flight
guardian.co.uk 25.1.2006

· Alcohol and drug blamed for 'disgraceful' behaviour
· Colonel was depressed by aftermath of tsunami

A senior British diplomat who went berserk on a flight from Abu Dhabi to London was yesterday found not guilty of being drunk on an aircraft after saying his behaviour was caused by an antidepressant he was taking to deal with the stress of the Asian tsunami. (...)

He said he been "shocked and amazed" when police described his behaviour. "It was extraordinarily disgraceful and must have been hugely upsetting to passengers. I can't offer any explanation for this at all, I'm absolutely shocked, I honestly don't remember any of that at all."

He said he had since learned that Seroxat could result in a "hyper-manic state" and was no longer taking it.

After hearing that Col Roberts had suffered adverse effects when mixing alcohol with antidepressants on a previous occasion, Judge Usha Karu rejected a defence application for costs. (...)

Defense lawyer blames antidepressants
Boston Globe 6.8.2005
Says drugs led to fatal shooting

The lawyer for a 60-year-old Brockton man charged in the slaying of a man during a traffic dispute this week said his client had been using antidepressant drugs that made him mentally unstable and extremely aggressive prior to the shooting.

Kevin J. Reddington said Walter Bishop had been taking Wellbutrin and Paxil for months when witnesses said he hunted down and shot Sandro Andrade, 27, on the street as Andrade carried his 9-month-old daughter after his vehicle and Bishop's nearly collided in Brockton on Tuesday morning. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

(Anm: Den såkalte økning i "midlertidig eksplosiv atferd" (IED), som tilsynelatende er registrert i USA, kan bl.a. skyldes bvirkninger knyttet til økte nivåer av serotonin i hjernen grunnet inntak av SSRI-preparater.)

Mere vold mod offentligt ansatte

Psykisk syge straffes i længere tid end raske
politiken.dk 23.11.2008
Der er sket en eksplosion i antallet af psykisk syge, der bliver dømt til behandling for vold og trusler mod offentligt ansatte.

Siden midt i 1990’erne er antallet af psykisk syge, der bliver dømt for vold og trusler mod sygeplejersker, politibetjente og socialrådgivere, eksploderet.

Blot 15 psykisk syge blev i 1995 dømt for at slå, sparke eller true offentligt ansatte. Det tal var sidste år steget til 104, hvilket svarer til en syvdobling. Dermed udgør den type domme nu en fjerdedel af det samlede antal behandlingsdomme rettet mod psykisk syge. (...)

Mere vold mod offentligt ansatte
berlingske.dk 15.8.2006
Øretæver og spark i ryggen bliver mere normalt for blandt andet politibetjente og socialrådgivere.

En arbejdsdag krydret med et par på kassen, et kvælertag om halsen eller et spark i ryggen bliver mere og mere almindeligt for socialrådgivere, parkeringsvagter, sygeplejersker, politibetjente og andre offentligt ansatte, skriver JydskeVestkysten.

Antallet af anmeldelser om vold mod offentligt ansatte er eksploderet det seneste par år. Sidste år blev der anmeldt ikke færre end 2931 tilfælde mod 1877 i år 2000. (...)

SSRI-induserte fosterskader

Åtte døde etter «lykkepille»-bruk
side2.no 20.5.2006
Dødsfallene omtales i en bivirkningsrapport fra Statens legemiddelverk (SLV), skriver VG. I tillegg har SLV fått 140 meldinger om alvorlige bivirkninger etter bruk av såkalte lykkepiller, som på fagspråket kalles SSRI (selektive serotonin reopptakshemmere).

- 39 prosent av bivirkningsmeldingene vi har fått på SSRI-preparater, er vurdert som alvorlige. Det omfatter overdose, selvskade, selvmordsforsøk, mageblødning, nyresvikt, forfølgelsesvannvidd, hallusinasjoner, aggresjon og angstfall. Noen pasienter har fått veldig alvorlige bivirkninger som i verste fall er dødelige, sier avdelingsoverlege Steinar Madsen ved Statens legemiddelverk til VG.

Av de som døde, er et foster, fire som begikk selvmord, en pasient døde av mageblødning, en fikk hertesykdom, en tok overdose og en fikk leversvikt. Bivirkninger vurderes som en mulig dødsårsak for alle, men det er ikke sikkert at dødsfallene skyldes legemidlene. Ingen av de ulike merkene antidepressiva peker seg ut som spesielt ille når det gjelder bivirkninger.

Det er første gang det meldes om fosterdød etter at moren har brukt antidepressiva i Norge, men det er rapportert om lignende hendelser fra andre land. Madsen understreker at man ikke vet om det er SSRI som var årsaken til at fosteret døde. (...)

Prozac-type drugs increase birth risks, study finds
theglobeandmail.com 6.4.2006
Women who take a popular class of antidepressants during pregnancy have a higher risk of birth complications, according to a new Canadian study.

The research shows that women who take selective serotonin reuptake inhibitors - SSRIs, a class of drugs that includes big-selling brand names such as Prozac, Paxil and Zoloft -- are at increased risk of having a fetus who dies, experiencing premature delivery, giving birth to an underweight baby and seeing their newborn have seizures.

Almost one-third of the women taking SSRIs experienced at least one of those complications.

"These results are unsettling," said Mark Walker, a scientist at the Ottawa Health Research Institute and lead author of the study. (...)

Pregnant Women Should Discuss Antidepressant Risks
psychiatryonline.org 7.4.2006
About one-third of infants in a recent study who were exposed to antidepressants while in the womb experienced symptoms of neonatal abstinence syndrome, which include tremors, disturbed sleep, gastrointestinal problems, and hypertonicity. (...)

Neonatal Abstinence Syndrome After In Utero Exposure to Selective Serotonin Reuptake Inhibitors in Term Infants
Arch Pediatr Adolesc Med. 2006;160:173-176.
(...) Conclusions Neonatal abstinence syndrome occurs in 30% of neonates exposed to SSRIs in utero. These neonates should be monitored for at least 48 hours after birth. The long-term effects of prolonged exposure to SSRIs, particularly in neonates who develop severe symptoms, have yet to be determined. (...)

– Paroksetin kan skade fosteret
Tidsskr Nor Lægeforen (7.11.2005)
Mødre som bruker paroksetin under svangerskapet kan ha økt risiko for å få barn med hjertefeil. (...)

Using antidepressants during pregnancy
CMAJ (November 8, 2005)In a recent CMAJ article, Gideon Koren and associates discuss maternal use of selective serotonin reuptake inhibitors (SSRIs) in the third trimester of pregnancy.1 Clinicians often speculate that a particular person with depressed mood has an abnormality of serotonin metabolism; however, life events, ingestion of toxins, abnormal biology and even poor diet or lack of exercise may be responsible for the depression instead. SSRIs and other antidepressant medications are often prescribed even though a specific test has not been done to confirm that the patient has abnormalities of serotonin levels or serotonin metabolism.

There is a dearth of strong evidence showing that antidepressant medications are substantially more effective than placebo or that the benefits of antidepressant medication outweigh the harms.2,3,4 We have not found any well-controlled studies showing that antidepressants reduce the risk of suicide in pregnancy, nor strong evidence that antidepressant medications are substantially more effective than placebo in reducing the pain of depression in pregnant women. (...)

– Paroksetin kan skade fosteret
Tidsskr Nor Lægeforen 7.11.2005
Mødre som bruker paroksetin under svangerskapet kan ha økt risiko for å få barn med hjertefeil.

Det er legemiddelselskapet GlaxoSmithKline som nå advarer europeiske legemiddelmyndigheter om dette etter å ha fått resultatene fra en epidemiologisk studie. Studien konkluderer med en mulig økt risiko for hjertefeil hos fosteret når mødre tar paroksetin tidlig i svangerskapet. Denne økte risikoen er ikke funnet for de øvrige SSRI-preparatene.

Ukjent årsak
Hva som er årsaken til den mulige effekten er ikke kjent. Medfødt hjertefeil rammer rundt 1 % av alle nyfødte, mens det i den omtalte studien rammet 2 % av barna. Den vanligste hjertefeilen var ventrikkelseptumdefekt (VSD). Også i en svensk studie som nylig ble gjennomført, ble paroksetin tatt i svangerskapets første trimester forbundet med en økt risiko for hjertefeil hos barnet. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

First trimester antidepressant risk
australiandoctor.com 15.9.2005
ANTIDEPRESSIVAET paroxetine bør unngås under svangerskap fordi det kan dobble forekomsten av fødselsdefekter, advarer Therapeutic Goods Administration. (THE antidepressant paroxetine should be avoided during pregnancy because it may double the rate of birth defects, the Therapeutic Goods Administration warns.)

Detaljer fra en innledende analyse av data fra GlaxoSmithKline viste en høyere forekomst av medfødte misdannelser, spesielt ventrikkelseptumdefekt, hos spebarn til kvinner som tar legemidlet. (Details from a preliminary analysis of GlaxoSmithKline data showed a higher incidence of congenital malformations, particularly ventricular septal defects, in babies born to women taking the drug.)

Dataene viste at spedbarn til kvinner, som tar paroxetine i første trimester av svangerskapet, var 2,2 ganger mer sannsynlig å være født med en medfødt misdannelse, og 2,08 ganger mer sannsynlig å ha kardiovaskulære misdannelser enn de født av kvinner som tar andre antidepressiva. (...) (Babies of women taking paroxetine in the first trimester of pregnancy were 2.2 times more likely to be born with a congenital malformation and 2.08 times more likely to have a cardiovascular malformation than those born to women taking other antidepressants, the data showed.)

(Anm: ventricular septal defects; ventrikkelseptumdefekt VSD; medfødt hol i hjartekammerskiljet – ventrikkelseptum; kan gi sterk hjartemislyd (systolisk), og kan vera årsak til hjartesvikt; stundom er det andre medfødde hjartelyte samstundes; jf Rogers sjukdom der ventrikkelseptumdefekten er liten og ikkje gir nemnande påkjenning på hjartefunksjonen EN ventricular septal defect. Kilde: Norsk medisinsk ordbok.)

Antidepressiva og risiko for misdannelser - foreløbige resultater
Lægemiddelstyrelsen 6.9.2005
En dansk registerundersøgelses foreløbige resultater¹ viser øget forekomst af misdannelser hos børn født af mødre, der havde fået depressionsmidlerne SSRI’ere i den tidlige graviditet (1. trimester). Resultaterne er netop blevet offentliggjort på International Conference on Pharmacoepidemiology. (...)

Note 1: Pia Wogelius, Mette Nørgaard, Estrid Muff Munk, Preben Bo Mortensen, Loren Lipworth, Henrik Toft Sørensen. Maternal Use of Selective Serotonin Reuptake Inhibitors and Risk of Adverse Pregnancy Outcomes. Pharmacoepidemiology and drug safety 2005; 14: S72:143.

Anti-depressant pregnancy concern (Bekymringer angående bruk av antidepressiva under svangerskap.)
BBC 1.9.2005
Forskning tyder på at bruk av en type antidepressiv medikasjon under svangerskap kan øke risikoen for fødselsdefekter som hareskår. (Use of a type of anti-depressant medication during pregnancy may increase the risk of birth defects such as cleft palate, research suggests.)

Danske og amerikanske forskere fant at bruk av SSRi-er i de første tre måneder av svangerskapet var linket til 40 % øket risiko – men resultatene er foreløpige. (Danish and US scientists found use of SSRIs in the first three months of pregnancy was linked to a 40% increased risk - but the results are preliminary.)

Hjertedefekter var 60% mer sannsynlige når kvinner brukte SSRi-er. (Cardiac defects appeared to be 60% more likely when the women used SSRIs.)

Men forskerne understreker at resultatene, som fremkommer i Pulse magazine, ikke betyr at kvinner bør slutte med legemidlene. (But the researchers stress the results, featured in Pulse magazine, do not mean women should stop taking the drugs.)

Resultatene ble presentert på konferansen til International Society for Pharmacoepidemiology. (...) (The findings were presented an International Society for Pharmacoepidemiology conference.)

I den siste studie, som fokuserer på 1 054 kvinner som tok SSRi-er under svangerskapet, fant forskerne også at bruk av legemidlene sent i svangerskapet var forbundet med en øket risiko på 40 % for prematur (for tidlig) fødsel. (In the latest study, focusing on 1,054 women who took SSRIs during pregnancy, scientists also found that use of the drugs late in pregnacy was associated with a 40% increased risk of premature birth.)

Og en annen studie av 377 tilfeller av vedvarende pulmonal hypertensjon hos spedbarn fant at bruk av SSRI sent i svangerskapet var linket til en 5,5-doblet risiko. (And a second study of 377 cases of persistent pulmonary hypertension in babies found SSRI use late in pregnancy was linked a 5.5-fold increased risk.)

Ledende forsker, professor Henrik Toft Sorensen, fortalte BBC News website, at studien fremdeles var i et tidlig stadie, og at det er uklart hvorvidt bruk av SSRI foråsaket problemer, eller hvorvidt det kanskje kunne skyldes andre faktorer, slik som usunn diett. (...) (Lead researcher Professor Henrik Toft Sorensen told the BBC News website that the study was still in its early stages, and it was unclear whether SSRI use caused problems, or whether some other factor, such as an unhealthy diet, might be to blame.)

(Anm: pulmonary hypertension; pulmonal hypertensjon; for høgt blodtrykk i lungepulsåra – arteria pulmonalis, kan gi tung pust ved pårøyning, brystsmerter, synkopetendens m v; kan skuldast mitralstenose eller andre slags, gjerne medfødde hjartesjukdommar, lungeemboliar (ev i form av kronisk tromboembolisk pulmonal hypertensjon), visse medikament (jf aminorex, fenfluramin), kollagene åresjukdommar m v; jf primær pulmonal hypertensjon og endotelin 1. Kilde: Norsk medisinsk ordbok.)

American Psychiatric Association (Amerikansk psykiatrisk forening)

Physicians May Overlook Black-Box Warnings
psychiatryonline.org 17.3.2006
To avoid "black-box violations," drug-label warnings must be clarified and simplified, making them more readily understandable.

Buried amid the seemingly never-ending advance of the U.S. Food and Drug Administration's (FDA) black-box warnings on the labels of most psychiatric drugs available today, there is increasing debate on the power of those warnings to change physicians' prescribing behavior. (...)

Drop in Youth Antidepressant Use Prompts Call for FDA Monitoring
Psychiatr News 2005:40:18 (October 7, 2005)
APA and AACAP are urging the FDA to track prescribing patterns of antidepressants in adolescent populations following the addition of a controversial warning to the labels of these medications.

Amid a steep decline in antidepressant prescriptions for children and adolescents since regulators mandated label warnings of possible links between the drugs and suicide risk, psychiatric organizations are urging the Food and Drug Administration (FDA) to track the impact on patients.

A September 2 letter from APA and the American Academy of Child and Adolescent Psychiatry (AACAP) alerted the FDA about a new analysis of data on antidepressant prescription patterns (Psychiatric News, September 2) and asked that the FDA monitor the impact of the black-box warning on antidepressants it issued on October 15, 2004. (...)

The letter to the FDA from APA and AACAP is posted at http://www.psych.org/news_room/press_releases/05-53APAonPsychNewsAnalysis%20_3_.pdf

Serotonin og marked

Du er hjernen din
morgenbladet.no 14.10.2005
– Sterke krefter jobber for at myndighetene skal bedømme hvor sannsynlig det er at et menneske skal begå kriminelle handlinger ut fra genetiske egenskaper i hjernen, sier professor Nikolas Rose.

Vi har hørt det før, innvendingene mot utbredelsen av antidepressiva og andre psykofarmaka: De skrives ut til triste, så vel som til frustrerte, så vel som til klinisk syke. "Gå til legen og få deg resept på lykkepiller," er blitt et kjerringråd.
Men hva slags syn på bevisstheten, på hjernen, og på mennesket har gjort dette mulig? (...)

Det klassiske bildet er det av den deprimerte hjernen. Dette er basert på hypotesen om at depresjon forårsakes av for lite serotonin i hjernen. Vi kan se et bilde av en frisk hjerne med mye serotonin, og så en deprimert hjerne med lite serotonin. Deretter får vi se medisinene, i dette tilfellet fluoxetinhydroklorid.
– Man må begå et kvante-sprang for å komme seg fra de kompliserte forklaringene i den molekylære nevrovitenskapen, de enkle grafiske fremstillingene man bruker for å gjøre medisinenes virkning begripelig, sier Rose. (...)

Sykeliggjøring. – La oss si at det finnes noe som heter "vanlige folk". Det er vel en del "vanlige folk" som går på lykkepiller også?
– Dette er den gruppen mennesker som føler de har mistet kontroll over livene sine og vil ha den tilbake. Disse menneskene tar disse medisinene for å føle seg frie, fordi det er slik medisinene markedsføres. Den hverdagslige lidelsen er blitt sykeliggjort.
– Hvem mener du har ansvaret for dette?
– Det er nok et samspill mellom legemiddelindustrien, legene, pasientene og myndighetene. Mange går til legene sine fordi de føler at livene deres er uutholdelige. Alt de ønsker seg er en pille som får dem til å føle seg bedre. Hvis jeg går til legen, og han sier til meg at jeg skal gå på helsestudio og trene, så sier jeg "Det har jeg ikke tid til, kan jeg få en pille isteden?". Dette er et komplisert samspill. (...)

Godkjenning

U.S. Alters Test Policy On Psychiatric Drugs
Washington Post 26.10.2005
FDA Won't Require 6-Month Studies
The government will back down from a plan to require long-term studies of new psychiatric drugs before allowing them on the market, regulators said yesterday.

The reversal of the recently adopted policy came after a panel of experts unanimously recommended against requiring such studies as a condition of approval. While such studies are needed, the experts said, delaying decisions on new medications would hurt patients. (...)

FDA rejects limits on psychiatric drugs
indystar.com 26.10.2005
Panel defeats proposal requiring long-term effectiveness before treatments approved. (...)

Antidepressant Long-Term Studies Prior To Approval Should Not Be Required, Cmte. Says
fdaadvisorycommittee.com 25.10.2005
Long-term efficacy studies for antidepressants should not be required to be completed prior to approval, FDA's Psychopharmacologic Drugs Advisory Committee said Oct. 25. (...)

FDA Division of Psychiatric Products Director Thomas Laughren pointed out that both acute and long-term efficacy are required by the European Medicines Agency for antidepressant drugs. (...)

Laughren acknowledged that most antidepressant drug manufacturers eventually conduct long-term studies but that it may take three to four years post-approval to complete them. FDA does not have regulatory mechanisms to ensure that they are completed in a timely manner, he added.

Committee members emphasized that long-term studies should be conducted as quickly as possible. Some committee members proposed that the studies be started prior to approval of the drug, or at least that the trial design be set by the company and FDA.

A number of committee members said that more long-term safety data on antidepressants in adults and children is an even greater need than efficacy data. (...)

Hjernen

New Brain Imaging Reveals Damage
MRI Misses
abcnews.go 17.2.2006
Diffusion Tensor Imaging Shows Colorful Pictures (...)

Zimmerman said he had been looking at professional boxers and those with minor head trauma. The DTI revealed damage to one boxer's corpus callosum, which looked fine in an MRI, by showing that the "colorful wires" looked pale and thin.

"With the regular MRI, the brain looks normal. And yet, look at how, how you just don't see this structure anymore," he said when looking at the DTI. "This is all disarrayed. So, this, the motion of water through this patient's corpus callosum is disturbed. And therefore we know this patient has had damage to the structure." (...)

Can't Focus? Aging Brain May Be to Blame
healthfinder.gov 6.2.2006
By middle age, neurological 'daydream' centers gain more control, researchers find

-- If you're midway through life and wondering why your powers of concentration aren't are sharp as they used to be, a new study could help explain why.

Gradual brain changes beginning in middle age cause older adults to be more easily distracted by irrelevant information, and to lose focus in busy environments, Canadian researchers report.

"It's known that older adults are more easily distracted. We think we've found a mechanism in the brain to explain this and generated new insight into when in the lifespan these brain changes begin to occur," study author Dr. Cheryl Grady, a senior scientist at the Rotman Research Institute in Toronto, said in a prepared statement. (...)

As reported in the February issue of the Journal of Cognitive Neuroscience, this pattern begins to break down in people aged 40 to 60. When middle-aged people do memory tasks, activity in the "daydreaming" medial frontal and parietal regions stays turned on, while activity in the concentration-linked dorsolateral prefrontal cortex declines.

This imbalance in brain activity is even more pronounced in people aged 65 and older, the researchers said, which may explain why older adults are less able to tune out irrelevant or distracting information. (...)

More information

The U.S. Centers for Disease Control and Prevention has information on healthy aging. (...)

Can Brain Scans See Depression?
New York Times 18.10.2005
They seem almost alive: snapshots of the living human brain.

Not long ago, scientists predicted that these images, produced by sophisticated brain-scanning techniques, would help cut through the mystery of mental illness, revealing clear brain abnormalities and allowing doctors to better diagnose and treat a wide variety of disorders. And nearly every week, it seems, imaging researchers announce another finding, a potential key to understanding depression, attention deficit disorder, anxiety. (…)

But there is a growing sense that brain scan research is still years away from providing psychiatry with anything like the kind of clear tests for mental illness that were hoped for.

"I think that, with some notable exceptions, the community of scientists was excessively optimistic about how quickly imaging would have an impact on psychiatry," said Dr. Steven Hyman, a professor of neurobiology at Harvard and the former director of the National Institute of Mental Health. "In their enthusiasm, people forgot that the human brain is the most complex object in the history of human inquiry, and it's not at all easy to see what's going wrong."

For one thing, brains are as variable as personalities. (...)

(Anm: Searching for the Person in the Brain. New York Times 5.2.2006.)

Ecstasy (og antispykotika) versus SSRI

BBC forsvarer narko-uttalelser
aftenposten.no 7.10.2006
- Ecstasy er bare fantastisk, sa BBC-komikeren Graham Norton, og blir forsvart av statskanalen. (...)

Prozac increases Ecstasy dangers
ninemsn.com.au 22.9.2006
The combination of the antidepressant drug Prozac and the illegal "club drug" Ecstasy increases the risk of acute toxic effects of Ecstasy, and may explain the increasing number of Ecstasy-related deaths, according to research presented at the annual meeting of the American College of Clinical Pharmacology. (...)

Kjent ecstasy-forsker til Norge
helserevyen.no 6.9.2006
En av verdens fremste eksperter på hallusinogener og ecstasy, Dr. John Halpern fra Harvard University, USA, kommer til Norge i november for å gi en oppdatering på et fagfelt som har vært i stor endring de siste årene. (...)

Dum av ecstasy
aftenposten.no 8.6.2006
Tesen om at ecstasy svekker hukommelsen og gir psykiske lidelser er styrket etter en sammenligning av 27 studier på dopmiddelet. (...)

MDMA (ecstasy) er et amfetaminlignende stoff som øker frigjøringen og hemmer reopptaket av viktige signalsubstanser i hjernen, særlig serotonin, men også dopamin og noradrenalin. MDMA har i dyrestudier vist å føre til skade av hjerneceller. (...)

40 000 ecstasy-tabletter på nio år
dagensmedicin.se 4.4.2006
Läkare i Storbritannien har i veckan avslöjat fler detaljer om "Mr A", den 37-årige man som uppges ha tagit 40 000 tabletter av narkotikapreparatet ecstasy.

Enligt läkare vid St George´s Hospital i London, Storbritannien, var mannens ecstasy-konsumtion extrem. Men samtidigt avslöjar den långtidseffekterna av en alltför stor konsumtion av det narkotikaklassade preparatet, uppger BBC. Enligt läkarna lider mannen fortfarande av minnesproblem, sju år efter den senaste tabletten.

Mannen, som går under beteckningen "Mr A", ska enligt uppgift ha påbörjat sitt missbruk när han var 21 år. De första två åren tog han "bara" fem tabletter varje helg. Därefter ökade han konsumtionen till 3,5 tabletter per dag i tre år för att sedan gå upp till hela 25 tabletter per dag i fyra år. Efter att ha kollapsat vid tre olika tillfällen slutade mannen att ta tabletter när han var 30 år.

I flera månader efter att ha slutat med drogen upplevde han det ändå som om han fortfarande tog ecstasy. Dessutom drabbades han av flera episoder av tunnelseende. Därefter utvecklade han svåra panik-attacker, ångest, depression samt muskelstelhet, främst i nacken och käkarna. Han upplevde även hallucinationer och fick paranoida idéer.

När han träffade läkarna på St George´s Hospital använde han fortfarande cannabis och tidigare hade han missbrukat lösningsmedel, benzodiazepiner, amfetamin, LSD, kokain och heroin.

Enligt läkarna går det inte att vara helt säker på att mannens uppgifter om ecstasy-missbruket stämmer, dels för att han lider av minnesproblem, dels för att mycket av uppgifterna bygger på hans egen berättelse. Men berättelsen stöds av de journalanteckningar som finns från den tid då mannen slutade att missbruka den ökända "partydrogen" för sju år sedan.

Fallet beskrivs i tidskriften Psychosomatics. (...)

(Anm: Neurological and Psychopathological Sequelae Associated With a Lifetime Intake of 40,000 Ecstasy Tablets. Psychosomatics 47:86-87 (February 2006).)

(Anm: SSRI-preparater kan allerede etter kort tids bruk (timer/dager/uker) forårsake bl.a. såkalt nevroleptisk malignt syndrom (malignt nevroleptikasyndrom; neuroleptic malignant syndrome (NMS) og/eller serotonin syndrom (SS) (NMS og SS er egentlig ett og samme syndrom)

Bivirkningene er tilsvarende de som kan oppstå ved bruk av såkalte nye og gamle antipsykotika.

Den amerikanske legemiddelkontrollen FDA advarer bl.a. om følgende bivirkninger: "somnolence, coma, nausea, tremor, tachycardia, confusion, vomiting, and dizziness. Other notable signs and symptoms observed with overdoses involving paroxetine (alone or with other substances) include mydriasis, convulsions (including status epilepticus), ventricular dysrhythmias (including torsade de pointes), hypertension, aggressive reactions, syncope, hypotension, stupor, bradycardia, dystonia, rhabdomyolysis, symptoms of hepatic dysfunction (including hepatic failure, hepatic necrosis, jaundice, hepatitis, and hepatic steatosis), serotonin syndrome, manic reactions, myoclonus, acute renal failure, and urinary retention" osv.)

(Anm: Bevegelsesforstyrrelser - hva bør gjøres? Tidsskr Nor Legeforen 2008; 128:2162. (9.10.2008).)

Selektive serotoninreopptakshemmere - skade ikke dokumentert?
Tidsskr Nor Lægeforen 2002; 122: 428
(...) Men hva sier egentlig forskningen om mulige hjerneskader av slike medikamenter? (...)

How ecstasy makes lovers loners (Telegraph)
australiandoctor.com 10.11.2005
Ecstasy is known as the love drug but research on rats suggests it causes social withdrawal in the long term, the Daily Telegraph reports. University of Sydney psychopharmacologist Dr Iain McGregor said the rat study confirmed the widely reported immediate effects in humans of a strong feeling of love and closeness to others. But he said long-term studies found the rats eventually became anti-social, depressed, anxious and stressed. Dr McGregor said giving the rats anti-depressants failed to improve their abnormal social behaviour. (...)

Depresjon: mer enn bare serotonin

Depression: more than just serotonin (Depression: more than just serotonin)
CMAJ 2005; 172 (12) (june 7)
Science and Medicine
Under nor circumstances, serotonin transporters remove serotonin from the synapse; SSRIs block these transporters and thus increase the concentration of serotonin. However, dopamine transporters are known to have a low affinity for serotonin and may therefore act as a substitute for serotonin transporters.

In a recent study, Zhou and colleagues1 demonstrated in mice that, in the presence of the SSRI fluoxetine or an excess of extracellular serotonin, dopamine nerve terminals will take up serotonin from the synapse. These neurons, which norly release only dopamine, will then release both dopamine and serotonin when they next fire. The authors suggest that this "hijacking" of dopamine transporters by serotonin may explain why it takes a few days for the effects of SSRI therapy to appear.

Serotonin is thought to play a crucial role in the pathophysiology of depression. The clinical effect of dopamine transporters in SSRI therapy is unclear, because the results described in the study by Zhou and associates do not touch upon whether dopamine and serotonin signalling interactions affect behaviour. However, they do point to dopamine transporters as an intriguing target of future study, the results of which may help in the design of new antidepressants that block the ability of dopamine receptors to uptake serotonin. (...)

Lykkepille-kur mot PMS slaktes

Should women be popping anti-depressants for PMS?
mirror.co.uk 7.8.2008
Worrying new figures indicate doctors are prescribing anti-depressants to women suffering from PMS. Does it help or do more harm? Your Life investigates. (...)

But new figures show she’s far from alone. A lack of understanding of the condition means many doctors now hand out happy pills such as Prozac to treat period problems. (...)

Liz took the antidepressants she was prescribed by her GP but found they didn’t help and the side-effects were harder to cope with than the PMS. (...)

Alarm over rising number of women being prescribed Prozac for PMS 'inappropriately'
dailymail.co.uk 7.8.2008
Rising numbers of women with premenstrual syndrome are being treated with antidepressants, a leading charity claimed yesterday.

But many find that the pills do not work - and the side effects can be worse than period pain, according to the National Association for Premenstrual Syndrome, or NAPS.

The majority of women experience some symptoms of PMS, such as stomach bloating and irritability, and two in five suffer from problems such as violent mood swings, which are so bad that they consult their GP. (...)

Lykkepille-kur mot PMS slaktes
vg.no 12.11.2005
Advarer mot farlig feilbehandling

Kvinner som får lykkepiller mot PMS, utsettes for lidelse og ren livsfare, advarer forsker Kaj Winther.

I Norge og Sverige kan kvinner få resept på antidepressiva ved premenstruelle plager (PMS).

Nå advarer eksperter mot utstrakt bruk av såkalte lykkepiller, antidepressiva av typen SSRI, mot PMS.

- Det er ofte helt feil behandling, dessuten er det farlig. SSRI-pillene øker risikoen for blødning ved en ulykke eller operasjon. De forstyrrer sexlysten og kan forandre et menneskes personlighet, sier Kaj Winther til den svenske avisen Expressen. (...)

Cipralex

Har Lundbeck fler jämförande studier i byrålådan?
Läkemedelsvärlden (November 2005)
LÄKEMEDELSUTVECKLING, NIONDE INLÄGGET, REPLIK PÅ KENNET BRYSTING OCH RICHARD BERGSTRÖMS INLÄGG I LMV 10/05 (SE LÄNK I HÖGERMARGINALEN)

Vem betraktar vanligen först ett nytt läkemedel på marknaden? Det är den förskrivande doktorn som läkemedelsbolagen vänder sig till och de är medvetna om att “beauty is in the eye of the beholder”. Jag drar mig till minnes en vacker annons från Lundbeck om Cipralex som förekom i svenska medicinska tidskrifter 2003.

Läsarens blick dras oemotståndligt mot en mörkblå himmel och under den ett hav av intensivt gula solrosor. En av dessa är avsevärt längre än de andra och avtecknar sig i eget majestät mot himlen. Annonsens budskap står i vitt mot den mörkblå himlen: ”Bilden klarnar”. Man missar inte att den resliga solrosen är Cipralex, i ett hav av tillväxthämmade släktingar.

Referenserna till annonstexten utgörs bara av posters. Förvisso har Cipralexannonser fällts flera gånger sedan introduktionen: tre gånger av NBL och sju gånger av IGM, hittills. Andra inadvertenser är till exempel att Lundbeck i sin redovisning av escitalopramresultat använt sig av tveksamma subgruppsanalyser och per protokollsanalyser (Svensson S, Mansfield P i Psychother Psychosom 2004;73:10-6). (...)

Även för escitalopram måste man därför beakta risken för publikationsbias. I det material som Lundbeck lämnade in till Läkemedelsverket för godkännande av Cipralex fanns tre jämförande studier av escitalopram och citalopram; av dessa publicerades de två där escitalopram gav bättre resultat än citalopram (se referens till Svensson och Mansfield ovan). Den opublicerade tredje studien utföll till citaloprams fördel med 0,1 MADRS-poäng.

Det kan därför vara på plats att fråga om Lundbeck har några fler ”negativa” escitalopram-citalopramstudier, som förpassats till byrålådan (utom den som LV fick se)? (...)

(Anm: bias; (...) valg og vurderinger som på systematisk måte avviker fra det som er faktisk korrekt. Kilde: Store norske leksikon.)

(Anm: bias [baies] -en, - skjevhet i vitenskapelig undersøkelse el. resultat pga. mangelfull systematikk i innsamlingen av data. Etym.: eng., fr. biais helning, tendens. Kilde: ordnett.no.)

Feildiagnostisering, overforskrivning og unødvendige bivirkninger

Study shows many misdiagnosed with depression (Studie viser at mange feildiagnostiseres som depressive)
chron.com 15.4.2007
Livet er ikke en dans på roser. Mennesker får sparken og blir skilt. Investeringer går skeis, og sparepenger går tapt. Venner og familiemedlemmer dør. Det er uunngåelig. (Life is not a bowl of cherries. People get fired or divorced. Investments go sour, and savings are lost. Friends and family members die. It's inevitable.)

Når ting går galt, føler mennesker seg ofte bedrøvet. Det er normalt. (When bad things happen, people frequently feel sad. It's normal.)

I løpet av de to siste tiår, har vår kultur blitt blind for denne sannhet. Mennesker blir medisinert i et forsøk på å motvirke menneskelige følelser. (During the past couple of decades, our culture has lost sight of this truth. People are being medicated in an attempt to counteract natural human emotions.)

En ny studie viser at så mange som en fjerdedel kan være feildiagnostisert som deprimerte når det de i virkeligheten erfarer er en relevant reaksjon på nedturer som fra tid til annen vil skje i livet (Archives of General Psychiatry, April 2007). Ikke sjelden fikk de en forskrivning av et antidepressiva. (A new study shows that as many as one-fourth may be misdiagnosed as depressed when what they are really experiencing is an appropriate reaction to life's occasional setbacks (Archives of General Psychiatry, April 2007). Not infrequently they get a prescription for an antidepressant.)

Mange lesere har erfaringer slik som denne: (Many readers have shared experiences like this one:)

"Jeg tar Zoloft og har forsøkt å slutte med det flere ganger. Hver gang jeg slutter erfarer jeg svært merkelige ting. Jeg blir ekstremt svimmel og får elektriske sjokkliknende fornemmelser i hodet. Jeg er helt sikker på dette er knyttet til bruken av Zoloft. Mindre enn to timer etter at jeg tar det på nytt forsvinner de overveldende symptomer fullstendig. Leger, sykepleiere og farmasøyter avviser meg og sier jeg er sprø, men jeg sverger det er sant." ("I take Zoloft and have tried to stop taking it several times. Each time I stop I experience a very strange thing. I get extremely dizzy and have electrical shock-like sensations in my head. I absolutely know this is associated with not taking Zoloft. Less than two hours after I take it again the overwhelming symptoms completely disappear. Doctors, nurses and pharmacists dismiss me as if I'm a nut case, but I swear this is true.")

Andre lesere beskriver seponeringssymptomer slik som kvalme, diaré, appetittmangel, svetting, feberfrysninger, irritabilitet og søvnløshet. Gradvis nedtrapping kan redusere alvorligheten av disse symptomer. (Other readers describe withdrawal symptoms such as nausea, diarrhea, loss of appetite, sweating, chills, irritability and insomnia. Gradual tapering may reduce the severity of these symptoms.)

Å oppleve en slik vanskelig seponering fra et legemiddel forskrevet etter at man hart mistet jobben eller blitt skilt legger stein til byrden. Ekte depresjon krever riktig behandling, men livsomstendigheter er ikke alltid tjent med legemidler. (...) (Facing such a difficult withdrawal from a drug prescribed for job loss or divorce adds insult to injury. True depression requires appropriate treatment, but life circumstances don't always deserve drugs.)

(Anm: Antidepressiva (REM-søvn). (mintankesmie.no).)

En av fire unødig på antidepressiva
dagensmedisin.no 13.1.2006
13.01.06
- Omkring én av fire pasienter på antidepressiva får medisin på feil indikasjon. Samtidig er det en stor andel deprimerte som underbehandles, mener psykiater Lars Tanum.

- Basert på klinisk erfaring er det anslagsvis 25 prosent av pasientene på antidepressiva som ikke oppfyller kriteriene for medisinsk behandling. (...)

Antidepressant Use for Kids Doubled Before FDA Warnings
medicinenet.com 15.11.2005
-- Even as concerns about teen suicide and antidepressant use surfaced during the last decade, prescriptions for the mood-altering drugs increased dramatically as therapy sessions declined, new research shows. (...)

Lykkepillen – både for lidt og for meget
Lægeforening og samfund
Ugeskrift for læger 1995;157:4150-53
(...) En del deprimerede får ikke antidepressiva, mens halvdelen af de, der får, ikke har egentlig depressionssygdom. Så hvis spørgsmålet er, om der bruges for lidt eller meget antidepressiva i almen praksis er svaret til begge ”ja!”. Så kort uttrykker Rosholm resultaterne af sin undersøgelse. (...)

Effexor

FDA approves Wyeth's Effexor for panic disorder
marketwatch.com 21.11.2005
- The Food and Drug Administration has approved Wyeth's top-selling antidepressant Effexor XR for the treatment of panic disorder.

Effexor had 2004 sales of over $3 billion, according to Wyeth.
The drug was first approved by the FDA in 1993. (...)

Forskrivning av SSRI-er i Norge

Nedgang i salget av legemidler mot depresjoner for første gang
fhi.no 25.1.2006
I 2005 var salget av antidepressiva 51,6 doser per 1000 innbyggere per døgn (DDD/1000 innb./døgn). Dette er en nedgang på 0,7 % i forhold til 2004, mens nedgangen målt i kroner var 20 %, viser ferske tall fra Folkehelseinstituttets grossiststatistikk. (...)

For ytterligere diskusjon om bruken av SSRI henvises artikkel: Forskrivning av selektive serotoninreopptakshemmere 1990 – 2004. Bramness GJ, Hausken AM, Sakshaug S, Skurtveit S,  Rønning M. Tidsskr Nor Lægeforen 2005; 125: 2470-3    (...)

Hvordan serotonin påvirker immunsystemet

Lipidmetabolismen reguleres av immunsystemet
Tidsskr Nor Lægeforen 2007; 127 (31.5.2007)
Hyperlipidemi er ofte forbundet med inflammasjon. Ny forskning på mus har vist at de proinflammatoriske cytokinene lymfotoksin og LIGHT (homolog til lymfotoksin), hovedsakelig produsert i T-lymfocytter, regulerer nøkkelenzymer i lipidmetabolismen (Science 2007; 316: 285 - 8). (...)

How inflammation promotes regeneration pp715 – 717
nature.com
Nature Neuroscience 9, 715 - 717 (2006)
Macrophages near neuronal cell bodies can promote regeneration in an otherwise inhibitory environment. Now Yin et al. identify oncomodulin as a factor secreted from macrophages that promotes extensive regeneration of lesioned optic nerve axons when applied together with elevated cyclic AMP (cAMP) and mannose. (...)

Svensk läkare: Hennes missbruk kan vara orsaken
aftonbladet.se 11.5.2006
1992 Whitney gör succé med filmen ”Bodyguard”.

Whitney Houston omskrivna drogmissbruk kan ha bidragit till hennes hjärntumör.

Det säger Carin Muhr, överläkare vid Akademiska sjukhuset i Uppsala.
– Det kan finnas ett indirekt samband, eftersom ett osunt leverne försämrar immunförsvaret. Det i sig gör att det finns en förhöjd risk att få en hjärntumör, säger hon. (...)

A novel form of immune signaling revealed by transmission of the inflammatory mediator serotonin between dendritic cells and T cells.
Blood. 2006 ;107(3):1010-7 (Feb 1)
Adaptive immunity is triggered at the immune synapse, where peptide-major histocompatibility complexes and costimulatory molecules expressed by dendritic cells (DCs) are physically presented to T cells. Here we describe transmission of the inflammatory monoamine serotonin (5-hydroxytryptamine [5-HT]) between these cells. DCs take up 5-HT from the microenvironment and from activated T cells (that synthesize 5-HT) and this uptake is inhibited by the antidepressant, fluoxetine. Expression of 5-HT transporters (SERTs) is regulated by DC maturation, exposure to microbial stimuli, and physical interactions with T cells. Significantly, 5-HT sequestered by DCs is stored within LAMP-1(+) vesicles and subsequently released via Ca(2+)-dependent exocytosis, which was confirmed by amperometric recordings. In turn, extracellular 5-HT can reduce T-cell levels of cAMP, a modulator of T-cell activation. Thus, through the uptake of 5-HT at sites of inflammation, and from activated T cells, DCs may shuttle 5-HT to naive T cells and thereby modulate T-cell proliferation and differentiation. These data constitute the first direct measurement of triggered exocytosis by DCs and reveal a new and rapid type of signaling that may be optimized by the intimate synaptic environment between DCs and T cells. Moreover, these results highlight an important role for 5-HT signaling in immune function and the potential consequences of commonly used drugs that target 5-HT uptake and release. (...)

Antidepressants may affect immune system
reutershealth.com 27.1.2006
NEW YORK (Reuters Health) - Antidepressants like Prozac and Zoloft, which affect a brain chemical called serotonin, may also influence the body's immune system, new research suggests.

Prozac and Zoloft belong to a group of drugs called selective serotonin reuptake inhibitors or "SSRIs," which are thought to combat depression by causing serotonin to linger longer at nerve junctions. The new findings, which appear in the medical journal Blood, suggest that serotonin also works as a signaling molecule between certain immune cells.

Using various laboratory techniques, Dr. Gerard P. Ahern, from Georgetown University in Washington, DC, and colleagues show that serotonin is passed between two types of immune cells -- dendritic cells and T cells.

The findings indicate that dendritic cells can pick up serotonin at sites of inflammation and then pass it to T cells, which influences their growth and division into new cells. Treatment with the antidepressant Prozac (fluoxetine) blocked this serotonin uptake.

Further research is needed to better understand how SSRIs might affect the immune system, the researchers note. It is possible that these drugs could one day be used to modify immune responses, they add. (...)

- SSRI-er endrer nivået av cytokiner

Extrapyramidal Signs Before and After Diagnosis of Incident Alzheimer Disease in a Prospective Population Study
Arch Neurol. 2009;66(9):1120-1126. (September)
Background Extrapyramidal signs (EPSs) are commonly accepted as a feature of Alzheimer disease (AD) and may influence both the profile of impairment and prognosis. (...)

Inflammation as enemy
latimes.com 17.4.2006
An immune reaction may contribute to diabetes, heart disease and Alzheimer's. Doctors are shifting focus to the common thread.

The idea is as simple as it is radical: Chronic inflammation, spurred by an immune system run amok, appears to play a role in a host of medical evils — including arthritis, Alzheimer's, diabetes and heart disease. (...)

FOR THE RECORD:
Inflammation —An article on chronic inflammation in the April 17 Health section referred to cytokines as inflammatory cells. Cytokines are proteins released by some immune cells. (...)

But when the inflammation process fails to shut off after an infection or injury is over, trouble sets in. Many doctors now think persistent, low-level inflammation may pave the way for the chronic diseases of later life.

Prog Neuropsychopharmacol Biol Psychiatry. 2006 Mar 6; [Epub ahead of print] Related Articles, Links (...)

Cytokines and serotonin transporter in patients with major depression
Prog Neuropsychopharmacol Biol Psychiatry. 2006 (Mar 6)
Altered cytokine secretion as a mechanism in the etiology of depression is still obscure. The serotonin transporter (5-HTT) may play an important role in the termination of serotonergic neurotransmission by serotonin (5-HT) uptaking into presynaptic neurons and representing as an initial action site for selective 5-HTT reuptake inhibitors (SSRI). In our study, we evaluated whether cytokines and 5-HTT acted as biological markers for depression. Blood samples were collected from 42 participants. The differences in cytokine and 5-HTT mRNA expressions of leukocytes were assessed between the patients with major depression (n=20) and the healthy controls (n=22), along with the measurements prior and after treatment with a SSRI, fluoxetine, for 3 months in the follow-up patient group (n=8). The results revealed that the mRNA expressions of IL-1beta, IL-6, IFNgamma, TNFalpha, and 5-HTT were higher in the depressed patients than those of the healthy controls. The higher level of mRNA expressions of IFNgamma and 5-HTT diminished after fluoxetine treatment. Furthermore, we found a positive correlation between 5-HTT and cytokines mRNA expressions in total participants, which suggested that pro-inflammatory cytokines and 5-HTT might play critical roles in the pathogenesis of major depression and that their levels were affected by chronic treatment with 5-HTT inhibitors. (...)

Diabetes øker risikoen for Alzheimer

Diabetes øker risikoen for Alzheimer
vg.no 17.3.2009
(VG Nett) Ny forskning viser en illevarslende forbindelse: Diabetes øker risikoen for Alzheimers sykdom.

Det er velkjent at diabetes kan være skadelig for hjertet, nyrer, øyne og bein, men nå har altså forskere funnet at sykdommen også kan ha konsekvenser for kognitive funskjoner hos eldre.

Leger har lenge hatt mistanke om at diabetes ødelegger blodårene som forsyner hjernen med blod. Nå tyder mye på at det er verre enn som så. Det ser ut som at ødeleggelsen starter før man oppdager at man har diabetes, men når kroppen gradvis mister evnen til å regulere blodsukkeret, skriver nyhetsbyrået Associated Press (AP).

I virkeligheten er skillet diffust mellom det ekspertene kaller vaskulær demens og den klassisk Alzheimers sykdom.

Yaakov Stern, Alzheimer-spesialist ved Colombia University Medical Senter, sier til AP at akkurat nå er det ikke mye man kan gjøre med Alzheimer. Dersom man imidlertid kunne kontrollere de vaskulære tilstandene (de bittesmå blodproppene), kunne man også sinke utviklingen av sykdommen. (...)

- Type 2 diabetes oppstår som et resultat av insulinresistens når kroppen gradvis mister sensitiviteten til dette hormonet som er essensielt for å omdanne blodsukker til energi. En lignende effekt i hjernen kan delvis forklare forbindelsen til demens, konkluderer dr. Suzanne Craft fra Veterans Affairs Puget Sound Health Care System, kriver i en artikkel publisert i Archives of Nevrology. (...)

SSRI-er mer enn fordobler risiko for diabetes

Telomere Dysfunction–Related Serological Markers Are Associated With Type 2 Diabetes
Diabetes Care 2011 (Published online before print August 26)
OBJECTIVE Recent studies have identified a set of serological markers for telomere dysfunction and DNA damage. The relevance of these serological markers in type 2 diabetes remains elusive. We investigated the association of serological markers (EF-1α, stathmin, and N-acetyl-glucosaminidase) with leukocyte telomere length, a functional variant of uncoupling protein-2 (UCP2), and susceptibility of type 2 diabetes. (...)

CONCLUSIONS Serological N-acetyl-glucosaminidase, telomere length, and the UCP2–886G>A variant are independent risk factors for type 2 diabetes. Serological N-acetyl-glucosaminidase correlates with telomere length but not with the UCP2–886G>A variant. (...)

(Anm: Serological; serological-test (britannica.com).)

From Faculty of 1000 Medicine
Long-Term Use of Antidepressants For Depressive Disorders and the Risk of Diabetes Mellitus. Ranked "Changes Clinical Practice" by F1000
medpagetoday.com 1.7.2009
Am J Psychiatry 2009 May 166(5):591-8
Commentary from Leo Sher and Maria Oquendo

Changes Clinical Practice: Patients receiving a moderate to high daily dose of antidepressants for greater than 12 months should be evaluated for impaired glucose tolerance/diabetes.

The authors of this study have shown that the long-term use of antidepressants in at least moderate daily doses was associated with an increased risk of diabetes. This finding indicates that blood glucose levels should be checked periodically in patients on long-term antidepressant therapy. (...)

Long-Term Use of Antidepressants for Depressive Disorders and the Risk of Diabetes Mellitus (Langtidsbruk av antidepressiva mot depresjon og risiko for diabetes mellitus)
Am J Psychiatry 2009; 166:591-598 (May) (American Psychiatric Association)
OBJECTIVE: Use of antidepressants has been reported to cause considerable weight gain. The aim of this study was to assess the risk of diabetes mellitus associated with antidepressant treatment and to examine whether the risk is influenced by treatment duration or daily dose. (...)

The magnitude of the risk was similar for long-term use of moderate to high daily doses of tricyclic antidepressants (incidence rate ratio=1.77, 95% CI=1.21–2.59) and selective serotonin reuptake inhibitors (incidence rate ratio=2.06, 95% CI=1.20–3.52). Treatment for shorter periods or with lower daily doses was not associated with an increased risk.

CONCLUSIONS: Long-term use of antidepressants in at least moderate daily doses was associated with an increased risk of diabetes. This association was observed for both tricyclic antidepressants and selective serotonin reuptake inhibitors. (...)

Diabetics found more prone to mild memory problems (Diabetikere mer tilbøyelige til å få hukommelsesproblemer)
reuters.com 9.4.2007
CHICAGO (Reuters) - Diabetics are at higher risk of getting a type of mild memory impairment that may later develop into Alzheimer's disease, U.S. researchers said on Monday.

Several studies have shown that people with diabetes are at greater risk of developing Alzheimer's disease.

A new study, published in the Archives of Neurology, found diabetes was linked to a significantly higher risk of a memory problem known as mild cognitive impairment. (...)

A prior study by the Mayo Clinic in Rochester, Minnesota, suggested that about 12 percent of people over the age of 70 have mild cognitive impairment. These patients are three to four times more likely to develop Alzheimer's disease. (...)

(Anm: Relation of Diabetes to Mild Cognitive Impairment. Arch Neurol. 2007;64:570-575.

Diabetes Mellitus and Risk of Developing Alzheimer Disease. Arch Neurol. 2006;63:1551-1555.)

Stress kan udløse sukkersyge
netdoktor.com/dk 20.11.2006
Stressede mennesker har næsten lige så stor risiko for at få type 2 diabetes som overvægtige. Det er en endnu ikke offentliggjort undersøgelse fra Karolinska Universitetssjukhuset i Stockholm, der giver de overraskende resultater. (...)

Professoren forklarer, at resultatet skyldes, at stresshormoner mindsker virkningen af kroppens insulin, som har til opgave at sænke mængden af sukker i blodet. (...)

Norge på diabetestoppen
aftenposten.no 3.7.2006
Med bred satsing på forebyggelse, tidlig diagnose og riktig behandling til alle, skal plager og samfunnskostnader som følge av diabetes reduseres. (...)

Health implications for antipsychotic drug
netdoctor.co.uk 3.7.2006
Schizophrenic patients being treated with antipsychotic drugs may be at increased risk from diabetes, heart disease or strokes, US researchers claim.

According to a study published in the American Journal of Psychiatry, patients regularly taking the drug clozapine – an effective antipsychotic medication – are between two and three times more likely to develop so-called 'metabolic syndrome'.

Metabolic syndrome refers to a wide range of conditions including high blood pressure and increased cholesterol levels that precipitate the development of heart conditions and diabetes. (...)

ADA: Antidepressants Raise Diabetes Risk (Antidepressiva øker risiko for diabetes)
medpagetoday.com 11.6.2006
(...) The authors also found, however, that people with elevated depressive symptoms on the Beck Depression Inventory who were not taking antidepressants at study entry had no increased risk for type 2 diabetes, said Dr. Rubin and colleagues. (...)

The investigators found that elevated depression inventory scores, which were present in 10.3% of patients on study entry, did not predict whether patients would develop diabetes during the study, but baseline antidepressant use did.

After controlling for demographic factors, baseline metabolic factors, and weight change, they found that participants on antidepressants who were assigned to the placebo arm of the study had a hazard ratio for developing diabetes of 1.9 (95% confidence interval, 1.2-3.1, P = 0.01). For patients assigned to the intensive lifestyle group, the hazard ratio was 2.8 (95% CI, 1.5-5.4, P=0.002).

In the intensive lifestyle arm only, antidepressant user reported at 50% or more of visits also predicted developing diabetes compared to no exposure (hazard ratio 2.6, 95% CI, 1.5-4.5, P< 0.001), although less frequent exposure did not.

The study was not sufficiently powered to detect which antidepressant agents might be associated with the greatest risk for type 2 diabetes, and it's not certain how the drugs might elevate risk for type 2 diabetes, but it does not appear to be through either weight gain or effects on fasting plasma glucose or insulin levels, Dr. Rubin said. (...)

Medscape Conference Coverage, based on selected sessions at the:
American Diabetes Association 66th Scientific Sessions
June 9 - 13, 2006, Washington, DC (...)

Hypoglycemia: Mechanism Risks, and Effects
medscape.com 2006
(...) Can Selective Serotonin Reuptake Inhibitors Reduce Hypoglycemia?
N.M Sanders and colleagues,[6] noting that hindbrain glucosensing neurons are serotonergic and that the acute effect of selective serotonin reuptake inhibitors (SSRIs) is to enhance serotonin neurotransmission, studied rats given a 6-day sertraline infusion vs a vehicle infusion, and showed that administration of the active increased the epinephrine response to 1 hypoglycemic episode. The sertraline-treated animals had 2- to 3-fold higher epinephrine levels compared with controls after a third episode of hypoglycemia during a 24-hour period, suggesting to the study authors that "diabetic patients maintaining tight glycemic control while on SSRI therapy may be more protected from developing inadvertent hypoglycemia." Vanessa J. Briscoe, PhD, APRN, CDE, and colleagues[7] presented a clinical study in which 12 nondiabetic persons underwent controlled hypoglycemia before and after 6 weeks of fluoxetine treatment. Study subjects showed a 51% increase in epinephrine, a 23% increase in norepinephrine, a 59% increase in cortisol, a 6-fold lower requirement for exogenous glucose, and a 32% increase in endogenous glucose production during hypoglycemia with fluoxetine administration, suggesting that SSRI treatment may increase adrenal autonomic responses to hypoglycemia. (...)

Antidepressants linked to increased risk of diabetes in high-risk patients
reutershealth.com 12.6.2006
WASHINGTON, DC (Reuters Health) - Study findings show a link between antidepressant use and diabetes, investigators here at the 66th Scientific Sessions of the American Diabetes Association announced. This is the first report of such an association, they say.

Depression is two to three times higher in diabetics than in the general population. In addition, 10%-15% of the US population takes antidepressants, "and the numbers are increasing," Dr. Richard R. Rubin of The Johns Hopkins University School of Medicine in Baltimore, Maryland, told meeting attendees Saturday.

Dr. Rubin is a co-investigator with the Diabetes Prevention Program Research Group. He presented findings from the 3187 participants in the trial with elevated blood glucose values showing that they were pre-diabetic. Of these, 5.7% reported regular use of antidepressants at baseline. Elevated scores on the Beck Depression Inventory were found in 10.3%.

Patients were randomized into three study arms: metformin therapy, intended to prevent the onset of diabetes; intensive lifestyle modification; or placebo. Mean length of follow-up was 3.2 years.

High scores on the Beck Depression Inventory by themselves did not predict the development of diabetes. However, after controlling for weight and baseline metabolic and demographic factors, the investigators found that antidepressant use did, with a hazard ratio of 1.9 in the placebo group and 2.8 in those in the intensive lifestyle modification arm. There was no increased risk of diabetes associated with depression in the metformin arm.

"We don't have a clue" as to why the association exists, Dr. Rubin told Reuters Health. In their abstract the investigators say the mechanism "does not appear to be increased weight or fasting plasma glucose or insulin levels."

Metformin acts primarily in the liver, and may change the body's response to antidepressants. "Or, the drug could be a marker for something else," Dr. Rubin suggested.

If the findings are confirmed in further studies, "it would have enormous public health implications," he commented. "In the meantime, patients should not stop taking their antidepressants. They have been proven to have tremendous relief, but those at risk of diabetes should have their blood sugar monitored frequently and perhaps - perhaps - begin oral anti-diabetic treatment early."

Dr. Rubin emphasized that patients in this study were all at very high-risk for developing diabetes. (...)

Concern Grows Over Increase in Diabetes Around World
nytimes.com 11.6.2006
WASHINGTON, June 10 — The number of people around the world suffering from diabetes has skyrocketed in the last two decades, from 30 million to 230 million, claiming millions of lives and severely taxing the ability of health care systemsto deal with the epidemic, according to data released Saturday by the International Diabetes Federation. (...)

Antidepressants may boost diabetes risk (Antidepressiva kan øke risiko for diabetes)
cnn.com 10.12.2006
Studieresultater viser at de som er predisponert for sykdommen er to til tre ganger mer sannsynlig å få den uavhengig av hvilken type antidepressiva som brukes. (...) (Study finds those predisposed to the disease were two to three times more likely to get it when using any form of antidepressant.)

WASHINGTON (CNNMoney.com) - The use of antidepressants appears to increase the onset of diabetes in some high-risk individuals, according to a government-funded study announced Saturday.

Overweight people with high blood-sugar levels and other "pre-diabetic" factors, but who were not taking the anti-diabetic treatment metformin, were two to three times as likely to become diabetic if they were taking antidepressants, according to investigator Dr. Richard Rubin of Johns Hopkins University.

Rubin said the study used all types of antidepressants and did not single out any specific drugs or drugmakers.

"All antidepressants seem to have the same effect," said Rubin, who said that people should not stop taking their antidepressants until researchers could learn more. "We have to find out what was actually going on. We don't want people to go off their medication; we want people to stay on their medication."
Rubin also said the results were not the focus of the test and emerged by accident among the placebo patients who were not taking metformin, but who were taking antidepressants. The diabetes was type 2, which is the most common.

"We didn't set out to study this in particular; this is just what we found," said Rubin, who made the announcement at the American Diabetes Association's annual conference.

Of the 3,187 participants in the test, 5.7 percent were taking antidepressants at the beginning of the trials and 13.6 percent were taking them at the end, said Rubin. The test, which continued for more than three years, is part of $200 million study funded by primarily by the National Institutes of Health. Wyeth (Research)'s Effexor XR is the leader of the antidepressant industry, with $3.5 billion in 2005 sales. Pfizer (Research)'s Zoloft is no. 2, with $3.3 billion in 2005 sales, but it's losing patent protection in late June, which is expected to trigger a huge plunge in price and revenue. GlaxoSmithKline's antidepressants Wellbutrin, with $1.4 billion in 2005 sales, and Paxil, with $1.1 billion, also are also pressured by generic competition.

Other antidepressants, with sales from last year, include Forest Laboratories (Research)' Lexapro, at $1.9 billion, andEli Lilly & Co. (Research)'s Cymbalta, at $680 million. (...)

Seroxatindusert åndedrettsnød (respiratory distress) og hypoglykemi (hypoglycemia) hos nyfødte

Perinatal outcome following third trimester exposure to paroxetine (Perinatalt resultat etter inntak av paroxetine i tredje trimester)
Arch Pediatr Adolesc Med 2002;156:1129-32
BAKGRUNN: Paroxetine hydrochloride vanlig brukt mot maternal depresjon, panikklidelser, og tvangslidelser (OCD). Legemidlet går lett over i den menneskelige morkake. Selv om det ikke synes å øke teratogenisk risiko, er der rapportert tilfeller av abstinens hos nyfødte. Symptomer er beskrevet tidlig etter fødsel og varte opp til en måned. (BACKGROUND: Paroxetine hydrochloride is commonly used for maternal depression, panic disorder, and obsessive-compulsive disorder. The drug readily crosses the human placenta. Although it does not appear to increase teratogenic risk, there have been case reports of neonatal withdrawal. Symptoms were described soon after birth and lasted up to 1 month.)

MÅL: Å undersøke hvorvidt der er et klinisk viktig seponeringssyndrom hos nyfødte utsatt for paroxetine i livmor. (OBJECTIVE: To investigate whether there is a clinically important discontinuation syndrome in neonates exposed to paroxetine in utero.)

FRAMGANGSMÅTE: Prospektiv, kontrollert kohort studie. (METHODS: Prospective, controlled cohort study.)

PASIENTER: Femtifem gravide kvinner prospektivt veiledet av Motherisk program i Toronto, Ontario, angående inntak av paroxetine i tredjetrimester og deres spedbarn ble inkludert i studiegruppen. Gravide kvinner som avsluttet paroxetine før tredje trimester eller de som fikk andre legemidler kjent for å forårsake typiske abstinenssymptomer, slik som opioider eller benzodiazepiner, ble ekskludert. En sammenligningsgruppe på 27 kvinner, som brukte paroxetine under det første eller andre trimester, og 27 kvinner som brukte ikke-teratogene legemidler ble matchet for maternal alder, alvorlighet, likhet, sosial legemiddelbruk, og ikke-teratogenisk legemiddelbruk. (PATIENTS: Fifty-five pregnant women counseled prospectively by the Motherisk program in Toronto, Ontario, regarding third-trimester exposure to paroxetine and their infants were included in the study group. Pregnant women who discontinued paroxetine before the third trimester or those receiving other drugs known to cause withdrawal-type symptoms, such as opioids or benzodiazepines, were excluded. A comparison group of 27 women using paroxetine during the first or second trimester and 27 women using nonteratogenic drugs were matched for maternal age, gravity, parity, social drug use, and nonteratogenic drug use.)

RESULTATER: Av de 55 nyfødte utsatt for paroxetine sent i svangerskapsperioden, hadde 12 komplikasjoner som krevde intensivbehandling og forlenget innleggelse. Det mest alminnelige kliniske bildet var åndedrettsnød (n = 9), fulgt av hypoglykemi (n = 2), og gulsott (n = 1). Symptomene forsvant innen 1 til 2 uker. I sammenligningsgruppen, erfarte bare 3 spedbarn komplikasjoner (P =.03). I logistisk regresjon, ble bare inntak av paroxetine i tredje trimester forbundet med nyfødtlidelser (odds ratio, 9,53; 95 % konfidensintervall, 1,14-79,3). (...) (RESULTS: Of the 55 neonates exposed to paroxetine in late gestation, 12 had complications necessitating intensive treatment and prolonged hospitalization. The most prevalent clinical picture was respiratory distress (n = 9), followed by hypoglycemia (n = 2), and jaundice (n = 1). The symptoms disappeared within 1 to 2 weeks. In the comparison group, only 3 infants experienced complications (P =.03). In logistic regression, only third-trimester exposure to paroxetine was associated with neonatal distress (odds ratio, 9.53; 95% confidence interval, 1.14-79.3).

KONKLUSJON: Når paroxetine er brukt nær termin, er det forbundet med en høy rate av nyfødtkomplikasjoner, mulig forårsaket av dets vanlige seponeringssyndrom. (...) (CONCLUSION: When used near term, paroxetine is associated with a high rate of neonatal complications, possibly caused by its common discontinuation syndrome.)

(Anm: hypoglycemia; hypoglykemi; for lågt blodsukker, lågare glukoseinnhald i blodet enn normalt, gir skjelving, kaldsveitte, svoltkjensle, minka kroppsvarme, forvildring, hovudverk, sanseviller (hallusinasjonar), rar oppførsel, stundom uvett (koma) og krampar; årsaka er oftast for store insulindosar, i visse tilfelle insulinom, binyresvikt, store arbeidspåkjenningar, bruk av perorale antidiabetika, alkohol, disopyramid, trimetoprim e a; sjå også Zollinger-Ellison-syndromet, øy-celletumor, leucin-indusert hypoglykemi, ketotisk hypoglykemi, neonatal hypoglykemi. EN hypoglycemia. ET [gr hypo under + glykys søt + haima blod] . Kilde: Norsk medisinsk ordbok.)

Kramper (convulsions) og hjernehinnebløding (subarachnoid haemorrhage) etter inntak av SSRI (lykkepiller)

Neonatal convulsions and subarachnoid hemorrhage after in utero exposure to paroxetine. (Kramper og subaraknoidalbløding (hjernehinnebløding) hos nyfødte etter bruk av Seroxat under svangerskapet)
Rev Neurol 2003;36:724-6
CASE REPORT. One newborn whose mother had been treated with paroxetine 20 mg/day during pregnancy, presented convulsions and subarachnoid haemorrhage in the first six hours of life. The newborn did not present symptoms of hypoxic ischaemic encephalopathy, withdrawal syndrome, infection, metabolic alterations, cerebral malformations or coagulopaties. DISCUSSION. The most probable etiology is that the paroxetine could decrease the seizure threshold, taking place the first seizure during delivery. The difficult fetal extraction would have provoked the subarachnoid haemorrhage in a patient with an impaired haemostatic function due to a depletion of platelet serotonin and may also contribute the increased vascular fragility due to paroxetine and reported in adults or in animals. CONCLUSION. Neonatal convulsions and subarachnoid haemorrhage may occur after paroxetine treatment in the third trimester of pregnancy. An accurate follow up of these newborns in the firsts days of life is strongly recommended.” (...)

(Anm: subaraknoidalbløding; hemorrhagia subarachnoidalis; hjernehinnebløding, d e bløding mellom araknoidea og pia, oftast frå ei rivna utposing eller utviding (divertikkel, aneurisme) på ei av hjernepulsårene; slike alvorlege blødingar kan koma hos unge eller eldre, ter seg gjerne med sterk brå hovudverk, stiv nakke som ter seg etter om lag 6 timar, kvalme/oppkast, uklar sinnstilstand og andre teikn på hjerneskade etter kor stor blødinga er; ekstra hjerneskade kan koma etter 4–12 dagar pga sviktande blodforsyning til hjernevev; kan utløysast av tunge tak, samleie e a; i spinalvæska er det blod og væska er gul etter sentrifugering; jf berry aneurysm, aneurysma intracraniale; EN subarachnoid hemorrhage; BM subaraknoidalblødning. Kilde: Norsk medisinsk ordbok.)

Hjerneslag og immunsystem

Antidepressants May Raise Women's Stroke Risk (Antidepressiva kan øke kvinners risiko for hjerneslag)
minorityhealth.hhs.gov 14.12.2009
(…) It found that women on selective serotonin uptake inhibitors (SSRIs, which include Celexa, Paxil, Prozac and Zoloft) had a 45 percent increase in risk for stroke and a 32 percent increase in risk for death from any cause, compared to non-users. Similar results were found for women on tricyclic antidepressants. (…)

Antidepressant Use and Risk of Incident Cardiovascular Morbidity and Mortality Among Postmenopausal Women in the Women's Health Initiative Study
Arch Intern Med. 2009;169(22):2128-2139 (Dec 14/28)
(...) Background Antidepressants are commonly prescribed medications, but their effect on cardiovascular morbidity and mortality remains unclear. (...)

Conclusions In postmenopausal women, there were no significant differences between SSRI and TCA use in risk of CHD, stroke, or mortality. Antidepressants were not associated with risk of CHD. Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality, and SSRIs with increased risk of hemorrhagic and fatal stroke, although absolute event risks are low. These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression. (...)

Immune cells cause more post-stroke brain damage: study (Immunceller forårsaker ytterligere hjerneskade etter slag, ifølge studie)
reuters.com 2.8.2009
HONG KONG (Reuters) - Scientists have identified a class of immune cells that floods the brain soon after a stroke, causing inflammation and more neurological damage.

In an experiment, Japanese researchers showed how mice that were deficient in these immune cells suffered far less brain damage after a stroke compared to normal mice.

The lead author of the study, Akihiko Yoshimura at Keio University's School of Medicine in Tokyo, explained that while the initial damage from a stroke cannot be prevented, drugs can be used to limit secondary damage caused by immune cells that rush to the site of the infarction, or stroke.

"The first damage happens immediately after a stroke, we can't block this because it is very rapid," Yoshimura said. (...)

Stroke May Trigger Memory Trouble
healthfinder.gov 10.4.2006
Decline can happen in the absence of other cognitive problems, such as dementia, researchers note

-- Stroke may harm memory without necessarily causing dementia or other cognitive impairment, researchers report.

Columbia University researchers in New York performed an initial assessment of nearly 1,300 people, averaging just over 76 years of age, with no cognitive impairment or dementia. The evaluations were done between January 1992 and December 1994, and the study volunteers were then re-examined at 18-month intervals until November 1999. (...)

Nya forskningsrön kan hjälpa strokepatienter
gp.se 23.2.2006
Uppdaterad: 2006-02-23 22:42
Samma immunsystem som bidrar till skada efter en stroke hjälper också till att reparera skadan. Upptäckten av denna dubbla roll kan på sikt leda till nya sätt att behandla stroke.

Den del av immunförsvaret det handlar om kallas för komplementsystemet. Det består av ett 20-tal proteiner som snabbt aktiveras när kroppen utsätts för fara i form av bakterier, virus eller skada. Komplementsystemet utgör ett slags förtrupper till de mer specificerade cellerna i immunförsvaret.

Nu har forskare vid Sahlgrenska Akademin studerat hur dessa proteiner beter sig på möss som får stroke. Fram tills nu har man ansett att komplementsystemet bidragit till de vävnadsskador man ser efter en stroke, främst genom den inflammation som uppstår. Men nu har docent Marcela Pekna, professor Milos Pekny och deras medarbetare upptäckt att proteinerna är viktiga aktörer också när det gäller att reparera skadorna.

Forskarna upptäckte till sin förvåning att både nervstamceller och omogna nervceller hade mottagare, receptorer, för komplementproteiner på sina ytor. Det visade sig att komplementsystemet spelar en aktiv roll i reparationsarbetet genom att reglera utmognaden av nya nervceller. En hittills helt okänd roll för vårt äldsta immunförsvarssystem.

- När vi tog bort signaleringen genom receptorerna minskade också nybildningen av de reparerande cellerna, säger Marcela Pekna. Det skedde i såväl den normala som i den strokedrabbade hjärnan.

Nu hoppas man kunna använda denna nya kunskap för att så småningom kunna stimulera tillväxt av nya nervceller efter stroke. Men först återstår det mödosamma arbetet att identifiera vilka mekanismer som ligger bakom den här positiva effekten. Det håller man som bäst på med.

- Hittar vi detta finns det goda möjligheter att både utveckla effektiva metoder att begränsa de negativa följderna av immunsvaret och stimulera de mekanismer som skyddar och reparerar nervcellerna, säger Marcela Pekna.

I ett större perspektiv syftar den här typen av forskning till att klarlägga vilka strategier man kan utnyttja för att ersätta skadade eller sjuka nervceller efter sjukdomar som Alzheimer, multipel skleros och stroke eller efter olyckor där nervsystemet skadats.

Senare i år hoppas man komma igång med en undersökning av strokepatienter i Göteborg. Studien presenteras i den ansedda medicintidskriften EMBO Journal, som ges ut av Nature. (...)

Nytt håp i Alzheimer-gåten?
mozon.no 2.2.2007
Dårlig motorikk kan være et tegn på svekket hukommelse hos eldre. Videre forskning kan vise om det har sammenheng med Alzheimers sykdom. (...)

Bilder av hjerne linker hjernslag til hjerteskader

Brain Images Link Strokes to Heart Damage
medpagetoday.com 25.4.2006
- Ischemic strokes in two specific area of the brain appear to send shockwaves through the sympathetic nervous system to cause myocardial injury.

Magnetic resonance imaging studies of patients who had new evidence of myocardial damage following an ischemic stroke indicated that infarctions occurring in the right insula and right inferior parietal lobule regions of the brain might be to blame, researchers here reported in an early online release in Neurology.

"The link between the brain and the heart in stroke patients is fascinating," said A. Gregory Sorensen, M.D., of Massachusetts General Hospital. "For instance, most patients with acute stroke have elevated blood pressure that returns to baseline over three to seven days. The connection is believed to be through the autonomic nervous system, but what the mechanism is has been unclear. (...)

Misdannede blodårer

ASA: Blame Hemorrhagic Stroke in Young Adults on Malformed Vessels or Drug Abuse (ASA: Skyld hemoragisk hjerneslag hos unge voksne på misdannede blodårer eller på substansmisbruk)
medpagetoday.com 21.2.2006
Forklar pasienter som spør at publiserte studier indikerer at for høyt blodtrykk er den mest vanlige årsak til intracerebrale blødninger, men for unge voksne kan det være aneurismer (utposninger), arteriovenøse misdannelser, eller andre vaskulopatier (sykdom eller feil i årene, oftest brukt om uklare tilstander), eller substansmisbruk. (...) (Explain to patients who ask that published studies indicate that hypertension is the most common cause of intracerebral hemorrhage, but for young adults it may be aneurysms, arteriovenous malformations, or other vasculopathies, or drug abuse.)

(Anm: Primary source: American Stroke Association International Stroke Conference. Source reference: Hoffmann, M et al. "Intracranial Hemorrhage in Young People Is Mostly Due to Vascular Abnormality or Drug Abuse and Mortality Rate Is Low" p395.)

Muskler og ledd

Research Brings New Insight Into Joint Health
healthfinder.gov 29.3.2006
Two compounds act as lubricants that help prevent arthritis

-- Realistic models of human joints are helping researchers learn more about how the body's natural joint lubricant prevents wear and tear that can lead to osteoarthritis.

The team, from Duke University's Pratt School of Engineering in Durham, N.C., found that a component of joint fluid called lubricin does more than simply reduce friction -- it forms a thin barrier that repels joint surfaces in order to prevent them from coming into contact with one another.

Lubricin, in combination with another joint fluid component called hyaluronic acid (HA), provides an even greater protective effect for joints than either of the two components on their own, the scientists also found.

"In the healthy joint, the intact superficial surface layer of cartilage provides an extremely efficient bearing surface with an apparently very low coefficient of friction," researcher Stefan Zauscher, assistant professor of mechanical engineering and materials science, said in a prepared statement.

"Any damage to this superficial zone or absence of lubricating factors may be the cause of a cascade of mechanical failures in joints that ultimately leads to the onset of osteoarthritis," he said.

The findings were expected to be presented Wednesday at a meeting of the American Chemical Society in Atlanta.

More information
The Arthritis Foundation has more about osteoarthritis.
(SOURCE: Duke University, news release, March 29, 2006) (...)

Prolaktin

Sex med partner er best
mozon.no 26.2.2006
Å ha sex med en partner er 400 ganger mer tilfredsstillende enn å onanere. Og gutta må ofte hvile etter økten, viser ny forskning.

Det er hormonet prolaktin som kan være nøkkelen til hvorfor det er slik.

Sex er som andre ting i livet, det er morsommere å gjøre det sammen med andre enn alene.

Hormonet er nok ikke den eneste forklaringen, men forskjellen viser seg blant annet i produksjonen av prolaktin.

Samleie tilfredsstiller
Prolaktin virker blant annet ved å motvirke effekten av dopamin, et lystbetont signalstoff som det produseres mer av under seksuell tenning, skriver New Scientist. Kroppen produserer mer av dette hormonet etter en orgasme.

Forskere har gjennomgått data fra tre studier studier hvor prolaktinnivået ble målt hos menn og kvinner som enten onanerte eller hadde samleie i laboratoriet - inntil de fikk orgasme.

For begge kjønn var økningen av prolaktinnivået hele 400 prosent høyere etter orgasmen fra samleiet enn etter den selvpåførte orgasmen.

Resultatene kan dermed indikere at samleiet er mer tilfredsstillende enn onani fra et fysiologisk standpunkt.

En hvil
Det finnes mange andre studier som viser at sex med en partner har fysiologiske og psykologiske fordeler som ikke kan sammenlignes med noen annen seksuell aktivitet.

Siden høye nivåer av prolaktin også har vært knyttet til ereksjonsproblemer hos menn, kan det også være med på å forklare hvorfor menn trenger litt tid til å komme seg etter at de har hatt en orgasme. (...)

Antidepressiva, allergi, hukommelsestap, parkinsons...

ICAD: PTSD Increases Risk of Dementia in Vets (ICAD: Int. Conference on Alzheimer's Disease and Related Disorders Meeting)
medpagetoday.com 13.7.2009
VIENNA, July 13 -- Veterans with a history of post-traumatic stress disorder (PTSD) were twice as likely as other vets to be diagnosed with dementia later on, scientists reported at the International Conference on Alzheimer's Disease. (...)

Primary source: Alzheimer's Association 2009 International Conference on Alzheimer's Disease. Source reference: Yaffe K, et al "Post-traumatic stress disorder and risk of dementia among U.S. veterans" ICAD 2009; Daily Program, July 13, p. 5. (...)

Depression may indicate early Parkinson's disease
reuters.com 3.6.2009
NEW YORK (Reuters Health) - Results of a new study provide more evidence that depressive symptoms are an early feature of Parkinson's disease, preceding the characteristic movement problems seen Parkinson's such as tremor and rigid muscles.

In the study, researchers found that starting antidepressant therapy was associated with a twofold increased risk of developing Parkinson's disease in the next 2 years. (...)

Allergy linked with Parkinson's
netdoctor.co.uk 8.8.2006
A common allergic reaction to dust and pet hair that causes symptoms similar to a "permanent cold" has been linked with Parkinson's disease in new research.

In a study conducted by the Mayo Clinic in the US, suffering from the allergy (rhinitis) was found to be associated with a three-fold increase in the risk of developing Parkinson's.

Researchers studied nearly 200 Parkinson's sufferers, finding that rhinitis, a condition where the sinuses swell up as a result of an over-sensitive immune response, was unusually common. (...)

Antikolinergika kan ge förvirring hos äldre
Läkemedelsvärlden 2006(1-2) (Mars)
Demensliknande symtom hos äldre personer som använder antikolinergika kan vara en biverkan av läkemedlet. Det visar en ny studie som publiceras i dagens British Medical Journal.

BIVERKNINGAR Antikolinerga läkemedel används av många äldre för att behandla irriterad tarm, inkontinens och Parkinsons sjukdom. Det är viktigt att läkare är medvetna om att läkemedlen kan orsaka mild kognitiv störning hos äldre personer så att de inte felaktigt får diagnosen demens.

Det menar forskare i Montpellier, Frankrike som gjort en studie på 372 personer över 60 år utan demens och intervjuat dem om läkemedelsanvändning och sjukdomshistoria.

Tio procent av personerna i studien hade använt antikolinerga läkemedel under en längre tid. Dessa hade i större utsträckning kognitiva störningar jämfört med de som inte använt antikolinergika och 80 procent uppfyllde kriterierna för mild kognitiv störning. Motsvarande siffra för de som inte använde läkemedlen var 35 procent. De som visade förvirringssymtom hade dock inte någon förhöjd risk för att verkligen drabbas av demens.

Forskarna menar att kognitiva störningar hos många äldre kan bero på att personerna använder antikolinergika. Om orsaken inte upptäcks och personerna istället får diagnosen demens kan de hamna i den bisarra situationen att få ett recept på läkemedel som stimulerar kolinerga receptorer för att motverka effekten av ett antikolinergt läkemedel. (...)

Common drugs could cause memory loss in elderly
netdoctor.co.uk 1.2.2006
Drugs used to treat Parkinson's disease, irritable bowel syndrome (IBS) and depression can have side effects which doctors may mistake for dementia, a study has suggested.

British Medical Journal (BMJ) researchers said doctors should be aware that the drugs, known as anticholinergics, can cause memory loss and disorientation. (...)

- «Lykkepillen» mest effektiv når den er fetende

«Lykkepillen» mest effektiv når den er fetende
bt.no 21.2.2006
Medisiner mot depresjon og psykoser kan gi fedme. Jo mer effektive medisinene er, jo større ser vektøkningen ut til å være. (...)

Fetende lykkepiller
mozon.no 23.2.2006
Lykkepillen og andre medisiner mot depresjon kan være fetende. Jo mer effektive medisinene er, desto større ser vektøkningen ut til å være. (...)

Høyere vekt av god medisin
For å finne hvilke gener som fører til økt vekt, isolerte forskerne lever og hjerneceller som var blitt behandlet med antipsykotika og antidepressiva. Det viste seg at et tjuetalls gener ble kraftig aktivert, og alle tilhørte fettsyntesen. Den største vektøkningen kom fra de mest effektive medikamentene.

Steen understreker at det ikke er forsket tilstrekkelig på dette, og skal nå undersøke om mekanismen som fører til overvekt har sammenheng med de mekanismene som gjør at medisinen fungerer. (...)

Aksonskade av serotonerge nevroner

Langtidseffekter av ecstasy
Tidsskr Nor Lægeforen 2006; 126: 596-8
Brukere av ecstasy - 3,4 -metylendioksymetamfetamin - har økt forekomst av psykisk sykdom og kognitiv svekkelse. En sikker årsakssammenheng er ikke dokumentert, men ecstasy er vist å føre til aksonskade av serotonerge nevroner. Dette viser en gjennomgang av publiserte studier. (...)

Mulige fysiske og pyskiske bivirkninger fra crystal meth og andre legale og illegale substanser

Dödsdrogens sanna ansikte
expressen.se 3.3.2006
Drogen crystal meth är starkt beroendeframkallande. Effekterna är mycket starkare än dem man får från kokain och amfetamin. Drogen ger kraftiga bilverkningar. Tänderna fräts ofta ner och missbrukarna kan inbilla sig saker, som att det kryper insekter under huden.

BILDSPECIAL: Så bröt drogen ner deras liv

Crystal meth är en starkt beroendeframkallande metaamfetamin. Effekterna är mycket starkare än dem man får från amfetamin och kokain och det gör den farligt populär.

För följderna blir ofta katastrofala. Det är detta polisen vill varna för genom att visa upp dessa bilder.

De sju personerna här intill kommer alla från Multnomah County i Oregon, USA, och har alla rökt, injicerat eller snortat crystal meth. En del har missbrukat i flera år, andra bara under några månader.

Drogen ger kraftiga både fysiska och psykiska bieffekter.

Tänderna fräts ner
Tänderna fräts ofta ner och drogmissbrukarna kan exempelvis börja inbilla sig att det kryper insekter under huden. Många drabbas också av förföljelsemani och våldsamt självdestruktivt beteende.

- Efter en smekmånadsperiod så tar drogen över hjärnans minne och lustzoner, säger missbruksexperten John Marsden.

Och resultatet? Det ser ni här intill. (...)

Markedsføring

Stor vækst i Kinas sundhedsindustri
berlingske.dk 12.2.2006
I takt med den voksende velstand på den kinesiske østkyst stiger forbruget af avanceret hospitalsudstyr og vestlig medicin til bekæmpelse af livsstilssygdomme. Det åbner store muligheder for danske virksomheder.

SHANGHAI: I takt med den voksende velstand på den kinesiske østkyst er livsstilssygdomme som diabetes, fedme og forhøjet blodtryk for alvor ved at få tag i Kina, og det åbner store muligheder for danske og andre udenlandske virksomheder i medico-industrien.

Ifølge en ny rapport fra det danske generalkonsulat i Shanghai vil Kina om seks-otte år blive det næststørste marked for hospitalsudstyr og instrumenter. Medicinmarkedet er allerede det næststørste i Asien efter Japan. (...)

Det store vækstpotentiale fik bl.a. medicinalproducenten Lundbeck til for et halvt år siden at etablere en ny salgs- og marketingsorganisation i Kina efter i mange år blot at have haft et lille repræsentationskontor i landet.

Lundbecks administrerende direktør i Kina, Michael Ryde, arbejder i øjeblikket på at få registreret virksomhedens første produkt i Kina. Det har vist sig at tage sin tid, fordi myndighederne kræver, at udenlandske medicinalvirksomheder laver specielle kliniske studier på den kinesiske befolkning, før produktet kan frigives til salg. Det kommer i alt til at tage to år.

»Det er sådan set ikke vanskeligere end andre steder. Det tager bare længere tid. Vi ser på længere sigt et kæmpe potentiale inden for behandling af psykiatriske og neurologiske sygdomme som f.eks. Alzheimers, depression, og skizofreni, som jo er Lundbecks speciale. Disse sygdomme bliver i dag ikke behandlet tilstrækkeligt i Kina,« siger han. (...)

NEJM: Good News and Bad News

Treatment Strategies after SSRI Failure — Good News and Bad News
Editorial
New England Journal of Medicine (NEJM) 2006;354:1305-1307 (March 23) (...)

Mixed News On Depression Drugs
cbsnews.com 23.3.2006
(CBS/AP) The largest study ever done on treating depression has found that patients who didn't get well with the first medicine they tried had a good chance of succeeding the second time around.

Up to one-third of those who added or changed medicines recovered from the crushing illness that is America's top mental health problem, researchers said.

(...) However, while the study showed that patients who do not respond well to one drug could be helped by another, the Washington Post reports that the results are also "discouraging for several reasons," David Rubinow, a professor and the chairman of the psychiatry department at the University of North Carolina at Chapel Hill said in an editorial published in the New England Journal of Medicine, which also published the study.

As the Washington Post reports, the findings trouble some doctors because it shows large numbers of patients continued to have problems, Rubinow said. Additionally, he noted that the drugs used in the study — Celexa, Wellbutrin, Zoloft and Effexor — work in very different ways yet had roughly equal effectiveness when it came to treating depression. This suggests that the underlying brain mechanisms of depression are far more complicated than simple notions of a single chemical imbalance, the Post reports. (...)

Nearly two dozen antidepressants are on the market; 189 million prescriptions were filled last year alone. Evidence on their effectiveness is limited, and the government recently ordered stronger warnings that some can worsen suicidal tendencies in teenagers in rare cases. The risk in adults is still being studied. (...)

- Highly worrying that the control of the emotions and behaviour of these million of people can be quickly modified by the assumption of one pill of SSRI for a few days or by its discontinuation...

Selective serotonine reuptake inhibitors prevents emotional lability in healthy subjects
Eur Rev Med Pharmacol Sci. 2005;9(6):343-8
BACKGROUND: Many subjects with depression and with brain lesions can poorly control their emotions with fits of weeping and tearfulness; neurological patients present outbursts of laughter as well. This condition is called Emotional Lability (EL). The antidepressant drugs of the family of selective serotonine reuptake inhibitors (SSRI) improve EL within a few days in both depressive and neurological disorders. EL can be present in healthy subjects as well, in whom it is considered as normal, although often embarrassing. METHODS: Two healthy subjects with EL, were treated with 20 mgs of Paroxetine or placebo for cycles of 5 days. Moreover the effect was observed of either Paroxetine or Fluoxetine on the emotion control of three patients with mood disorders both when they were depressed and after recovering from the depression. RESULTS: In all subjects, after few days of treatment, EL disappeared, and their emotion control and behaviour were both modified. CONCLUSIONS: (1) In healthy subjects EL is often embarrassing; the possibility is interesting of preventing it on selected occasions with a brief treatment with no side effects and a cheap cost. (2) SSRI are among the most used drugs in the word and every day they are assumed by millions of people including politicians, business man, soldiers, army commanders, policemen and criminals. The idea is very stimulating and highly worrying that the control of the emotions and behaviour of these million of people can be quickly modified by the assumption of one pill of SSRI for a few days or by its discontinuation. (...) (BACKGROUND: Many subjects with depression and with brain lesions can poorly control their emotions with fits of weeping and tearfulness; neurological patients present outbursts of laughter as well. This condition is called Emotional Lability (EL). The antidepressant drugs of the family of selective serotonine reuptake inhibitors (SSRI) improve EL within a few days in both depressive and neurological disorders. EL can be present in healthy subjects as well, in whom it is considered as normal, although often embarrassing. METHODS: Two healthy subjects with EL, were treated with 20 mgs of Paroxetine or placebo for cycles of 5 days. Moreover the effect was observed of either Paroxetine or Fluoxetine on the emotion control of three patients with mood disorders both when they were depressed and after recovering from the depression. RESULTS: In all subjects, after few days of treatment, EL disappeared, and their emotion control and behaviour were both modified. CONCLUSIONS: (1) In healthy subjects EL is often embarrassing; the possibility is interesting of preventing it on selected occasions with a brief treatment with no side effects and a cheap cost. (2) SSRI are among the most used drugs in the word and every day they are assumed by millions of people including politicians, business man, soldiers, army commanders, policemen and criminals. The idea is very stimulating and highly worrying that the control of the emotions and behaviour of these million of people can be quickly modified by the assumption of one pill of SSRI for a few days or by its discontinuation.

- Bør vi screene depresjon?

Should we screen for depression?
BMJ 2006;332:1027-1030 (29 April)
Analysis and comment (...)

- The next battle

Sepracor turns attention to antidepressants
boston.com 8.7.2006
Firm looks to profit as market shifts from Prozac-like drugs

Sepracor Inc., a relatively small drug maker whose sleeping pill, Lunesta, has become one of the most recognizable brands on the market, plans to build on the drug's success to establish a portfolio of drugs directed at the central nervous system.

The company, which makes asthma drug Xopenex and is awaiting US approval for a drug to treat smoker's cough, sees its next big opportunity in the antidepressant market.

The Marlborough company, which has become the focus of intermittent takeover speculation, has two products in early to midstage development that it says will become the focus of its attention once its emphysema drug, arformoterol, is approved.

"The next big thing for us is definitely going to be these antidepressants," said David Southwell, Sepracor's chief financial officer. ``The potential market is very big."

The market for antidepressants is changing as generic competition cuts into sales of the class of drugs ushered in by Prozac, known as selective serotonin reuptake inhibitors.

As sales of SSRIs fall, the sales of a newer generation of drugs that block the reuptake, and therefore increase the amount of the brain chemicals serotonin and norepinephrine, are growing. These drugs include Wyeth's Effexor and Eli Lilly & Co.'s Cymbalta.

"The next real battle in the antidepressant market will be among the serotonin-norepinephrine inhibitors," Southwell said. (...)

Yates

Anti-depressant warning may help Yates
wfaa.com 5.7.2006
Andrea Yates' treatment for post-partum depression played a big role in her first murder trial. Now the pills she was prescribed for depression may be the key in her second defense.

The FDA in November quietly ordered a safety labeling change for Effexor XR, a warning that in rare cases patients will experience "homicidal" thoughts.
Harris HEB psychiatrist Cathal Grant has been treating patients for depression for over 20 years.

He says many doctors probably don't know the warning has been added to Effexor. But this extreme side-effect doesn't surprise him either. (...)

Most anti-depressants do warn of side - effects including suicidal thoughts, hostility, aggressiveness, and manic reactions. Homicidal thoughts are not on any other anti-depressant labels, we could find.

Still, the vast majority of people take the medicine safely. Defense attorneys will no doubt argue Effexor's new labeling could prove Andrea Yates did not. (...)

- Belgisk mor drepte sine fem barn

Belgisk mor drepte sine fem barn
aftenposten.no 1.3.2007
På inngangsdøren hang en lapp med teksten "Ring politiet".
En belgisk politimann står vakt utenfor huset der barna ble funnet drept i byen Nivelles. (...)

Den 51 år gamle kvinnen skal ha prøvd å ta sitt eget liv etter drapene, men ringte nødnummeret. Kvinnen, som har fått behandling for depresjon, er nå lagt inn på sykehus.

Barna skal ha blitt stukket i hjel. Det spekuleres i at de ble dopet ned før drapene. Kvinnen skal selv ha tatt medisiner før drapene, og barnas far skal jobbe i farmasøytisk industri. (...)

- Experts Battle Over Safety And Efficacy Of SSRIs

Experts Battle Over Safety And Efficacy Of SSRIs
By Evelyn Pringle
countercurrents.org 8.12.2006
Every time the FDA is even thinking about taking measures to protect the public from the increased risk of suicide associated with SSRIs, Big Pharma sends out the hired guns to publish some half-baked study to dispute the suicide risk. (...)

To reach their conclusions, the researchers say they looked at county by county suicide data across the US for children aged 5 to 14, for the 2-year period of 1996 through 1998, and found that the counties with the highest prescription rates for SSRIs had the lowest suicide rates in this age groups.

According to Dr Stefan Kruszewski, MD, a Psychiatrist and Addictionologist, from Harrisburg, Pennsylvania, studies such as this are fiction. "These retrospective data analysis," he says, "generally cherry-pick the suicide statistics that the authors wish to use to attempt to transform an association of facts to something that it is not." (...)

Who are these guys?

One of the study’s co-authors, John Mann, is a member of the, American College of Neuropsychopharmacology Task Force on SSRIs and Suicidal Behavior in Youth. (...)

Mr Mann himself has served as a paid speaker, consultant, and expert witness for SSRI makers and has received tens of millions of dollars in grants from the same companies to fund his research over the years - resulting in studies that always just happen to favor the drug makers' position. (...)

While testifying in a jury trial in Cheyenne, Wyoming, on May 21, 2006, Mr Mann served as an expert witness for Paxil maker, GlaxoSmithKline, and the now famous Houston attorney, Andy Vickery, asked Dr Mann about how much money he had received from drug companies to conduct his research.

According to the trial transcript, Mr Vickery said, "we've looked at it just straight from your CV from 1990 or '91 to the present, and it looks like the total amount of grants was $31,520,124."

He asked Mr Mann whether that sounded about right and Mr Mann flippantly said, "I've never added it up."

Mr Vickery then asked whether it sounded like the amount was in the right ballpark, "over $30 million?" and Mr Mann said, "It is possible."

In addition to fraudulent studies, thirty million apparently buys a lot of publicity because news of Mr Mann's latest research was pumped out and accepted by just about every major media outlet in the US and Canada. (...)

Dr David Healy, a professor at North Wales Department of Psychological Medicine, at Cardiff University, in the UK, will be testifying at the December 13, FDA hearing. He says there is little difference in the research on the suicidality risks associated with SSRIs with adults verses with children. "There is a striking overlap between the results in trials from adults and pediatric trials," he notes. (...)

A possible explanation, he explains, is that the literature has had a significant ghostwriting input, a possibility that the ACNP Report, he says, that was published 10 days before the February 2004, hearing, did nothing to dispel.

"The Task Force," Dr Healy says, "reported SSRIs to be effective, safe and well-tolerated, but the authors claimed that they might be mistaken in that they had not seen the raw data."

Yet the some of authors of the report, he points out, including Graham Emslie and Karen Wagner, were also authors on almost all of the randomized trials on SSRIs, so Dr Healy questions how these people can claim that they have not seen the raw data.

"Science depends on access to, or a fair representation of, all of the data," he says.

"Portraying positive only results as science," he points out, "in other settings, has been called fraud." (...)

"Forskningen er forfeilet..."

FDA panel to hear testimony on antidepressants
usatoday.com 13.12.2006
(...) The research is flawed, says psychiatrist Joseph Glenmullen, a clinical instructor at Harvard Medical School, who is scheduled to testify Wednesday. Most antidepressant studies exclude patients who are seriously suicidal, "but suicidal people are the first to get these drugs, so how much can we know if they're not even in the studies?" he says.

Also, the FDA summarizes the risk for patients 25 to 64 years old. Patients in some subgroups are at heightened risk. For example, those 45 to 54 years old have about the same higher risk as youths up to age 24, says Glenmullen, author of Prozac Backlash and The Antidepressant Solution. (...)

- Studie: Gentester ubrukelig for depresjon

Er farmakogenetisk CYP2D6-testing nyttig?
Tidsskr Nor Legeforen 2010; 130:2224-8 (18.11.2010)
(...) Fortolkning. CYP2D6-analysen kunne i liten grad forklare bivirkninger eller terapisvikt, til tross for at analysen ble utført i en selektert pasientgruppe med problemer knyttet til medikamentbehandlingen. Dette skyldes sannsynligvis manglende eller svak indikasjon for gentestingen samt at CYP2D6-genotype bare er én av mange faktorer som bestemmer den individuelle medikamentresponsen. (...)

CDC Working Group Doesnt Back Genetic Test for Depression Treatment Efficacy
ohsonline.com 21.12.2007
The independent Evaluation of Genomic Applications in Practice and Prevention Working Group has issued its first recommendation, saying it found insufficient evidence to support a recommendation for or against use of CYP450 testing in adults who are beginning treatment with selective serotonin reuptake inhibitors (SSRIs), which are the first-line choice for drug therapy in the United States. The statement says the CYP450 family of enzymes is a major subset of all drug-metabolizing enzymes, and testing for it could guide treatment for the large number of patients suffering depression, with individualized treatment possibly reducing lost work and school days and improving patients' quality of life. Other factors, including diet and medications, also affect SSRI metabolism, it notes. (...)

Cytochrome P450 genotyping and antidepressants
Editorials
BMJ 2007;334:759 (14 April)
An imperfect measure of a modest predictor of response to antidepressants may not be ready for clinical application (...)

Lack of evidence for CYP450 polymorphism testing
phgu.org.uk 11.1.2007
The US Agency for Healthcare Research and Quality (AHRA) has released a report on the utility of testing for cytochrome P450 (CYP450) polymorphisms in adults prior to the use of selective serotonin reuptake inhibitor (SSRI) anti-depressants. Common variants in the P450 enzymes that metabolise SSRIs can affect the rate of drug metabolism, and hence the therapeutic dose; individuals who metabolise SSRIs more rapidly than normal would require higher doses for a therapeutic effect, whilst those who metabolise them very slowly would be at risk of side-effects from standard doses. The first commercial microarray-based pharmacogenetic test, Roche’s AmpliChip CYP450 test, which detects polymorphisms in the CYP2C19 and CYP2D6 genes for the purpose of determining the probable metabolic status of patients was licensed by the US FDA in 2005 (see previous news story).

After considering 1,200 scientific abstracts and reviewing a total of 37 articles, the authors conclude that there were tests with “high sensitivity and specificity for detecting only a few of the more common known polymorphisms of 2D6, 2C19, 2C8, 2C9, and 1A1”. There was found to be a general paucity of good-quality data on utility of testing for CYP450 genotypes and mixed evidence for an association between different genotypes and the metabolism or efficacy of SSRIs in the treatment of depression. In particular, there were said to be no data regarding whether testing polymorphism testing led to improved outcomes; was useful for medical, personal or public health decision making; influenced management decisions by patients or healthcare providers; or was associated with direct or indirect harms for patients. (...)

New Report Finds Little Evidence to Determine the Usefulness of Genetic Tests in the Treatment of Depression
drugnewswire.com 5.1.2007
ROCKVILLE, Md., Jan. 4 /PRNewswire-USNewswire/ -- There is insufficient evidence to determine if current gene-based tests intended to personalize the dose of medications in a class of drugs called selective serotonin reuptake inhibitors (SSRIs) improve patient outcomes or aid in treatment decisions in the clinical setting, according to a new evidence report supported by a collaboration of the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention's (CDC) National Office of Public Health Genomics. (...)

The report found that tests evaluating differences in genes belonging to the Cytochrome P450, or CYP450, family that affect the rate at which a person metabolizes SSRIs are largely accurate. However, the researchers did not find any evidence that such tests led to improved patient outcomes or had an impact on treatment decisions for patients with depression. The researchers noted that other genetic factors and non-genetic factors such as diet and other medical conditions may have an impact on a patient's response to treatment. (...)

- Hva er forskjellen på disse to påstander?

Tester ny medisin mot depresjon
nrk.no 12.1.2011
Lege Torbjørn Tvedten er ansvarlig for testingen på norske pasienter.

Senter for Terapi og veiledning i Skien holder for tiden på med et forskningsprosjekt for å prøve ut et nytt legemiddel mot depresjon som er tenkt lansert på markedet i 2012.

Liv Østbye Pedersen forteller at mange med depresjoner ønsker å være med på prosjektet.

– Responsen har vært veldig stor, vi hadde en annonse i høst og da snakket jeg med nærmere 100 mennesker. Når vi nå har avertert igjen har vi hatt rundt 30 interessenter, sier Østbye Pedersen.

Skal virke raskere
Medisinen skal virke raskere og ha færre bivirkninger enn de som er på markedet i dag. Det er det danske legemiddelfirmaet H.Lundbeck AS står bak undersøkelsen som involverer 700 pasienter fra 13 land. Lege Torbjørn Tvedten er ansvarlig for testingen på norske pasienter.

– Når vi har kommet så langt at vi prøver legemidler ut på syke mennesker, så er det allerede forsket mye på dette. Så mye at vi er rimelig trygge på at det ikke er farlig å være med på. Men hele tiden underveis så tar vi ukentlige blodprøver og hjerteprøver for å forsikre oss om at det ikke oppstår noen uventede komplikasjoner, sier Tvedten.

Ifølge Tvedten er det mange preparater mot depresjoner på markedet, men det er ingen som er mer effektivt enn det første preparatet som ble oppfunnet i 1954.

– Vi har ikke kommet så veldig langt i utviklingen av nye preparater. Det vi håper å få til med preparatet vi prøver ut, er et preparat som er mer effektivt, og med færre bivirkninger, sier Tvedten. (...)

DON'T MISS' PANORAMA - MONDAY, STV,8.30pm
therapeuticsdaily.com 27.1.2007
Scottish reporter Shelley Joffre investigates a pharmaceutical firm charged with misrepresenting information over production of its anti-depressants. (...)

This is not only hard-hitting, it's frankly terrifying.

What's the difference between these two statements?

"... demonstrates remarkable efficacy and safety in the treatment of adolescent depression..."

"...the results of the studies were disappointing. The possibility of obtaining a safety statement from this data was considered but rejected..."

The first is what drugs company GlaxoSmithKline (GSK) told its sales reps after it tested an adult antidepressant on teenagers. (...)

Lundbeck

Lundbeck-direktør: Salg kan nå 5-10 mia kr
medwatch.dk 15.5.2012
Lundbecks lægemiddelkandidat for depression er et skridt tættere på markedet. Bliver det godkendt, kan midlet sælge for mellem 5 og 10 mia. kr., vurderer Lundbecks udviklingsdirektør.

Medicinalkoncernen Lundbeck kalder forskningsresultaterne fra nye undersøgelser med depressionsmidlet Lu Aa21004 for meget overbevisende, og gentager tidligere fremsatte estimater om, at det er et middel, der kan nå et årligt salg på 5-10 mia. kr. (...)

Lancering i 2014
Godkendelsesprocessen på et lægemiddel tager typisk et års tid, hvilket så vil sige, at det kan blive godkendt i løbet af andet halvår 2013 - hvorefter man man påbegynde en lancering.

"En lancering vil formentlig blive en gang i begyndelsen af 2014, vil jeg tro," siger Anders Gersel Pedersen.

Tidligere har Lundbeck været kritiseret for ikke at have haft tilstrækkeligt slagkraftige lægemidler til at afløse lægemidler truet af patantudløb, hvilket har ramt depressionsmidlet Lexapro i USA og i 2014 sker for Cipralex i Europa.

Lundbeck vurderer dog nu at have mange kort på hånden i pipelinen. (...)

Lundbeck lægger pres på indiske medicinalmedier
information.dk 11.5.2012
Medicinalfirmaet Lundbeck greb til juridiske trusler mod et indisk tidsskrift, der havde påpeget, at godkendelsen af Lundbecks præparat var kritisabel

Hvad, lægemidlet Deanxit helt præcist skal anvendes til, er lidt uklart, i hvert på mange indiske klinikker, hvor lægemidlet fra Lundbeck er blevet brugt til mange forskellige formål med udgangspunkt i Lundbecks egne formuleringer.

I september 2009 skriver det anerkendte indiske lægetidsskrift og månedsmagasin, MIMS, en kritisk artikel om Lundbeck pillen, Deanxit – udstyret med røde advarselslamper.

»Deanxit: Ulovligt godkendt«, lyder overskriften. Historien bliver trykt i adskillige hundrede eksemplarer i Indien sammen med flere andre kritiske artikler om medicinalindustrien.

Artiklen bliver efterfølgende citeret bredt i de øvrige indiske medier og såvel sundhedsfagligt personale som myndigheder begynder at tvivle på produktet. For eksempel har man svært ved at opspore forsøg, der kan dokumentere dets effekt, hvilket ellers er kravet for at få godkendt et nyt lægemiddel på det indiske marked. (...)

Lundbeck får positive resultater med skizofreni-behandling
medwatch.com 8.5.2012
Medicinal & Biotek: En af første lægemiddelkandidater i rækken, som Lundbeck via sin millardinvestering i det japanske biotekselskab Otsuka satser på at booste indtjeningen med, viser positive resultater.

Lundbeck har haft gode resultater af det kliniske fase III studie med Aripiprazol intramuskulær depotformulering til vedligeholdelsesbehandling af voksne med skizofreni.

Studiet løb over et år og viser at Aripiprazol givet en gang månedligt forsinkede tiden til begyndende tilbagefald i forhold til placebo signifikant. Netop denne parameter var studiets primære effektmål. (...)

Konkurrence og patenter presser Lundbecks storsællert
business.dk 2.5.2012
Lundbecks største produkt er under større pres end analytikerne havde ventet, viser regnskabet for første kvartal. Foto: Morten Germund

Salget af Lundbecks depressionsmiddel Cipralex skuffer trods lave forventninger - midlet er udfordret af kopiproducenter og prispres i både Europa og USA. (...)

Cipralex er hårdt presset i både Europa og USA. I Spanien udløb patentet på produktet sidste år, og det har givet frit spil for kopiproducenter, der presser prisen helt i bund. Og i Tyskland har politisk dikterede ændringer i prissætningen sidste år efterladt dybe ar på kvartalsregnskabet - også selv om den lavere prissætning er annulleret igen.

I marts udløb Lundbecks patent samtidig på samme middel i USA, dog solgt under navnet Lexapro, i marts 2012, og på bare en enkelt måned er Lundbecks markedsandel faldet fra 100 procent til 16,8 procent på den anden side af Atlanten.

Læs også: Analytiker spår storsalg af Lundbeck-middel i Japan

Over en bred kam faldt også Lundbecks samlede salg fra 4103 mio. kroner i årets første tre måneder sidste år til 3778 mio. kroner i samme periode i år. Et fald, der var større end ventet - om end analytikerne er klar over, at de kommende år er udfordrende for Lundbeck. (...)

(Anm: Cipralex (Lexapro) (escitalopram) - Cipramil (Celexa) (citalopram)- H. Lundbeck A/S (mintankesmie.no).)

Lundbeck-rival får igen positive resultater med antidepressiv
medwatch.dk 28.4.2012
Det amerikanske medicinalselskab Forest Laboratories har offentliggjort yderligere positive resultater fra et fase III forsøg med antidepressivet Levomilnacipran.

Resultaterne af behandling med Levomilnacipran viser væsentligt reducerede depressions-symptomer sammenlignet med placebo. Det er det tredje positive fase III-studie med stoffet hos depressive voksne.

Forest Labs er nu igang med yderligere analyser af dataene, og selskabet venter at indsende en godkendelsesansøgning som New Drug Application til de amerikanske sundhedsmyndigheder, FDA, i tredje kvartal i år.

Forest arbejder sammen med den franske partner Pierre Fabre om udviklingen. Forest står ligesom Lundbeck med udfordringer i forhold til at kompensere for omsætningstabet, når patentet på deres fælles antidepressiv, Lexapro, udløber i USA til marts.

Lundbeck er gået sammen med japanske Takeda Pharmaceutical Company om at udvikle et nyt antidepressiv, Lu AA21004. (...)

Forest backs pipeline as profits fall on Lexapro expiry
pharmatimes.com 18.4.2012
Forest Laboratories has seen its fiscal fourth-quarter earnings take a bashing as sales of its flagship product Lexapro were reduced by nearly $240 million due to generic competition.

Net income came in at $192.7 million, a fall of 40.3%, while sales decreased 8.7% to $996.9 million, Lexapro (escitalopram), the antidepressant licensed from Denmark’s Lundbeck, contributed $355.8 million, down from $594.8 million in the like, year-earlier period. Patent protection for Lexapro expired on March 14,
On the positive side, Namenda (memantine) for the treatment of moderate and severe Alzheimer's disease, reached $393.1 million, up 19.5%, while the antihypertensive Bystolic (nebivolol) jumped 32.6% to $96.9 million. Earlier this month, Forest agreed to acquire all US and Canadian intellectual property from Johnson & Johnson related to Bystolic for $357 million. Savella (milnacipran), a selective serotonin and norepinephrine dual reuptake inhibitor for fibromyalgia, brought in $25.3 million, up 6.5%. (...)

Stenrig fond bevilger 121 millioner kroner til danske forskere, som skal finde årsagerne til psykisk sygdom
b.dk 19.3.2012
Over 100.000 mennesker med og uden psykisk sygdom skal have deres gener og anonymiserede livshistorie gransket i detaljer i et historisk stort psykiatrisk forskningsprojekt. Målet er at finde årsagen til psykisk sygdom.

- Vi håber, at ved at finde frem til årsagerne til psykisk sygdom, kan vi få en større indsigt i de biologiske mekanismer. Det kan hjælpe os med at udvikle bedre medicin og måske kan vi også tidligere udpege dem, der er i særlig risikogruppe, så vi kan tage bedre vare på dem, siger videnskabelig leder af projektet, professor i medicinsk genetik ved Aarhus Universitet, Anders Børglum.

Projektets officielle navn er "Lundbeckfondens Initiativ for Integreret Psykiatrisk Forskning", forkortet ”iPSYCH”. Den videnskabelige ledelse foregår fra Aarhus Universitet og Aarhus Universitetshospital, men i projektgruppen sidder også forskere fra Region Hovedstadens Psykiatri. Projektet skal se på fem sindslidelser: Skizofreni, maniodepressivitet, depression, autisme og ADHD.

- Det er alvorlige sindslidelser med stor udbredelse, og hvor behandlingstilbuddene i nogle tilfælde ikke er tilfredsstillende, så det ville vi gerne kunne gøre bedre. Men de senere år er vi også blevet klar over, at der er overlappende symptomer imellem de her sygdomme, og i høj grad også overlappende årsagsfaktorer, siger Anders Børglum. (...)

Lundbeck venter fald i salget i 2012
business.dk 8.2.2012
Medicinalkoncernen Lundbeck omsatte i 2011 for 16 mia. kroner og fik et overskud på 2,3 mia. kroner. Næste år ventes et samlet salg på 14,5-15,2 mia. kroner. (...)

Mod forventning solgte antidepressivet Lexapro en tand bedre sidste år end i 2010 - nemlig 2.535 mio. kroner mod 2010-resultatet på 2.443 mio. kroner. Det er udløbet af patentet på midlet i USA her til marts, der lå til grund for forventningen om, at midlet ville sælge dårligere, fordi den amerikanske partner Forest Laboratories formentlig er ved at rydde lagrene af Lexapro. (...)

Optakt til Lundbeck-regnskab: Lexapro-indtægter klinger af
medwatch.dk 7.2.2012
Lundbeck må snart undvære en stor bid af indtægterne fra sit storsælgende antidepressiv Lexapro, og derfor er der udsigt til tilbagegang på top- og bundlinje i 2012. Spørgsmålet er blot, hvor meget.

Kopiproducenterne står klar fra dag et, når Lexapro-patentet udløber til marts, for at overtage markedet med billigere versioner af pillen. Analytikere, som SME Direkt har talt med, venter forud for regnskabet, der offentliggøres onsdag morgen ved 8-tiden, et fald i Lundbecks indtægter fra Lexapro til blot 0,4 mia. kr. i år fra 2,4 mia. kr. i 2011. Jyske Bank er mere skeptisk og spår et salg på blot 155 mio. kr. i 2012. (...)

"Vi forventer, at Lundbecks guidance vil være lavere end konsensus. Alligevel gentager vi vores "Stærkt Køb"-anbefaling, hvilket skyldes, at vi ser med stigende optimisme frem mod offentliggørelsen af Lu AA21004 (Lundbecks næste antidepressiv, red.) fase 3-resultaterne i andet kvartal, som, vi forventer, vil bane vejen for en succesfuld lancering af produktet," skriver senioranalytiker Frank Hørning Andersen i et notat.

Han venter, at Lundbecks forventninger til 2012 vil lyde en omsætning på 14,3 mia. kr. Markedsforventningerne er ifølge SME Direkt 14,7 mia. kr. (...)

Lundbeck dropper dødssprøjte-midlet Nembutal
business.dk 22.12.2011
Medicinalselskabet frasælger en en stribe produkter - deriblandt det kontroversielle Nembutal, som er blevet brugt til henrettelser i USA.

Lundbeck frasælger nu en række produkter i USA - blandt andet det omstridte dødssprøjtemiddel Nembutal.

- Det amerikanske marked er en vigtig vækstfaktor for Lundbeck. Aftalen giver os mulighed for at fokusere på nyere, strategiske produkter med markant omsætningspotentiale som Onfi, aripiprazol depotformulering og Lu AA21004, siger Lundbecks koncernchef Ulf Wiinberg.

Lundbeck får en engangsbetaling og en milepælsbetaling efter tre år som samlet maksimalt vil løbe op i 60 mio. dollar (342 mio. kr.). (...)

Lundbeck vil i stedet fokusere på nyere, strategiske produkter i dets portefølje. (...)

'Lykkepiller' kan give hjertestop
videnskab.dk 24.11.2011
Det populære antidepressive middel Cipramil kan ifølge et nyt studie få hjertet til at slå ude af takt, så det i sjældne tilfælde går i stå. Lægemiddelstyrelsen ændrer nu sine anbefalinger til brugen af 'lykkepillerne'.

(Redaktionel note, 24. november 2011: Nyheden om det amerikanske studie har hurtigt fået mange patienter til at blive bekymrede for, om de skal holde op med at tage deres medicin. Lægemiddelstyrelsen beder i den forbindelse om, at man ikke ringer til styrelsen, men taler med sin egen læge, hvis man er usikker på sin medicin. Lægemiddelstyrelsen understreger samtidig, at det er sundhedsfarligt at holde op med at tage sin medicin uden lægens anbefaling.)

Et nyt amerikansk studie har for nylig afsløret en hidtil ukendt potentiel farlig bivirkning ved Cipramil, som mange depressive danskere for øjeblikket bliver behandlet med. Omkring 178.000 danskere er i behandling med Cipramil og kopiudgaverne af dette lægemiddel, der alle rummer det virksomme stof Citalopram. (...)

Det kan undre, hvorfor man ikke fra begyndelsen undersøgte, om lægemidlet havde denne effekt, men Lundbecks pressechef Mads Kronborg fortæller, at man ikke tidligere har været opmærksom på mekanismen, da indrapporteringerne fra læger og patienter i årenes løb ikke viser nogen tegn på, at der skulle være en forhøjet risiko. (...)

Dansk Psykiatrisk Selskab og Dansk Kardiologisk Selskab har netop behandlet dette spørgsmål og andre problemer med medicinen i en fælles rapport. (...)

Drugmakers Lundbeck, Otsuka form global alliance
reuters.com 11.11.2011
(Reuters) - Drugmakers Otsuka Holdings Co and Danish peer Lundbeck on Friday announced they would jointly develop and sell up to five psychiatric and neuroscience drugs in a deal analysts said offered Lundbeck's pipeline a much-needed boost.

Shares in Lundbeck jumped in the wake of the announcement, and were trading up 6.4 percent at 112.7 Danish crowns at 1020 GMT, against a 0.3 percent rise in the STOXX Europe 600 healthcare index and a 0.5 percent fall in the Copenhagen bourse's bluechip index.

"We see this deal as clearly positive for Lundbeck and it bodes well for long-term revenue, top-line diversification and company perception," said Nordea in a note to clients.

"There is no doubt that this is not a cheap deal for Lundbeck, but it is necessary," Nordea said. Lundbeck's most important drug will lose patent protection in 2012. (...)

Lundbeck generates most of its revenue from antidepressant Cipralex, sold as Lexapro in the United States by Forest Laboratories.

The group is working to find replacements for the key antidepressant as patents expire between 2012 and 2014. (...)

Ros til Lundbecks milliardaftale
business.dk 11.11.2011
Lundbeck-topchefen Ulf Wiinberg har indgået en stor og dyr aftale. Foto: Christian Als

Det danske medicinalselskabs milliarddyre partnerskabsaftale med japanske Otsuka ser ikke bare fornuftig ud - den kan løse Lundbecks pipeline-problem, vurderer analytiker.

Det danske medicinalselskab Lundbeck meddelte tidligt fredag morgen, at det har indgået en partnerskabsaftale med japanske Otsuka. Aftalen betyder, at Lundbeck skal lægge 1,1 milliard kroner på bordet nu og her for at få del i det japanske selskabs pipeline.

Fra SEB Enskilda er reaktionen positiv. Analytiker Henrik Damkjær Simonsen mener, det er en lovende aftale for Lundbeck.

"Det er en klart positiv deal," siger han til Berlingske og tilføjer:

"Det kan sende dem et skridt foran på psykiatriområdet med noget moderne medicin." (...)

Lundbecks omsætning skal på fedekur
business.dk 15.8.2011
Samarbejde med andre virksomheder og internationale forskningsmiljøer er nogle af Mats Petterssons ideer til at bringe Lundbeck ud af patentknibe. Ensidigt fokus på hjernesygdomme vil begrænse mulighederne, mener manden, der satte sig for bordenden i bestyrelsen i dette forår.

Lundbeck mister i løbet af det næste par år op mod halvdelen af sin nuværende omsætning, når patentet udløber for selskabets depressionsmiddel. Men selskabets nye bestyrelsesformand, Mats Pettersson, har ikke mistet modet af den grund.

»New business« var det således, at Lundbeck i den forgangne uge præsenterede sit halvårsregnskab. Selskabet overraskede positivt med sit bedste resultat nogensinde. (...)

Lundbeck-partner under hård beskydning
business.dk 1.8.2011
En sag om ulovlig markedsføring af Lundbecks lykkepiller i USA har fået et benhårdt efterspil i USA. Lundbecks USA-partner risikerer at miste den amerikanske stat som kunde, og rasende investorer kræver udskiftning af ledelsen.

Sagen om den ulovlige markedsføring af Lundbecks lykkepiller til børnelæger i USA ruller videre for fuld kraft. Lundbecks amerikanske partner, Forest Laboratories, er under hård beskydning fra selskabets investorer, som kræver udskiftninger i bestyrelsen og den 83-årige topchef, Howard Solomons, afgang.

Baggrunden for det dramatiske efterspil er, at Forest Labs. sidste år erklærede sig skyldig i ulovlig markedsføring af Lundbecks lykkepiller til børnelæger og børnepsykiatere. Lykkepillen var imidlertid ikke godkendt til behandling af depressioner hos børn i den årrække, hvor den agressive markedsføring fandt sted. Det kostede Forest Labs. en milliardbøde.

Oven i det kom de amerikanske sundhedsmyndigheder så i foråret med en overraskende trussel om personligt at fratage Forest Labs. topchef, Howard Solomon, retten til at levere til det offentlige i USA - en betydelig kunde for ethvert medicinalselskab.

Det har ikke alene rystet den amerikanske medicinalbranche, fordi en ledelse hidtil har kunnet betale sig fra ulovlighederne, det har også fået flere af investorerne i Forest Labs. op af stolen for at rette skarp kritik mod ledelsen og kræve udskiftninger i toppen. (...)

Ekspert: Lundbeck vil altid huskes for dødssprøjten
business.dk 4.5.2011
Lundbecks røde stjerne vil nu ringe genklang med dødssprøjte og henrettelser, mener ekspert. (...)

ATP kræver svar fra Lundbeck om skandalesager
business.dk 4.5.2011
ATP savner større klarhed om de etisk varme kartofler hos Lundbeck, mens eksperter i kommunikation og etisk ansvarlighed mener, at Lundbeck med sin ageren står med et troværdighedsproblem i forhold til sin etiske profilering.

Landets toneangivende investor, ATP, er ikke tilfreds med informationsniveauet fra Lundbeck i de to problemsager, som i flere måneder har hjemsøgt den danske medicinalvirksomhed med hovedsæde i Valby. Sagen om Lundbecks Nembutal, som bruges i dødssprøjter i USA, og sagen om USA-partneren Forest Laboratories’ ulovlige markedsføring af Lundbecks lykkepiller til børnepsykiatere har fået ATP til at kræve, at Lundbeck lægger flere fakta på bordet. (...)

Pennevenner vælter ikke Lundbeck
business.dk 2.5.2011
Trods et forslået image, der i dag fik endnu en mavepuster, skal der mere til for at få Lundbeck til at trække sit omstridte middel Nembutal tilbage fra USA, der bruger det i forbindelse med henrettelser.

Et enkelt liv og en tårevædet appel fra en bekymret penneven til en dødsdømt i Texas er ikke nok for at få medicinalkoncernen H. Lundbeck til at trække det omstridte Nembutal-middel tilbage og undgå, at det bliver brugt i forbindelse med henrettelser i USA. Det mener en ekspert i Corporate Social Responsibility - virksomheders adfærd i offentligheden. (...)

Men trods et slidt og forslået image, skal der meget mere til, for at Lundbeck er så hårdt ramt, at det dropper produktionen af det omdiskuterede sove- og epilepsimiddel.

”Hvis Lundbeck vælger at trække sit produkt tilbage, så vil det være fordi, at nogle store kunder slår bremsen i. Ikke fordi, at en enkelt penneven skriver en appel,” siger lektor i samfundsansvar på CBS, Esben Rahbek Pedersen, til Business.dk. (...)

Lundbecks problemstof er en god forretning
business.dk 2.5.2011
På få år har Lundbecks amerikanske datterselskab formået at udvikle det gamle lægemiddel Nembutal der i øjeblikket er i fokus, fordi det bruges i dødssprøjter i USA til en god forretning. (...)

Lundbeck ønsker ikke selv at oplyse finansielle detaljer om stoffet, men ifølge de salgstal, som Berlingske Business har fået oplyst fra analyseinstituttet IMS Health, udgjorde omsætningen af Nembutal fra Lundbeck sidste år 25,5 millioner dollar eller 143 millioner kr. Det er en stigning på 16 pct. i forhold til 2009, og intet mindre end 151 pct. siden 2006.

Læs også: Øget kritik af Lundbeck i sag om dødssprøjter

»Der har siden 2006 været en svagt faldende tendens i antallet af solgte doser, mens omsætningen er øget på grund af prisstigninger,« siger Anders Schroll, kommunikationsdirektør hos Lundbeck.

Om årsagen til den markante prisstigning på Nembutal, siger Anders Schroll:

»Jeg kan ikke kommentere på det finansielle, når det gælder Nembutal, men generelt kan jeg sige, at prisstigninger er almindelige på det amerikanske marked, og at det er sådan, at når et selskab overtager et produkt fra et andet, kan det betyde, at der kommer andre udgifter til produktion og distribution.«
(...)

Lundbeck opjusterer forventningerne
business.dk 24.2.2011
Stigende omsætning og et resultat på knap en halv milliard mere end sidste år får Lundbeck til at opjustere forventningerne til næste år. Lundbeck forventer næste år en omsætning på over 15 mia. kroner og et resultat på mellem 2,3 og 2,6 mia. kroner. (opdateret 08:23)

(...) Resultatet er dog en smule dårligere end analytikernes forventninger. (...)

- I 2011 forventer vi at kunne fortsætte vores vækst og nå en omsætning og driftsindtjening på henholdsvis 15,3-15,8 mia. kr. og 3,3-3,6 mia. kr. til trods for, at vi i 2011 vil investere væsentlige beløb i produktlanceringer og tidlig markedsføring. Vores hovedprodukter Cipralex, Ebixa og Azilect har stadig mere potentiale, og nyere produkter som Xenazine og Sabril vil bidrage mere til vores forretning, siger Ulf Wiinberg, administrerende direktør for Lundbeck.

Lundbeck forventer næste år en omsætning på 15,3 til 15,8 mia. kroner og et resultat på mellem 2,3 og 2,6 mia. kroner. (...)

Lundbeck raser over dødssprøjte
business.dk 28.1.2011
Lundbeck er langt fra tilfreds med de amerikanske myndigheders brug af dets midler.

Dansk medicinalvirksomhed protesterer mod anvendelse af dets medicin ved henrettelser i USA. "Lundbeck arbejder for at redde menneskeliv," lyder det fra selskabet.

Mindst 15 personer, der er dømt til døden for drab og andre forbrydelser i den amerikanske delstat Ohio, venter på at blive henrettet med et nyt produkt fra Lundbeck, men den danske medicinalvirksomhed har protesteret mod denne anvendelse af dets medicin, skriver den amerikanske avis The Columbus Dispatch.

Læs også: Lundbeck får sex-konkurrence fra amerikanere

Lundbeck har sendt et protestbrev, efter at myndighederne i delstaten tirsdag meddelte, at de ville begynde at bruge stoffet pentobarbital i stedet for sodium thiopental til de dødelige indsprøjtninger, som anvendes ved henrettelser. (...)

LUNDBECK(H0 : Lundbeck to establish a strong, dedicated sales force behind Lexapro® in China as part of a new co-promotion agreement
4-traders.com 14.12.2010

• Lundbeck will substantially increase sales and marketing efforts behind Lexapro® in China
• Lundbeck already has a foothold in China and stands to benefit from the rapidly evolving Chinese CNS market

H. Lundbeck A/S (Lundbeck) announced today a revised agreement with its partner in China, Xian-Janssen Pharmaceuticals Ltd. (Xian-Janssen), that change the terms from the current license agreement for Lexapro® to a co-promotion agreement. The new agreement also means that both parties will invest substantially in more joint sales and marketing efforts for Lexapro® in China.

Lundbeck plans to double its current sales organisation in China and the new joint sales efforts behind Lexapro® is to be further expanded in the coming years. The agreements provide for a highly competitive share of voice in the Chinese market for anti-depressants. (...)

Lundbeck sees China as land of opportunity for Lexapro
pharmatimes.com 16.12.2010
Lundbeck has unveiled plans to double its sales force in China with a specific emphasis on promoting the blockbuster Lexapro in the growing antidepressant market there.

The Danish drugmaker has revised its pact with partner Xian-Janssen Pharmaceuticals, changing the terms from a licence agreement for Lexapro (escitalopram), sold exclusively by the latter, to a co-promotion deal. Both firms say they will "invest substantially in more joint sales and marketing efforts" for the antidepressant in China. (...)

Lundbeck vil være frontløber med skræddersyet medicin
business.dk 4.10.2010
Lundbeck satser på en fremtid, hvor skræddersyet medicin til hjernesygdomme skal være virksomhedens primære indtjeningskilde. Efterhånden som forskning i hjernen har øget forståelsen af, hvordan den fungerer, har det åbnet muligheden for at målrette medicin mod specifikke sygdomsbilleder, og det er denne såkaldte skræddersyede medicin, Lundbeck vil satse på i fremtiden.

Som den første medicinalvirksomhed med fokus på hjernesygdomme siger Lundbeck - næsten - farvel til one-size-medicin og goddag til skræddersyet medicin. Strategien løser ikke Lundbecks problem med patentudløb, men den er forudsætningen for, at Lundbeck har en position i fremtidens marked.

Fremtiden tilhører de medicinalkoncerner, som har skræddersyet medicin på hylderne, der beviseligt kan behandle en sygdom hos specifikke patienttyper. Det er, hvad medicinalindkøberne kommer til at efterspørge, og derfor har alverdens medicinalvirksomheder kastet sig over skræddersyet medicin.

I sidste uge sadlede danske Lundbeck også den hest, men noget usædvanligt er Lundbeck den første medicinalvirksomhed med fokus på hjernesygdomme, som nu har det som sin erklærede forsknings- og udviklingsstrategi. For Lundbeck er det imidlertid ikke et spørgsmål om først at have set lyset i september 2010, men et spørgsmål om, at den biologiske forståelse af hjernesygdomme først inden for de seneste år er blevet stor nok til, at det overhovedet nu er muligt at forfølge en strategi om skræddersyet medicin mod sygdomme som depression, skizofreni, Parkinsons og Alzheimers.

»For at kunne tage springet fra one-size-fits-all til skræddersyet medicin er man nødt til at have et vist niveau af basisviden om de sygdomme, man arbejder med, og her må man bare sige, at cns-området (centralnervesystemet, red.) er langt bagefter de fleste andre områder. Forståelsen af de sygdomme, vi har med at gøre, er først inden for de seneste få år kommet op på et niveau, hvor man kan lave noget fornuftigt,« siger Lundbecks koncernforskningschef, Peter Høngaard Andersen. (...)

Escitalopram filed in Japan
marketwatch.com15.9.2010
Valby, Denmark, Sep 15, 2010 (Thomson Reuters ONE via COMTEX) -- H. Lundbeck A/S (Lundbeck) today announced that our partner Mochida Pharmaceutical Co., Ltd. (Mochida) has filed a new drug application (NDA) for escitalopram for the treatment of depression with the Japanese Ministry of Health, Labour and Welfare (MHLW). If approved, Lundbeck expects that escitalopram in Japan would be a meaningful contribution to Lundbeck's financial performance already in the period 2012-2014.

The commercialization of escitalopram will be supported by two highly CNS-experienced Japanese companies which will co-market the product; Mochida and Mitsubishi Tanabe Pharma Corporation (Mitsubishi Tanabe). Yoshitomiyakuhin Corp., a subsidiary of Mitsubishi Tanabe, will participate in the promotion. This means that the launch will be supported by more than 1,500 sales reps, which is fully competitive in the Japanese market.

"We are very excited about the early filing of escitalopram in Japan and we are now one step closer in making escitalopram available also for the Japanese patients," says Ulf Wiinberg, President & Chief Executive Officer at Lundbeck. "The Japanese antidepressant market represents a substantial commercial opportunity, and would contribute meaningfully to Lundbeck's financial performance already in the period 2012-2014." (...)

Lundbeck-CFO: Vi har turbo på salgsmaskinen
business.dk 13.8.2010
Lundbecks nøgleprodukt, Cipralex, var en af de positive overraskelser i medicinalkoncernens regnskab.

Antidepressivet omsatte for 1507 mio. kr. i årets andet kvartal mod en forventning om et salg på 1400 mio. kr. ifølge RB-Børsens estimat.

- Vi er blevet favorabelt påvirket af valutakurser. Det er en ting. Det næste er, at vi bliver ved med at tage markedsandele i stort set samtlige lande. Det går imponerende godt. Cipralex bliver mere og mere accepteret af patienterne, som synes, at det er et førsteklasses medikament. Det gør, at vi har meget turbo på vores salgs- og marketingsmaskine i Europa, men det går også super godt i Latinamerika, Canada og i emerging markets, siger koncernøkonomidirektør Anders Götzsche fra Lundbeck. (...)

Novel agent Lu AE04621 enters Lundbeck's development pipeline
worldpharmanews.com 7.4.2010
(...) Lu AE04621 is a novel agent that acts on the areas of the brain that are affected in Parkinson's disease with similar net effect as Lu 02-750, which entered phase I in November 2009. In animal models, the compound has demonstrated very convincing effects when compared to conventional treatments. Expectations are that the compound can offer Parkinson's patients a new and higher level of disease control. (...)

Lundbeck klar til nye forsøg med to lykkepiller
business.dk 3.3.2010
Lundbeck er undervejs med fase 3 forsøg med to forskellige depressionsmidler, som - hvis de klarer hele vejen til markedet - kan blive meget vigtige for den danske medicinalkoncerns fremtidige omsætning og indtjening.

Det ene af depressionsmidlerne, LU AA21004, skuffede sidste sommer, da Lundbeck fremlagde resultaterne af fase 3-forsøgene, men nu har videre granskning af resultaterne givet Lundbeck og japanske Takeda Pharmaceuticals blod på tanden til at foretage yderligere undersøgelser af depressionsmidlet. Undersøgelserne bliver sat i gang her i løbet af årets første seks måneder. (...)

EU granskar danska Lundbeck
lakemedelsvarlden.se 8.1.2010
Den europeiska kommissionen kommer att inleda en närmare undersökning av det danska företaget Lundbeck. Anledningen är misstankar om att Lundbeck missbrukat sin dominanta ställning för att hämma konkurrensen för produkter med citalopram.

EU-kommissionen meddelade på torsdagen att de inleder en utredning mot Lundbeck efter misstankar om att de hindrar försäljning av generiskt citalopram. (...)

EU opens antitrust proceedings against Lundbeck
pharmatimes.com 8.1.2010
The European Commission announced yesterday that it has opened a formal antitrust investigation into Danish drugmaker H Lundbeck.

The Commission says it will investigate, “as a matter of priority,” potential breaches by the company of European Union (EU) rules on restrictive business practices and abuse of a dominant market position. In particular, it intends to probe “unilateral behaviour and agreements” by Lundbeck related to delays in entry of generic versions of its antidepressant Celexa/Cipramil (citalopram) into European Economic Area (EEA) markets. Lundbeck’s patent on the drug, a selective serotonin reuptake inhibitor (SSRI), expired in 2003. (...)

Schweizer tredobler erstatningskrav mod Lundbeck
business.dk 13.11.2009
Det danske medicinalselskab Lundbeck og dets amerikanske partner Forest Laboratories kan se frem til et forhøjet erstatningskrav fra det schweiziske selskab Infosint.

Schweizerne har tidligere af en jury under retskreds i New York delvis fået ret i sin påstand om, at Lundbeck skulle have forbrudt sig imod et af Infosints patenter i forbindelse med en fremstillingsproces i forhold til antidepressivet Lexapro.

Ved den lejlighed besluttede en jury, at Lundbeck som kompensation skal betale 15 mio. dollar til Infosint. Nu forhøjer Infosint kravet mod Lundbeck til 43 mio. dollar. (...)

(Anm: Cipralex (Lexapro) (escitalopram) - Cipramil (Celexa) (citalopram)- H. Lundbeck A/S (mintankesmie.no).)

Lundbeck tjener flere penge
business.dk 3.11.2009
(...) Medicinalselskabet Lundbeck tjente 2,3 mia. kr. før skat i årets første ni måneder og fastholder forventninger til hele året, selv om omsætningen skuffer en smule. (...)

Lundbecks amerikanske afdeling bliver set som en af de satsninger, der skal hjælpe Valby-virksomheden med at opretholde sin indtjening, når selskabets milliardsælgende depressionspille Lexapro mister sit patent i henholdsvis 2012 i USA og 2014 i Europa. (...)

Lundbeck-partner på anklagebænken
business.dk 5.10.2009
Lundbecks amerikanske partner Forest er på anklagebænken i Massachusett for særdeles aggressiv markedsføring af Lundbecks depressionsmidler til børn. Samtidig skjulte Forest angiveligt studier, der viste øget selvmordsrisiko og manglende positiv effekt.

Lundbecks amerikanske partner, Forest, som står for salget af Lundbecks to succesfulde depressionsmidler Cipramil og Cipralex i USA, er kommet på anklagebænken ved distriksdomstolen i Massachusett. (...)

Lundbeck fyrer 200-220
politiken.dk 24.9.2009
Medicinalselskabet Lundbeck fyrer 200-220 ansatte i Danmark. Der skal spares og effektiviseres. (...)

Selskabet må nedlægge det store antal arbejdspladser, fordi der skal omstruktureres og rationaliseres, oplyser Lundbeck. (...)

LÆS ARTIKEL Lundbeck bliver straffet hårdt (...)

USA tvivler på Lundbecks skizofreni-middel
politiken.dk 26.6.2009
Det danske medicinalfirma Lundbeck bliver holdt på pinebænken i USA.

De amerikanske sundhedsmyndigheder, FDA, har bedt medicinalkoncernen Lundbeck om at komme med yderligere informationer om skizofreni-midlet Serdolect. Det oplyser selskabet i en fondsbørsmeddelelse.

Pressechef Mads Kronborg konstaterer, at det naturligvis ikke var det svar, man havde sat næsen op efter, efter at have ventet 13 måneder siden ansøgningen. (...)

Lundbeck afventer godkendelse af ny afløser til Lexapro
npinvestor.dk 14.5.2009
Der håb forude for den danske medicinalkoncern Lundbeck, som igennem længere tid har søgt efter en erstatning til produktet Lexapro som går af patent i 2012.

Muligvis allerede på fredag kan Lundbeck sikre væksten med det nye skizofrenimiddel Serdolect fra 2012-2014, og der med vil indtjeningen bevares når Lexapro/Cipralex går af patent. Lundbeck afventer de amerikanske myndigheders godkendelse af produktet.

- Serdolect er et højmarginalprodukt, og hvis vi får en acceptabel label, så har vi en klar ambition om at skabe vækst i perioden 2012-2014 – også på indtjeningen, siger Anders Götzsche, koncernøkonomidirektør i Lundbeck til dagbladet Børsen. (...)

Lundbeck overrasker eksperterne
politiken.dk 13.5.2009
Den danske medicinalvirksomhed opjusterer forventningerne til hele året efter rekordomsætning i første kvartal. (...)

Omsætningen landede i årets første tre måneder på rekordstore 3,2 milliarder kroner - en vækst på 15 procent. På bundlinjen blev det til et overskud på 697 millioner kroner. Indkøbet af det amerikanske datterselskab Ovation i midten af marts er indregnet som omsætning i Lundbeck.

Det nyligt erhvervede selskab ventes isoleret set at have en vækst i omsætningen på mere end 25 procent i 2009. (...)

Blandet modtagelse af Lundbecks Serdolect i USA
business.dk 8.4.2009
De amerikanske sundhedsmyndigheders rågivningskomite gav i nat medicinalkoncernen Lundbeck en blandet vurdering af skizofreni-midlet, Serdolect. Vurderingen får onsdag stor betydning for kursudviklingen på Lundbeck-aktien.

Den såkaldte Psycopharmacology Drug Advisory Committee (PDAC) mente enstemmigt, at Serdolect er effektivt i behandling af patienter med skizofreni. Men komiteen mente ikke, at datagrundlaget var tilstrækkelig robust til at støtte en yderligere regulatorisk påstand relateret til behandling af selvmordsadfærd blandt patienter med skizofreni.

Et flertal af komiteens medlemmer var betænkelige ved produktets sikkerhed og stemte imod anvendelsen af Serdolect i en bred population af patienter med skizofreni. (...)

Lundbeck køber amerikanske Ovation for 5,2 milliarder kr.
business.dk 9.2.2009
Medicinalkoncernen H. Lundbeck køber amerikanske Ovation Pharmaceuticals, der er specialiseret i sygdomme i centralnervesystemet, for 5,2 milliarder kr., oplyser Lundbeck. (...)

Lundbeck Journeys To The U.S.
forbes.com 9.2.2009
Danish drugmaker scoops up Ovation Pharmaceuticals, granting it access to new markets.

Danish drugmaker Lundbeck is breaking into the U.S. market by acquiring a small, affordable pharmaceuticals company with a late-stage pipeline.

Lundbeck announced Monday that it had agreed to buy privately owned, Deerfield, Ill.-based Ovation Pharmaceuticals for up to $900.0 million, or 5.2 billion Danish kroner. The acquisition will give Lundbeck access to the U.S. through a company with an established sales force and management team. The purchase comes just in time for the drugmaker, which is expecting an influx of generic competition for its antidepressant blockbuster Lexapro when it goes off patent in 2012. (...)

Lundbeck will make an upfront payment of $600.0 million, or 3.5 billion Danish kroner, immediately upon closing the transaction. The company will then make up to $300.0 million, or 1.7 billion Danish kroner, in additional milestone payments related to the regulatory approval of Sabril. (...)

Lundbecks opkøbsmuskler skrumper
business.dk 14.10.2008
Tirsdag den 14. oktober 2008, 06:41
Finanskrisen har voldsomt begrænset Lundbecks opkøbsmuligheder.

Medicinalkoncernen har brug for opkøb, for at erstatte kommende patentudløb, men hvor selskabet for et år siden kunne købe virksomheder eller lægemidler for 27 mia. kr., betyder den reducerede lånemulighed i banken, at Lundbeck i dag højst kan bruge 4 mia. kr. på opkøb. Det skriver dagbladet Børsen tirsdag. (...)

Øget amerikansk interesse for Lundbeck
business.dk 6.10.2008
På trods af at det danske medicinalselskab Lundbeck står over for en række udfordringer, er de amerikanske investorers appetit på selskabet vokset kraftigt i løbet af den seneste tid. (...)

Alene siden årsskiftet er Lundbeck-aktien faldet med over 20 procent samtidig med, at selskabet dag for dag kommer tættere og tættere på den dato, hvor deres storsælgende medicin Cipralex/Lexapro mister sit patent.

Det sker i henholdsvis år 2014 og 2012 uden Lundbeck reelt er kommet tættere på en løsning. Det danske selskabet forsøgte ellers med købet af Alzheimers-midlet Flurizan i foråret at lukke det store hul i selskabets pipeline.(...)

Kursmareridt for Lundbeck-aktionærer
business.dk 21.8.2008
Som det eneste af landet største selskaber har medicinalvirksomheden Lundbeck takket være fejlslagne produkter og tvivl om fremtiden ikke formået at levere et positivt afkast til aktionærerne i løbet af de sidste fem år. (...)

”Lundbeck har ikke fundet nogle væsentlige erstatninger for sine lægemidler og samtidig har selskabet fejlet alle de potentielle produkter, de havde på vej i deres pipeline, og det skaber usikkerhed om fremtiden,” siger Martin Parkhøi, der understreger, at Lundbeck også har undervurderet, hvor stor konkurrencen fra producenter af kopimedicin reel har været. (...)

Lundbecks fremtid skiller vandene
business.dk 12.8.2008
(...) I perioden 2012 til 2014 mister Lundbeck patentet på det milliardsælgende depressionsmiddel Lexapro/Cipralex. I en årrække har selskabet forsøgt at finde en erstatning for midlet, der alene står for næsten to tredjedele af selskabets omsætning. Men uden held. (...)

Lundbeck presses ud i gambling
Business.dk 31.7.2008
(...) Til trods for den yderst risikable satsning vil der dog ifølge analytikere ikke gå længe, før Valby-virksomheden igen bliver tvunget til at spille roulette for millioner og købe et potentielt lægemiddel, som har mindst lige så store chancer for at floppe, præcis som Flurizan gjorde.

”Lundbeck er presset til at købe produkter, der er så tæt på markedet som muligt, og er derfor tvunget til at betale tæt ved den maksimale pris.

Kan ikke følge med
Lundbeck er nemlig pisket til at købe nye produkter for at opveje det enorme tab, selskabet har, når det milliardsælgende middel Lexapro/Cipralex mister sit patent i 2012.

Men den danske virksomhed har hverken størrelsen eller kapital til at følge med medicinalbranchens helt tunge drenge, som snupper de bedste produkter for næsen af Lundbeck. (...)

Dansk medicinal-industri under pres
business.dk 1.7.2008
De danske medicinalselskaber er under benhård hård konkurrence for at udvikle og købe nye bestsellere

Verden over jagter store medicinalselskaber på linje med Lundbeck nye lægemidler, der kan få kasseapparaterne til at ringe. Lundbeck er faktisk i en ”luksus-situation” i forhold til bl.a. andre danske selskaber, siger Lundbecks topchef. (...)

Den hårde konkurrence og Lundbeck-chefens udtalelser understøttes af tal, som brancheforeningen Dansk Biotek offentliggjorde for knap to måneder siden. De viste således, at de store farmaselskaber i 2007 i snit havde købt 63 procent af deres potentielle lægemidler i sidste og tredje udviklingsfase eksternt, hvilket er en voldsom stigning siden 2002. (...)

Lundbeck går målrettet efter milliardmarked
business.dk 30.4.2008
Lundbeck har netop købt rettighederne til at sælge sovemidlet Circadin på en række større udenlandske markeder, som samlet set vurderes at have en værdi tæt på en milliard dollar.

Det danske medicinalselskab Lundbeck øjner en milliardforretning med sovemidlet Circadin. (...)

Eksport af medicin runder 40 mia.
business.dk 18.3.2008
De danske medicinalselskaber eksporterer lægemidler i hidtil uset omfang, og 2007 blev med en eksport på over 40 mia. kr. endnu et rekordår for branchen. Men for få produkter og svigtende tilskud truer den voldsomme vækst. (...)

Ifølge direktør i Lægemiddelindustrien (LIF) Ida Sofie Jensen, understreger branchen store eksportfremgang et skift fra traditionelle erhverv som landbrug og industri til mere videnstunge erhverv. (...)

Lundbeck under massivt pres
business.dk 7.3.2008
Ud over at skulle finde en ny direktør står Danmarks næststørste medicinalselskab over for en række store udfordringer den kommende tid. Se hvilke her. (...)

Her er Lundbecks vigtigste udfordringer:
Lundbeck skal hurtigst muligt finde et stof, der kan overtage stafetten fra deres storsælgende lykkepille Lexapro. Selskabet knytter indtil videre deres forhåbninger til stoffet LUA21004, som er i fase 2.

Men ingen ud over selskabet selv kender potentialet i det nye lægemiddel. Samtidig skal det have nogle markant bedre virkninger end de mange kopier på markedet, der typisk er langt billigere. (...)

Lundbeck lider under, at hvis de får LU AA21004 på gaden, så skal de hurtigt få de nuværende patienter ført fra Lexapro til det nye lægemiddel.

Problemet er blot, at hvor det er Forest Labs, der er partner på Lexapro, så er det selskabet Takeda, der står for salget af det nye middel. (...)

Lundbeck i ledelseslimbo
business.dk 5.3.2008
Claus Bræstrup kaster håndklædet i ringen og fratræder sin stilling som topchef i regnskabsaktuelle Lundbeck. Det efterlader selskabet i et stort ledelsesmæssigt tomrum. (...)

Medarbejderflugt hos Lundbeck
business.dk 4.3.2008
Lundbecks franske datterselskab har mistet 31 kernemedarbejdere. Krisen kan skade Lundbecks muligheder for at finde nye stoffer.

Medicinalselskabet Lundbeck har stadig svært ved at styre tropperne i det franske datterselskab. Det har over det sidste år mistet 31 ud af 36 ledende medarbejdere. (...)

Lundbeck får ingen blockbuster
business.dk 22.1.2008
Medicinalselskabet Lundbeck kan blive tvunget til at købe sig til en bredere pipeline, men flere analytikere understreger, at selskabet ikke vil komme i nærheden af en blockbuster i samme stil som depressionsmiddelet Lexapro. (...)

Resultater er "sindssygt vigtige" for Lundbeck
business.dk 2.10.2007
Lundbecks nye data fra fase II-studiet med depressionsmidlet Lu AA21004 viser ifølge administrerende direktør Claus Bræstrup "knivskarpe effekter" mod depression, og derfor vækker resultaterne glæde i den ellers pressede medicinalkoncern. (...)

Læs også - Lundbeck-aktien stiger kraftigt efter positivt studie (02.10.07)
- De her resultater er tæt på at være sindssygt vigtige. Studiet viser, at vi har knivskarpe effekter mod depression både på den lille og den høje dosis. Med andre ord er det det, der i fagsproget hedder robuste gode data, siger Claus Bræstrup til RB-Børsen. (...)

Drøje hug til Lindeløv om lederkrise i Lundbeck
business.dk 23.8.2007
Lundbecks bestyrelsesformand Flemming Lindeløv skaber usikkerhed om ledelsen i medicinalkoncernen, mener bl.a. Danske Bank. Lundbecks ejer, Lundbeckfonden, er gået »under jorden« i den særprægede uenighed i toppen af koncernen. (...)

»Ledelsen i Lundbeck burde hellere bruge al deres energi på at finde et produkt, der kan tage over efter Cipralex (den storsælgende antidepressive lykkepille, red.) frem for at slås indbyrdes. Det er meget tidligt at sætte fokus på en ny topchef med risiko for interne magtkampe i en længere periode. Derfor er det meget uheldigt, at der er ledelseskrise i et selskab, som i forvejen har nok at slås med,« siger Peter B. Andersen. (...)

SSRI-prepatater (lykkepiller) og kronisk tretthetssyndrom

Discontinuing or switching selective serotonin-reuptake inhibitors (Seponering eller bytte av selektive serotoninreopptakshemmere)
Ann Pharmacother. 2002 Apr;36(4):578-84
OBJECTIVE: To describe reasons for discontinuing or switching selective serotonin-reuptake inhibitors (SSRIs) at 3 and 6 months after starting treatment, and to identify information provided to patients that may help prevent premature discontinuation of medication. (...)

RESULTS: Significantly more patients discontinued or switched their SSRI because of an adverse effect within the first 3 months of starting (43%) compared with the second 3 months (27%; p = 0.023). The adverse effect most frequently reported as the reason for early discontinuation or switching was drowsiness/fatigue (10.2%), followed by anxiety, headache, and nausea - all at just over 5%. The odds ratio for discontinuation was 61% less in patients who recalled being told to take the medication for at least 6 months compared with those who did not (OR 0.39; p < 0.001). Patients who recalled being informed of potential adverse effects increased their reported incidence of mild to moderate adverse effects by 55% (OR 1.55; p < 0.05) without affecting rates of premature discontinuation (OR 1.06; p = 0.77). CONCLUSIONS: Adverse effects are the most frequent reason for discontinuing or switching SSRIs within the first 3 months of treatment. Patients are more likely to continue taking their antidepressant if they fully understand how long to take the medication. Informing patients of potential adverse effects does not appear to prevent premature discontinuation, but may increase the patient's awareness and reporting of mild to moderate adverse effects. (...)

SSRI Discontinuation Syndrome
about.com 22.10.2007
Part 1 - Cause and Effects
A scenario:
You've been on an SSRI antidepressant for five weeks or more. The doctor feels that the dosage needs to be decreased or the medication needs to be discontinued. He prescribes changes and tapering in the usual 10mg increments.

Within a couple of days of starting this, you begin to exhibit severe flulike symptoms - headache, diarrhea, nausea, vomiting, chills, dizziness and fatigue. There may be insomnia. Agitation, impaired concentration, vivid dreams, depersonalization, irritability and suicidal thoughts are sometimes occurring. These symptoms last anywhere from one to seven weeks and vary in intensity. You wonder what the heck is going on.

It's called SSRI discontinuation syndrome, and it can really be the pits. Here is what causes it:

Some SSRI medications have a very short half-life. (...)

- They describe these effects as a "nightmare" and like "torture."

Antidepressants Now No. 1 Drug Prescribed For Women 18-44
nbc4.com 16.11.2007
High Number Of Prescriptions Worrying Some Experts (...)

But not everyone is so lucky. In fact, about two-thirds of people on these drugs experience side effects, which can be severe and devastating.

Internet bloggers are even sharing their experiences with antidepressants online. They describe these effects as a "nightmare" and like "torture." Common reactions include "weight gain, decreased sex drive and severe stomach cramping."

"Something is going on with these drugs," Zuckerman said. "Not everybody metabolizes them the same way. It doesn't have the same effect on every person and some people are harmed by them."

Casalihno is now exercising to combat her depression. She says a pill wasn't the answer for her.

"I was overloaded with everything and I wasn't really addressing the root of the problems," Casalihno said. (...)

- Studie: Gentester ubrukelig for depresjon

SSRI-Sensitivity Gene Tests for Consumers Called 'Misleading'
medpagetoday.com 3.4.2008
(...) The problem is there's no evidence to support such claims, the researchers said, arguing that the federal government should take a more active role in regulating genetic tests marketed directly to consumers.

"Doctors as well as consumers need to be aware of the lack of oversight (by federal regulators) of genetic tests in general, as highlighted by the CYP450 tests," said Sara Katsanis, M.S., a co-author.

While most genetic tests on the market are only ordered by physicians, those sold directly to consumers are "particularly troubling," especially if marketing claims are misleading, the researchers said. (...)

Not Yet: CDC panel questions antidepressant gene test
sciencenews.org 22.12.2007
About half of all depressed people who take standard antidepressant drugs fail to improve. Some suffer unpleasant side effects and abandon the medicines, while others simply don't feel better. Commercial tests claim to predict, by a genetic analysis, how well individual patients will fare on different antidepressants, but a panel convened by the Centers for Disease Control and Prevention (CDC) in Atlanta now says that the tests don't work as advertised.
The panel "discourages" use of such tests until further studies clarify their value, according to a statement the group published in the December Genetics in Medicine. (...)

Evidence Doesn't Support CYP450 Gene Testing Before Antidepressant Treatment (Bevis støtter ikke CYP450-gentester før antidepressivabehandlng)
medicalnewstoday.com 20.12.2007
Cytochrome P450 (CYP450) gene testing is currently not recommended to guide treatment with selective serotonin reuptake inhibitor (SSRI) drugs for patients with depression, concludes an expert panel report in the December issue of Genetics in Medicine, published by the American College of Medical Genetics (ACMG) and by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"In the absence of supporting evidence, and with consideration of other contextual issues, EGAPP discourages use of CYP450 testing for patients beginning SSRI treatment until further clinical trials are completed," according to the statement by the independent Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group (http://www.egappreviews.org). The underlying EGAPP initiative was developed by the National Office of Public Health Genomics at the Centers for Disease Control and Prevention, with the goal of supporting evaluation of genetic tests and other genomic applications that are in transition from research to clinical and public health practice. (...)

Study: Gene tests no use for depression (Studie: Gentester ubrukelig for depresjon)
upi.com 4.1.2007
WASHINGTON, Jan. 4 (UPI) -- Using gene-based tests designed to personalize the dose of anti-depressants has not been shown to improve patient outcomes, a new U.S. study says.

The tests use genetic analysis to determine the right dose of selective serotonin reuptake inhibitors (SSRIs), a class of anti-depressants which includes Eli Lilly's Prozac.

But so far, there is little evidence to indicate the tests are useful, according to a new report funded by the Agency for Healthcare Research and Quality and the National Office of Public Health Genomics.

The tests themselves, which evaluate differences in genes that affect how fast a person metabolizes the drugs, were found to be accurate, according to the research by a team at Duke University. However, the researchers did not find any evidence that such tests led to improved patient outcomes or had an impact on treatment decisions for patients with depression. (...)

- Stressramte parkeres på lykkepiller

Stressramte parkeres på lykkepiller
politiken.dk 13.9.2008
Piller træder ind, hvor relevant behandling for stress mangler. Det koster pensionsselskaberne dyrt.

Kun hver femte dansker sygemeldt med stress er i en relevant behandling efter tre måneder. (...)

Dermed varetager det offentlige ikke pligten til at få de sygemeldte tilbage i job, lyder anklagen fra de store pensionsselskaber, som nu vil gå det offentlige i bedene, skriver Morgenavisen Jyllands-Posten. (...)

Det koster pensionsselskaberne dyrt i form af øgede erstatninger.

»Alt for mange mennesker med stressrelaterede psykiske lidelser får ikke relevant behandling. De er i en svær situation og får lykkepiller, men medicin gør det ikke alene. Det er afgørende, at vi bliver bedre til at håndtere de psykisk syge,« siger underdirektør i PFA Pension Anette Damgaard.

Hun efterlyser bedre samarbejde mellem kommuner, læger, virksomheder og pensionsselskaber. (...)

Veteraner som tar PTSD-legemidler dør under søvn

Vets taking PTSD drugs die in sleep (Veteraner som tar PTSD-legemidler dør under søvn)
wvgazette.com 25.5.2008
Hurricane man's death the 4th in West Virginia

A Putnam County veteran who was taking medication prescribed for post-traumatic stress disorder died in his sleep earlier this month, in circumstances similar to the deaths of three other area veterans earlier this year.

Derek Johnson, 22, of Hurricane, served in the infantry in the Middle East in 2005, where he was wounded in combat and diagnosed with post-traumatic stress disorder while hospitalized.

Military doctors prescribed Paxil, Klonopin and Seroquel for Johnson, the same combination taken by veterans Andrew White, 23, of Cross Lanes; Eric Layne, 29, of Kanawha City; and Nicholas Endicott of Logan County. All were in apparently good physical health when they died in their sleep.

Johnson was taking Klonopin and Seroquel, as prescribed, at the time of his death, said his grandmother, Georgeann Underwood of Hurricane. Both drugs are frequently used in combination to treat post-traumatic stress disorder. Klonopin causes excessive drowsiness in some patients. (...)

(Anm: Antidepressiva (REM-søvn). (mintankesmie.no).)

Veterans' families question cause of deaths
wvgazette.com 1.3.2009
Post-traumatic stress syndrome treatment cited

CHARLESTON, W.Va. -- Stan and Shirley White's son Andrew, a Marine reservist, died at home 2 1/2 years after he returned from Iraq. Janette Layne lost her husband, Eric, in similar circumstances after his return from Iraq.

More than a year later, they still don't know if the medication their loved ones were taking for post-traumatic stress disorder contributed to their deaths. (...)

The prescriptions were given by doctors at VA facilities in Huntington, Charleston and a residential program in Cincinnati where Layne had just completed an eight-week in-patient treatment. White's doctor instructed him to take as much Paxil and Seroquel as needed, Shirley White said.

"They said he had lethal amounts in his system," she said. "So, no, we don't have answers."

A second look
Stan White hopes to convince policy-makers in Washington to take a second look at pharmaceuticals prescribed to PTSD sufferers.

How safe are the combinations? How carefully should they be dosed? Should people with PTSD, which sometimes includes forgetfulness and memory loss, be given prescriptions that require careful monitoring? (...)

(Anm: Paxil (Seroxat; generisk navn paroxetine; paroksetin i Norge).

Antidepressiva (SSRI-er) mer enn fordobler risiko for øyesykdom

For Men Over 50, Odds of Eye Discomfort Increases (Ubehag i øye øker for menn over 50)
healthfinder.gov 12.6.2009
Use of antidepressants and other medications raise risk, study says.

FRIDAY, June 12 (HealthDay News) -- Here's more bad news for men turning 50: After their half-century mark, about 4 percent of males develop dry eye disease, making it one of the most common eye conditions and reasons for seeing an eye doctor in the United States, researchers say.

Dry eye disease causes a persistent dryness, itching or burning sensation in the eyes, according to the North American Neuro-Ophthalmology Society. Some people with dry eye disease also say that it feels like they have sand or grit in their eye.

While research has shown the condition is more common among women, about 1.68 million men over age 50 in the United States have it, Debra A. Schaumberg of Brigham and Women's Hospital in Boston and colleagues noted in the June issue of the Archives of Ophthalmology.

Among men, increasing age, high blood pressure, benign prostatic hyperplasia (a noncancerous enlargement of the prostate) and the use of antidepressants increase the chances of developing dry eye disease, the study authors explained.

"It is an important public health problem, causing increased risk of ocular infections and bothersome symptoms of ocular discomfort, fatigue and visual disturbance that interfere with crucial activities, such as reading, working on a computer and driving a car," Schaumberg and colleagues wrote. (...)

(Anm: Prevalence of Dry Eye Disease Among US Men. Arch Ophthalmol. 2009;127(6):763-768. (June).)

Prevalence of Dry Eye Disease Among US Men. (Forekomst av tørre øyne hos amerikanske menn)
Arch Ophthalmol. 2009;127(6):763-768. (June)
Objective To estimate the prevalence and risk factors for dry eye disease (DED) among US men. (...)

Conclusions Dry eye disease is prevalent and increases with age, hypertension, benign prostatic hyperplasia, and antidepressant use. (...)

Thus, in this subgroup, we further evaluated possible associations with reported use of medications for treatment of benign prostatic hyperplasia and hypertension, as well as reported use of antidepressants and statin medications. Finally, we also had information on diagnosis of rheumatoid arthritis in this subgroup and evaluated its association with DED. (...)

Thus, in this subgroup, we further evaluated possible associations with reported use of medications for treatment of benign prostatic hyperplasia and hypertension, as well as reported use of antidepressants and statin medications. Finally, we also had information on diagnosis of rheumatoid arthritis in this subgroup and evaluated its association with DED. (...)

In addition, men who used antidepressants had a nearly 2-fold higher risk of DED compared with men who did not use these drugs (OR, 1.90; 95% CI, 1.39-2.61). (...)

Hypertension and benign prostatic hyperplasia are associated with an increase in the prevalence of DED in this population. Medications associated with DED included drugs to treat hypertension and benign prostatic hyperplasia and antidepressants. (...)

We observed a strong association between the use of antidepressant medications and risk of DED, a finding consistent with data from at least 2 other epidemiological studies.^{30 31} In contrast, dry eye is not common in the reporting of clinical trials of antidepressant drugs, whereas dry mouth is prevalent.^{32 33} However, this may be a methodological issue, as adverse effects in such trials are often assessed by spontaneous reporting by patients or by closed-ended lists that do not include dry eye.³⁴ For example, a recent study presented patients with a list of 17 common adverse effects reported by patients taking antidepressants. The only ocular symptom on the list was blurred vision, which was reported by 11% of patients. In light of the knowledge that DED is known to cause fluctuating visual blur, one wonders whether the blurred vision reported by patients could have been due at least in part to DED. (...)

- Här får du ett medel och dina personlighetsdrag kommer att förändras

Antidepressants Make Shrimps See the Light (Antidepressiva får reker til å se lyset)
sciencedaily.com 12.7.2010
ScienceDaily (July 12, 2010) — Rising levels of antidepressants in coastal waters could change sea-life behaviour and potentially damage the food-chain, according to a new study. (...)

Research into the behaviour of shrimps exposed to the antidepressant fluoxetine, showed that their behaviour is dramatically affected. The shrimps are five times more likely to swim toward the light instead of away from it -- making them more likely to be eaten by fish or birds, which could have devastating effects on the shrimp population. (...)

Dr Ford's research was motivated by a species of parasite which can alter the behaviour of aquatic creatures through changing serotonin levels within the brains of the organisms. Serotonin is a neuro-hormone found in many animals, including humans, known to control types of behaviour, such as modulating mood and decreasing anxiety.

Drugs to combat depression in humans are often designed to target levels of serotonin which led to the question of whether they could also alter the behaviour of marine organisms.

Dr Ford said: "Effluent is concentrated in river estuaries and coastal areas, which is where shrimps and other marine life live -- this means that the shrimps are taking on the excreted drugs of whole towns." (...)

(Anm: Anti-depressants make amphipods see the light. Aquatic Toxicology 2010 (Jun 4).)

Prozac Pollution Making Shrimp Reckless (Prozac forurensning gjør reker likeglad)
news.nationalgeographic.com 17.6.2010
Antidepressant's key ingredient is flushed into coastal waters, study says.

There's no happy ending for shrimp exposed to the mood-booster Prozac, according to a new study.

Remnants of antidepressant drugs flushed into waterways worldwide are altering shrimp behavior and making them easier prey, experts say.
(See "Cocaine, Spices, Hormones Found in Drinking Water.")

To mimic conditions in the wild, scientists exposed the estuary-dwelling shrimp Echinogammarus marinus to the antidepressant fluoxetine at levels detected in average sewage-treatment waste. Fluoxetine is the key ingredient in the drugs Prozac and Sarafem.

Shrimp normally gravitate toward safe, dark corners. But when exposed to fluoxetine, the animals were five times more likely to swim toward a bright region of water, the team discovered.

"This behavior makes them much more likely to be eaten by a predator, such as a fish or bird," said study co-author Alex Ford, a biologist at U.K.'s University of Portsmouth.

The fluoxetine likely makes shrimp's nerves more sensitive to serotonin, a brain chemical known to alter moods and sleep patterns, according to the study, recently published in the journal Aquatic Toxicology. (...)

Medicin ändrar personligheten
sr.se 8.12.2009
En typ av antidepressiva medel, så kallade SSRI preparat, ger en personlighetsförändring. Det handlar om minskad ängslighet. Det visar en mindre amerikansk studie på totalt 240 personer. (...)

Elias Eriksson som är professor i farmakologi vid i Göteborg. Han menar att problemet är att SSRI preparat först lanserades som antidepressiva läkemedel, även om de inte har störst effekt där. De ska absolut inte ska användas för personer som är ledsna:

– Om man är ledsen av yttre orsaker bör man inte äta sådant här. Det tror jag är ett av de vanligaste felen till överförskrivning, det är att man skriver ut det här till personer som varken har någon depressions sjukdom eller något ångesttillstånd utan som har en nedstämdhet orsakad av yttre omständigheter. Då ska man inte förskriva de här medlen. Däremot vid depression eller ångettillstånd bör de användas.

Men kan du förstå då om det kan låta obehagligt för personer att höra "här får du ett medel och dina personlighetsdrag kommer att förändras"? (...)

(Anm: Personality Change During Depression Treatment. Arch Gen Psychiatry. 2009;66(12):1322-1330 (December).)

(Anm: personlighetsendring; varig endring i en persons måte å tenke, reagere og være på i personlige og sosiale situasjoner (jfr. personlighet). (…)

Årsaker - Personlighetsendring kan være forårsaket av legemlige sykdommer eller skader som rammer hjernen (bl.a. organisk betingede psykiske lidelser som f.eks. demens), skyldes langvarig misbruk av stoff eller andre rusmidler (f.eks. alkohol), eller forekomme som en del av utviklingen av en alvorlig psykisk lidelse som f.eks. schizofreni. Tilstander som kan minne om varig personlighetsendring, finnes også hos psykologisk sett selvusikre, søkende individer som på jakt etter klare verdier og med behov for å tilhøre et fellesskap trekkes inn i enkelte ekstreme religiøse bevegelser. Kilde: Store norske leksikon.)

(Anm: SSRI-utløst aggresjon? (mintankesmie.no).)

Antidepressiva kan endre din personlighet
nrk.no 7.12.2009
Ifølge en studie utført på vegne av det amerikanske helsevesenet kan medisiner med virkestoffet Paroxetine gjøre folk både mindre nevrotiske og mer utadvendte, skriver Reuters.

Paroxetine finnes i blant annet Paroxat, Paroxetin og Seroxat, som selges som reseptbelagte midler i Norge. (...)

- Det er en dramatisk forskjell, sier Tang, og forklarer at man tidligere har trodd at endring i personligheten kom fordi man fikk depresjonen mer under kontroll. (...)

Antidepressiva linket til økt risiko for katarakt (cataract)

Researchers: Cataracts a Potential Paxil Side Effect (Forskere: Katarakt en mulig bivirkning av Seroxat (Paxil))
lMontreal, QC A study suggests that the list of Paxil side effects, which already includes an increased risk of birth defects, should be updated to include cataracts. Meanwhile, a different study suggests that Paxil and other selective serotonin reuptake inhibitors (SSRIs) may not be as effective at treating depression as once thought. (...)

Recently, a review of safety trials of SSRIs sent to the US Food and Drug Administration (FDA) suggests that SSRIs may be only marginally better than a placebo at treating depression. Placebos—usually sugar pills—are given to some patients in a trial to determine whether the medication is actually working or if it only appears to be working because the patient expects it to have an effect.

When researchers analyzed a trial called STAR*D (Sequenced Treatment Alternatives to Relieve Depression), they found that only 2.7 percent of participants experienced a sustained benefit from taking an SSRI—meaning that most participants either relapsed or dropped out by the end of the study.

The study, published in the August issue of Psychotherapy and Psychosomatics, does not say there is no benefit to taking SSRIs. In fact, there may still be some benefit to the medications. But it indicates that patients and their doctors should consider other courses of action rather than simply taking the SSRIs. (...)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

New Study Suggests Effexor Side Effects May Include Cataracts (Ny studie tyder på at sideeffekter for Effexor kan inkludere katarakt)
lawyersandsettlements.com 3.4.2010
Vancouver, BC: A new study has found that an increased risk of cataracts may be one of many previously unreported Effexor side effects.

Researchers from British Columbia and Quebec examined around 205,700 Quebec residents aged 65 and older, 18,700 with cataracts and 187,000 without cataracts, to draw a statistical analysis of this population. According to the Vancouver Sun, researchers found a substantial link between cataract diagnosis or surgery and the usage of antidepressant medications, like selective serotonin reuptake inhibitors (SSRIs).

Resultatene av studien tyder på en 34 prosent økning i risiko for utvikling av katarakt for de som tar Effexor; økningen i katarakt for de som tar Seroxat var 23 prosent. Forskerne håper å studere dette fenomenet nærmere i fremtiden. (...) (The results of the study suggests a 34 percent increase in the risk of developing cataracts for those taking Effexor; the increase in cataract risk for those taking Paxil was 23 percent. Researchers hope to study this phenomenon more closely in the future.)

(Anm: Efexor / Effexor (venlafaxine) - Pristiq (desvenlafaxine) (mintankesmie.no).)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

(Anm: katarakt; grå stær; cataracta, (av gr. 'foss') øyesykdom der linsen i øyet er fordunklet og ugjennomsiktig. Tidligere trodde man tilstanden skyldtes at grå væske rant ned som en foss foran øyets linse og stivnet der med blindhet til følge. Oftest utvikles grå stær uten kjent årsak hos eldre mennesker, cataracta senilis. I andre tilfeller er grå stær en følge av andre sykdommer, f.eks. sukkersyke, kronisk betennelse i regnbuehinnen, sviktende skjoldbruskkjertelfunksjon og radioaktiv stråling. Grå stær kan også være medfødt, cataracta congenita, f.eks. der moren har hatt røde hunder i løpet av første 3 måneder av svangerskapet.

Grå stær er og har alltid vært en av våre vanligste og mest utbredte øyesykdommer. Tilstanden sees også hos dyr. Tidligere var grå stær fryktet som en hyppig årsak til blindhet. Kilde: Store norske leksikon.)

(Anm: Øyesykdommer (øyner er sjelens vindu). (mintankesmie.no).)

Anti-depressant Use Linked to Higher Risk of Cataracts (Antidepressiva linket til økt risiko for katarakt)
calorielab.com/labnotes 9.3.2010
A statistical relationship between the use of SSRIs and the incidence of cataracts has been shown by researchers at the University of British Columbia, Vancouver Coastal Health Research Institute and McGill University. Researchers, using a database of more than 200,000 people aged 65 and older, found that patients who take SSRIs were about 15 percent more likely to have cataracts than those who did not take them. (...)

Cataracts World's Leading Cause of Vision Loss (Katarakt verdens ledende årsak til synstap)
abcnews.go.com 30.8.2008
Age a key factor, but group cites other risks during August disease awareness month.

FRIDAY, Aug. 29 (HealthDay News) -- Cataracts -- the leading cause of vision loss and blindness in the United States and the world -- affect more than 22 million Americans aged 40 and older, says Prevent Blindness America.

Each year in the United States, about $6.8 billion is spent on direct medical costs for outpatient, inpatient and prescription drug services for cataracts, according to a study funded by the group, which has designated August as Cataract Awareness Month. It's projected that more than 30.1 million Americans will have cataracts by 2020. (...)

"Cataract is something that most of us will develop at some point in our lives. The key is to understand what we can do now to help protect our vision in the future," Hugh R. Parry, president and CEO of Prevent Blindness America, said in a news release from the organization.

Age is the major risk factor for cataract, but there are several other possible risk factors, such as:

• Intense heat or long-term exposure to UV rays from the sun.
• Certain diseases, such as diabetes.
• Inflammation in the eye.
• Genetics.
• Long-term steroid use.
• Eye injuries and eye diseases.
• Smoking.
• Pre-birth factors, such as German measles in the mother.

Surgery to remove cataracts has a 95 percent success rate and is the most frequently performed surgery in the United States. Each year, about 3 million Americans have cataract surgery, according to Prevent Blindness America. (...)

Tørre øyner blir ofte oversett

'Dry eye' dangers are often missed
usatoday.com 25.7.2006
Nancy Frankhouser's eyes itched and became irritated when she traveled to New York, Los Angeles, San Francisco and London during the past four years. She finally knows why.

"I never knew I suffered from dry eye until my last appointment with my ophthalmologist about six months ago," says the retired health care executive, 70, who travels to New York and London every year.

"I felt the discomfort but just thought it was part of the aging process."
Most of the more than 20 million Americans who have dry eye don't know they have it and blame their eye problems on other factors, says Marguerite McDonald, a surgeon in Long Island, N.Y., who performed the world's first laser eye surgery. The condition afflicts twice as many women as men and is found more commonly in menopausal women, older people, contact lens wearers, computer users and people who are taking medication.

Dry eye occurs when eyes do not produce the right amount or quality of tears.
It can cause blurred vision, sensitivity to light and a sensation that a foreign object is in the eye. It most often occurs in the summer and is aggravated by the environment of many cities. (...)

Psykiater dømt til drøyt 8 års fengsel for svindel bl.a. i Seroxat-forsøk

Maria Carmen Palazzo: Debarment Order (Maria Carmen Palazzo: Kjennelse om utelukkelse)
federalregister.gov 28.3.2011
The Food and Drug Administration (FDA) is issuing an order under the Federal Food, Drug, and Cosmetic Act (the FD&C Act) permanently debarring Maria Carmen Palazzo, M.D. from providing services in any capacity to a person that has an approved or pending drug product application. We base this order on a finding that Dr. Palazzo was convicted of felonies under Federal law for conduct relating to the development or approval, including the process for development or approval, of any drug product or otherwise relating to the regulation of any drug product under the FD&C Act. Dr. Palazzo was given notice of the proposed permanent debarment and an opportunity to request a hearing within the timeframe prescribed by regulation. (...)

FDA's finding that debarment is appropriate is based on the felony convictions referenced herein for conduct relating to the development or approval, including the process for development or approval, of any drug product and otherwise relating to the regulation of any drug product under the FD&C Act. The factual basis for those convictions is as follows: Dr. Palazzo was a licensed medical doctor with offices located in New Orleans, Louisiana. SmithKline Beecham, Corporation, d.b.a. GlaxoSmithKline (SKB) was a pharmaceutical company engaged in developing, testing, and marketing pharmaceutical products including Paroxetine, also known as “Paxil.” Under the FD&C Act and its implementing regulations, SKB had to apply to FDA for approval to market Paxil. SKB was required to demonstrate, through clinical investigations in which Paxil was given to human subjects, the safety and effectiveness of the drug in order to receive approval from FDA. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Paxil Researcher Pleads Guilty to Charges (Seroxat-forsker erklærer seg skyldig i anklager)
lawyersandsettlements.com 2.9.2010
Washington, DC: GlaxoSmithKline er gjenstand for mer dårlig publisitet etter at en forsker angivelig har forfalsket data i forsøk på Seroxat (Paxil). Samtidig er legemiddelfirmaet saksøkt grunnet påstander om at nyfødte er påført fødselsskader grunnet eksponering for Seroxat (Paxil) i svangerskapet. (Washington, DC: GlaxoSmithKline is the subject of more bad publicity after a researcher was allegedly found to have falsified data in trials about Paxil. Meanwhile, the drug maker faces lawsuits alleging newborns suffered Paxil Birth defects when they were exposed to Paxil prior to birth.)

The psychiatrist who reportedly falsified clinical data, Dr. Maria Carmen Palazzo, was a clinical investigator on studies conducted by SmithKline Beecham (doing business as GlaxoSmithKline). According to CNBC on 8/20/10, Palazzo has now pleaded guilty to 15 counts of failing to prepare and maintain records with the intent to defraud and mislead.

Palazzo reportedly included children in a study that involved diagnoses the children did not have. Prosecutors claimed that Palazzo also reported symptoms that her study subjects did not exhibit. She was sentenced to 13 months in prison, which she is serving at the same time as an 87-month term for healthcare fraud.

Ifølge BNET (08/19/10) ble Palazzo anklaget av den amerikanske legemiddelkontrollen FDA (Federal Drug Administration) for hennes innrullering av barn i studier med tvangslidelser (OCD) og tyngre depressive lidelser til tross for at barna hun undersøkte ikke hadde en egnet diagnose for inkludering i studien. (According to BNET (08/19/10), Palazzo was charged after the Federal Drug Administration (FDA) accused her of enrolling children in studies of obsessive-compulsive disorder and major depressive disorder even though the children she studied did not have the proper diagnosis for inclusion in the study.)

Paxil now carries a black box warning about the risk of suicide in children. It also carries a warning about the risk of birth defects in babies exposed to the antidepressant prior to birth. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Jailed psychiatrist pleads guilty (Fengslet psykiater erkjenner seg straffeskyldig)
cnbc.com 20.8.2010
NEW ORLEANS – En 58 år gammel psykiater involvert i to kliniske forsøk som evaluerte legemidlet Seroxats (Paxils) sikkerhet og effekt hos barn og ungdommer har i forbindelse med disse kliniske forsøk erkjent seg straffeskyldig på 15 statlige tiltalepunkter for manglende utarbeidelse og oppfølging av protokoller, med den hensikt å bedra og villede. (NEW ORLEANS - A 58-year-old psychiatrist involved in two clinical trials evaluating the drug Paxil's safety and effectiveness in children and adolescents has pleaded guilty to 15 federal counts of failing to prepare and maintain records, with intent to defraud and mislead, in connection with those clinical trials.)

Dr. Maria Carmen Palazzo var klinisk forsker hos SmithKline Beecham som utførte arbeider under GlaxoSmithKline. Aktorene sa at hun i løpet av disse studier inkluderte psykiatriske diagnose uten overensstemmelse med pasienters psykiatriske historier; utarbeidet atskillige psykiatriske evalueringer på studiedeltakere som inneholdt forskjellige diagnoser og rapporterte symptomer hun visste studiedeltakerne ikke hadde. (Dr. Maria Carmen Palazzo was a clinical investigator for SmithKline Beecham doing business as GlaxoSmithKline. Prosecutors say that during those studies she included psychiatric diagnoses inconsistent with patients' psychiatric histories; prepared multiple psychiatric evaluations on study patients which contained different diagnoses and reported symptoms she knew the study subject did not demonstrate.)

Hennes tilståelse kom torsdag for den amerikanske distriktsdommeren Mary Ann Vial Lemmon, som dømte henne til 13 måneders fengsel. Denne tiden løper samtidig som hun soner en fengselsdom på 87-måneders for svindel innen helsevesenet. (...) (She entered the plea Thursday before U.S. District Judge Mary Ann Vial Lemmon, who sentenced her to 13 months in prison. That term will run at the same time as her current 87-month prison term for health care fraud.)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

(Anm: Uredelighet og fusk i medisinsk forskning. (mintankesmie.no/).)

JAILED PSYCHIATRIST PLEADS GUILTY AND IS SENTENCED ON CHARGES OF FALSIFIED RECORDS OF CLINICAL TRIALS INVOLVING CHILDREN (FENGSLET PSYKIATER ERKLÆRER SEG SKYLDIG OG ER DØMT FOR ANKLAGER OM FORFALSKNING AV JOURNALER FOR KLINISKE FORSØK SOM INVOLVERER BARN)
justice.gov 19.8.2010
DR. MARIA CARMEN PALAZZO, age 58, pled guilty in federal court today before U. S. District Judge Mary Ann Vial Lemmon to fifteen (15) counts of failing to prepare and maintain records, with intent to defraud and mislead, in connection with clinical trials to evaluate the efficacy and safety of Paxil in children and adolescents with Obsessive-Compulsive Disorder (OCD), announced U. S. Attorney Jim Letten.

According to court documents, PALAZZO, who specialized in psychiatry, was a clinical investigator for SmithKline Beecham d/b/a GlaxoSmithKline, was involved in two clinical trials evaluating Paxil’s safety and effectiveness in children and adolescents. Some of the study records indicated that PALAZZO included psychiatric diagnoses inconsistent with patients’ psychiatric histories; prepared multiple psychiatric evaluations on study patients which contained different diagnoses and treatment plans; reported symptoms of OCD when PALAZZO knew that the study subject did not demonstrate such symptoms; and reported that PALAZZO examined study subjects when she had not.

PALAZZO is currently serving an 87 month prison sentence after being convicted of 39 counts of health care fraud following a 12-day trial in April 2008. In the instant case, PALAZZO was sentenced to thirteen (13) months in prison to run concurrent to the previous sentence as well as serve one (1) year of supervised release during which time she will be under federal supervision and risk additional imprisonment should she violate any rulesof the release. Additionally, PALAZZO was ordered to pay restitution to GlaxoSmithKline in the amount of $91,824 and $1,500 in special assessments.

The case was investigated by the Food and Drug Administration’s Office of Criminal Investigations, U. S. Department of Health and Human Services, Office of Inspector General, the Federal Bureau of Investigation and the Louisiana Medicaid Fraud Control Unit.

The case was prosecuted by Assistant U. S. Attorney Patrice Harris Sullivan, the Health Care Fraud Coordinator in this District.

(Download Factual Basis) (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

10 Years Later, Glaxo Still Haunted by Faked Studies of Paxil in Kids (Glaxo 10 år senere fortsatt hjemsøkt av forfalskede studier på Seroxat hos barn)
bnet.com 19.8.2010
A crooked doctor who faked data in a GlaxoSmithKline (GSK) study of the antidepressant Paxil in children pled guilty to criminal charges today, causing groans among GSK’s senior management as the company hopes to fend off a different criminal investigation into whether it manipulated clinical data on its diabetes drug, Avandia. She was sentenced to 13 months in prison. (...) (A crooked doctor who faked data in a GlaxoSmithKline (GSK) study of the antidepressant Paxil in children pled guilty to criminal charges today, causing groans among GSK’s senior management as the company hopes to fend off a different criminal investigation into whether it manipulated clinical data on its diabetes drug, Avandia. She was sentenced to 13 months in prison.)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Psychiatrist indicted for fraud in Paxil trials (Psykiater anklaget for svindel i Seroxat-forsøk)
dailycomet.com 14.6.2007
NEW ORLEANS Dr. Maria Carmen Palazzo was indicted by a federal grand jury on 55 counts of health care fraud and false documentation in connection with a clinical trial of Paxil in children and adolescents, U.S. Attorney Jim Letten said on Thursday. (...)

According to the indictment, Palazzo, as a clinical investigator for SmithKline Beecham doing business as GlaxoSmithKline, fraudulently failed to maintain and prepare records required by the FDA for evaluation the drug's safety and effectiveness in children and adolescents.

If convicted, Palazzo faces a maximum term of 445 years, and a fine of $10.15 million, Letten's office said. (...)

(Anm: paroksetin (parxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

- Antikolinerge effekter av vanlige legemidler knyttet til økt dødelighet

OBS! på medicin med antikolinerg effekt
irf.dk 31.8.2011 (Institut for Rationel Farmakoterapi (IRF)
Et epidemiologisk studie med ca.13.000 ældre viser, at medicin med antikolinerg effekt svækker den kognitive funktion og muligvis resulterer i øget mortalitet (1). Medicin med antikolinerg effekt er fx urologiske spasmolytika, tricykliske antidepressiva, samt visse antipsykotika og ældre antihistaminer. (...)

(Anm: Anticholinergic syndrome (scribd.com).)

(Anm: Anticholinergic Medication Use and Cognitive Impairment in the Older Population: The Medical Research Council Cognitive Function and Ageing Study. Journal of the American Geriatrics Society 2011 (24 JUN).)

Risky mix
indianexpress.com 3.3.2012
Many people are unaware that dozens of painkillers, antihistamines and psychiatric medications - from drugstore staples to popular antidepressants - can adversely affect brain function, mostly in the elderly. Regular use of multiple medications that have this effect has been linked to cognitive impairment and memory loss.

Called anticholinergics, the drugs block the action of the neurotransmitter acetylcholine, sometimes as a direct action, but often as a side effect.

cetylcholine is a chemical messenger with a range of functions in the body, memory production and cognitive function among them.
The difficulty for patients is that the effect of anticholinergic drugs is cumulative. Doctors are not always aware of all of the medications their patients take, and they do not always think to review the anticholinergic properties of the ones they prescribe. It’s a particular problem for older patients, who are more vulnerable to the effects of these drugs and who tend to take more medicines overall.

After following more than 13,000 British men and women or older for two years, researchers found that those taking more than one anticholinergic drug scored lower on tests of cognitive function than those who were not using any such drugs, and that the death rate for the heavy users during the course of the study was 68 per cent higher.

That finding, reported last July in The Journal of the American Geriatrics Society, stunned the investigators. (...)

(Anm: Anticholinergic syndrome (scribd.com).)

(Anm: Anticholinergic Medication Use and Cognitive Impairment in the Older Population: The Medical Research Council Cognitive Function and Ageing Study. Journal of the American Geriatrics Society 2011 (24 JUN).)

Anticholinergic Meds May Impair the Brain (Antikolinerge legemidler kan svekke hjernen)
northcarolinainjurylawyerblog.com 27.2.2012
Are some popular drugs, in fact, dangerous drugs? According to The New York Times, many people don’t realize that there are dozens of antihistamines, painkillers, and psychiatric medications that can negatively impact the brain—especially if the person is elderly. The Times reports that taking more than one of the medications that can have this effect may lead to memory loss and cognitive impairment.

These drugs, known as anticholinergics, block the neurotransmitter acetylcholine, which is usually tasked with a number of bodily functions (including cognitive function and memory production.) The drugs’ effects are cumulative. (...)

Cocktail of Popular Drugs May Cloud Brain (Cocktail av populære legemidler kan gjøre hjernen uklar eller sløret (kognitiv svekkelse))
well.blogs.nytimes.com 27.2.2012
Many people are unaware that dozens of painkillers, antihistamines and psychiatric medications — from drugstore staples to popular antidepressants — can adversely affect brain function, mostly in the elderly. Regular use of multiple medications that have this effect has been linked to cognitive impairment and memory loss.

Called anticholinergics, the drugs block the action of the neurotransmitter acetylcholine, sometimes as a direct action, but often as a side effect. Acetylcholine is a chemical messenger with a range of functions in the body, memory production and cognitive function among them.

The difficulty for patients is that the effect of anticholinergic drugs is cumulative. Doctors are not always aware of all of the medications their patients take, and they do not always think to review the anticholinergic properties of the ones they prescribe. It’s a particular problem for older patients, who are more vulnerable to the effects of these drugs and who tend to take more medicines over all.

Now a spate of new research studies has focused on anticholinergic medicines.

After following more than 13,000 British men and women 65 or older for two years, researchers found that those taking more than one anticholinergic drug scored lower on tests of cognitive function than those who were not using any such drugs, and that the death rate for the heavy users during the course of the study was 68 percent higher. (...)

Even Mild Cognitive Impairment Predicts Early Death (Selv mild kognitiv svekkelse kan forutsi tidlig død)
medscape.com 6.9.2011
— Even mild cognitive impairment has a strong independent impact on life expectancy, on the same order as other chronic diseases, such as diabetes, according to a new study.

In nearly 4000 older adults, mild and moderate to severe cognitive impairment at baseline was associated with an increased risk for death over roughly the next decade after controlling for other mortality risk factors.

Identifying all types of cognitive impairment in primary care practices should be given a "higher priority," the study team concludes in a report published in the September 6 issue of the Annals of Internal Medicine. (...)

(Anm: Cognitive Impairment: An Independent Predictor of Excess Mortality. Annals of Internal Medicine 2011;155(5):300-308 (September 6).)

Anticholinergic effects of common drugs are associated with increased mortality in over 65s (Antikolinerge effekter av vanlige legemidler knyttet til økt dødelighet hos mennesker over 65)
BMJ 2011; 342:d4037 (28 June)
The combined anticholinergic effects of many common drugs increase the risk of cognitive impairment and death in people aged over 65, a large scale study of the long term effect of drugs on health has found.

Taking just two drugs with anticholinergic effects, such as some drugs for heart disease, antihistamines, antidepressants, antipsychotics, and even warfarin, can treble the risk of death in the over 65s. Doctors have been advised to assess the combined anticholinergic burden of all drugs that a patient is taking—prescribed drugs and those bought over the counter—before prescribing any additional ones. GPs have also been reminded of the importance of regularly reviewing patients’ drugs.

The study, published in the Journal of the American Geriatrics Society on Friday (http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2011.03491.x/abstract), looked at the prescribed drugs and drugs bought over the counter taken by more than 13 000 people aged over 65 in the United Kingdom during the early 1990s.

A total of 86 drugs were identified as having an anticholinergic effect, and around half the patients were found to be taking at least one. Each drug was given an anticholinergic burden (ACB) score on the basis of the strength of its anticholinergic activity, with 0 being no effect, 1 a mild effect, 2 a moderate effect, and 3 a severe effect. The cumulative ACB score for each patient was then worked out. (...)

A study in the United States looking at the anticholinergic effects of drugs on younger patients in intensive care is expected to report soon. (...)

(Anm: Antidepressiva (nytteverdi) (mintankesmie.no).)

(Anm: antikolinerge midler, midler som hemmer det parasympatiske nervesystem (parasympatolytika) eller virkningen av acetylkolin og andre kolinerge stoffer på muskarinreseptorer (muskarinfølsomme kolinerge reseptorer) både perifert og i sentralnervesystemet. (...) Brukes bl.a. for å motvirke spasmer i glatt muskulatur (steinsmerter, kolikksmerter), for å hemme spyttsekresjon (bl.a. under generell anestesi), ved parkinsonisme, ved astma (ipatropin til inhalasjon), bevegelsessyke (skopolamin) og forgiftning med nervegass. Kilde: Store norske leksikon.)

Drugs may increase risk of mental decline, say Norwich scientists (Legemidler kan øke risiko for mental svekkelse, ifølge forskere fra Norwich)
edp24.co.uk 25.6.2011
(...) The findings have been published in the Journal of the American Geriatrics Society following a study of more than 13,000 people aged over 65.

Led by researchers at the University of East Anglia, the two-year research project has shown that a side-effect of many drugs commonly used to treat depression, bladder or heart problems, epilepsy and glaucoma appears to increase the risks of both cognitive impairment and death in older people.

Findings of the study have been revealed as part of a drive to find ways of reducing risk factors for dementia which affects 820,000 people in the UK. (...)

Some of the most dangerous (score three) drugs are commonly available, including the antihistamines chlorphenamine (used in the brand Piriton) and promethazine (used in Phenergan), anti-depressants amitriptyline (used in several brands) and paroxetine (used in Seroxat) and the incontinence drug oxybutynin (used in Ditropan).

The study has been welcomed by leading dementia research charity but patients have been warned not to stop taking their medication but to speak to their doctor if they are concerned.

Susanne Sorensen, head of research at the Alzheimer’s Society, said: “This robust study provides valuable findings, and must be taken seriously. However, it is vital that people do not panic or stop taking their medication without consulting their GP.” (...)

“The known side-effects of anticholinergic medicines are described in the product information for prescribers and in patient information leaflets. (...)

(Anm: Anticholinergic syndrome (scribd.com).)

(Anm: Anticholin ment in the Older Population: The Medical Research Council Cognitive Function and Ageing Study. Journal of the American Geriatrics Society 2011 (24 JUN).)

Drugs 'linked to mental decline' (Legemidler "linket til mental svekkelse")
nursinginpractice.com 24.6.2011
Researchers have linked commonly taken drugs to mental decline and death in older people.

The study involved 13,000 people and looked at 80 drugs including painkillers, blood thinners, eye drops for glaucoma and antihistamines.

Each drug was examined for the 'anticholinergic activity' side-effect, which affects the brain by blocking the acetylcholine neurotransmitter and was then given a ranking from one to three according to the strength of this effect.

Drugs given a rating of one had the mildest effect, while those ranked three were of most serious concern. (...)

(Anm: Anticholinergic Medication Use and Cognitive Impairment in the Older Population: The Medical Research Council Cognitive Function and Ageing Study. Journal of the American Geriatrics Society 2011 (24 JUN).)

Medications Found to Cause Long Term Cognitive Impairment of Aging Brain, Study Finds (Det er oppdaget at legemidler kan gi langvarig kognitiv svekkelse)
sciencedaily.com 13.7.2010
ScienceDaily (July 13, 2010) — Drugs commonly taken for a variety of common medical conditions including insomnia, allergies, or incontinence negatively affect the brain causing long term cognitive impairment in older African-Americans, according to a study appearing in the July 13, 2010 print issue of Neurology, the medical journal of the American Academy of Neurology. (...)

These drugs, called anticholinergics, block acetylcholine, a nervous system neurotransmitter, and are widely-used medical therapies. They are sold over the counter under various brand names such as Benadryl®, Dramamine®, Excedrin PM®, Nytol®, Sominex®, Tylenol PM®, and Unisom®. Other anticholinergic drugs, such as Paxil®, Detrol®, Demerol® and Elavil® are available only by prescription. Older adults most commonly use drugs with anticholinergic effects as sleep aids and to relieve bladder leakage problems.

Researchers from Indiana University School of Medicine, the Regenstrief Institute and Wishard Health Services conducted a six-year observational study, evaluating 1,652 Indianapolis area African-Americans over the age of 70 who had normal cognitive function when the study began. In addition to monitoring cognition, the investigators tracked all over-the-counter and prescription medications taken by study participants.

"We found that taking one anticholinergic significantly increased an individual's risk of developing mild cognitive impairment and taking two of these drugs doubled this risk. This is very significant in a population -- African-Americans -- already known to be at high risk for developing cognitive impairment," said Noll Campbell, PharmD, first author of the study. Dr. Campbell is a clinical pharmacist with Wishard Health Services.

"Simply put, we have confirmed that anticholinergics, something as seemingly benign as a medication for inability to get a good night's sleep or for motion sickness, can cause or worsen cognitive impairment, specifically long-term mild cognitive impairment which involves gradual memory loss. As a geriatrician I tell my Wishard Healthy Aging Brain Center patients not to take these drugs and I encourage all older adults to talk with their physicians about each and every one of the medications they take," said Malaz Boustani, M.D., IU School of Medicine associate professor of medicine, Regenstrief Institute investigator and IU Center for Aging Research center scientist. (...)

(Anm: Use of anticholinergics and the risk of cognitive impairment in an African American population (Bruk av antikolinerge legemidler og risiko for kognitiv svekkelse i den afrikansk-amerikanske befolkningen) NEUROLOGY 2010;75:152-159.)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

(Anm: What Are Anticholinergic Effects? (Hva er antikolinerge effekter?) (merck.com).)

(Anm: kognitiv; det som har med fornuft, oppfatning (sansning) og tenkning å gjøre; skilles fra det som omhandler følelser (emosjoner, affekter) og viljesliv ...
Kilde: Store norske leksikon.)

(Anm: antikolinerge midler, midler som hemmer det parasympatiske nervesystem (parasympatolytika) eller virkningen av acetylkolin og andre kolinerge stoffer på muskarinreseptorer (muskarinfølsomme kolinerge reseptorer) både perifert og i sentralnervesystemet. (...) Brukes bl.a. for å motvirke spasmer i glatt muskulatur (steinsmerter, kolikksmerter), for å hemme spyttsekresjon (bl.a. under generell anestesi), ved parkinsonisme, ved astma (ipatropin til inhalasjon), bevegelsessyke (skopolamin) og forgiftning med nervegass. Kilde: Store norske leksikon.)

(Anm: Legemidler som kan gi delirium hos eldre. Tidsskr Nor Lægeforen 2005; 125:2366-7 (8.9.2005).)

Use of anticholinergics and the risk of cognitive impairment in an African American population (Bruk av antikolinerge legemidler og risiko for kognitiv svekkelse i den afrikansk-amerikanske befolkningen)
NEUROLOGY 2010;75:152-159
Background: Anticholinergic properties of certain medications often go unrecognized, and are frequently used by the elderly population. Few studies have yet defined the long-term impact of these medications on the incidence of cognitive impairment.

Methods: We report a 6-year longitudinal, observational study, evaluating 1,652 community-dwelling African American subjects over the age of 70 years who were enrolled in the Indianapolis-Ibadan Dementia Project between 2001 and 2007 and who had normal cognitive function at baseline. The exposure group included those who reported the baseline use of possible or definite anticholinergics as determined by the Anticholinergic Cognitive Burden scale. Our main outcome measure was the incidence of cognitive impairment, defined as either dementia or cognitive impairment not dementia, or poor performance on a dementia screening instrument during the follow-up period.

Results: At baseline, 53% of the population used a possible anticholinergic, and 11% used a definite anticholinergic. After adjusting for age, gender, educational level, and baseline cognitive performance, the number of definite anticholinergics was associated with an increased risk of cognitive impairment (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.07–1.99; p = 0.02), whereas the number of possible anticholinergics at baseline did not increase the risk (OR 0.96, 95% CI 0.85–1.09; p = 0.55). The risk of cognitive impairment among definite anticholinergic users was increased if they were not carriers of the APOE 4 allele (OR 1.77, 95% CI 1.03–3.05; p = 0.04).

Conclusions: Limiting the clinical use of definite anticholinergics may reduce the incidence of cognitive impairment among African Americans. (...)

Studies Prove that These Drugs Make Your Brain Stop Working… (Studier beviser at disse legemidler får hjernen din til å stanse å arbeide...)
foodconsumer.org 4.8.2010
Posted By Dr. Mercola | August 03 2010

Drugs commonly taken for a variety of common medical conditions negatively affect your brain, causing long term cognitive impairment. These drugs, called anticholinergics, block acetylcholine, a nervous system neurotransmitter.

They include such common over-the-counter brands as Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM, and Unisom.

Other anticholinergic drugs, such as Paxil, Detrol, Demerol and Elavil are available only by prescription.

Physorg reports:

"Researchers ... conducted a six-year observational study, evaluating 1,652 Indianapolis area African-Americans over the age of 70 who had normal cognitive function when the study began ... '[T]aking one anticholinergic significantly increased an individual's risk of developing mild cognitive impairment and taking two of these drugs doubled this risk.'"

Sources:
Physorg July 13, 2010

Neurology July 13, 2010; 75(2):152-9 (...)

Common medicines may harm seniors' mental ability (Vanlige legemidler kan skade eldres "mentale evner")
reutershealth.com 15.6.2009
NEW YORK (Reuters Health) - Legemidler hyppig brukt av eldre mennesker kan forårsake forvirring, demens og kognitive problemer, bekrefter en ny analyse av 27 studier. (- Drugs frequently taken by older people can cause confusion, dementia and other cognitive problems, a new analysis of 27 studies confirms.)

Many doctors prescribe these medications, known as anticholinergics, to their older patients, Dr. Malaz Boustani of the Regenstrief Institute in Indianapolis, one of the authors of the research review, told Reuters Health. "Unfortunately their use is very, very high in our health care system ... especially among those who are 65 and older."

Drugs with anticholinergic effects range from over-the-counter antihistamines like Benadryl to prescription medications used to treat urinary incontinence (oxybutinin, sold as Ditropan) and antidepressant medications such as paroxetine (Paxil), Boustani explained. These drugs, he said, have one thing in common: they can impair the function of the cholinergic system, which is essential for attention, concentration, and memory.

While it's long been suspected that anticholinergic medications impair cognitive function in older people, Boustani told Reuters Health, "there wasn't any systematic, standardized way of looking at the evidence."

To fill this gap in knowledge, he and his colleagues identified 27 studies in which researchers measured anticholinergic activity of medications that patients were taking and the effect on cognitive performance. (...)

(Anm: The cognitive impact of anticholinergics: A clinical review. Clin Interv Aging. 2009; 4: 225–233. (June 9).)

Studies Prove that These Drugs Make Your Brain Stop Working… (Studier beviser at disse legemidler får hjernen din til å stanse å arbeide...)
foodconsumer.org 4.8.2010
Posted By Dr. Mercola | August 03 2010

Drugs commonly taken for a variety of common medical conditions negatively affect your brain, causing long term cognitive impairment. These drugs, called anticholinergics, block acetylcholine, a nervous system neurotransmitter.

They include such common over-the-counter brands as Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM, and Unisom.

Other anticholinergic drugs, such as Paxil, Detrol, Demerol and Elavil are available only by prescription.

Physorg reports:

"Researchers ... conducted a six-year observational study, evaluating 1,652 Indianapolis area African-Americans over the age of 70 who had normal cognitive function when the study began ... '[T]aking one anticholinergic significantly increased an individual's risk of developing mild cognitive impairment and taking two of these drugs doubled this risk.'"

Sources:
Physorg July 13, 2010

Neurology July 13, 2010; 75(2):152-9 (...)

Atypiske antipsykotika hos eldre pasienter med demens
Tidsskr Nor Legeforen 2008; 128:1060-1 (1.5.2008)
Atferdsforstyrrelser og psykiatriske symptomer er vanlig ved demens, særlig blant beboere i sykehjem. Symptomene er belastende for pasienter og omsorgsgivere og behandles ofte med atypiske antipsykotika. Eldre personer med demens ser ut til å være ekstra utsatt for cerebrovaskulære bivirkninger og død ved bruk av disse medikamentene. Vi gir en kort oversikt over hvilke hensyn som må veies mot hverandre ved valg av behandling. (...)

. En metaanalyse av kliniske studier viste at risikoen for hjerneslag ved bruk av olanzapin og risperidon var tredoblet i forhold til placebo. For olanzapin fant man en dobling av dødelighet (7). Den økte risikoen var ikke begrenset til pasienter med kjente kardiovaskulære risikofaktorer. I kontrast til dette har man ved sammenstilling av store offentlige databaser ikke funnet sammenheng mellom bruk av atypiske antipsykotika og cerebrovaskulære hendelser hos eldre personer med demens (8). (...)

En rekke hypoteser for å forklare overhyppigheten av cerebrovaskulære hendelser ved bruk av atypiske antipsykotika er blitt lansert. De vanligste er tromboembolisme på grunn av økt aggregering av blodplater, takykardi på grunn av antikolinerg eller antiadrenerg effekt, ortostatisk hypotensjon på grunn av antiadrenerg effekt samt hyperprolaktinemi, som er en mulig markør for aterosklerose og har vært knyttet til økt aggregering av blodplager. Økt sedasjon, som i neste omgang gir venøs stase, dehydrering og hemokonsentrasjon, er en annen tentativ mekanisme. Til slutt er det blitt foreslått at ekstrapyramidale bivirkninger, særlig dystonier og parkinsonisme kan føre til venøs stase og økt risiko for cerebrovaskulære bivirkninger. Ingen av disse hypotesene er blitt endelig bekreftet i studier, men det er grunn til å ta dem med i vurderingen når man veier fordeler og ulemper ved bruk av antipsykotiske medikamenter hos den enkelte pasient. (...)

(Anm: dystonia; dystoni; endring i muskulaturens spenningstilstand, ofte i form av ufrivillige muskelsammentrekninger (f.eks. i nakkemuskulaturen og svelgmuskulaturen. Dystoni kan være symptom ved indremedisinske og nevrologiske sykdommer, men kan også opptre som bivirkning av legemidler som blokkerer signalsubstansen dopamin. Akutte dystonier sees hos yngre menn noen dager etter at vedkommende har begynt på relativt høye doser med nevroleptika. (...) Ved akutte dystonier på grunn av legemidler er behandlingen tilførsel av antiparkinsonmidler. Kilde: Store norske leksikon.)

- Tegn på aldring kan være linket til blokkerte blodårer i hjernen

Signs of Aging May Be Linked to Undetected Blocked Brain Blood Vessels (Tegn på aldring kan være linket til blokkerte blodårer i hjernen)
sciencedaily.com 1.9.2011
— Many common signs of aging, such as shaking hands, stooped posture and walking slower, may be due to tiny blocked vessels in the brain that can't be detected by current technology.

In a study reported in Stroke: Journal of the American Heart Association, researchers examined brain autopsies of older people and found:

• Microscopic lesions or infarcts -- too small to be detected using brain imaging -- were in 30 percent of the brains of people who had no diagnosed brain disease or stroke.
• Those who had the most trouble walking had multiple brain lesions.
• Two-thirds of the people had at least one blood vessel abnormality, suggesting a possible link between the blocked vessels and the familiar signs of aging.

"This is very surprising," said Aron S. Buchman, M.D., lead author of the study and associate professor of neurological sciences at Rush University Medical Center in Chicago. "There is a very big public health consequence because we're not capturing this 30 percent who have undiagnosed small vessel disease that is not picked up by current technology. How would you even get them on your radar? We need additional tools in our toolkit." (...)

The lesions couldn't be detected by current scans.

During the annual exams of the nuns and priests, researchers used the motor skills portion of a Parkinson's disease survey to assess their physical abilities. Researchers observed and rated the participants':

• Balance
• Ability to maintain posture
• Walking speed
• Ability to get in and out of chairs
• Ability to make turns when walking
• Sense of dizziness

"Often the mild motor symptoms are considered an expected part of aging," said Buchman, who is also a member of the Rush Alzheimer's Disease Center. "We shouldn't accept this as normal aging. We should try to fix it and understand it.

If there is an underlying cause, we can intervene and perhaps lessen the impact." (...)

- "Minislag" linket til lavere forventet levetid

Having a “Mini-Stroke” Can Shorten Life Expectancy (Et "minislag" kan forkorte forventet levetid)
Ivanhoe.com 15.11.2011
(Ivanhoe Newswire) – Having a transient ischemic attack (TIA), or a "mini stroke" can reduce your life expectancy by 20 percent, according to this study.
"People experiencing a TIA won't die from it, but they will have a high risk of early stroke and also an increased risk of future problems that may reduce life expectancy," Melina Gattellari, Ph.D., senior lecturer at the School of Public Health and Community Medicine in The University of New South Wales, Sydney and Ingham Institute in Liverpool, Australia, was quoted as saying.

"Our findings suggest that patients and doctors should be careful to intensely manage lifestyle and medical risk factors for years after a transient ischemic attack," Dr. Gattellari said. (...)

“Ministrokes” Linked With Lower Life Expectancy ("Minislag" linket til lavere forventet levetid)
JAMA 2011 (November 10)
Transient ischemic attacks, often called ministrokes, may reduce life expectancy by up to 20%.

A transient ischemic attack (TIA) isn’t just a harbinger of stroke. New research shows that TIAs, which often are called ministrokes, can cut life expectancy by up to 20%.

The study, published online today in Stroke: Journal of the American Heart Association, is the first to examine life expectancy in people who have had a TIA compared with expected mortality rates from all causes of death in the general population. An estimated 240 000 TIAs occurred in the United States in 2002. Studies show that about 15% of strokes are preceded by a TIA. (...)

- Antidepressiva øker risiko for autisme

Antidepressiv medicin øger risiko for autisme hos rotter
dagensmedicin.dk 18.11.2011
Rotter, der lige efter fødslen fik ssri-præparater, udviklede velkendte autistiske lidelser som anormaliteter i hjernen og adfærdsforstyrrelser.

Det viser en ny undersøgelse i tidsskriftet Proceedings of the National Academy of Sciences.

Opdagelsen bekræfter et tidligere befolkningsstudie i år, der viste, at kvinder, der tog ssri-midler under graviditeten, fik børn, der havde dobbelt så stor risiko for at udvikle autisme. Begge studier antyder, at indtagelse af de meget udbredte form for antidepressiv medicin under graviditeten kan være en medvirkende forklaring på den dramatiske stigning i udviklingshæmmede børn.

Antallet af gravide kvinder, der tager ssri-midler, er steget fra 0,5 pct. i 1985 til næsten 10 pct. i dag. Samtidig er forekomsten af autisme steget fra 1 ud af 1.000 fødsler i 1996 til 1 ud af 100 i dag. Den større opmærksomhed og forbedrede diagnosticering af autismelidelserne kan ikke forklare stigningen alene.

Forskerne behandlede mere end 200 rotter med ssri-midlet citalopram på vigtige tidspunkter i rotternes hjerneudvikling. Rotter fødes på et tidligere udviklingstrin, svarende til slutningen af 6. måned hos et menneskefoster. Behandlingen blev givet i to uger fra 8. dag efter fødslen, en periode, der svarer til hjernens udviklingsperiode hos menneskefostre i 3. trimester.

I modsætning til kontrolgruppen var de behandlede rotter uinteresserede i at udforske og lege som små og viste tegn på dårlige sociale kompetencer som voksne. Rotternes adfærd og neurologiske problemer pegede på, at deres hjerner ikke i tilstrækkelig grad kunne udføre og forarbejde informationer. Den adfærd var mere udtalt blandt hanrotter end hunrotter – en kønsforskel, der også findes for autisme, der oftere diagnosticeres hos drenge og mænd.

Forskerne udførte eksperimenter, der viste, at behandling med antidepressiv medicin havde stor indflydelse på tindingelappen – den del af hjernen, der tager sig af bearbejdning af lyde og tale. Forsøgsrotternes hjerner modnedes ikke normalt, og udviklingen af tindingelappen var meget forsinket og funktionerne nedsat. Forsinket udvikling af tindingelappen er også et kendetegn hos autistiske børn, der kæmper med sprog- og læsevanskeligheder. (...)

(Anm: Perinatal antidepressant exposure alters cortical network function in rodents. PNAS (Proceedings of the National Academy of Sciences) 2011 (Published online before print October 24).)

(Anm: - Antikolinerge effekter av vanlige legemidler knyttet til økt dødelighet (BMJ 2011; 342:d4037 (28 June).)

Antidepressant Linked to Autistic Behavior (Antidepressiva linket til autistisk atferd)
depression.about.com 28.10.2011
According to researchers at the University of Mississippi Medical Center and the University of California, San Francisco, rats exposed to the antidepressant citalopram (Celexa) as fetuses and just after birth showed behaviors similar to autism.

Most of the rats received the medication during what would be equivalent to the third trimester and early infancy in humans.

The types of behaviors that were observed in the treated rats were that they were uninterested in play when young and, as adults, they displayed poor social behaviors. The rats also showed abnormal responses to changes in their environment, for example, showing little interest in new toys. The study authors noted that these behavior are similar to those seen in humans with autism.

The authors also noted that the behaviors were seen more frequently in male rats than in female rats. Similarly, autism spectrum disorders are diagnosed more often in boys.

The researchers emphasized, however, that these study results do not mean that you should not take an antidepressant during pregnancy and breastfeeding. First of all, there are difficulties in extrapolating from animal data just what these results really mean for humans. Secondly, there are also risks associated with untreated depression which should be carefully considered. Women should consult with their physician to determine what is best for them personally.
The study was published online on October 24, 2011 in the journal Proceedings of the National Academy of Sciences. (...)

(Anm: Perinatal antidepressant exposure alters cortical network function in rodents. PNAS (Proceedings of the National Academy of Sciences) 2011 (Published online before print October 24).)

- Inntak av antidepressiva før fødsel endrer kortikal nettverksfunksjon hos gnagere

Perinatal antidepressant exposure alters cortical network function in rodents (Inntak av antidepressiva før fødsel endrer kortikal nettverksfunksjon hos gnagere)
PNAS (Proceedings of the National Academy of Sciences) 2011 (Published online before print October 24)
Abstract Serotonin (5-HT) plays a key role in early brain development, and manipulation of 5-HT levels during this period can have lasting neurobiological and behavioral consequences. It is unclear how perinatal exposure to drugs, such as selective serotonin reuptake inhibitors (SSRIs), impacts cortical neural network function and what mechanism(s) may elicit the disruption of normal neuronal connections/interactions. In this article, we report on cortical wiring organization after pre- and postnatal exposure to the SSRI citalopram. We show that manipulation of 5-HT during early development in both in vitro and in vivo models disturbs characteristic chemoarchitectural and electrophysiological brain features, including changes in raphe and callosal connections, sensory processing, and myelin sheath formation. Also, drug-exposed rat pups exhibit neophobia and disrupted juvenile play behavior. These findings indicate that 5-HT homeostasis is required for proper brain maturation and that fetal/infant exposure to SSRIs should be examined in humans, particularly those with developmental dysfunction, such as autism. (...)

Diverse artikler

Opbremsning i antal brugere af antidepressiv medicin
laegemiddelstyrelsen.dk 17.5.2012
Antallet af danskere, der køber antidepressiv medicin, har været stigende i mange år. I 2011 var der dog ikke længere en stigning i antal brugere, men derimod et mindre fald i forhold til 2010.

Dette er bemærkelsesværdig set i lyset af, at antallet af brugere steg med mere end 50 procent fra 2001 til 2010. Således købte små 290.000 danskere antidepressiv medicin i 2001, mens knap 463.000 købte medicinen i 2010.

I 2011 var tallet faldet en smule til 461.000 personer. Dette svarer til at 1 ud af 12 danskere købte antidepressiv medicin.

Gennem de seneste 10 år har næsten dobbelt så mange kvinder som mænd købt antidepressiva. Andelen af mænd er dog langsomt steget gennem perioden, således at mændene er rykket en lille smule nærmere kvinderne.

I hele perioden har der været væsentligt flere i behandling blandt de ældre end blandt de yngre. Den største ændring ses hos de 13 til 34-årige, hvor antallet af brugere er mere end fordoblet i løbet af 10 år. For alle aldersgrupper gælder, at antallet af nye brugere var lavere i 2011 end i de foregående par år.

Læs mere i rapporten: Forbruget af antidressiva 2001-2011 (...)

Utøya-offer: Breivik var slet ikke så farlig
bt.dk 15.5.2012
Ane Kollen Evenmo gav som det eneste af dagens vidner i retssagen mod Anders Breivik interview efter retssagen.

17-årige Ane Kollen Evenmo, der overlevede Utøya-massakren, var meget nervøs, før hun mandag skulle vidne mod massemorderen Anders Breivik. Men da hun så ham i salen, forsvandt nervøsiteten.

Først skød Breivik hende i benet, og dernæst skød han efter hende, da hun flygtede i en båd.

Men selv om nu 17-årige Ane Kollen Evenmo var tæt på at miste livet i Breiviks kugleregn på Utøya, så virkede hun overraskende selvsikker, da hun mandag vidnede mod massemorderen i Oslo Tingrett.

- Han var slet ikke så farlig, som jeg havde gået og troet. Han kan jo ikke gøre mig noget mere, sagde hun til BTs udsendte efter sin afhøring. (...)

Depression Linked to Higher Odds for Poor Leg Circulation
health.usnews.com 20.4.2012
In study, depressed patients were more apt to develop peripheral artery disease

FRIDAY, April 20 (HealthDay News) -- Depressed people may be at higher risk for the debilitating circulatory condition known as peripheral artery disease (PAD), a new study suggests.

PAD is due to a narrowing of the arteries in the legs and pelvis. It was known that depression is a risk factor for the constriction of heart arteries, but its link with PAD specifically was unclear.

In this study, researchers led by Marlene Grenon of the University of California, San Francisco, Medical Center examined data on more than a thousand men and women who were followed for about seven years.

At the start of the study, PAD was present in 12 percent of the participants with depression and in 7 percent of those without depression. During the seven-year follow-up, PAD-related events occurred in 9 percent of participants with depression and in 6 percent of those without depression, the researchers said.

One expert wasn't surprised by the findings.

"The study reminds us of the importance of screening all patients for signs and symptoms of depression," said Dr. Lawrence Phillips, an assistant professor in the department of medicine at NYU Langone Medical Center in New York City. "Aggressive treatment of depression can improve modifiable risk factors and decrease the development of both coronary artery disease and peripheral artery disease," he added.

Still, Phillips said more study may be needed to clarify the relationship between depression and PAD. (...)

(Anm: - Brukere av antidepressiva har mer åreforkalkning og dermed økt risiko for hjertesykdom og hjerneslag sammenlignet med ikke-brukere (mintankesmie.no).)

Post-Prozac Nation
pharmacytimes.com 19.4.2012
The Science and History of Treating Depression (...)

But this theory has been widely criticized. In The New York Review of Books, Marcia Angell, a former editor of The New England Journal of Medicine, wrote: “After decades of trying to prove [the chemical-imbalance theory], researchers have still come up empty-handed.” Jonathan Rottenberg, writing in Psychology Today, skewered the idea thus: “As a scientific venture, the theory that low serotonin causes depression appears to be on the verge of collapse. This is as it should be; the nature of science is ultimately to be self-correcting. Ideas must yield before evidence.”

Is the “serotonin hypothesis” of depression really dead? Have we spent nearly 40 years heading down one path only to find ourselves no closer to answering the question how and why we become depressed? Must we now start from scratch and find a new theory for depression?

Science may be self-correcting, but occasionally it overcorrects — discarding theories that instead need to be rejuvenated. The latest research suggests that serotonin is, in fact, central to the functioning of mood, although its mechanism of action is vastly more subtle and more magnificent than we ever imagined. Prozac, Paxil and Zoloft may never turn out to be the “wonder drugs” that were once advertised. But they have drastically improved our understanding of what depression is and how to treat it. (...)

What about the converse experiment? In 1994, male subjects at McGill University in Montreal were given a chemical mixture that lowered serotonin. Doctors then measured the fluctuations in the mood of the men as serotonin levels dipped in the blood. Though serotonin was depleted, most of them experienced no significant alterations in their mood. (...)

We may not understand how serotonin-enhancing antidepressants work, but do we know whether they work at all? (...)

(Anm: SSRI-preparater har uheldige effekter på mitokondrier (mintankesmie.no).)

Flere dør av livmorkreft - overvekt kan være årsaken
tv2nyhetene.no 17.4.2012
Stadig flere kvinner får livmorkreft, og antall dødsfall har økt med 34 prosent fra 1999 til 2009. Forskere mener overvekt kan forklare økningen i forekomsten. (...)

700 kvinner får diagnosen årlig
Rundt 700 norske kvinner får diagnosen og 146 kvinner dør av livmorkreft årlig.

I 1999 døde 113 av livmorkreft, og i 2009 151 kvinner. Det er en økning på 34 prosent i antall dødsfall.

I samme periode fra 1999 til 2009 økte forekomsten av livmorkreft med 20 prosent. (...)

Psychiatric Medication For Children? Important New Book Gives Pause
boston.com 14.4.2012
Two things most stood out for me in Kaitlin Bell Barnett's new book Dosed: The Medication Generation Grows Up. The first is the stories of women struggling to get off of SSRI's, started in early adolescence, when they decide to get pregnant. The second is Bell Barnett's review of the literature regarding sexual dysfunction as a side effect of SSRIs in adolescence.

The book as a whole has much to say that is very important. As I write in my blurb for the cover:

Dosed is a fascinating, well-researched, and very important book. After reading it, I hope that no parent, pediatrician or psychiatrist will give psychiatric medication to a child or adolescent without very careful consideration of the potential long-term consequences. Bell Barnett shows that these medications are often not a ‘quick fix,’ but rather have deep, lasting impact, not only on physical and emotional health, but also on a person’s core sense of self.

Bell Barnett is a journalist who was herself started on SSRIs as a teenager. Her book intertwines in depth interviews with people who were started on psychiatric medication in childhood and are now young adults, with a journalistic study of the history of psychiatric medication use in children. I could probably write several posts covering all the important issues she addresses, but have chosen to focus on these two.

I first learned of the emerging evidence that SSRIs may cause long term sexual dysfunction last fall when I attended a talk by Robert Whitaker, author of the controversial book about psychiatric illness and medication Anatomy of an Epidemic. I was so alarmed about this data that I wanted to immediately write a blog post about it. But shortly after that talk I received the galleys of Bell Barnett's book. I discovered that she has a through review of the rather scant literature on the subject along with some very poignant stories, so I decided to wait until her book came out. I recommend that anyone who is concerned about this issue (as anyone who takes or prescribes these drugs should be) read her book. The subject is covered in the chapter entitled "Side Effects." Here are a few sample quotes.

A comprehensive review of the literature conducted in 2004 found just one clinical trial that reported erectile dysfunction in a teenager; most clinical guidelines and reviews of SSRIs didn't mention sexual side effects at all.

This is pretty shocking since, as the authors of the study cited above noted, anywhere from 30-40 percent of adults experience some kind of SSRI induced problems with libido, arousal, or orgasm. (...)

Mom's Obesity May Sway Child's Risk for Autism
medpagetoday.com 9.4.2012
Mothers who are obese or who have diabetes appear to be more likely to have children with neurodevelopmental disorders, including autism, researchers found.

Maternal obesity was associated with greater odds of the offspring receiving a diagnosis of an autism spectrum disorder (OR 1.67, 95% CI 1.10 to 2.56) or a developmental delay (OR 2.08, 95% CI 1.20 to 3.61) by age 5, according to Paula Krakowiak, MS, a PhD candidate at the MIND Institute at the University of California Davis, and colleagues.

A combination of maternal metabolic conditions was associated with a range of impairments in the children's development, the researchers reported ahead of the May issue of Pediatrics. (...)

Pilots forced to weigh job, mental health treatment under FAA rules
wtop.com 30.3.2012
Emergency workers tend to a JetBlue captain that had a &quot;medical situation&quot; during a Las Vegas-bound flight from JFK International airport, Tuesday in Amarillo, Texas.

WASHINGTON - Pilots troubled by mental health challenges, which in many cases can be controlled with medication, face the likelihood of being prohibited from flying if they seek treatment.

A JetBlue pilot suffering an apparent breakdown in-flight has prompted focus on the Federal Aviation Administration's medical screening policies. Pilots and pilot advocates worry that acknowledging most mental health symptoms can ground them, often permanently.

In 2010, the FAA for the first time specified four drugs -- Celexa, Lexapro, Prozac, and Zoloft -- that pilots could take for mild to moderate depression that would not automatically disqualify them from flying, at least temporarily.

"They're only using it to augment their mood, getting through a rough spot in the road, such as relationship issues or where they may have lost a loved one," says David Hale, president of Pilot Medical Solutions, a pilot advocacy group aiming to assist pilots in navigating the FAA's stringent health requirements. (...)

Tusinder gør oprør mod lykkepille-læger
ekstrabladet.dk 28.3.2012
nationens! Elsebeth H har samlet imponerende 3,665 støtter til sin sag om psykofarmaka. Hun mener at alt for mange danskere får lykkepiller

Det er ikke nogen nyhed, at mange danske læger mener, at danskerne har brug for lykkepiller. Helt præcist var 462,476 nemlig på lykkepiller i 2010 - 200.000 flere end i 1999 - og fra 2009 til 2010 kom mere end 25.000 flere danskere på antidepressiver.

Nej, det nye er, at oprøret mod de læger, der udskriver lykkepiller, på kort tid har samlet flere tusinde danskere. Elsebeth Halckendorff oprettede sin sag 'Fuld belysning af skadevirkning af psykofarmaka' d. 1. januar, og kan i dag konstatere at hele 3,600 har støttet hende.

Du kan også støtte sagen - klik her

- Det er jeg meget glad, for lægerne udskriver jo bare de her piller for et godt ord, uden at vide noget om skadevirkninger og bivirkninger, siger Elsebeth, der selv fik udskrevet lykkepiller og stillet diagnosen depression, da hun henvendte sig til sin læge med svedeture og rysten på hænderne.

- Men det viste sig at være en hjertesygdom - begge hjerteklapper i venstre side af hjertet, var holdt op med at fungere hos mig. Det er det, der kaldes hjertesvigt - og han havde givet mig lykkepiller - ha, siger en vred Elsebeth, der siden den oplevelse har brugt meget tid på at læse om lykkepiller og skadevirkninger.

- Det er bevist, at man få en lobotomi - altså et kemisk hvidt snit - ved at spise de piller, og det er bevist at pillerne får hjernen til at skrumpe.

Voksne mennesker får ødelagt hjernen
- I på Ekstra Bladet har jo også afsløret, at pillerne kan skade gravide og deres fostre - det var der heller ingen, der havde fået at vide - nu må turen være kommet til, at skadevirkninger på voksne bliver trukket frem i lyset, så ikke flere mennesker skal lide med en ødelagt hjerne, siger Elsebeth, der har prøvet at råbe formanden for de praktiserende læger op.

- Men jeg får ikke noget svar.

Hvis du også mener, at der skal mere fokus på skadevirkningerne ved psykofarmaka, så støt Elsebeths sag her. Når der er 5000 der støtter sagen skriver vi om det igen.

Elsebeths mål er at få mere oplysning til patienter og læger om skadevirkningerne ved psykofarmaka, ligesom hun vil have, at læger bliver mere grundige når de udskriver eller fornyer recepter på lykkepiller. (...)

Depression drug research goes off the rails (again) (Forskning på legemidler mot depresjon sporer av (igjen))
fiercepharma.com 23.3.2012
What a bummer for drug developers. In an analysis today, veteran Reuters reporters help us count the ways that R&D of antidepressants has sunk to new lows in recent years, even as mood disorders plague populaces around the world.

AstraZeneca ($AZN) and partner Targacept ($TRGT) this week revealed the latest sad chapter in the pharma industry's saga of failed depression programs, announcing that they're scrapping development of their experimental antidepressant TC-5214. And, as Reuters notes, AstraZeneca made the announcement after ditching its own discovery efforts in the depression field a while back after years of frustration.

AstraZeneca's exit from antidepressant discovery comes amid an exodus from the field across the pharma industry, which has largely turned its attention to safer bets in developing drugs for cancer and rare genetic diseases. In trials for new depression meds, developers have struggled to show that their pills lift patients' moods any better than placebos. Patients in many cases even feel better after taking sugar pills, showing just how delicate the disorder can be.

Meanwhile, researchers have been tossing up all kinds of ideas about new ways of combating the blues. U.K. researchers have seen evidence that a psychoactive compound in magic mushrooms could help people who are out of sorts, and U.S. researchers have been experimenting with the painkiller ketamine--sold on the street as "Special K"--to treat severe depression. (...)

Pregnant Women on Antidepressants Less Likely to Breastfeed (Mindre sannsynlig at gravide kvinner på antidepressiva gir brystmelk)
health.ucsd.edu 8.3.2012
Researchers Say Results Show Need for Additional Breastfeeding Support and Education

Researchers at the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a statewide non-profit organization based at the University of California, San Diego School of Medicine, have found women exposed to certain antidepressants during pregnancy were significantly less likely to breastfeed their babies compared to unexposed women. The results of the study were recently published online in The Journal of Human Lactation.

The study uses data obtained by counselors at the CTIS Pregnancy Health Information Line, a toll-free service offering evidence-based clinical information about exposures during pregnancy and breastfeeding. It focused on 466 pregnant women who contacted the CTIS Pregnancy Health Information Line over a ten year period with questions about a wide variety of exposures and, after being counseled, agreed to participate in a follow-up study of their pregnancy outcome.

The study specifically examines breastfeeding choices of women exposed to selective serotonin reuptake inhibitor (SSRI) antidepressants at the time of delivery, compared to those who discontinued use of antidepressants earlier in pregnancy, as well as to those women who report not taking antidepressants at all. The results showed women exposed to an SSRI anytime in pregnancy were about 60 percent less likely to initiate breastfeeding than women who took no antidepressant. (...)

Eldre kvinner medisineres dobbelt så tungt som menn ved depresjon
aftenposten.no 28.2.2012
Mange eldre får for mye medisin fordi det er vanskelig å måle hvor mye de trenger.

Aftenposten skrev i går at hver tredje eldre person får medisiner som er uheldige for dem. Nå viser en studie publisert i siste nummer av Tidsskrift for Den norske legeforening at kvinner over 65 med depresjon hadde dobbelt så mye medisin i blodet som jevnaldrende menn og yngre av begge kjønn. Dette skyldes at det brukes mye standard doser uten at medisineringen tilpasses den enkelte pasient godt nok. Både alder og kjønn påvirker hvor mye av medisinen som tas opp og skilles ut av kroppen. (...)

Antidepressant use linked to hip surgery dissatisfaction (Bruk av antidepressiva linket til mindre tilfredshet ved hoftekirurgi)
hospitalpharmacyeurope.com 9.2.2012
Patients taking antidepressants up to three years prior to undergoing a total hip replacement (THR) are more likely to report greater pain before and after surgery and less satisfaction with their procedure, according to research presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

In the study, 1,657 patients (13 percent of the study population) used antidepressants up to three years before surgery.

The patients were surveyed before and one year after the THR. The researchers found that a patient's mental health status, assessed by the use of antidepressants before surgery, was a significant factor in predicting outcomes, as well as gender (men are more likely to report lower outcomes), advanced age and co-morbidity (other joint diseases or conditions which affect walking).

The researchers concluded that a patient's mental health status should be assessed prior to surgery and taken into consideration during post-operative care.

American Academy of Orthopaedic Surgeons (...)

Zoloft Overdose
depression.about.com 9.2.2012
Important Notes Before Reading:

If you suspect that you or someone you know has had a Zoloft overdose, please seek immediate medical attention. (...)

Brain Activity in Adolescent Major Depressive Disorder Before and After Fluoxetine Treatment
Am J Psychiatry. 2012 Jan 19. [Epub ahead of print]
(...) OBJECTIVE: Major depression in adolescents is a significant public health concern because of its frequency and severity. To examine the neurobiological basis of depression in this population, the authors studied functional activation characteristics of the brain before and after antidepressant treatment in antidepressant-naive depressed adolescents and healthy comparison subjects.

METHOD: Depressed (N=19) and healthy (N=21) adolescents, ages 11 to 18 years, underwent functional MRI assessment while viewing fearful and neutral facial expressions at baseline and again 8 weeks later. The depressed adolescents received 8 weeks of open-label fluoxetine treatment after their baseline scan.

RESULTS: Voxel-wise whole brain analyses showed that depressed youths have exaggerated brain activation compared with healthy comparison subjects in multiple regions, including the frontal, temporal, and limbic cortices. The 8 weeks of fluoxetine treatment normalized most of these regions of hyperactivity in the depressed group. Region-of-interest analyses of the areas involved in emotion processing indicated that before treatment, depressed youths had significantly greater activations to fearful relative to neutral facial expressions than did healthy comparison subjects in the amygdala, orbitofrontal cortex, and subgenual anterior cingulate cortex bilaterally. Fluoxetine treatment decreased activations in all three regions, as compared with the repeat scans of healthy comparison subjects.

CONCLUSIONS: While effective treatments are available, the impact of depression and its treatment on the brain in adolescents is understudied. This study confirms increases in brain activation in untreated depressed adolescents and demonstrates reductions in these aberrant activations with treatment. (...)

Georgia lawyer says Paxil made client rob Bank of America (Georgia-advokater sier Seroxat (Paxil) gjorde at klienten ranet Bank of America)
socialenterpriselive.com 24.1.2012
A lawyer for a man accused of robbing a Bank of America (NYSE: BAC) branch in Augusta says his client was a victim of “involuntary intoxication” at the time due to the Paxil anti-depressant he was taking, reports the Augusta Chronicle.

Assistant District Attorney Hank Syms isn’t buying lawyer Peter Johnson’s claims, and “waved away any claim” of such intoxication when the robbery occurred in July 2010, the newspaper reported. Syms said about one-third of clients that make guilty pleas say they are affected by some form of medication, but added he’s never heard the Paxil defense because most lawyers know better than to claim it. (...)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

Retinal Vascular Geometry Predicts Incident Renal Dysfunction in Young People With Type 1 Diabetes
Diabetes Care 2012 (Published online before print January 16)
OBJECTIVE To examine the relationship between retinal vascular geometry parameters and development of incident renal dysfunction in young people with type 1 diabetes. (...)

CONCLUSIONS Retinal venular geometry independently predicted incident renal dysfunction in young people with type 1 diabetes. These noninvasive retinal measures may help to elucidate early mechanistic pathways for microvascular complications. Retinal venular geometry may be a useful tool to identify individuals at high risk of renal disease early in the course of diabetes. (...)

Drug Monitoring
Investigating beneficial drug reactions
BMJ 2012;344 (4 January)
(...) All clinicians are familiar with drugs that have multiple uses. Codeine, for example, may be given to reduce cough (when it may have the adverse effect of constipation) or to treat diarrhoea (when suppressing the cough reflex becomes the unintended adverse effect). (...)

Other examples abound, in the professional and lay literature, such as recent discussion, including on the BBC, concerning clomipramine’s potential to have a beneficial effect on brain tumours. (...)

In general such potential repurposings have been identified serendipitously by alert doctors who have observed an unexpected beneficial effect that might be due to a prescribed drug, in the same way that they might note possible adverse drug reactions. However, adverse reactions are identified in numerous ways that should also be adopted and modified appropriately for beneficial drug reactions. Of course, as with adverse reactions, such possibilities need careful investigation, again using the validated methods already in place. (...)

Fearless Youth: Prozac Extinguishes Anxiety by Rejuvenating the Brain
scientificamerican.com 22.12.2011
New research shows that the antidepressant reduces fear in adult mice by increasing brain plasticity

Once adult lab mice learn to associate a particular stimulus—a sound, a flash of light—with the pain of an electric shock, they don't easily forget it, even when researchers stop the shocks. But a new study in the December 23 issue of Science shows that the antidepressant Prozac (fluoxetine) gives mice the youthful brain plasticity they need to learn that a once-threatening stimulus is now benign. (...)

Nina Karpova, Eero Castrén and their colleagues at the University of Helsinki's Neuroscience Center created and extinguished fearful behaviors in mice. First, Castrén placed mice in a cage and repeatedly played a tone just before electrically shocking their feet. Soon the animals froze in fear whenever they heard the tone, at which point Castrén put them through "extinction training." He moved the mice to a different cage and played the same tone again. This time there was no electric shock.

Researchers have previously shown that young mice less than three weeks old quickly learn that the tone is no longer a herald of danger and stop freezing in fear. But adult mice are harder to put at ease. Even if the adults become less fearful during extinction training, their relaxation is not permanent—a week later the tone turns them into statues again.

In Castrén's study, adult mice that took fluoxetine while they went through extinction training behaved much like young mice—they lost their fear much faster than mice that were not taking the drug, and their anxiety did not return. In contrast, mice that were given fluoxetine but never went through extinction training remained anxious. (...)

Research has not supported the idea that antidepressants treat depression simply by correcting chemical imbalances in the brain. More recently, researchers have hypothesized that depression kills neurons whereas antidepressants like Prozac encourage new neural growth in the brain. Castrén's study suggests Prozac returns regions of the brain to an immature state in which neurons make or break more connections with one another than is typical of the adult brain. In other words, Prozac increases brain plasticity. (...)

Fear Erasure in Mice Requires Synergy Between Antidepressant Drugs and Extinction Training
Science 2011;334(23):1731-1734 (December)
Antidepressant drugs and psychotherapy combined are more effective in treating mood disorders than either treatment alone, but the neurobiological basis of this interaction is unknown. To investigate how antidepressants influence the response of mood-related systems to behavioral experience, we used a fear-conditioning and extinction paradigm in mice. Combining extinction training with chronic fluoxetine, but neither treatment alone, induced an enduring loss of conditioned fear memory in adult animals. Fluoxetine treatment increased synaptic plasticity, converted the fear memory circuitry to a more immature state, and acted through local brain-derived neurotrophic factor. Fluoxetine-induced plasticity may allow fear erasure by extinction-guided remodeling of the memory circuitry. Thus, the pharmacological effects of antidepressants need to be combined with psychological rehabilitation to reorganize networks rendered more plastic by the drug treatment.

(Anm: Fear conditioning is a behavioral paradigm in which organisms learn to predict aversive events.[(en.wikipedia.org).)

Blood Test Might Predict How Well a Depressed Patient Responds to Antidepressants
newswise.com 12.12.2011
Newswise — MAYWOOD, Ill. -- Loyola University Medical Center researchers are reporting what could become the first reliable method to predict whether an antidepressant will work on a depressed patient.

The method would involve a blood test for a protein called vascular endothelial growth factor (VEGF). A Loyola study found that among depressed patients who had higher than normal blood levels of VEGF, more than 85 percent experienced partial or complete relief from depression after taking escitalopram (brand name Lexapro®). By comparison, fewer than 10 percent of depressed patients who had low levels of VEGF responded to the drug. (...)

Scientists aren't certain why SSRIs work in some patients but not in others. One possible mechanism is that SSRIs help restore a chemical balance in the brain. Some scientists recently have proposed a second possible mechanism, called neurogenesis -- SSRIs help to regenerate brain cells in specific parts of the brain that have atrophied in depressed patients.

The Loyola study supports the neurogenesis theory. It appears that escitalopram, the SSRI used in the Loyola study, jump-starts brain cells that have become inactive. This regeneration is fueled by VEGF. In the brain, VEGF stimulates the growth of blood vessels and works in other ways to keep brain cells healthy and active.

It appears that in patients with higher levels of VEGF, there was more regeneration, helping to reduce depression. Conversely, in patients with lower VEGF levels, there was less regeneration of brain cells and less relief from depression. (...)

Link Between SSRIs and Rare Newborn Condition Still Unclear
medscape.com 14.12.2011
December 14, 2011 — The link between the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy and persistent pulmonary hypertension of the newborn (PPHN) remains unclear, says the US Food and Drug Administration (FDA).

In a drug and safety communication released December 14, the agency says it is uncertain whether SSRIs cause PPHN because the data are conflicting.

"Two studies suggest an increased risk for PPHN with SSRI use in pregnancy. Three other studies do not support this association and the potential risk with SSRI use during pregnancy remains unknown," the FDA release notes.

As a result, the agency recommends that pregnant women who are taking antidepressants do not stop treatment.

The update follows an FDA advisory released in July 2006 and reported by Medscape Medical News at that time regarding the potential risk for PPHN associated with gestational exposure to SSRIs. (...)

Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants: Drug Safety Communication - Use During Pregnancy and Potential Risk of Persistent Pulmonary Hypertension of the Newborn
fda.gov 12.12.2011
Including Celexa (citalopram); Lexapro (escitalopram); Prozac, Sarafem, Symbyax (fluoxetine); Luvox, Luvox CR (fluvoxamine); Paxil, Paxil CR, Pexeva (paroxetine); Zoloft (sertraline); Viibryd (vilazodone) (...)

ISSUE: FDA notified healthcare professionals and the public on the use of selective serotonin reuptake inhibitor (SSRI) antidepressants by women during pregnancy and the potential risk of a rare heart and lung condition known as P ersistent Pulmonary Hypertension of the Newborn (PPHN). The initial Public Health Advisory in July 2006 on this potential risk was based on a single published study. Since then, there have been conflicting findings from new studies evaluating this potential risk, making it unclear whether use of SSRIs during pregnancy can cause PPHN.
FDA has reviewed the additional new study results and has concluded that, given the conflicting results from different studies, it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN. FDA will update the SSRI drug labels to reflect the new data and the conflicting results.

BACKGROUND: SSRIs are marketed under various brand and generic drug names, and are used to treat depression and other psychiatric disorders. There are no adequate and well-controlled studies of SSRIs in pregnant women.

PPHN occurs when a newborn baby does not adapt to breathing outside the womb. Newborns with PPHN may require intensive care support including a mechanical ventilator to increase their oxygen level. If severe, PPHN can result in multiple organ damage, including brain damage, and even death.

RECOMMENDATION: FDA advises health care professionals not to alter their current clinical practice of treating depression during pregnancy. See the Data Summary in the FDA Drug Safety Communication for additional information. (...)

(Anm: FDA Drug Safety Communication: Selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and reports of a rare heart and lung condition in newborn babies. (fda.gov 12.12.2011).)

SSRI bleeding risk with post-MI therapy (SSRI-blødningsrisiko etter hjerteinfarkt-terapi (Myocardial Infarction (MI))
imt.ie 13.10.2011
Doctors should exercise caution when prescribing SSRIs in patients who are taking antiplatelet therapy, researchers say, after finding it may raise their risk of recurrent MI by almost 60 per cent.

The Canadian researchers explored a database of 27,000 MI patients discharged from hospital on antiplatelet therapy — some 690 of whom were concurrently prescribed an SSRI during their follow-up care.

Adding an SSRI to aspirin alone increased the risk of bleeding requiring hospitalisation by 42 per cent, the study found. The risk was even greater for patients given dual antiplatelet therapy (aspirin plus clopidogrel), in whom SSRIs raised the bleeding risk by 57 per cent.

The researchers noted that up to 20 per cent of patients with cardiovascular disease experienced depression and were most often prescribed an SSRI, while those who had an MI would be taking antiplatelet therapy.

“Ultimately, clinicians must weigh the benefits of SSRI therapy against the risk of bleeding in patients with major depression following an acute myocardial infarction,” they concluded.

The effect on bleeding risk in the study was similar for the ‘high affinity’ SSRIs fluoxetine, paroxetine and sertraline, and for the ‘intermediate affinity’ agents citalopram, escitalopram and fluvoxamine.

Potential drug-drug interactions, especially when clopidogrel was used with sertraline or fluoxetine, seemed to have little effect.

Bleeding rates in the study were lower than in major clinical trials of antiplatelet therapy. This might have reflected non-compliance with the prescribed regimens, even though the analysis was based on prescriptions dispensed, the authors said.

They suggested the effects of SSRIs on bleeding might be greatest in the first month of treatment, leading to a dilution of their impact during longer-term follow-up. (...)

Antidepressant Use Increases
JAMA. 2011;306(20):2207 (November 23/30)
About 1 in 10 US individuals older than 12 years takes an antidepressant medication, according to a report from the US Centers for Disease Control and Prevention's National Center for Health Statistics.

Based on data from the CDC's annual National Health and Nutrition Examination Survey (NHANES), use of antidepressants among US individuals increased nearly 400% between 1988 and 2008. Women between the ages of 40 and 59 years were the most likely to report taking an antidepressant, with 23% of women in this age group reporting taking such a medication. There were no differences in antidepressant use among various income groups. (...)

Flopp för Astras nya antidepressiva
lakemedelsvarlden.se 9.11.2011
I den första fas III studien på en ny antidepressiv substans mot egentlig depression nådde man inte det uppsatta målet.

STUDIE Vintern 2009 ingick Astrazeneca och det amerikanska forskningsbolaget Targacept ett avtal om att utveckla och marknadsföra en ny kandidat TC-5214 som tilläggsbehandling vid depression. För det avtalet betalade Astrazeneca 200 miljoner dollar som förstagångsbetalning.

I den här första fas III studien ingick 295 patienter som testade substansen som tilläggsbehandling under åtta veckor, men man nådde inte det uppsatta målet.
Men ytterligare tre fas III studier pågår och enligt analytiker behöver loppet inte vara kört.

Bank of Americas analytiker anser, enligt nyhetsbyrån Six, att det visserligen var ett bakslag, men att blandade resultat inte är ovanligt när det gäller antidepressiva läkemedel. Nu behöver företaget visa på effekt för två av de tre återstående studierna samt den långsiktiga säkerhetsstudien för att kunna ansöka om godkännande.

Deutsche Banks analys är att det är mycket möjligt att de återstående studierna visar på bättre resultat, men är samtidigt skeptiska till det eftersom man i den här studien inte lyckades nå upp till det primära målet. (...)

Brain Development In Rats Stunted By Perinatal Antidepressant
medicalnewstoday.com 3.11.2011
Rats exposed to an antidepressant just before and after birth showed substantial brain abnormalities and behaviors, in a study funded by the National Institutes of Health.

After receiving citalopram, a serotonin-selective reuptake inhibitor (SSRI), during this critical period, long-distance connections between the two hemispheres of the brain showed stunted growth and degeneration. The animals also became excessively fearful when faced with new situations and failed to play normally with peers - behaviors reminiscent of novelty avoidance and social impairments seen in autism. The abnormalities were more pronounced in male than female rats, just as autism affects 3-4 times more boys than girls.

"Our findings underscore the importance of balanced serotonin levels - not too high or low - for proper brain maturation," explained Rick Lin, Ph.D., of the University of Mississippi Medical Center, Jackson, a Eureka Award grantee of the NIH's National Institute of Mental Health.

Lin and colleagues report on their discovery online during the week of Oct. 24, 2011, in the Proceedings of the National Academy of Sciences. (...)

Depression kan skade hjernen
videnskab.dk 18.10.2011
Mennesker med depression risikerer, at hjernen skrumper og holder sig lille efter endt sygdom. Opdagelsen giver ny viden om hjernen samt en ny forståelse af, hvordan antidepressiver virker. (...)

»Metastudiet viser, at en depression sætter et markant aftryk på hjernen ved i gennemsnit at medføre 10 procents skrumpning af hjerneområdet hipocampus. Skrumpningen varer i nogle tilfælde ved, selv om depressionen i sig selv er ovre,« siger professor dr. med. og speciallæge i psykiatri Poul Videbech. (...)

Undersøgelser på Center for Psykiatrisk forskning, hvor man har fulgt mennesker med depression i mere en 10 år med hjernescanninger, tyder under alle onstændigheder på, at skrumpningen af hippocampus kan gå tilbage, hvis man behandler depressionen. (...)

Stamceller danner nye nerveceller
Et spørgsmål, som Poul Videbech gerne vil have svar på er, hvorfor nogle mennesker genvinder deres oprindelige evne til at huske og koncentrere sig efter endt depression.

Hans egen teori er, at det skyldes hjernens plasticitet – hjernen kan ikke blot nedbryde sig selv gennem forskellige processer, men har også en indbygget evne til at genopbygge beskadiget hjernevæv ved at danne nye hjerneceller.

Evnen til at genopbygge sig selv kaldes for 'neurogenese' og blev opdaget tilbage i 1996. Selv om denne opdagelse har et årti på bagen, har nyheden endnu ikke rigtigt spredt sig blandt forskere, så det er stadig megt begrænset, hvem, der kender til det, påpeger Poul Videbech.

Man ved ikke, hvorfor neurogenese kun optræder hos nogle mennesker. Men man regner med, at processen sættes i gang af stamceller i hipocampus, der kan dele sig og danne nye nerveceller. (...)

Fakta
Mange studier viser, at terapi med elektrochock giver neurogenese. Til gengæld findes der endnu ingen undersøgelser, der viser, at psykoterapi giver neurogenese, men Poul Videbech er overbevist om, at det vil kunne påvises, hvis man undersøger det. Der er nemlig talrige studier, der dokumenterer, at psykoterapi har en gavnlig effekt på depression.

I raske personer er de to processer hele tiden i balance, men nogle sygdomme giver større nedbrud end opbygning, som f.eks. forskellige former for demens og ved depression. (...)

Styrelse erkender fejl
ekstrabladet.dk 24.10.2011
Sundhedsstyrelsen erkender, at læger og gravide skulle have været informeret om bivirkninger ved lykkepiller

Lægemiddelstyrelsen hemmeligholdte i flere år overfor landets patienter og læger, at der havde været dødsfald og andre alvorlige bivirkninger hos danske babyer som følge af deres mødres brug af lykkepiller.

Og Styrelsen erkender nu, at lægerne skulle have været informeret. Det skriver Ekstra Bladet.

Læs også: Heidis søn døde

Lægemiddelstyrelsen vidste allerede i 2007, at der havde været mindst 48 indberetninger om alvorlige bivirkninger og dødsfald hos danske spædbørn.

Alligevel kom den information først ud til lægerne i 2011, og det skulle være sket tidligere, erkender overlæge i afdeling for forbrugersikkerhed, Doris Stenver.

- Det er væsentligt information for lægerne, og det må vi erkende i dag, siger hun.

Læs også: Gravide proppet med livsfarlige lykkepiller

Lægemiddelstyrelsen er nu i gang med at se på, hvordan kommunikationen kan blive bedre. (...)

Antidepressant Use Skyrocketed in Past 20 Years: CDC
health.yahoo.com 19.10.2011
WEDNESDAY, Oct. 19 (HealthDay News) -- The rate of antidepressant use among Americans of all ages increased nearly 400 percent over the last two decades, and 11 percent of Americans aged 12 and older now take antidepressant drugs, according to a federal government report released Wednesday.

The analysis of 2005-2008 data from the U.S. National Health and Nutrition Examination Surveys also showed that antidepressants are the third most common prescription drug taken by Americans of all ages and the most frequently used by those aged 18 to 44.

Of people with severe depression, about one-third takes antidepressant medication. More than 60 percent of Americans taking an antidepressant drug have taken it for two years or longer and nearly 14 percent have taken the medication for 10 years or more, according to the U.S. Centers for Disease Control and Prevention researchers.

The investigators also found that less than one-third of people taking one antidepressant and less than half of those taking multiple antidepressants had seen a mental health professional in the past year. (...)

Angst og depresjon påvirker ikke forstervekst
dagensmedisin.no 18.10.2011
Det er ingen sammenheng mellom symptomer på angst- og depresjon i svangerskapet og lav fødselsvekt, ifølge fersk studie.

Angst- og depresjonssymptomer er ikke uvanlig i graviditeten, og mange gravide spør om dette påvirker barnet. Nå viser en studie fra Akershus universitetssykehus og Folkehelseinstituttet at det ikke er noen sammenheng mellom angst- og depresjonssymptomer hos mor i svangerskapet og lav fødselsvekt hos barnet, ifølge Folkehelseinstituttets nettside.

Lav fødselsvekt kan forutsi sykdom, både umiddelbart etter fødselen og senere i livet. Det er derfor viktig å undersøke årsaker til lav fødselsvekt. Fordi angst- og depresjonssymptomer ikke er uvanlig i svangerskapet, var det viktig å undersøke en eventuell sammenheng med fostervekst. (...)

SSRIs associated with 40% increase in bleeding risk when used with aspirin
pulsetoday.co.uk 29.9.2011
GPs have been advised to show caution when prescribing SSRIs in patients taking aspirin following an acute myocardial infarction, after an analysis showed an increased risk of bleeding.

SSRIs and antiplatelet agents - such as aspirin and clopidogrel – have been individually associated with increased risk of bleeding, but this Canadian study looked at the effect of combinations of these drugs in clinical practice.

The study looked retrospectively at data from 27,058 patients, aged 50 years or older, who were discharged from hospital after an acute myocardial infarction between January 1998 and March 2007.

Following discharge, 14,426 of the patients in the cohort took aspirin alone, while 406 took both aspirin and an SSRI. They found patients taking both aspirin and an SSRI had a 42% increased risk of a bleeding episode - gastrointestinal bleeding, hemorrhagic stroke or other bleeding that required hospital admission - compared with those taking aspirin alone. (...)

(Anm: Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. CMAJ 2011 (September 26).)

Certain Antidepressants With Blood Thinners May Pose Risk for Heart Patients (Enkelte antidepressiva kan sammen med blodtynnende legemidler utgjøre en risiko for hjertepasienter)
health.yahoo.com 26.9.2011
MONDAY, Sept. 26 (HealthDay News) -- Heart attack patients who take both selective serotonin reuptake inhibitor (SSRI) antidepressants and antiplatelet drugs such as aspirin or Plavix have a higher risk for bleeding than those who take anti-clotting drugs only, a new study finds.

Commonly prescribed SSRIs include Zoloft, Prozac, Paxil and Lexapro.

Antiplatelet drugs prevent blood cells from sticking together and forming a blood clot. Heart attack patients are commonly prescribed antiplatelet therapy to reduce their risk of another heart attack. But there's an increased risk of bleeding, which increases even further when certain other drugs are taken at the same time.

It so happens that many heart attack patients have depression symptoms and are prescribed antidepressants, noted the researchers at McGill University in Montreal.
"We're always concerned about how other medicines might interact with the medicines we know are essential to heart health and recovery after heart attack," said Dr. Kirk Garratt, clinical director of interventional cardiovascular research at Lenox Hill Hospital in New York City. "Although SSRIs are used in only a few cardiac patients, learning that SSRIs can increase [the] risk of bleeding complications could have important implications for how we care for patients after stents and other heart procedures."

In the Canadian study, the researchers looked at more than 27,000 heart attack patients, aged 50 and older, and found that patients taking aspirin or Plavix alone had a similar risk of bleeding. But taking an SSRI antidepressant and aspirin increased the risk of bleeding by 42 percent, and taking an SSRI with both aspirin and clopidogrel (dual antiplatelet therapy) increased the risk by 57 percent.

Bleeding included gastrointestinal bleeding, hemorrhagic stroke or other bleeding that required hospitalization or occurred in the hospital during treatment.
The researchers also found that the risk of bleeding was lower in women and in patients who had angioplasty after their heart attack.

The study appears Sept. 26 in the Canadian Medical Association Journal. (...)

(Anm: Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. CMAJ ( September 26).)

Depression Drugs Could Worsen Bleeding After MI (Legemidler mot depresjons kan forverre blødning etter hjerteinfarkt)
medpagetoday.com 26.9.2011
Depression may accompany myocardial infarction (MI) but prescribing selective serotonin reuptake inhibitors (SSRIs), combined with antiplatelet therapy, carries an increased risk of bleeding, researchers found.

Following MI, those taking aspirin with an SSRI had a 42% increased risk of bleeding compared with taking aspirin alone, reported Elham Rahme, PhD, from McGill University in Montreal, and colleagues.

The risk increased to 49% when patients were taking an SSRI with both aspirin and clopidogrel (Plavix) compared with aspirin alone, according to the study published online in CMAJ.

And when patients added an SSRI on top of dual antiplatelet therapy, the risk of bleeding was 57% higher compared with dual antiplatelet therapy alone.

The risk of bleeding with antiplatelet therapy is always a concern, but it may be increased with other medication use, Rahme and colleagues wrote.

They noted that up to 20% of patients with cardiovascular disease suffer from depression and most of them are prescribed SSRIs. (...)

(Anm: Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. CMAJ ( September 26).)

Strokes Rising Among Teens, Young Adults: CDC (Hjerneslag øker blant tenåringer, unge voksne: CDC)
healthland.time.com 1.9.2011 (Time)
THURSDAY, Sept. 1 (HealthDay News) -- Strokes are on the rise among teens and young people, a new government report shows.

The number of people aged 15 to 44 hospitalized for stroke jumped by more than third between 1995 and 2008, say researchers from the U.S. Centers for Disease Control and Prevention. The increase may be due partly to the increasing numbers of young people who have diseases such as high blood pressure and type 2 diabetes -- diseases usually associated with older adults, they added.

High blood pressure, smoking, diabetes, obesity and high cholesterol are all risk factors for stroke, the researchers noted. (...)

Only 1 In 5 Medicaid-Covered Kids In Ohio Finish Antidepressant Treatment (Bare én av fem Medicaid-dekkede barn i Ohio fullfører behandlingen med antidepressiva)
medicalnewstoday.com 23.8.2011
About half of Medicaid-covered children and adolescents in Ohio who are in treatment for depression complete their first three months of prescribed antidepressants, and only one-fifth complete the recommended minimum six-month course of drugs to treat depression, new research suggests.

Among those at the highest risk for not completing treatment are adolescents as opposed to younger children - and minority youths, particularly African Americans, according to the analysis of Medicaid prescription data over a three-year period.

Optimal follow-up visits and adequacy of antidepressant dosing was associated with better adherence during both the acute and continuation phases of treatment. (...)

FDA Warns Against High-Dose Citalopram (FDA advarer mot høye doser av citalopram (Cipramil; Celexa))
medpagetoday.com 24.8.2011
Citing increased risk of cardiac arrhythmias and a lack of therapeutic benefit associated with high doses of the selective serotonin reuptake inhibitor (SSRI) citalopram hydrobromide (Celexa), the FDA has reduced the recommended maximum to 40 mg/day.

Previously, the agency had approved a 60-mg/day dose of the antidepressant for certain patients.

The new dosing instruction was prompted by postmarketing surveillance reports and a prospective trial linking the 60-mg dose to unacceptable QT interval prolongations and Torsade de Pointes.

The trial -- a randomized, placebo-controlled, crossover study in 119 adults -- examined citalopram's effects on QT intervals at doses of 20 mg and 60 mg, the FDA said. (...)

(Anm: Celexa (citalopram hydrobromide): Drug Safety Communication - Abnormal Heart Rhythms Associated With High Doses. (fda.gov 24.8.2011).)

Antidepressant Tied to Dangerous Heart Rhythm, FDA Says (Antidepressiva knyttet til farlig hjerterytme, ifølge FDA)
health.yahoo.net 24.8.2011
WEDNESDAY, Aug. 24 (HealthDay News) -- High doses of the popular antidepressant Celexa can cause potentially fatal abnormal heart rhythms and should no longer be prescribed to patients, the U.S. Food and Drug Administration said Wednesday.

Doses of Celexa (citalopram hydrobromide) greater than 40 milligrams a day can cause changes in the electrical activity of the heart, which can lead to abnormal heart rhythms, including a potentially deadly arrhythmia known as Torsade de Pointes, according to the agency.

Patients at high risk for changes in the electrical activity of the heart include those with pre-existing heart conditions (including congestive heart failure) and those prone to low levels of potassium and magnesium in the blood, the FDA said. (...)

(Anm: Celexa (citalopram hydrobromide): Drug Safety Communication - Abnormal Heart Rhythms Associated With High Doses. (fda.gov 24.8.2011).)

Flere kvinner får hjerteinfarkt
fvn.no 25.8.2011
Oslo (NTB): Stadig flere kvinner mellom 35 og 79 år får hjerteinfarkt. Samtidig rammes menn i samme aldersgruppe sjeldnere, viser en ny studie.

Hvem som står i risikosonen for å få hjerteinfarkt er i ferd med å endres, viser undersøkelsen, som er utført av kardiolog Jan Torbjørn Mannsverk og hans kolleger ved Universitetssykehuset Nord-Norge og Universitetet i Tromsø, skriver Dagens Medisin.

Studien bygger på materiale fra Tromsøundersøkelsen, en 30-årig oppfølgingsstudie som bygger på gjentatte helseundersøkelser av personer mellom 12 og 97 år i Tromsø kommune. (...)

(Anm: Age and gender differences in incidence and case fatality trends for myocardial infarction: a 30-year follow-up. The Tromso Study. Eur J Cardiovasc Prev Rehabil. 2011 Aug 22. .)

Lægerne overser hjertesyge kvinder
netdoktor.com/dk 23.8.2011
Hjertekarsygdomme er den hyppigste dødsårsag blandt kvinder i Danmark. Alligevel oplever hver femte kvinde, at hun ikke bliver taget alvorligt, når hun henvender sig til lægen med symptomer på den alvorlige hjertesygdom.

Ny undersøgelse fra Hjerteforeningen viser nemlig, at to ud af ti hjertesyge kvinder ikke har følt sig taget alvorligt, første gang de har henvendt sig til en læge med henblik på hjerteproblemer.

”Det gør os frustrerede. Det er ikke i orden, at vi sidder fast i en myte om, at kvinder ikke rammes af hjertesygdomme. Vi har vidst i mange år, at det er den hyppigste dødsårsag hos kvinder. Der dør næsten en kvinde i timen året rundt”, siger Inge Vestbo, der er direktør for Hjerteforeningen.

De symptomer, som kvinder oplever i forbindelse med hjertekarsygdomme, er ofte anderledes end mænds. De typiske symptomer er smerter i brystet, i venstre arm, og op i kæberne. Men mange kvinder oplever i stedet, at de bliver trætte og matte, eller at der bare er ’noget galt’. (...)

Han opfordrer til, at der bliver lavet flere undersøgelser af kvinders symptomer, ligesom han også mener, at der bør undervises yderligere på området på lægernes efteruddannelse. (...)

Hyponatraemia during psychopharmacological treatment: results of a drug surveillance programme
Int J Neuropsychopharmacol. 2011 Jul 22:1-10. [Epub ahead of print]
Hyponatraemia (HN) can be a life-threatening medical condition which may lead to severe neurological and psychiatric symptoms. The AMSP (Arzneimittelsicherheit in der Psychiatrie) is a multicentre drug surveillance programme that assesses severe or new adverse drug reactions during psychopharmacological treatment in psychiatric inpatients. We report on a total of 263 864 psychiatric inpatients monitored from 1993 to 2007 in 80 psychiatric hospitals in Germany, Switzerland and Austria. During this period plasma sodium levels below 130 mmol/l (severe HN according to AMSP) were reported in 93 patients (relative frequency 0.04%). On average, the plasma sodium levels of all cases were 119.7 mmol/l (±5.8 s.d.); median 121 mmol/l (range 104-129 mmol/l). Patients who showed no clinical signs (n=65, 70%) had a mean sodium level of 121.3 mmol/l (±5.0 s.d.); median 122 mmol/l (range 114-129 mmol/l). By contrast, patients with clinical symptoms (n=28, 30%) had a mean sodium level of 116.0 mmol/l (±6.0 s.d.); median 117 mmol/l (range 104-125 mmol/l). HN was mainly observed during treatment with selective serotonin reuptake inhibitors (SSRIs) (0.06%), Serotonin noradrenaline reuptake inhibitors (SNRIs) (0.08%), carbamazepine (0.10%) and oxcarbazepine (1.29%); the highest rate was found for oxcarbazepine. Antipsychotics, mirtazapine and tricyclic antidepressants were only rarely involved in HN (0.003-0.005%). Combinations of several drugs known to induce HN significantly increased the risk of HN, e.g. more than 10-fold for SSRI+diuretics+ACE inhibitors (0.37%) vs. SSRI given alone (0.02%). This is clinically relevant because such combinations, e.g. SSRI+diuretics may occur especially in elderly patients, who are in general at higher risk of developing HN. (...)

Pregnancy-Related Strokes on the Rise (Graviditetsrelaterte hjerneslag øker)
JAMA 2011 (July 28)
More women are experiencing strokes during pregnancy or shortly after delivery, according to a study published today in the journal Stroke.

The researchers used data from the Nationwide Inpatient Sample, the largest collection of nationwide data on hospitalizations, to compare pregnancy-related strokes in women during 2 periods: in 1994-1995 and 2006-2007. They found that although the rate of hospitalization for stroke during delivery stayed steady, the rate of hospitalization for stroke during pregnancy increased by 47% (from 0.15 to 0.22 per 1000 deliveries) and by 83% after delivery during the 12-week postpartum period (from 0.12 to 0.22 per 1000 deliveries).

Most of the increase in pregnancy-related strokes can be explained by increased rates of hypertension and heart disease among pregnant women, according to the authors. Changes in demographics, such as more women having children later in life, and improvements in medical care for women with chronic conditions, such as congential heart disease or autoimmune disorders, may explain why more women are beginning their pregnancies with cardiovascular risk factors, they note. (...)

(Anm: Trends in Pregnancy Hospitalizations That Included a Stroke in the United States From 1994 to 2007. Stroke 2011 (Published online before print July 28).)

Heat Spikes Death Risk from Drugs
healthland.time.com 22.7.2011 (Time)
With relentless heat enveloping much of the nation, no one, it seems is spared. That includes a group at especially high risk of harm from high temperatures: drug users, both therapeutic and recreational, particularly those who take stimulants like cocaine, methamphetamine and Ritalin or antidepressants and other psychiatric medications.

One study found that for every week that the temperature exceeds 75 degrees Fahrenheit, New York City will experience two extra cocaine-related deaths. And, as the temperature climbs, the number of deaths leaps proportionally. A week like this with temperatures in the 90's and possibly 100's might tally 4-7 extra cocaine deaths in New York City alone.

“High doses of stimulants can produce extremely high body temperatures,” says Zheng-Xiong Xi, a researcher at the National Institute on Drug Abuse. And extremely high body temperatures can kill. (...)

(Anm: Ambient temperature and risk of death from accidental drug overdose in New York City, 1990-2006. Addiction. 2010 June; 105(6): 1049–1054. (June 1).)

Effects of sertraline on brain current source of the high beta frequency band: analysis of electroencephalography during audiovisual erotic stimulation in males with premature ejaculation
Int J Impot Res. 2011 Jun 23.[Epub ahead of print]
Abstract To identify the effects of sertraline, a selective serotonin reuptake inhibitor, for the treatment of premature ejaculation (PE), changes in brain current-source density (CSD) of the high beta frequency band (22-30 Hz) induced by sertraline administration were investigated during audiovisual erotic stimulation. (...)

Comparing between before and after sertraline administration in the patients with PE, the CSD of the high beta frequency band at 4 h after sertraline administration increased significantly in both superior frontal gyri and the right medial frontal gyrus (P<0.01). The CSD of the beta-3 band of the patients with PE were less activated significantly in the middle and superior temporal gyrus, lingual and fusiform gyrus, inferior occipital gyrus and cuneus of the right cerebral hemisphere compared with the normal volunteers 4 h after sertraline administration (P<0.01). In conclusion, sertraline administration increased the CSD in both the superior frontal and right middle temporal gyrus in patients with PE. The results suggest that the increased neural activity in these particular cerebral regions after sertraline administration may be associated with inhibitory effects on ejaculation in patients with PE.International Journal of Impotence Research advance online publication, 23 June 2011; doi:10.1038/ijir.2011.30. (...)

Ending the Era of Mass Psychiatry
Marilyn Wedge, Ph.D.
huffingtonpost.com 17.6.2011
The number of Americans who are diagnosed or diagnosable with a serious mental illness has skyrocketed. Social Security claims for disability due to mental illness have also exploded. In 1987, the number was one in 84 Americans, whereas in 2007 it increased to one in 76. In children, the picture looks even bleaker: there was a 35-fold increase in disability claims for mental illness between 1987 and 2007. What is going on? Why are Americans suffering a mental health epidemic that is unique in the developed world?

In a recent article in The New York Review of Books, physician Marcia Angell looks to three recent books to answer these questions: "The Emperor's New Drugs: Exploding the Antidepressant Myth," "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America" and "Unhinged: The Trouble with Psychiatry -- A Doctor's Revelations About a Profession in Crisis." The authors of all three books are in agreement on a rather startling view. Based on many years of researching the burgeoning epidemic of depressive, anxiety and psychotic disorders, all three authors argue that it is pharmaceutical companies rather than unbiased medical research that decide what constitutes mental illness and how each illness should be treated. I recently made a similar argument specifically for children's mental health problems in my book "Suffer the Children: The Case Against Labeling and Medicating and an Effective Alternative."

One intriguing issue that seems to fly in the face of the view that most mental illnesses are convenient fictions spun by drug companies is that many psychotropic drugs seem to work. Like most therapists, I have seen the light go on in the eyes of many a depressed patient a few weeks after she has started to take an antidepressant. If depression is not actually a chemical imbalance curable by a drug, as authors Whitaker, Kirsch and Carlat argue, why do many people feel better a week or so after they begin taking medication?

Daniel Carlat provides one cogent answer: according to clinical trial data obtained from the FDA, in cases of depression, placebos were between 75 percent and 82 percent as effective as the antidepressants tested. The negative data from these trials, which indicated that placebos were almost as effective as the popular drugs Prozac, Paxil, Zoloft, Celexa, Serzone and Effexor, was conveniently hidden by the manufacturers of the drugs. The placebo effect thus offers a cogent alternative explanation to the theory that psychotropic drugs work by correcting a serotonin deficiency in the brain. As Angell points out, there is no hard evidence for the latter hypothesis. (...)

Are Addiction and Mental Illness Really Brain Diseases?
Stanton Peele
huffingtonpost.com 16.6.2011
The two primary (New York) intellectual organs, the New York Review of Books and The New York Times, have recently featured two powerful cultural icons saying exactly opposite things.

Marcia Angell, the first woman editor-in-chief of the New England Journal of Medicine and now at the Harvard Medical School, in an ongoing, two-part series in the New York Review of Books (part 1 of which is in the June 23 issue), argues against the firmly ensconced American view that mental illness can be (and it has been) resolved to brain functioning.

The New York Times, for its part, once again supports, with a profile of Nora Volkow, the visionary director of the National Institute on Drug Abuse (NIDA), the slightly more come-lately view of addiction as a brain disease.

Angell has fought her way to cultural icon status by combating the medical-pharmaceutical-industrial complex, first in her position as editor of the NEJM, and subsequently from her ethics perch at Harvard (where she also sometimes treads on toes).

Angell is naturally led to an anti-brain-disease position because it has been fostered and foisted by the pharmaceutical industry with which she has been warring. Quoting her in the New York Review of Books, the modern "psychiatric revolution" appeared due to "the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs." This revolution was spearheaded when the antidepressant "Prozac came to market in 1987 and was intensively promoted as a corrective for a deficiency of serotonin in the brain."

Today, Angell points out, 10 percent of all Americans over the age of 6 are on antidepressants. This figure must grow, since younger Americans are being medicated at a much higher rate than current adults -- there was a 350 percent jump in youth mental illness diagnoses in the two decades after the introduction of Prozac, a figure that continues to climb. (...)

How your medicine could be draining vital nutrients from your body
dailymail.co.uk 8.6.2011
Medication can do much to alleviate the symptoms that make your life miserable. But in most cases they don’t actually tackle the cause. There is also the risk of side-effects.

And as a new book suggests, they might be adding to your health woes by ‘stealing nutrients from your system or preventing their absorption’. As a result, you could end up feeling worse, or even being diagnosed with another condition.

The book, Drug Muggers: Which Medications Are Robbing Your Body Of Essential Nutrients, has been written by leading U.S. pharmacist Suzy Cohen. (...)

ANTIDEPRESSANTS
The most common treatment is with a selective serotonin reuptake inhibitor (SSRI), thought to work by boosting levels of brain chemicals linked to mood.

But these, such as paroxetine and fluoxetine (Prozac), may also lower the level of thyroid hormones vital for regulating metabolic rate, digestive functions and muscle control. They also help in mood and overall immune function.

As hormone levels drop, the body needs more iodine, essential to their production.

RISK: Hypothyroidism, depression, weight gain, lowered immunity. (...)

Antidepressants–Not Depression Alone–Linked to Thicker Carotids
Psychiatr News 2011;46(11):17 (June 3) (American Psychiatric Association)
Emory University scientists hypothesize an interaction between the use of antidepressant medications and a biomarker for atherosclerosis.

A study of middle-aged male twins funded by the National Institutes of Health suggests an association between use of antidepressants and increased intima media thickness in the carotid arteries.

Participants in the Vietnam Era Twin Registry taking antidepressants at the time of the study had an average carotid intima media 41 microns thicker than their brothers who were not taking antidepressants, Amit Shah, M.D., a cardiology fellow at Emory University, said at the American College of Cardiology's annual scientific session in New Orleans in April. The findings appeared in the April 5 Journal of the American College of Cardiology. (...)

Drugging our kids on anti-depressants
dailytelegraph.co.uk 30.5.2011

THE number of children aged six and under being prescribed anti-depressants has soared by almost 50 per cent since the federal government pledged to investigate the issue, new figures show.

Federal health department data reveals prescribing rates of the controversial drugs have risen from 852 in 2007-08 to 1264 in 2009-10.

But despite Health Minister Nicola Roxon ordering an investigation three years ago, a Freedom of Information request shows the government held just two meetings. (...)

Australian Childhood Foundation chief executive Dr Joe Tucci said he would have expected the government to act by now.

"I cannot think of a good reason why any six-year-old, or younger, should be treated with antidepressants," he said. "I think it's gone up because medication is being used to treat the symptoms and not the cause."

The Royal Australian and New Zealand College of Psychiatrists said it was alarming any anti-depressants were being prescribed for children and demanded answers. (...)

Genetic link to depression is replicated by two separate research teams
BMJ 2011; 342:d3050 (16 May)
Two groups of researchers working independently have identified variations in the same region of a chromosome in people with severe depression. Although the association may contribute to only a small proportion of the risk of depression, it is hoped that the finding will help to locate the genes affected in people with depression, enable better understanding of the mechanism underlying the disease, and ultimately lead to more personalised treatments that reflect the wide variation in how depression presents. (...)

The first study, which was led by scientists at King’s College, London, and involved teams from nine countries, is the result of 10 years of work from the Depression Network project, which looked at 800 families where at least two siblings had recurrent depression (American Journal of Psychiatry, doi:10.1176/appi.ajp.2011.10091342). In the second study a team from Washington University, St Louis, looked for genetic variations in 91 families where siblings smoked and had severe depression (American Journal of Psychiatry, doi:10.1176/appi.ajp.2011.10091319).

Gerome Breen, lead author of the first study and a lecturer at the Institute of Psychiatry at King’s College London, said, “In a large number of families where two or more members have depression we found robust evidence that a region called chromosome 3p25-26 is strongly linked to the disorder. These findings are truly exciting, as possibly for the first time we have found a genetic locus for depression.”

Although Dr Breen acknowledged that this region of the genome might account for only 4% of the risk of depression, the discovery could lead to more specific and effective therapies in the next 10-15 years. The team is now conducting detailed sequencing examinations in 40 of the families involved to try to identify specific genes and variations.

Lefkos Middleton, professor of neurology at Imperial College London and an author of the paper, who was speaking at a press conference to discuss the findings, said that it is still not yet clear whether depression is one disease or many different diseases with different pathways leading to the same set of symptoms. (...)

Lohan Probation Report -- Lindsay's a Drug Addict
tmz.com 11.5.2011
(...) The Probation Report lists the drugs Lindsay has been taking: Trazadone (for depression), Nexium (for heartburn), Yaz (birth control), Zoloft (anti-depressant), Doxycycline (antibiotic), Zyrtec (allergies) and Zythromax (antibiotic).

The Probation Report mentions Lindsay failed an alcohol test on February 8, 2011 -- this is about a month AFTER Lindsay left the Betty Ford Clinic. (...)

Gene linked to causing depression
hospitalpharmacyeurope.com 28.4.2011
German scientists have linked a gene to major depression, which could pave the way for new treatments.

They compared DNA from more than 15,000 depressed and healthy individuals to complete their study, with altered letters in the genetic code associated with serious depression.

The anomaly appeared to influence the SLC6A15 gene, which is believed to regulate an important brain signalling chemical called glutamate.

Lead researcher Dr Elisabeth Binder, from the Max Planck Institute for Psychiatry in Munich, said: "Because it is assumed that the communication between the neuron clusters is disturbed in depression, we considered whether the gene we had identified could possibly influence this process through glutamate." (...)

Move Over Prozac: New Drug Offers Hope for Depression
sciencedaily.com 24.4.2011
ScienceDaily (Apr. 24, 2011) — The brain chemistry that underlies depression is incompletely understood, but research suggests that aberrant signaling by a chemical called Brain-Derived Neurotrophic Factor through its receptor TrkB, may contribute to anxiety and depression. Here, researchers describe a screen for stable small molecules that could specifically inhibit TrkB action. They identified one they dubbed ANA-12, which had potent behavioral effects when administered to mice that suggest it will have antidepressant and anti-anxiety activity in humans. (...)

Do painkillers ‘stop Prozac working?’
nhs.uk 30.4.2011
Mice were given citalopram either by itself or with ibuprofen

“Aspirin and other popular painkillers could prevent Prozac from working properly,” the Daily Mail reported. This news story was based on research that was predominantly in mice, examining the effects of combining anti-inflammatory painkillers such as ibuprofen and aspirin with a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), to which Prozac belongs.

The study found that SSRIs work by increasing the levels of a depression “biomarker” called p11. The anti-inflammatory drugs prevent SSRIs from increasing the levels of this protein. They also blocked the mouse behavioural response to SSRIs, but had no effect on other types of antidepressant. (...)

This was well-conducted basic research but, at the moment, there is insufficient evidence of its application to humans. The observations from analysing human data suggest that further follow-up examining how anti-inflammatory painkillers alter the effectiveness of SSRI antidepressants is warranted. (...)

The study was published in the peer-reviewed medical journal Proceedings of the National Academy of Sciences. (...)

Links to the headlines
How painkillers like aspirin and ibuprofen may stop happy pills working. Daily Mail, April 26 2011

Links to the science
Warner-Schmidt JL, Vanover KE, Chen EY, et al. Antidepressant effects of selective serotonin reuptake inhibitors (SSRIs) are attenuated by antiinflammatory drugs in mice and humans. Proceedings of the National Academy of the United States of America 2011. Published online before print April 25 (...)

New Drug Offers Hope For Depression
medicalnewstoday.com 19.4.2011
An estimated 19 million Americans suffer from depression, and though the symptoms might be recognizable, the brain chemistry that underlies them is incompletely understood. Research suggests that aberrant signaling by a chemical called Brain-Derived Neurotrophic Factor (BDNF) through its receptor TrkB, may contribute to anxiety and depression, and inhibiting this pathway in mice can reduce anxiety and depression-related behaviors. However, translating these findings to clinical studies will require the development of small molecule inhibitors of the BDNF/TrkB pathway that could be used pharmacologically. (...)

Hallucination induced by paroxetine discontinuation in patients with major depressive disorders
Psychiatry Clin Neurosci. 2011 Apr 14. [Epub ahead of print]
Abstract Discontinuation symptoms can follow the stoppage of almost all classes of antidepressants, including selective serotonin reuptake inhibitors. We report two cases suffering from visual and auditory hallucinations: Case 1 abruptly stopped taking paroxetine (20 mg/day), and Case 2 discontinued paroxetine after reducing the dose from 20 mg/day to 10 mg/day for 5 months. Both cases experienced visual and auditory hallucinations in addition to dizziness, headache, insomnia, and nausea a couple of days after paroxetine discontinuation. These observations suggest that hallucinations are a part of the discontinuation syndrome that results from paroxetine discontinuation. Physicians should be aware of this symptom. (...)

It Might Not Be the Flu!
depression.about.com 14.4.2011
Antidepressant Withdrawal Symptoms and How to Avoid Them

Feeling like you're coming down with the flu lately? If you've recently discontinued an antidepressant you might actually be going through withdrawal, or what is more properly called "discontinuation syndrome."

What Is Discontinuation Syndrome?
Many people who discontinue their antidepressant abruptly may experience symptoms like fatigue, nausea, myalgia, insomnia, anxiety, agitation, dizziness, hallucinations, blurred vision, irritability, tingling sensations, vivid dreams, sweating or electric shock sensations. Some will experience only minor symptoms and miss the connection with their antidepressant thinking that perhaps they have the flu. For others, the symptoms are so debilitating that they feel they cannot stop their antidepressant for fear of how it will interfere with their lives. (...)

Study reveals new target for antidepressants
reuters.com 12.4.2011
* Study finds antidepressants affect key stress protein
* Glucocorticoid receptor useful new target for future drugs

LONDON, April 12 (Reuters) - British scientists using human stem cells say they have found out how antidepressants make new brain cells -- a finding that should help drug researchers develop better and more efficient medicines to fight depression.

Previous studies have shown that antidepressants such as tricyclics and selective serotonin reuptake inhibitors (SSRIs) generate new brain cells, but until now scientists had not been clear how they did it.

In a study published in the journal Molecular Psychiatry that used Pfizer's (PFE.N) Zoloft and other antidepressants, researchers from King's College London's Institute of Psychiatry found that the drugs regulate the glucocorticoid receptor (GR) -- a key protein involved in the stress response.

The study also showed that all types of antidepressant are dependent on the GR to create new cells, the scientists said.

"Having identified the glucocorticoid receptor as a key player in making new brain cells, we will now be able to use this novel stem cell system to model psychiatric illnesses in the laboratory, test new compounds and develop much more effective, targeted antidepressant drugs," said Christoph Anacker, a doctorate student at the IoP who led the study. (...)

Antidepressants Linked to Thicker Arteries (Antidepressiva linket til tykkere arterier)
sciencedaily.com 11.4.2011
ScienceDaily (Apr. 2, 2011) — Antidepressant use has been linked to thicker arteries, possibly contributing to the risk of heart disease and stroke, in a study of twin veterans. The data is being presented on April 5 at the American College of Cardiology meeting in New Orleans.

Depression can heighten the risk for heart disease, but the effect of antidepressant use revealed by the study is separate and independent from depression itself, says first author Amit Shah, MD, a cardiology fellow at Emory University School of Medicine. The data suggest that antidepressants may combine with depression for a negative effect on blood vessels, he says. Shah is a researcher working with Viola Vaccarino, MD, PhD, chair of the Department of Epidemiology at Emory's Rollins School of Public Health.

The study included 513 middle-aged male twins who both served in the U.S. military during the Vietnam War. Twins are genetically the same but may be different when it comes to other risk factors such as diet, smoking and exercise, so studying them is a good way to distill out the effects of genetics, Shah says.

Researchers measured carotid intima-media thickness -- the thickness of the lining of the main arteries in the neck -- by ultrasound. Among the 59 pairs of twins where only one brother took antidepressants, the one taking the drugs tended to have higher carotid intima-media thickness (IMT), even when standard heart disease risk factors were taken into account. The effect was seen both in twins with or without a previous heart attack or stroke. A higher level of depressive symptoms was associated with higher IMT only in those taking antidepressants. (...)

(Anm: Arteriene (norsk: Pulsårene) transporterer blod fra hjertet og ut i kroppen. De systemiske arteriene fører blodet fra venstre hjertekammer, gjennom aorta (hovedpulsåren/den store kroppspulsåren), og videre ut i kroppen, bortsett fra til lungene. (en.wikipedia.org).)

Paxil May Increase Suicide Risk for Patients with Major Depression: Study
aboutlawsuits.com 11.4.2011
The antidepressant Paxil may increase the risk of suicide among individuals who are already suffering from major depressive disorders, according to new research.

A study published in the Journal of Clinical Psychiatry, which was funded by the drug’s maker, GlaxoSmithKline, found that some individuals taking Paxil were more likely to consider suicide than individuals who were given a placebo. (...)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

Chronic Depression Linked To Accelerated Immune Cell Aging
medicalnewstoday.com 6.4.2011
Certain cases of major depression are associated with premature aging of immune cells, which may make people more susceptible to other serious illness, according to findings from a new UCSF-led study.

The findings indicate that accelerated cell aging does not occur in all depressed individuals, but is dependent upon how long someone is depressed, particularly if that depression goes untreated. The study was published online in March 2011 by the journal PLoS One.

"There's a lot more to depression than feeling blue," said first author Owen Wolkowitz, MD, a professor of psychiatry at UCSF. "As if feeling depressed is not bad enough, we are finding that long-term depression may be associated with damage to cells in the body, and this may predispose patients to certain physical diseases."

Previously considered a mental illness affecting only the brain, major depressive disorder, or MDD, now is believed to be tied to significant physical damage outside the brain, explained Wolkowitz. For example, depressed individuals are more likely to develop the diseases of advanced age, including diabetes, heart disease, osteoporosis, stroke and dementia.

In probing the links between depression and physical disease, the research team explored aging of the immune system as measured by the shortening of telomeres in immune cells taken from the blood.

Telomeres are tiny units of DNA-protein complexes that seal off and protect the ends of chromosomes and act as a biological clock controlling a cell's life. Telomere shortening predicts earlier onset of several major age-related diseases and earlier mortality, and may serve as one index of human longevity. (...)

(Anm: Leukocyte Telomere Length in Major Depression: Correlations with Chronicity, Inflammation and Oxidative Stress - Preliminary Findings. PLoS ONE 6(3): e17837 (March 23).)

Tonic water, white bread, painkillers - the unlikely passion killers sapping your sex drive
dailymail.co.uk 28.3.2011
(...) ANTIDEPRESSANTS
Selective serotonin reuptake inhibitors — a modern family of antidepressants including Prozac (fluoxetine), Seroxat (paroxetine) and sertraline — cause a loss of libido and delayed orgasm in the majority of people who take them, says Professor David Taylor, director of pharmacy and pathology at South London and Maudsley NHS Foundation Trust.

In fact, they are sometimes prescribed to patients suffering from premature ejaculation for this very reason.

‘These drugs work by increasing levels of serotonin, a brain chemical that stimulates certain receptors in the brain to improve mood,’ he explains. ‘However this also stimulates other receptors which appears to lower libido.’

A new drug called agomelatine (or Valdoxan) does not cause these side effects, nor does mirtazapine (Avanza, Zispin).

However older antipsychotic drugs such as haloperidol (Serenace) and chlorpromazine (Largactil) and some newer ones such as risperidone (Risperdal) also affect sexual desire in up to three-quarters of people who take them.

Sexual Advice Association, www.sda.uk.net (...)

Starte opp og slutte med et antidepressivum – like lett?
relis.no 28.3.2011
Globalt er antidepressiva den tredje mest solgte legemiddelgruppen i verdi (1). Ifølge det norske reseptregisteret hentet rundt 300 000 personer i Norge ut en resept på et antidepressivum i 2009 (2).

Antidepressiva er assosiert med flere alvorlige bivirkninger, inkludert økt risiko for suicid og suicidaltanker og voldshand-linger. Dette kom ikke minst frem i forbindelse med en dokumentarserie på BBCs Panorama der det også ble avslørt at produsenten av Seroxat® (paroksetin) hadde tilbakeholdt informasjon som var kjent allerede under utprøvning av preparatet (3). I denne artikkelen settes det fokus på problemer relatert til seponering av antidepressiva. (...)

Behavioral destabilization induced by the selective serotonin reuptake inhibitor fluoxetine (Destabiliserende atferd forårsaket av den selektive serotoninreopptakshemmeren (SSRI-en) fluoxetine (Prozac))
Molecular Brain 2011, 4:12 doi:10.1186/1756-6606-4-12 (16 March)
Background Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat mood and anxiety disorders. However, neuronal bases for both beneficial and adverse effects of SSRIs remain poorly understood. We have recently shown that the SSRI fluoxetine can reverse the state of maturation of hippocampal granule cells in adult mice. The granule cell "dematuration" is induced in a large population of granule cells, and greatly changes functional and physiological properties of these cells. Here we show that this unique form of neuronal plasticity is correlated with a distinct change in behavior of mice. (...)

Conclusions Our results demonstrate that the SSRI fluoxetine can induce marked day-to-day changes in activity levels of mice in the familiar environment, and that the dematuration of the hippocampal granule cells is closely associated with the expression of this destabilized behavior. Based on these results, we propose that the granule cell dematuration can be a potential cellular basis underlying switching-like changes in the behavioral state associated with SSRI treatments. (...)

Depression Drugs -- SSRIs -- May Reorganize Brain Plasticity, New Research Suggests (Legemidler mot depresjon -- SSRI-er -- kan ifølge ny forskning reorganisere hjernens plastisitet)
sciencedaily.com 18.3.2011
ScienceDaily (Mar. 18, 2011) — Selective serotonin reuptake inhibitors (SSRI) such as Prozac are regularly used to treat severe anxiety and depression. They work by immediately increasing the amount of serotonin in the brain and by causing long term changes in brain function. However it can take weeks of treatment before a patient feels any effect and both beneficial effects and side effects can persist after treatment is stopped.

New research published by BioMed Central's open access journal Molecular Brain investigates physiological changes within the brain that may be caused by SSRI treatment.

The hippocampus is an area of the brain involved in long term memory and spatial awareness, and is involved in symptoms afflicting people with Alzheimer's disease, such as loss of memory and disorientation. Neuronal cells in the hippocampus can change their activity and strength of connections throughout life, a process known as plasticity, which thought to be one of the ways new memories are formed. Altered plasticity is often associated with depression and stress.

Researchers from the Department of Pharmacology, Nippon Medical School, showed that chronic treatment of adult mice with fluoxetine (Prozac) caused changes to granule cells, one of the main types of neuronal cells inside the hippocampus, and to their connections with other neuronal cells. The granule cells appeared to undergo serotonin-dependent 'dematuration', which increased their activity and reversed adult-type plasticity into an immature state. These changes to the cell's plasticity were associated with increased anxiety and in alternating between periods of hyper or hypo activity.

Katsunori Kobayashi explained, "Some of the side effects associated with Prozac in humans, such as anxiety and behavioral switching patterns, may be due to excessive dematuration of granule cells in the hippocampus." (...)

Prozac reorganizes brain plasticity (Prozac reorganiserer hjernens plastisitet)
eurekalert.org 15.3.2011e
Selective serotonin reuptake inhibitors (SSRI) such as Prozac are regularly used to treat severe anxiety and depression. They work by immediately increasing the amount of serotonin in the brain and by causing long term changes in brain function. However it can take weeks of treatment before a patient feels any effect and both beneficial effects and side effects can persist after treatment is stopped. New research published by BioMed Central's open access journal Molecular Brain investigates physiological changes within the brain that may be caused by SSRI treatment.

The hippocampus is an area of the brain involved in long term memory and spatial awareness, and is involved in symptoms afflicting people with Alzheimer's disease, such as loss of memory and disorientation. Neuronal cells in the hippocampus can change their activity and strength of connections throughout life, a process known as plasticity, which thought to be one of the ways new memories are formed. Altered plasticity is often associated with depression and stress.

Researchers from the Department of Pharmacology, Nippon Medical School, showed that chronic treatment of adult mice with fluoxetine (Prozac) caused changes to granule cells, one of the main types of neuronal cells inside the hippocampus, and to their connections with other neuronal cells. The granule cells appeared to undergo serotonin-dependent 'dematuration', which increased their activity and reversed adult-type plasticity into an immature state. These changes to the cell's plasticity were associated with increased anxiety and in alternating between periods of hyper or hypo activity.

Katsunori Kobayashi explained, "Some of the side effects associated with Prozac in humans, such as anxiety and behavioral switching patterns, may be due to excessive dematuration of granule cells in the hippocampus." (...)

(Anm: Behavioral destabilization induced by the selective serotonin reuptake inhibitor fluoxetine (Destabiliserende atferd forårsaket av den selektive serotoninreopptakshemmeren (SSRI-en) fluoxetine (Prozac)). Molecular Brain 2011, 4:12 (16 March).)

A New Troublesome Long-Term Effect Of Antidepressant Drugs; Tardive Dysphoria (En ny plagsom langtidseffekt av antidepressiva, tardive dysfori)
medicalnewstoday.com 8.3.2011
(...) A possible prodepressant effect of antidepressants has been previously proposed. Fava was the first to suggest that an antidepressant-related neurobiochemical mechanism of increasing vulnerability to depression might play a role in worsening the long-term outcome of the illness. Understanding of potential mechanisms of this phenomenon can be gleaned from observations regarding the short form of the serotonin transporter (5HTTR). Patients with the short form of the 5HTTR and prolonged antidepressant exposure, may be particularly vulnerable to antidepressant-related worsening. In other words, prolonged exposure to antidepressants can induce neuroplastic changes that result in the genesis of antidepressant-induced dysphoric symptoms. The investigators propose the term 'tardive dysphoria' to describe such a phenomenon and describe diagnostic criteria for it. Tapering or discontinuing the antidepressant might reverse the dysphoric state. Antidepressant discontinuation may not provide immediate relief. In fact, it is likely that transient symptoms of withdrawal will occur in the initial 2-4 weeks following antidepressant discontinuation or tapering. However, after a prolonged period of antidepressant abstinence, one may see a gradual return to the patient's baseline. (...)

(Anm: Antidepressants: Tardive dysphoria in an elderly patient?: case report. Journal of Psychotherapy and Psychosomatics 2011 (January 29).)

Initial prescription of antipsychotics and antidepressants in general practice and specialist care in Norway
Acta Psychiatrica Scandinavica 2011 (14 MAR)
Objective:  To examine the incidence rates of antipsychotic (AP) and antidepressant (AD) drug treatment in Norway and the proportions initiated in general practice and specialist care respectively. (...)

Results:  One-year incidence rates per 1000 inhabitants were 3.4 for APs and 8.6 for ADs. GPs initiated 58% of APs and 73% of ADs, while psychiatrists initiated 15% and 6% respectively. Psychiatrists initiated treatment more often among younger patients, and they prescribed relatively newer drugs more commonly than GPs. A large share of incident users did not refill their prescriptions for APs (57%) or ADs (33%).

Conclusion:  GPs have a key role as regards initiating treatment with APs and ADs in Norway, while psychiatrists’ influence seems limited, particularly among older patients. Efforts for quality improvement of mental health care need to involve primary health care. In addition, an increased focus from psychiatrists towards the increasingly ageing part of the population seems requisite. (...)

Langvarig udsættelse for antidepressiva kan fremkalde tardive Dysfori
news-medical.net/news.com 9.3.2011
I den aktuelle udgave af psykoterapi og Psykosomatik en ny vigtig bivirkning af antidepressiv medicin er beskrevet: tardive dysfori.

Behandling-resistent depression (TRD) kan være relateret til utilstrækkeligt dosering af antidepressiva eller antidepressiv tolerance. Alternativt er der grund til at tro, at antidepressiv behandling selv kan bidrage til en kronisk depressiv syndrom. Denne undersøgelse rapporterer et tilfælde af antidepressiv ophør i en TRD patient, en 67-årig hvid mand med pludseligt opstået major depressiv sygdom i en alder af 45 år. (...)

Are Psychiatric Medications Causing More Mental Illness? (Forårsaker psykiatriske legemidler mer psykisk sykdom?)
radioboston.wbur.org 19.1.2011
According to some sources, the use of psychiatric drugs like ritalin, prozac and xanax, has doubled in the last decade

A local science journalist and author, Robert Whitaker, says in his recent book, “Anatomy of an Epidemic: Magic Bullets, Psychiatric Durgs, and the Astonishing Rise of Mental Illness in America,” that the long-term use of these popular psychiatric medications is actually causing more mental illness — not less.

Whitaker says his research which examines for the first time the long-term effects of psychiatric drugs, shows that these medications are often making diseases such as depression and schizophrenia worse, not better. He points to a major increase in the number of people getting federal disability benefits for mental illness who are taking these medications as a sign that the drugs are, in fact, contributing to chronic mental illness in America. For example, Whitaker points out that between 1987 and 2007, “the number of disabled mentally ill children rose thirty-five fold.”

Whitaker’s claims are refuted by reputable members of the psychiatric community here in Boston. (...)

Blood pressure drugs feeding the obesity epidemic?
reuters.com 10.3.2011
(Reuters Health) - Blood pressure drugs known as beta-blockers could be helping to fuel the obesity epidemic, by dampening the body's ability to burn calories and fat over the long term, researchers say in a new report.

Weight gain is a known side effect of beta blockers, particularly older ones such as atenolol (Tenormin) and metoprolol (Lopressor, Toprol-XL). Newer versions, like carvedilol (Coreg), appear to carry less risk of added pounds.

Beta-blockers are not the only medications that promote weight gain. Antidepressants, corticosteroids and some diabetes medications are among the other culprits. (...)

Drug companies and psychiatry profession still singing the same old duet
alison-bass.blogspot.com 7.3.2011
The same drug giants paying millions of dollars to settle claims that they engaged in illegal and improper marketing of anti-psychotic drugs in the U.S. are even now looking for new worlds to conquer. Consider the study published today in the Archives of General Psychiatry. It surveyed more than 60,000 adults in 11 countries in Eastern Europe, Asia and South America and concludes that the treatment needs for people with bipolar disorder are "often unmet, particularly in low-income countries." (...)

Ny kunnskap om mekanisme som fører til depresjon
Tidsskr Nor Legeforen 2011; 131:434 (4.3.2011)
Oppregulering av MKP-1 i hippocampus ser ut til å ha betydning for utvikling av depresjon.

De molekylære mekanismene for utvikling av depresjon er i stor grad ukjente. En amerikansk forskergruppe har nå gjort helgenomekspresjonsanalyse av hippocampusvev tatt postmortem fra 21 individer med depresjon og 18 kontrollpersoner uten depresjon (1). Forskerne identifiserte MKP-1 som signifikant oppregulert i hippocampusregioner hos deprimerte individer, både på RNA og på proteinnivå. MKP-1 er et protein som defosforylerer både treonin og tyrosin, og er således en negativ regulator av mitogenaktivert proteinkinase (MAPK)-kaskaden, som er essensiell for hjernens funksjon. (...)

Forest Labs bets $1.2 billion on Clinical Data to beat patent cliff
pharmatimes.com 23.2.2011
Forest Laboratories is preparing to splash out $1.2 billion to acquire Clinical Data, getting access to the latter's recently-approved antidepressant Viibryd.

Forest will pay $30 per share in cash, which actually is down 12% on CD's closing price on Friday, and an additional $6 a share based on the success of Viibryd (vilazodone). The selective serotonin reuptake inhibitor and a 5-HT1A receptor partial agonist was approved by the US Food and Drug Administration a month ago for the treatment of adults with major depressive disorder.

With Celexa (citalopram) and Lexapro (escitalopram), Forest notes that it has a "proven track record of successfully commercialising novel anti-depressants" and it plans to launch Viibryd in the USA during the second half of 2011. Importantly, it is expected to retain market exclusivity until March 2020 "including full patent term extension of its composition of matter...and anticipated paediatric exclusivity".

Forest is gambling that Viibryd will help offset the loss of earnings it will suffer when Lexapro goes off-patent in 2012. Chief executive Howard Solomon said that "this transaction is consistent with our strategy to acquire new products that will help offset the loss of revenues due to patent expiries". (...)

For Some Troops, Powerful Drug Cocktails Have Deadly Results (For noen soldater, har kraftige cocktailer av legemidler dødelige resultater)
nytimes.com 18.2.2011
In his last months alive, Senior Airman Anthony Mena rarely left home without a backpack filled with medications.

He returned from his second deployment to Iraq complaining of back pain, insomnia, anxiety and nightmares. Doctors diagnosed post-traumatic stress disorder and prescribed powerful cocktails of psychiatric drugs and narcotics.

Yet his pain only deepened, as did his depression. “I have almost given up hope,” he told a doctor in 2008, medical records show. “I should have died in Iraq.”

Airman Mena died instead in his Albuquerque apartment, on July 21, 2009, five months after leaving the Air Force on a medical discharge. A toxicologist found eight prescription medications in his blood, including three antidepressants, a sedative, a sleeping pill and two potent painkillers.

Yet his death was no suicide, the medical examiner concluded. What killed Airman Mena was not an overdose of any one drug, but the interaction of many. He was 23.

After a decade of treating thousands of wounded troops, the military’s medical system is awash in prescription drugs — and the results have sometimes been deadly. (...)

Drugs Pose Danger to Our Veterans and Service Members
huffingtonpost.com 21.2.2011
The figures have become familiar: the number of veterans and troops in the wars in Iraq and Afghanistan who suffer from post-traumatic stress disorder are at record levels: 300,000 men and women. What isn't so well known is what most of these people experience when they turn to the military for help. They get prescriptions for serious drugs. Multiple prescriptions.

Prozac, Effexor, Elavil or Trazodone for depression. Paxil for depression, obsessive-compulsive disorder or anxiety. Zoloft for depression, obsessive-compulsive disorder, anxiety. Wellbutrin for depression, anxiety, attention deficit disorder. Celexa for anxiety, panic attacks, ADHD. Valium for anxiety and insomnia. Klonopin, Ativan, or Xanax for anxiety and panic attacks. Topamax for migraines. Percocet, Lyrica, or OxyContin for pain. Adderall or Ritalin for ADD, or ADHD. Haldol, Risperdal or Seroquel for psychosis. Ambien, Lunesta, or Restoril for insomnia.

A group of veterans I had the honor and privilege of meeting with recently shared how this pharmaceutical approach to their physical and emotional pain and inability to sleep -- which I discovered is a universally disabling consequence of combat -- quickly alienates them, producing cynicism towards the VA. "They just push pills," one man told me. "They act as if there's a quick fix: just pop these pills." (...)

UPDATE MODULE 1560: CYTOCHROME P450 ENZYMES
CHEMISTANDDRUGGIST.CO.UK 16.2.2011
Sharmila Chauhan PhD MRPharmS
How this tricky aspect of drug metabolism can affect your patients, and what you can do about it

Why read this module
Six cytochrome P450 enzymes metabolise 90 per cent of drugs, but can be influenced by a variety of factors. This Update covers how drugs, diet and genetics can affect P450 enzymes and the potential consequences.

What non-drugs can interact with P450s?

Herbal remedies such as St John's wort, dietary choices such as drinking grapefruit juice and eating chargrilled food, drinking and smoking can all affect P450 enzymes. (...)

What is cytochrome P450?
The CYP450 enzymes are heme-containing membrane proteins, which are located primarily in the liver. In the body, they are responsible for the production of cholesterol, steroids, prostayclin and thromboxane A. They are also involved in the metabolism of many medicines. There are more than 50 enzymes, although six of them metabolise about 90 per cent of drugs: CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4 and CYP3A5.1

There are five main factors that account for the inter-patient variability of CYP450 biotransformation of drugs: genetic polymorphism, disease, age, drugs and certain foods/botanicals.² (...)

Fluoxetine, paroxetine CYP2D6 inhibitor Risperidone, tramadol CYP2D6 Increased risk of extrapyramidal adverse effects caused by increased risperidone level; decrease in analgesic effect caused by low level of active metabolite (...)

A number of food and botanical supplements interact with CYP450 and these should always be considered when investigating a potential drug interaction.

Clinical trials indicate that St John's wort reduces the plasma concentrations of a number of drugs including amitriptyline, atorvastatin, digoxin, erythromycin, fexofenadine and warfarin. Ginseng (Panax ginseng) may interact with phenelzine and warfarin, and kava (Pip3r methysticum) may interact with alprazolam, levodopa and paroxetine. Even garlic (Allium sativum) has been shown to interact with ritonavir and warfarin.² (...)

(Anm: Prozac (fluoxetine). (mintankesmie.no).)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Danskene er verdens mest mentalt utslitte folk
aftenposten.no 14.2.2011
Danmark er det landet i verden hvor flest mennesker slutter å jobbe fordi de er psykisk utslitte. Det viser en OECD-rapport ifølge den danske avisen Berlingske.

Annenhver danske som blir førtidspensjonist eller får innvilget fleksitid, har store psykiske problemer. I 1995 var tallet én av fire.

Det gjør Danmark til et foregangsland for en internasjonal tendens til at psykiske lidelser slår ut store deler av den totale arbeidsstyrken.

«Vi er kort sagt verdens mest mentalt utslitte», skriver Berlingske.

– Dette er en ekstremt urovekkende utvikling. Vi ser ikke bare at et stigende antall faller utenfor arbeidsmarkedet, men at det stadig skjer for yngre mennesker. Den typisk mentalt utslitte var tidligere omkring 55 år, men i dag er han like under 50, sier rapportens forfatter, Christopher Prinz til Berlingske.

– Derfor er det tragisk at vi ikke er gode nok til å håndtere dette, sier han. (© NTB)

Vi er verdens mest mentalt nedslidte
b.dk 14.2.2011
Danmark er det land i verden, hvor flest mennesker forlader arbejdsmarkedet, fordi de er psykisk slidt ned, viser OECD-rapport.

Danmark er det land i verden, hvor flest mennesker må forlade arbejdsmarkedet på grund af psykisk sygdom. Det nedslående faktum fremgår af en omfattende OECD-rapport, der afslører, at når fire danskere fik en førtidspension eller et fleksjob i 1995, så var den ene af dem slået ud af sin egen psyke. I dag er det hver anden, der har så svære psykiske problemer, at vedkommende ikke kan klare et normalt arbejde.

Det gør Danmark til global frontløber for en international tendens, hvor sygdomme i sindet sengelægger en stadigt stigende del af arbejdsstyrken. Vi er kort sagt verdens mest mentalt nedslidte. (...)

23.000 barn og unge medisineres mot psykiske plager
nrk.no 4.2.2011
Tallet på barn og unge som medisineres mot psykiske sykdommer har økt kraftig. (...)

23.000 får medisiner
Tall fra Reseptregisteret viser at Inga ikke er alene. Tallet på barn og unge som medisineres mot angst, depresjoner, ADHD og psykoser øker stadig.

Se dokumentaren: Louis Theroux - barn og medisinering i nett-tv.

Bare siden 2004 har tallet på medisinerte barn og unge i aldersgruppen 0 – 20 år øket kraftig.

Ferske tall viser at mer enn 23.000 barn og unge får medisiner mot psykiske lidelser; mer enn 2000 bare i Hordaland. (...)

Lundbeck-partner betaler kæmpebøde for bedrageri
business.dk 4.2.2011
Forest hemmeligholdt tilsyneladende oplysninger om, at pillerne var mistænkt for at øge selvmordsrisikoen blandt børn.

Lundbecks amerikanske partner, Forest Laboratories, har betalt milliardstor bøde for ulovlig markedsføring af danske lykkepiller i USA og begået bedrageri over for de offentlige sundhedsmyndigheder.

Lundbecks partner i USA, Forest Laboratories, har indgået aftale med de amerikanske myndigheder om at betale svimlende 1,7 milliarder kroner for at få afsluttet sager om ulovlig markedsføring af blandt andet lægemidlerne Celexa og Lexapro fra den danske medicinalkoncern Lundbeck.

Ifølge de amerikanske myndigheder erkender Forest Laboratories sig skyldig i at have begået lovovertrædelser. (...)

Will New Antidepressant Have Same SSRI Side Effects?
lawyersandsettlements.com 31.1.2011
Los Angeles, CA: For women who are dealing with depression while pregnant, SSRI side effects are probably a constant concern. Specifically, women may be concerned about SSRI side effects such as PPHN (Persistent Pulmonary Hypertension of the Newborn). Now, a new antidepressant has been approved for use, but whether or not it has the same risk of SSRI side effects as older SSRIs is not known.

The US Food and Drug Administration (FDA) approved a new antidepressant, called Viibryd (known generically as vilazodone). According to the Los Angeles Times (01/24/11), the drug is the first combination of selective serotonin reuptake inhibitor and 5HT1A receptor partial agonist. The drug works by not only increasing the levels of serotonin in the brain—the SSRI portion of the drug—it also affects alleles in the 5 HT transporter gene. (...)

FDA Approves New Antidepressant Said to Carry Fewer Side Effects
aolhealth.com 27.1.2011
(...) Two randomized, double-blind trials showed 40 mg of Vilazodone given once daily to adults suffering from MDD proved the drug is significantly more effective than the placebo in improving depressive symptoms. Like other drugs, Vilazodone works to control the brain chemical serotonin, but can also boost dopamine levels. (...)

During safety studies, researchers monitored 2,177 patients diagnosed with MDD. Their side effects included diarrhea, nausea, vomiting and insomnia. A little more than 7 percent of patients who received vilazodone discontinued treatment due to adverse reactions. (...)

This drug will be sold in 10, 20 and 40 mg tablets and will contain a label, just like other antidepressants, warning users about increased risk of suicide and suicidal behavior in children, adolescents and young adults. The warning label also says depression and other serious psychiatric disorders are the most important causes of suicide, and close monitoring of patients starting these medications is necessary, says Walsh.

"As with any drug, the FDA will continuously monitor adverse events reported for any unknown safety signals," Walsh adds. (...)

Bra och dåligt för nya antidepressiva
lakemedelsvarlden.se 25.1.2011
Företaget Clinical Data har fått godkänt för sitt nya antidepressiva preparat Viibryd i USA. Samtidigt kommer negativa resultat för en tidigare lovande kandidat mot egentlig depression. (...)

An antidepressant with fewer sexual side effects is approved [Updated]
latimes.com 24.1.2011
Antidepressants can help people recovery from major depression, but some people dislike the medications because of their effects on sexual function. An antidepressant approved by the Food and Drug Administration on Monday, however, appears to have fewer sexual side effects.

The drug, called Viibryd (or vilazodone), is the first antidepressant that is a selective serotonin reuptake inhibitor combined with and a 5HT1A receptor partial agonist. Many of the so-called SSRI antidepressants, such as Prozac or Zoloft, work on the serotonin system of the brain. Viibryd is a dual-mechanism medication in that it also affects certain allelic variations in the 5 HT transporter gene. (...)

FDA Approves New Antidepressant
medpagetoday.com 21.1.2011
Vilazodone (Viibryd) has been approved for treatment of major depression, the FDA announced.

The drug is an oral serotonin reuptake inhibitor and also a partial agonist at the 1A serotonin receptor subtype, similar to the established antidepressant trazodone (Desyrel).

According to the drug's manufacturer, PGxHealth, the approval was based primarily on two eight-week clinical trials comparing vilazodone with placebo. The drug was also tested in a 52-week uncontrolled study with efficacy results similar to those seen in the randomized trials.

Patients receiving the drug showed more improvement in scores on the Montgomery-Åsberg and Hamilton depression symptom scales.

A total of 2,900 patients have received vilazodone in clinical studies, PGxHealth said.

Diarrhea, nausea, vomiting, and insomnia were the most common adverse effects reported with the drug.

As with all antidepressants, the product's label will include a boxed warning and patient medication guide about risk of suicidal thinking and behavior in patients younger than 25 when treatment first begins.

The drug will be produced in 10-, 20-, and 40-mg tablets. (...)

Escitalopram helps a little with hot flushes (Ecitalopram (Cipralex) hjelper lite mot hetetokter)
BMJ 2011; 342:d313 (19 January)
JAMA2011;305:267-74 [Abstract/Full text]
(...) Absolute differences were small, however, thanks to a powerful placebo effect. Daily frequency of hot flushes fell from 9.9 to 5.3 in women given escitalopram (−4.60, 95% CI −5.47 to −3.74) and from 9.7 to 6.4 in controls given placebo (−3.20, −4.15 to −2.24)—a difference of just 1.41 episodes a day (95% CI 0.13 to 2.69). Severity scores also fell in both groups during the trial. Scores on a three point scale fell 0.22 points further in women given escitalopram (−0.40 to −0.05). Side effects such as tiredness were common in both groups, but only nine women discontinued their treatment, including seven taking escitalopram.

These results are broadly in line with expectations. Escitalopram helps, but probably not as much as hormone therapy, say the authors, who recommend a head to head trial next. The mechanism of action remains unknown, but escitalopram seemed to work much faster for hot flushes than it would for anxiety or depression. In this trial, treatment effects were noticeable within a week. (...)

Questions about Antidepressants and Pregnancy
lawyersandsettlements.com 14.1.2011
There’s a lot in the news about pregnancy and antidepressants (SSRI’s in particular—and especially Paxil, which has a Category D rating by the FDA). And we get a lot of comments and emails from readers who are either looking for information about SSRI drugs and pregnancy—or who share their stories about negative side effects they’ve experienced while taking antidepressants. (...)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

Kommunen tilbød Gerd (92) lykkepillen istedet for sykehjemsplass
tv2nyhetene.no 5.1.2011
Nå har hennes sønn anmeldt Nøtterøy kommune til politiet for brudd på regjeringens verdighetsgaranti. (...)

Ble tilbudt antidepressiva
(...) Nøtterøy kommune kunne imidlertid ikke gi henne plass.

I et møte foreslo de i stedet at hun kunne bruke antidepressiva hvis hun var bekymret.

– Jeg greide ikke å plassere de depressivgreiene, for jeg tenkte: Er jeg så gæren, da? Jeg vet ikke, jeg, sier Gerd Fagerlie til TV 2. (...)

Forsvarer bruk av lykkepiller
Ordføreren i kommunen forsvarer at man gir lykkepiller til de eldre.

– Ja, så møter man også mer positive mennesker og man har en bedre livssituasjon, sier ordfører Roar Jonstang i Nøtterøy kommune til TV 2.

Da slipper vel kommunen veldig mye plagsomme spørsmål, hvis folk er fornøyd fordi de er dopa?

– Her må vi jo finne løsninger totalt som er de beste. Vi har jo som mål å gjøre det best mulig for folk, det er jo det som er målet vårt, poengterer ordfører Jonstang. (...)

Depression Plus Diabetes Raises CV Death Risk
medpagetoday.com 3.1.2011
The coexistence of depression and diabetes confers a high mortality risk on middle-age women, particularly for death from cardiovascular disease, a prospective study showed.

Compared with women who had neither depression nor diabetes, the relative risk for all-cause mortality among a large cohort of women who had both conditions was 3.11 (95% CI 2.70 to 3.58), according to Frank B. Hu, MD, PhD, of Harvard University, and colleagues.

And the relative risk for cardiovascular death was 5.38 (95% CI 4.19 to 6.91), the researchers reported in the January Archives of General Psychiatry. (...)

Zoloft and Birth Defect PPHN
lawyersandsettlements.com 27.12.2010
Zoloft (known generically as sertraline) is a drug used to treat depression, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder (PTSD) and premenstrual dysphoric disorder. Zoloft is in a class of drugs known as SSRIs—Selective Serotonin Reuptake Inhibitors. Studies have found a link between SSRIs, such as Zoloft, and PPHN, a life-threatening lung disorder. These medications have also been linked to an increased risk of heart defects in newborns. (...)

Barn med lav fødselsvekt mer psykisk syke
dagbladet.no 20.12.2010
Angstlidelser og ADHD vanligst.

Barn med lav fødselsvekt har større risiko for psykisk sykdom i 20-årene enn jevngamle med normal fødselsvekt, ifølge en studie utført ved NTNU.

Blant de undersøkte for tidlig fødte barna med lav fødselsvekt hadde én av tre fått en diagnose som omfattet en psykisk lidelse ved 20 års alder.

Hos jevngamle som hadde hatt normal fødselsvekt, var dette tilfelle for under én av ti. Hos personer som ble født til termin, men med lav fødselsvekt, forekom psykisk sykdom hos hver fjerde da de var 20 år gamle, skriver Dagens Medisin. (...)

Duloxetine-related tardive dystonia and tardive dyskinesia: a case report
Gen Hosp Psychiatry. 2010 Nov-Dec;32(6):646.e9-646.e11. Epub 2010 Jun 3.
Tardive dyskinesia and tardive dystonia are caused by dopamine receptor blocking agents, mostly antipsychotics and sometimes antidepressants or calcium channel blockers. Duloxetine-related tardive syndrome is rarely reported in the literature. We report one case of tardive dystonia and tardive dyskinesia occurring in a 58-year-old female with major depressive disorder, who developed distressing oral dyskinesia, mandibular dystonia with trismus and dystonia over left neck after treatment of duloxetine (30-60 mg per day) for 18 months. Despite discontinuation of duloxetine, she only obtained partial remission. Even though this association has been rarely reported, duloxetine may pose a potential risk of inducing tardive syndrome. Clinicians should cautiously detect early signs of movement abnormality when prescribing antidepressants. (...)

CLDA: Links to FDA labels for approved antidepressants
themarketfinancial.com 12.12.2010
Written by ChasingTheAlpha.com Alerts, FDA Updates, US Markets Dec 12, 2010

Update( 7:21 PM PST) - Below are links to labels for Cymbalta, Lexapro, Zoloft, Effexor, Pristiq, Paxil and Wellbutrin. Hopefully this helps in order to compare the CLDA efficacy and safety data. We can take a look the differences later.

Cymbalta - http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022516lbl.pdf

Lexapro - http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021323s030s031,021365s021s022lbl.pdf

Zoloft - http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019839s070,020990s032lbl.pdf

Effexor - http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020151s056s057lbl.pdf
Effexor XR - http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020699s090lbl.pdf

Pristiq - http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021992s013lbl.pdf

Seroxat - Paxil - http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020031s063,020710s027lbl.pdf
Seroxat CR - Paxil CR - http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020936s041lbl.pdf

Wellbutrin - http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/018644s038,020358s045lbl.pdf

See WikInvest article on Antidepressant market - http://www.wikinvest.com/wiki/Antidepressant_Drug_Market (...)

New Depression Target
JAMA. 2010;304(21):2350 (December 1)
Research led by scientists at Yale University in New Haven, Conn, indicates that an enzyme called mitogen-activated protein kinase phosphatase 1 (MKP-1) is linked to major depressive disorder (MDD) and might point the way to a new treatment approach (Duric V et al. Nat Med. 2010;16[11]:1328-1332).

Whole-genome expression profiling of postmortem human brain tissue from 21 individuals with depression and 18 healthy controls revealed that tissue from individuals with depression expressed increased levels of MKP-1. This enzyme removes phosphate groups from proteins and is a negative regulator of a signaling pathway involved in neuronal function.

The researchers also found in rodent models of depression that increased MKP-1 expression (resulting from stress or infusions of a virus carrying the gene encoding MKP-1) caused depressive behaviors. Chronic treatment with an antidepressant normalized stress-induced MKP-1 expression and behavior. Also, mice lacking MKP-1 were resilient to stress.

The findings "identify MKP-1 as a key factor in [depression] pathophysiology and as a new target for therapeutic interventions," the authors said. (...)

Neurological Protein May Hold The Key To New Treatments For Depression
medicalnewstoday.com 30.11.2010
Neuroscientists at the Centre for Addiction and Mental Health (CAMH) have developed a protein peptide that may be a novel type of highly targeted treatment for depression with a low side-effect profile. Depression affects one in ten Canadians at some time in their lives and is a leading cause of disability worldwide.

The study published in this month's Nature Medicine found that coupling between two dopamine receptors was significantly elevated in the brains of people who had been diagnosed with major depression. "We identified a potential therapeutic target for development of novel anti-depressants." said Dr. Fang Liu, Principal Investigator and Senior Scientist in CAMH's Neuroscience Program and Associate Professor of Psychiatry at the University of Toronto. Working from this discovery, researchers sought to find a way to disrupt coupling between the two receptors in hopes that it would have an anti-depressant effect. (...)

Courtney Love apologises for her wild and inappropriate behaviour (including recent naked interview)
dailymail.co.uk 11.11.2010
Courtney Love has apologised for behaving in a wild and inappropriate manner during a recent interview with a newspaper reporter.

The singer's interview with New York Times reporter Eric Wilson lived 'right up to my worst reputation,' as she put it.

Love, 46, claims she was drunk and on antidepressant Zoloft when she met Wilson in her hotel room for the interview, which explains why she wasn't wearing any clothes at the time. (...)

Courtney: Zoloft, Naked Interviews, Pulling It Together?
newser.com 8.11.2010
– The interview got off to the kind of start one might expect—but somehow still be surprised by—from Courtney Love: She told Eric Wilson to wait in the 6th floor Mercer Hotel room she's lived in for much of the last year, only to appear later ... naked. (...)

During their five-hour interview, she came across as funny, smart, and incredibly knowledgeable about the fashion industry—even if it began with her calling Russell Simmons demanding an apology for remarks he made about her ... after she posted nude photos of herself online. In "unusually coherent" texts, she apologized to Wilson for "living right up to my worst reputation," blaming Zoloft and a cocktail for the naked hotel scene. Her parting words: “I trust you understand that our hearts can take us all to dark and ill timed places. Warmly, Courtney. xx.” Click here to read the New York Times piece in its entirety. (...)

Rapid Halt of Antidepressants Shortens Time to Recurrence
Psychiatr News 2010;45(21):1 (November 5) (American Psychiatric Association)
There was little difference across antidepressant types in time to recurrence following abrupt discontinuation, but with gradual reduction, the time to recurrence was five months longer for tricyclics than for newer antidepressants.

Patients who stopped using antidepressant medication over one to seven days experienced a recurrence of mood disorder sooner than patients who were tapered off their medications over 14 days or more.

Moreover, the time to recurrence for those who rapidly discontinued antidepressants was one-fourth the estimated averageprevious interval between episodes of mood disorder in the same patients.

These findings appeared in the August American Journal of Psychiatry. (...)

Hormone Shows Potential as Antidepressant
depression.about.com 29.10.2010
Oxytocin, a hormone which is produced by breast-feeding mothers and by both genders during sexual activity, could eventually be used as an antidepressant, say researchers.

According to Dr. Ziad Nahas, a researcher at the Medical School of South Carolina, when depressed subjects inhaled the hormone, their brain activity began to more closely resemble that of healthy subjects.

Oxytocin has been linked to social bonding and attachment, said Nahas, and acts as a stress reliever. Since depressed individuals feel anxious and socially disconnected, oxytocin might help them feel less depressed. (...)

Differential pharmacological responses of catatonia-like signs in frontotemporal dementia.
Neurocase. 2010 Oct;16(5):436-50
Abstract
Sequential therapeutic trials for catatonoid frontal signs in clinically-evident frontotemporal dementia (n = 2) revealed differential benefits for lorazepam, amantadine, memantine, pramipexole, aripiprazole, quetiapine, citalopram, and donepezil, although certain signs also worsened. Citalopram and donepezil were poorly tolerated. Ramelteon was without effect. While memantine appeared to improve cognition in case 1, this remains to be established by more reliable neuropsychological testing. Parkinsonism (case 2) responded to pramipexole, but not amantadine or levodopa. Possible relationships of catatonoid signs requiring future confirmation include insufficient GABA-A (multiple signs) and D2 (mutism) and excessive NMDA (immobility, rigidity), D2/D3 (mannerisms, verbal perseveration), and 5HT1a (staring) receptor stimulation. Low-dose lorazepam and quetiapine required close monitoring. (...)

Making a Market in Antipsychotic Drugs: An Ironic Tragedy
huffingtonpost.com 24.9.2010
Remember not so long ago when Prozac became the world's largest selling medication of any kind, and then for years how Prozac, Paxil and Zoloft took over many of the top 10 spots? Remember the explanations at the time--that they were wonder drugs and that 15-50 percent or more of Americans would need them some time in their lives? To many people this seemed like a scientific breakthrough when in reality it was ... a triumph of marketing. Some studies suggest that the antidepressants are little or no more effective than a sugar pill and a lot more dangerous. Recent research examined all antidepressant studies submitted in recent years to FDA in regard to antidepressant efficacy and found that the drug performed no better than placebo except in "severely depressed patients," reaching "clinical significance" only "at the upper end of the very severely depressed category." Even then, the difference between the antidepressant and the placebo was "relatively small." (...)

Penile Amputation: Nightmare Side Effect (Penisamputasjon: marerittaktig bivirkning)
blogs.forbes.com 23.9.2010
When you wind up in the emergency room, do tell your doctor about every medicine that you are taking. Case in point, a recent medical journal report I found while researching a widely used psychiatric drug.

WARNING: The included link contains graphic medical photographs that may not be safe for work.

“Penile Amputation After Trazodone-Induced Priapism: A Case Report,” was published in the Primary Care Companion to The Journal of Clinical Psychiatry this year, and recounts the case of a 35-year-old man who was prescribed trazodone, an antidepressant that predates Prozac and Paxil and is still the #12 most-used psychiatric drug, by a psychiatrist to treat sleep problems. The article was written by doctors at hospitals in Germany and Belgium. (...)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

(Anm: - priapisme - langvarig ereksjon Hva er priapisme? Priapisme er langvarig og smertefull ereksjon. Ereksjonen har gjerne vedvart i noen timer. Etter hvert vil det utvikle seg smerter i penis og mellomkjøttet (området mellom penis og endetarmsåpningen). (nhi.no).)

(Anm: Penile Amputation After Trazodone-Induced Priapism: A Case Report. Prim Care Companion J Clin Psychiatry2010;12(2):PCC.09l00816.)

Reversible escitalopram-induced hypothyroidism
Gen Hosp Psychiatry. 2010 Sep-Oct;32(5):559.e5-7.
Some drugs can cause alterations in the concentration of thyroid hormones in blood even without clinical signs of dysfunction or pathology of the thyroid gland. Apart from the well-known relationship between depression and hypothalamic-pituitary-thyroid (HPT) axis, and the impact of selective serotonin reuptake inhibitors (SSRIs) on thyroid indices, hypothyroidism is a very rare adverse effect of SSRI treatment. However, the case presented here demonstrates that escitalopram may have the potential to induce hypothyroidism without any significant clinical signs and symptoms. Therefore, the possibility of SSRI-induced asymptomatic hypothyroidism presented here may help clinicians in this regard. (...)

Amnesty for unreported SSRI use ends Sept. 30
aopa.org 18.8.2010
The period of amnesty for pilots who failed to disclose their antidepressant use on past airmen medical applications is nearing its end.

Effective April 5, 2010, the FAA began considering individuals for special issuance medical certification who are being treated for depression with one of four SSRI medications. The agency gave pilots who had not reported information about their condition on previous medical applications until Sept. 30 to come forward without fear of prosecution.

“Once the amnesty period ends, pilots who have failed to disclose their use of antidepressants on previous medical applications will once again be subject to prosecution if the FAA becomes aware of the unreported medication usage,” said AOPA Director of Medical Certification Gary Crump. (...)

SSRI Antidepressants May Do More Harm Than Good Against Autism: Study (Antidepressiva (SSRI-er) kan gjøre mer skade enn nytte, ifølge studie)
aboutlawsuits.com 10.8.2010
The findings of a new study suggest that physicians may not be helping by prescribing SSRI antidepressants off-label to treat autism, and may actually be harming patients instead.

An analysis of the effects of selective serotonin reuptake inhibitors (SSRIs) for autism in adults and children were published this week in the Cochrane Database of Systematic Reviews. Researchers say that there is little evidence that giving the medications to autistic patients has any effect. In fact, the patients may be being exposed to the side effects of SSRI antidepressants despite the lack of measurable benefit.

Doctors frequently prescribe SSRIs to autistic children to help with behavioral problems, and to adults for anxiety and depression. Some estimates suggest up to 40 percent of autistic children are being dosed with antidepressants to control their behavior. But last year, a study found that the SSRI Celexa was no more effective than a placebo in affecting autistic behavioral symptoms. (...)

Don't go cold turkey
chicagotribune.com 28.8.2010
Reducing your reliance on antidepressants requires patience and a doctor's involvement (...)

Generally, patients should stay on antidepressants for at least nine to 12 months to reduce the likelihood of a depression relapse, Banov said. But beyond that, it's up to patients to work with their doctors on whether and how to wean themselves off the drugs. Sometimes the process is unpleasant.

About 20 percent of people who try to quit suffer what the drug companies coined "antidepressant discontinuation syndrome," which can cause symptoms including depression, anxiety, irritability, dizziness, nausea, light-headedness and electric shocks known as "brain zaps."

Symptoms can be more severe the longer you have taken antidepressants, the higher the dosage and the more sensitive your body happens to be, Banov said. They also depend on the drug. Paxil and Effexor are associated with some of the worst withdrawal symptoms because they clear out of your system quickly, leaving little time for your body to adjust to the sudden drop in the neurotransmitter serotonin. Prozac, meanwhile, takes a long time to leave your body, diffusing the withdrawal effects. (...)

Dee Woods: Antidepressants may damage your eyes (Dee Woods: Antidepressiva kan skade øynene dine)
thereporteronline.net 28.8.2010
Doctors will admit that medications have side effects. Unfortunately, very often we don’t realize the degree of side effects until the offending drugs have been on the market for many years.

Even then, there are times when the degree of negative side effects does not become apparent for another few years. (...)

How to Cope With Antidepressant Side Effects
depression.about.com 18.8.2010
All antidepressants have potential side effects, although not everyone will experience all of them or to the same degree. Some antidepressant side effects will go away on their own as your body adjusts to your medication. Others may never completely subside. It is important to speak to with your doctor about any antidepressant side effects you experience, as some of these may be quite serious. Never stop your medication or adjust your dose without consulting your doctor first. You may experience a return of your depression or unpleasant symptoms called discontinuation syndrome.

Click on the links below to explore strategies for coping with some of the most common antidepressant side effects. (...)

Lindsay Lohan Poisoned! Along with 300 Million Other Americans
prisonplanet.com 26.8.2010
Alex Jones explains why Lindsay Lohan, and by extension millions of Americans are being poisoned with methamphetamine style drugs like Ritalin that cause brain shrinkage, heart problems and a myriad of other disorders. Alex also highlights how SSRI prozac drugs are turning people into psychopaths and leading to a massive increase in suicides and other reckless behavior.

Young girls and even babies are now going into puberty as a result of milk laced with hormones, Bisphenol A and a toxic cocktail of other ingested substances.

Alex also highlights the deadly threat of sodium fluoride and how it causes IQ reduction, bone cancer, and how vaccines are also contributing to a massive and sustained chemical attack on free humanity as the globalists’ eugenics agenda goes into high gear. (...)

Lindsay Lohan's father accuses her doctors of misdiagnosis (Lindsay Lohhans far anklager hennes lege for feildiagnoser)
deccanherald.com 14.9.2010
Hollywood beauty Lindsay Lohan's doctors are being investigated by the Medical Board of California after her father accused them of ''over-prescribing'' to his troubled daughter.

Michael Lohan complained that the 'Mean Girls' star who recently underwent a prison and rehab stint, was misdiagnosed by her doctors.

Lohan's lawyer Lisa Bloom confirmed that she had asked the medical board to look into the physicians' prescription practices and the investigation is underway, reported CNN online.

Bloom lodged a complain with the California Attorney General against "the unscrupulous doctors (who) over-prescribed Lindsay."

"The Medical Board is investigating and Michael and I are co-operating with them," said Bloom.

According to medical reports Lindsay was taking Dilaudid, Adderall, Nexium, Zoloft, Trazodone and Ambien for various medical conditions when she checked into a rehab facility following a prison spell this summer.

The medicine experts diagnosed her with Attention Deficit Hyperactivity Disorder (ADHD) and directed a remedy that has put her health in an alarming state, said the lawyer. (...)

 

Inget bevis antidepressiva hjälper vid autism
lakemedelsvarlden.se 10.8.2010
Att behandla barn med autism med antidepressiva medel gör ingen nytta. Det menar forskare vid Cohraneinstitutet som gått igenom befintliga data.

TVEKSAMT Autistiska besvär är ofta svåra att behandla eftersom patienternas symptom varierar och ofta skiljer sig mellan individer. Trots att det inte finns som godkänd indikation används i flera länder SSRI-preparat för att behandla barn och vuxna som diagnostiserats med autism. Men åtminstone barn borde inte behandlas med dessa är slutsatserna efter en Cohranegenomgång. (...)

Little evidence antidepressants helpful for autism (Lite bevis for at antidepressiva hjelper mot autisme)
reuters.com 9.8.2010
(Reuters Health) - While antidepressants are commonly given to people with autism, there is no evidence from clinical trials that the drugs are helpful for children with the disorder, and only limited evidence that they benefit adults, a new research review finds.

The analysis, reported in the Cochrane Database of Systematic Reviews, adds to doubts about the use of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) in autism.

Last year, a U.S.-government-funded study found that the SSRI citalopram (Celexa) was no better than a placebo at improving repetitive behaviors in children with autism. At the time, experts expressed surprise at the lack of benefit and said the results illustrated the need to test antidepressants against placebos in people with autism.

For the new review, researchers evaluated the findings of the Celexa study, along with those of six other -- much smaller -- clinical trials in the medical literature.

Overall, they found no evidence that SSRIs were better than placebos at improving repetitive behaviors or other symptoms in children with autism. And there was only limited evidence from two small clinical trials that certain SSRIs might improve anxiety, depression and other symptoms in autistic adults.

On the whole, there is no basis for recommending the routine use of SSRIs in treating autism, according to the researchers, led by Dr. Katrina Williams, a pediatrician at the University of New South Wales and Sydney Children's Hospital in Australia. (...)

Illness Risk Following Rapid Versus Gradual Discontinuation of Antidepressants
Am J Psychiatry 2010; 167:934-941 (May 17)
Objective: Rapid discontinuation of some psychotropic medications is followed by discontinuation symptoms as well as an increased risk of early illness recurrence. Recurrence occurs earlier after rapid than after gradual discontinuation with lithium and antipsychotics. The authors compared illness recurrence after rapid versus gradual discontinuation of antidepressants. (...)

(...) Conclusions: The recurrence risk for depression or panic was much shorter after rapid than after gradual discontinuation of antidepressants. These findings have implications for both clinical management and the design and interpretation of clinical trials. (...)

Onset of psoriasis during therapy with fluoxetine (Psoriasis etter oppstart med Prozac (fluoxetine))
Gen Hosp Psychiatry. 2010 Jul-Aug;32(4):446.e9-446.e10. Epub 2009 Sep 24.
OBJECTIVE: Psoriasis is a commonly diagnosed skin disorder that requires a long-term management and can have a profound impact on the quality of life of patients. Drugs that have been associated with the precipitation or exacerbation of psoriasis include lithium, beta-adrenergic receptor blocking agents and antimalarials. Despite extensive use of selective serotonin reuptake inhibitors (SSRIs) in clinical practice, there have been very few reports of selective serotonin reuptake inhibitor-related psoriasis. The main purpose of this study was to report fluoxetine-induced psoriasis in two Chinese women. RESULTS AND CONCLUSION: Although both patients had been taking fluoxetine for an extended period of time, the time scale of these two case studies suggests that fluoxetine played a causative role in these patients' psoriasis. (...)

(Anm: Ulike typer psoriasis (nhi.no).)

Antidepressants Like Paxil May Affect Personality (Antidepressiva som Seroxat (Paxil) kan påvirke personlighet)
mentalhealthnews.org 27.7.2010
Antidepressants may do more than just treat depression; certain drugs may also directly impact personality traits. There are five main traits that are used to determine personality: neuroticism, extraversion, openness, conscientiousness, and agreeableness. For years, it has been assumed that the changes people experience in neuroticism and extraversion were a result of the antidepressant’s affect on their depression, but a new twin study has determined that the antidepressant may be acting directly on the personality traits. (...)

(Anm: neuroticism; nevrotisisme; personlighetstrekk kjennetegnet ved tendens til å bli lett bekymret, til å gruble, til å bli sårbar overfor kritikk fra andre og usikker på seg selv. Kilde: Store norske leksikon.).)

Increased Risk Of Cardiovascular Problems In Depressed Men With Erectile Dysfunction
medicalnewstoday.com 14.7.2010
A new study in the Journal of Sexual Medicine found that the presence of depressive symptoms in men with erectile dysfunction constitutes a risk factor for a major cardiovascular event.

Erectile dysfunction and depressive mood are often associated, and both are associated with an increased risk of cardiovascular disease and death. To investigate clinical correlates further, researchers led by Elisa Bandini of the University of Florence studied approximately 2,000 male patients in a clinic for sexual dysfunction using a structured interview while also scoring for depressive symptoms. (...)

Results show that in these subjects with erectile dysfunction, depression increases cardiovascular problems independently from other known risk factors. Furthermore, even the use of antidepressant medications did not alter the relationship between severe depressive symptoms and adverse cardiovascular events. (...)

(Anm: Severe Depressive Symptoms and Cardiovascular Risk in Subjects with Erectile Dysfunction. Journal of Sexual Medicine 2010 (Published Online: 13 Jul 2010).)

Blame your serotonin levels for being a crybaby (Skyld på dine serotoninnivåer om du er en skrikerunge)
dnaindia.com 16.7.2010
Washington, DC: Always end up crying while watching a movie high on emotional quotient? Well, blame your serotonin levels for it, says a new study.
Frederick van der Veen of the Erasmus Medical Centre and colleagues have found that due to the differences in the neurotransmitter some people are more likely to cry in emotional situations than others.

The researchers gave 25 female volunteers a single dose of either paroxetine - a selective serotonin reuptake inhibitor (SSRI) that briefly increases serotonin levels - or a placebo. (...)

Bit of a crybaby? Blame your serotonin levels (Bitt av en skrikerunge? Skyld på dine serotoninivåer)
newscientist.com 15.7.2010
(...) Although SSRIs are used to treat depression, their mood-boosting effects do not normally show up for around six weeks. The women reported no change in mood in the current study. "We're looking at the direct effect of a single dose of paroxetine," says van der Veen, who adds that the findings might help explain why some people report blunted emotions when taking SSRIs.

"Our understanding of the neurobiology of crying is fairly limited," says Christopher Lowry, a serotonin researcher at the University of Boulder in Colorado. "It makes sense that it is tapping into circuitry involving serotonin."

Van der Veen now wants to find out whether genetic differences in serotonin production affect the tendency to cry. (...)

Use of Antidepressants During Pregnancy and Risk of Attention-Deficit/Hyperactivity Disorder in the Offspring. (Bruk av antidepressiva i løpet av svangerskapet og risiko ADHD hos barn)
J Dev Behav Pediatr. 2010 Jul 6. [Epub ahead of print]
OBJECTIVE:: Little is known about the impact of in utero exposure to antidepressants on children's long-term mental health. This study analyzed the impact of exposure to antidepressants during pregnancy on the risk of attention-deficit/hyperactivity disorder (ADHD) in the offspring. METHODS:: Claims-based data from 38,074 families were used to identify deliveries, parental mental health diagnoses, maternal exposure to antidepressants, and diagnosis or treatment for ADHD in the children. Multiple logistic regressions were performed using the presence of ADHD in the child by the age of 5 years as the dependent variable. (...)

CONCLUSION:: Children of mothers treated with bupropion during pregnancy have an increased risk of being diagnosed with ADHD; a possible causal effect needs to be further studied. Assessing the mental health of caregivers should be considered as part of the evaluation and treatment of children with ADHD. (...)

A Psychiatric Drug Story of Tragedy and Triumph
huffingtonpost.com 7.7.2010
(...) As it seems to be in Janice's case, the vast majority of the adults labeled "bipolar" that I see in my practice are suffering from antidepressant-induced mania in addition to whatever original life trauma led them to be diagnosed in the first place. I document several similar stories and provide the background science in Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime.

Notice how much courage and motivation Janice received from a single doctor verifying for her that her problems were due to psychological trauma and not to an alleged psychiatric disease. This should lend inspiration to health care practitioners who choose to speak honestly to their patients about the origins of their emotional problems in the story of their lives.

Janice went off psychiatric drugs cold turkey and suffered greatly as a result. I never recommend this. But unfortunately too few health care providers have any idea about the merits of withdrawing from psychiatric drugs and how to help patients go about tapering off psychiatric drugs in way to minimize the withdrawal effects. (...)

Going off antidepressants turned me into a nympho (Å slutte med antidepressiva gjorde meg til nymfoman)
salon.com 6.7.2010
When I went off Celexa, I expected my self-doubt to return. What I didn't anticipate was the surge of my desire (...)

When I forgot to take a pill one day, I decided to go cold turkey. Big mistake. Three days in, I had vertigo, what's known as "brain zaps," and nearly fainted on a subway platform -- all phenomena of "discontinuation syndrome." (Discontinuation syndrome is eloquently described in this New York Times article by science writer Bruce Stutz.) But once I started tapering gradually, the brain zaps and other unpleasantness slowly went away. (...)

(Anm: THE NEW MIDDLE AGES - Self-Nonmedication (nytimes.com 6.5.2007).)

Adverse drug reactions from psychotropic medicines in the paediatric population: analysis of reports to the Danish Medicines Agency over a decade
BMC Research Notes 2010, 3:176 (23 June)
(...) Conclusions
The high number of serious ADRs reported for psychotropic medicines in the paediatric population should be a concern for health care professionals and physicians. Considering the higher number of birth defects being reported greater care has to be given while prescribing these drugs for pregnant women. (...)

THE NEW MIDDLE AGES (DE NYE MIDDELALDRENDE)
Self-Nonmedication ("Selv-ikke-medisinering")
nytimes.com 6.5.2007
(...) Drug-company brochures and Web sites reported that the symptoms of going off antidepressants were usually mild and short-lived — a week or two. They all recommended tapering off, preferably by half-steps, in consultation with a doctor. I thought about calling my psychiatrist, but it had been four years, and I didn’t want to return to the place, physically or mentally, where I had gone through so much pain. I also knew my psychiatrist well enough to know that he didn’t take his job lightly and would have most likely asked me to come in. But I couldn’t afford more sessions. (...)

Over the next several days they came in handy, especially at night, when I would wake up feeling dizzy, almost seasick, disoriented and in a heavy sweat, the pillow soaked. One night, awake and not eager to go back to lying restlessly in bed, I went online, typed in “Effexor withdrawal” and found bulletin boards full of pained, plaintive and sometimes angry posters who had quit taking their medication and were suffering a broad but surprisingly consistent range of symptoms: dry mouth, muscle twitching, sleeplessness, fatigue, dizziness, stomach cramps, nightmares, blurred vision, tinnitus, anxiety and, weirdest of all, what were referred to as “brain zaps” or “brain shivers.” While there were those who went off with few or no symptoms at all, others reported taking months to feel physically readjusted. In the face of those symptoms, many despaired, gave up and returned to the drugs.

By the end of the second week, I felt confident that I could continue on 75 milligrams a day. But then my symptoms became more physical: the chills at night and the cold sweats continued. I felt tingling in my shoulders and hands, spasms in my legs. These came and went, seemingly with no reason. And then one night as I lay back to go to sleep, I felt a quick spasm in my head as if an electrical current had suddenly been sent through a circuit somewhere inside my brain. Two more followed in quick succession. With each came a wave of nausea. I sat up. They seemed to disappear. They returned. I realized these were the brain zaps, and over the next few weeks they would come, with no distinguishable pattern, several times a day.

Coping with the ever-changing and seemingly capricious symptoms was beginning to exhaust me. I couldn’t stick to any sleep schedule. I couldn’t think clearly. I was becoming unfocused, agitated and unable to sit long enough to read or work. The stress of anxiety and sleeplessness that I’d almost forgotten seemed to be returning. And that scared me. (...)

Jennifer Capriati Overdose: Prescription Drugs Blamed, Says Rep
cbsnews.com 28.6.2010
(CBS) Jennifer Capriati's spokesperson is calling it an "accidental overdose," but the circumstances surrounding the former tennis star's early morning rush to a Florida hospital remain murky. (...)

Antidepressants and Tamoxefin
depression.about.com 24.6.2010
The June 2010 issue of the Harvard Mental Health Letter warns that breast cancer survivors who are using the drug tamoxefin along with an antidepressant should be aware that the two drugs may interact, causing women to receive less benefit or no benefit at all from tamoxefin.

Tamoxefin, according to the report, is a standard treatment given to breast cancer patients for five years following their initial treatment in order to prevent the recurrence of cancer. Depression is common following cancer so a significant number of women may also be using an antidepressant at the same time they are using tamoxefin. (...)

Defining Bruxism
presssubmission.com 26.6.2010
(...) Bruxism саn bе induced due tο stress bυt аƖѕο mіɡht bе a spontaneous response due tο misalignment οf teeth. Bruxism саn аƖѕο bе a sign οf ѕοmе οf thе rare neuromuscular diseases thаt involves thе face. In сеrtаіn rare cases, bruxism саn bе аn аftеr effect οf сеrtаіn medicines used fοr treating depression, such аѕ Prozac, Paxil аnԁ Zoloft. People having habitual bruxism саn even ɡο through a breakage іn fillings іn restored teeth. Whеn thе teeth аrе rubbed together іt causes thе outer mοѕt enamel layers tο erode thus, exposing thе dentin, аnԁ causing tooth sensitivity. Severe bruxism саn аƖѕο bе a common cause οf dysfunction οf thе jaws, unexplained morning headaches аnԁ frustrating facial pain. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

How to Deal With Depression
health.msn.com (17.6.2010)
If you're taking an antidepressant, chances are you've gone off your meds a few times. Here's a smarter Rx for feeling like yourself again. (...)

Now that antidepressants are as commonly dispensed as Pez, it's easy to forget that most are less than 20 years old. Prozac, the first SSRI (selective serotonin reuptake inhibitor; these keep the happy chemical serotonin in your brain longer), was launched in 1987, the same year Patrick Swayze swiveled his hips in Dirty Dancing. Now antidepressants are a $12.6 billion business, and 90 percent of the prescriptions are for SSRIs, including Lexapro, Paxil, and Zoloft, or for their close cousins, SNRIs (serotonin and norepinephrine reuptake inhibitors) such as Cymbalta and Effexor. (...)

A pregnant question (Et gravid spørsmål)
sciencenews.org 5.6.2010
Drugs known as SSRIs can fight depression during pregnancy but may also have a lasting effect on a developing baby's brain. (...)

Over the past few years, a handful of studies have found that mice and rats exposed to antidepressants shortly before birth or just afterward grow up anxious and depressed. Other animal studies link early exposure to SSRIs to improved decision-making and spatial-learning abilities. Though many of the documented reactions fall within the normal range of behavior, the drugs can influence how an animal experiences and relates to its surroundings, says Judith Homberg of Radboud University in Nijmegen, the Netherlands.

No one knows for sure if people experience the same risks or benefits over the long haul, but a new study shows that children exposed to antidepressants in the womb are more likely to appear sad or withdrawn at age 3 than those whose moms didn’t take the drugs.

Though the mechanism underlying such changes is still unknown, a picture is beginning to emerge. In the February Trends in Pharmacological Sciences, Homberg and her colleagues outline research in animals linking exposure to SSRIs during early development to faulty brain organization and abnormalities. And recent studies in fruit flies support a theory that sensitivity to serotonin can be set early in life.(...)

Influence of citalopram on interdigestive gastrointestinal motility in man.
Aliment Pharmacol Ther. 2010 May 8.
Abstract Administration of 5-Hydroxytryptamine (5HT), and selective 5HT receptor ligands modify interdigestive motility in animals and in man. (...)

Conclusions: In the interdigestive state in man, intravenous administration of the selective 5-HT reuptake inhibitor citalopram induces a premature intestinal phase 3 and suppresses gastric activity fronts. Phase 2 motility is stimulated both in the stomach and in the small bowel after citalopram. These data suggest 5HT is involved in the control of interdigestive motility. (...)

Coming Off Antidepressants Can Be Tricky Business
vpr.net 24.5.2010
Although millions of Americans take antidepressant drugs, little is known about if and when it's safe to stop.
"This is an area of great importance to patients, and given the very limited data available, there is a clear need for studies to inform clinicians and patients," says Maurizio Fava, professor of psychiatry at Harvard Medical School. (...)

Ocular adverse effects of common psychotropic agents: a review. (Uheldige okulære (øyet / øyner) effekter vanlige for psykotrope substanser. En gjennomgang)
CNS Drugs. 2010 Jun 1;24(6):501-26.
Abstract
All psychotropic medications have the potential to induce numerous and diverse unwanted ocular effects. Visual adverse effects can be divided into seven major categories: eyelid and keratoconjunctival disorders; uveal tract disorders; accommodation interference; angle-closure glaucoma; cataract/pigmentary deposits in the lens and cornea; retinopathy; and other disorders. The disorders of the eyelid and of the keratoconjunctiva are mainly related to phenothiazines and lithium. Chlorpromazine, at high dosages, can commonly cause abnormal pigmentation of the eyelids, interpalpebral conjunctiva and cornea. It can also cause a more worrisome but rarer visual impairment, namely corneal oedema. Lithium can rarely lead to a bothersome eye irritation by affecting sodium transport. Uveal tract problems are mainly associated with tricyclic antidepressants (TCAs), typical antipsychotics, topiramate and selective serotonin reuptake inhibitors (SSRIs). TCAs, typical antipsychotics and SSRIs can all cause mydriasis that is often transient and with no major consequences, but that can promote closure of angles in susceptible patients. Topiramate has been frequently associated with a number of significant ocular symptoms including acquired myopia and angle-closure glaucoma. Problems with accommodation are related to TCAs and to low-potency antipsychotics. TCAs cause transient blurred vision in up to one-third of patients. Angle-closure glaucoma is a serious condition that has been mainly associated with TCAs, low-potency antipsychotics, topiramate and, to a lesser extent, SSRIs. When patients with narrow angles are given TCAs, they all appear to experience induction of glaucomatous attacks. Antipsychotics and SSRIs may lead to an added risk of developing angle-closure glaucoma, but only in predisposed eyes. Topiramate can lead to an allergic-type reaction whereby structures of the lens and ciliary body are displaced, which results in angle-closure glaucoma. Cataractous changes can result from antipsychotics, mainly from high dosages of chlorpromazine or thioridazine. These two drugs, when used at high dosages and for prolonged periods, frequently cause lenticular opacifications. Retinopathy has been shown to be related to high dosages of typical antipsychotics, mainly chlorpromazine and thioridazine. The frequency of occurrence of retinal effects seems to be proportional to the total amount of drug used over a long period of time. Other visual problems of special concern are the ocular dystonias, other eye movement disorders, and decreased ability to perceive colours and to discriminate contrast. Ocular dystonias can occur with antipsychotics (especially high-potency ones), carbamazepine (especially in polytherapy), topiramate and, rarely, with SSRIs. Disturbance in various eye movements is frequently seen with benzodiazepines, antiepileptic drugs and lithium. Impairment in the perception of colours and the discrimination of contrasts has been shown to occur not uncommonly with carbamazepine and lorazepam. Thus, typical antipsychotics, TCAs, lithium, benzodiazepines, carbamazepine, topiramate and SSRIs appear to produce most of the currently recognized ocular problems. Psychiatrists, ophthalmologists and patients need to be aware of and prepared for any medication-induced adverse effect. Early prevention and intervention can avoid most of the serious and potentially irreversible ocular toxicities. (...)

Mania associated with antidepressant treatment: comprehensive meta-analytic review
Acta Psychiatrica Scandinavica 2010;121:404-414
Objective: To review available data pertaining to risk of mania–hypomania among bipolar (BPD) and major depressive disorder (MDD) patients with vs. without exposure to antidepressant drugs (ADs) and consider effects of mood stabilizers. (...)

Conclusion: Use of ADs in adults with BPD or MDD was highly prevalent and moderately increased the risk of mania overall, with little protection by mood stabilizers. (...)

Glaxo, Paxil and the Catholic Sex Abuse Cover-Up: Drug Implicated in Priest's Suicide (Glaxo, Seroxat og det skjulte katolske sexmisbruk: Legemiddel implisert i prests selvmord)
industry.bnet.com 7.4.2010
GlaxoSmithKline (GSK), which was already the focus of controversy over whether it ignored the suicide risk of its antidepressant Paxil, has found itself linked to the Catholic Church’s cover-up of child abuse in the death of a priest who took the drug.

Download the Tucker v. GSK ruling here.

The case seems bound to become a further PR headache for GSK, which in 2008 was accused of obscuring the suicide risk of Paxil in studies for 15 years. (...)

Why There’s No Epidemic of Depression
psychcentral.com 29.3.2010
Scientific American has an accessible and interesting interview with the authors of a new book called The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Illness. Despite the book’s title, the authors argue that there’s no new epidemic of depression, just greater awareness (and treatment seeking) of it: (...)

What the authors of the new book, Allan Horwitz and Jerome Wakefield, are really arguing is that the psychiatric definition for depression is too general and not specific enough to limit the diagnosis of depression when a person might just be going through a normal and expected period of grief following a significant loss in their life. (...)

Dangerous Drugs for Combat Soldiers
Dr. Phil Leveque - Salem-News.com
salem-news.com 28.3.2010
Zombies on the Attack

Anti-depressant drugs are doubly dangerous. Most of them cause a severe drug hangover which is far worse than alcohol. Their adverse side effects are possibly/probably causing or worsening PTSD.

(MOLALLA, Ore.) - I could NOT believe what I was seeing on ABC TV News March 24, 2010; that the Army Shrinkologists (Psychiatrists) were prescribing zombifying drugs to frontline combat troops.

I was a Combat Infantryman, Battalion Scout, Pointman and Forward Observer in WWII. I am not only lucky but astonished that I lived through it. I can thoroughly empathize with the frontline troops in Iraq et cetera and what they are being prescribed as some of the most dangerous zombifying drugs – the anti-depressants such as Prozac, Zoloft and Paxil. These drugs really scramble the brain and have caused many suicides AND accidental deaths by overdose. These drugs are supposed to be treating these Combat Soldiers for Combat Anxiety and Stress but in many/most cases they could be doing the opposite. (...)

Regulator warns on congential heart defects with SSRI (Tilsyn advarer om at SSRI-er forårsaker medfødte hjertedefekter)
pulsetoday.co.uk 11.3.2010
The UK medicines regulator has warned of a ‘possible small risk’ of congenital heart defects when prescribing the selective-serotonin reuptake inhibitor fluoxetine.

The Medicines and Healthcare products Regulatory Agency said they had looked at the evidence from a number of studies and had calculated that fluoxetine doubles the background rate of congenital heart defects.

The background incidence of congenital cardiac defects is approximately 1/100 and the MHRA estimates to increase to less than 2/100 pregnancies with fluoxetine prescription.

The MHRA said that a class effect with SSRIs on heart formation in utero ‘could not be excluded’ and recommended GPs were mindful of this when prescribing the drugs.

A MHRA statement said: ‘When prescribing fluoxetine to treat depression during pregnancy, prescribers should be aware that there may be a small increased risk of congenital cardiac defects in infants exposed in early pregnancy, similar to that seen with paroxetine.’

Drug Safety Update; 3(8); pg. 4 (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

A New Generation Of Rapid-Acting Antidepressants?
medicalnewstoday.com 10.3.2010
Conventional antidepressant treatments generally require three to four weeks to become effective, thus the discovery of treatments with a more rapid onset is a major goal of biological psychiatry. The first drug found to produce rapid improvement in mood was the NMDA glutamate receptor antagonist, ketamine.

In a new issue of Biological Psychiatry, published by Elsevier, researchers from the National Institutes of Health report that another medication, scopolamine, also appears to produce replicable rapid improvement in mood. Scopolamine temporarily blocks the muscarinic cholinergic receptor, thought to be overactive in people suffering from depression. (...)

Antidepressant Initiation May Raise Risk for Anxiety in Depressed Patients: Presented at ADAA
docguide.com 9.3.2010
BALTIMORE, Md -- March 9, 2010 -- Initiation of antidepressant therapy may increase the risk of developing anxiety in certain patients, according to a study presented here at the Anxiety Disorders Association of America 30th Annual Conference (ADAA).

At particular risk are those with major depression, those of a younger age, women, and white and Hispanic individuals, researchers said here on March 5.

Previous studies have shown that individuals with anxiety disorders are at higher risk for suicide, as are those with psychiatric disorders, especially depressive disorders. (...)

Anti-depressant Use Linked to Higher Risk of Cataracts (Antidepressiva linket til økt risiko for katarakt)
calorielab.com/labnotes 9.3.2010
A statistical relationship between the use of SSRIs and the incidence of cataracts has been shown by researchers at the University of British Columbia, Vancouver Coastal Health Research Institute and McGill University. Researchers, using a database of more than 200,000 people aged 65 and older, found that patients who take SSRIs were about 15 percent more likely to have cataracts than those who did not take them. (...)

Mest antidepressivabruk i Østfold
kommunal-rapport.no 5.3.2010
Forbruket av antidepressive medikamenter i Norge har store geografiske forskjeller. I fjor var forbruket per innbygger størst i Østfold. (...)

Cold Case Files - Paxil Birth Defects (Kalde arkivbevis - Seroxatrelaterte fødselsdefekter)
by Evelyn Pringle
scoop.co.nz 2.3.2010
Almost like an episode of the TV show, Cold Case Files, the first Paxil birth defect trial was dominated by a story about what happened to the rat pups that died around 1979 and1980, involved in a study in which Paxil was being tested on pregnant female rats. (...)

The family's lead attorney in the case of Kilker v Glaxo, Sean Tracey from Houston, brought in the world-famous neuropsychopharmocology expert from Wales, Dr David Healy, to testify extensively about rat pup study 295.

In summary, Healy told the jury that all the rat pups born to mothers who received Paxil were dead four days after they were born, while eighty-eight percent of the pups not exposed to Paxil were still alive on day four.

In fact, of the 415 rat pups born to mothers who received Paxil, Healy testified that, “One in every ten or actually maybe more like possibly one in every eight or so were born dead.”

As far as he could make make out, all the rats were not autopsied, Healy said, so the question was why the pups died.

“It's clearly the drug that has caused the death,” he told the jury.

“One of the possible reasons for their death is they're born with birth defects that lead to them actually dying early in infant life,” he testified. “A responsible approach to data like this is to investigate it further and find out just what the cause is.”

Doctor Suzanne Parisian, a former FDA scientist, also served as an expert for the plaintiffs. She testified that the first safety signals that indicated Paxil could cause birth defects were seen in the animal studies conducted in 1979-1981 period, as well.

Parisian said the studies showed birth defects, embryos that died, and rat pups that did not survive.

Adam Peavy, of the Houston firm of Bailey, Perrin and Bailey, handled her testimony. While testifying, Peavy had Parisian review comments in a memo by a Doctor John Baldwin to Glaxo in 1980, discussing the Ferrosan studies, which stated: “There remains the possibility that this compound could be teratogenic at high-dose levels.”

“We need to ascertain whether Ferrosan have conducted or are conducting or intend to conduct a peri- and postnatal study and a neonatal acute toxicity study,” Baldwin wrote.

Based on her review the documents, Parisian told the jury, Glaxo never ascertained whether Ferrosan did the studies and Glaxo never conducted the studies.

As far as she knew, the company never told the FDA about Baldwin's statements either, she said, but “they should have.” (...)

Antidepressants May Slow Fetal Development (Antidepressants kan forsinke fosterutvikling)
medpagetoday.com 22.2.2010
Exposure to antidepressants in the womb was associated with slightly delayed developmental milestones in the first 19 months of life, particularly for boys, researchers found.

At age 6 months, babies who were exposed to antidepressants in utero were twice as likely to be unable to sit without support as those whose mothers had untreated depression during pregnancy (OR 2.1, 95% CI 1.23 to 3.60), according to Lars Henning Pedersen, MD, PhD, of Aarhus University in Denmark, and colleagues.

And at 19 months, although gross motor function was similar in the two groups, exposed children were twice as likely to be unable to occupy themselves for longer than 15 minutes, a measure of attention (OR 2.1, 95% CI 1.09 to 4.02), the researchers reported in the March issue of Pediatrics. (...)

(Anm: Fetal Exposure to Antidepressants and Normal Milestone Development at 6 and 19 Months of Age. PEDIATRICS (Published online February 22, 2010).)

Evelyn Pringle: Paxil Birth Defect Litigation
scoop.co.nz 18.2.2010
GlaxoSmithKline has paid out close to $1 billion to resolve lawsuits involving Paxil since the drug came on the market in 1992, according to a December 14, 2009 Bloomberg report. But the billion dollars does not cover the more than 600 Paxil birth defect cases currently pending in multi-litigation in Pennsylvania.

Glaxo has settled about 10 birth defect cases, according to Sean Tracey, a Houston attorney who represented the family of a child victim in the first jury trial that decided in favor of the plaintiff on October 13, 2009, Bloomberg reports. The settlements in those lawsuits averaged about $4 million, people familiar with the cases told the new service. (...)

A possible explanation for dizziness following SSRI discontinuation.
Acta Otolaryngol. 2010 Feb 10. [Epub ahead of print]
Abstract Dizziness is the most commonly reported symptom of abrupt discontinuation from the selective serotonin reuptake inhibitor (SSRI) category of antidepressants. The reported dizziness is exacerbated by even slight head movement, and therefore is likely to be vestibular in origin. The SSRIs most implicated are those with short half-lives and which are most selective for serotonin (as opposed to noradrenaline), e.g. paroxetine and sertraline. Since the vestibular nucleus complex (VNC) has an abundance of serotonin receptors, the abrupt withdrawal from an SSRI is likely to have a substantial impact on the electrophysiological activity of neurons within it. Here we suggest that the abrupt withdrawal from an SSRI is likely to cause a sudden decrease in serotonin in the VNC, which will disrupt the function of VNC neurons bilaterally, causing dizziness without vertigo. (...)

No evidence for switching the antidepressant: systematic review and meta-analysis of RCTs of a common therapeutic strategy
Acta Psychiatrica Scandinavica 2009;121(3):174 - 179
Objective: Switching antidepressants is a common strategy for managing treatment-resistant depressed patients. However, no systematic reviews have been conducted to date. (...)

Conclusion: There is a discrepancy between the published evidence and the frequent decision to switch antidepressants, indicating an urgent need for more controlled studies. Pending such studies we recommend that physicians rely on more thoroughly evaluated strategies. (...)

Døde av overdose med lykkepiller
nrk.no 6.2.2010
(...) Den foreløpige obduksjonsrapporten viser at en 60 år gamle mann som døde i politiarresten i Kristiansand 28. desember hadde en dødelig dose lykkepiller i kroppen, skriver VG.

Spesialenheten for politisaker etterforsker nå om politiet har gjort noe straffbart. En politibetjent har status som mistenkt i saken. Helsetilsynet i Vest-Agder har også åpnet tilsynssak mot legevakta i Kristiansand. (...)

Firm halts antidepressant research
pharmacyeurope.net 5.2.2010
A major pharmaceutical firm is halting research into antidepressants in a bid to save £500m a year in costs by 2012.

GlaxoSmithKline announced the move as it unveiled an 18% rise in full-year pre-tax profits to £7.9bn. This was an increase of 16% to £28.4bn in the 12 months to December 31.

Antidepressant medicines have represented a major part of the company's sales, with more than £2bn generated from Wellbutrin and Seroxat or Paxil. The last drug was criticised by regulators and drew a series of litigations against the company. (...)

GSK to cut more jobs as it ends research into painkillers
business.timesonline.co.uk 4.2.2010
Hundreds of research and development jobs in the UK will go at GlaxoSmithKline, as Europe’s biggest pharmaceuticals company ends development of new depression and pain medicines. (...)

Typically, six large-scale clinical trials have to be carried out on a new antidepressant because of the difficulty in measuring, clinically, whether they have succeeded.

A degree of controversy has attached itself to Paxil, GSK’s biggest-selling antidepressant, which is also known as Seroxat, after it was linked to an increased risk of suicide in some cases. The company has agreed to pay about $100 million (£63 million) to settle a number of lawsuits relating to the drug. (...)

Venlafaxine and cardiovascular toxicity
BMJ 2010;340:c411 (5 February)
(...) Risk seems no greater than for selective serotonin reuptake inhibitors
People with depression have a higher incidence of cardiovascular disease and mortality from cardiovascular disease than people without depression.1 Ideally, the use of antidepressants should not add to this risk. Depression may also provoke suicide, so toxicity in overdose is a crucial consideration when choosing an antidepressant. (...)

Antidepressant medication and executive dysfunction: a deleterious interaction in late-life depression.
Am J Geriatr Psychiatry. 2010 Feb;18(2):128-35.
OBJECTIVES: To determine whether there is differential response to placebo or citalopram among older patients with and without deficient response inhibition (DRI). DESIGN: This is an 8-week, double-blind, placebo-controlled trial. SETTING: Outpatient psychiatry. PARTICIPANTS: Unipolar depressed patients aged 75 years and older. INTERVENTION: Citalopram (20-40 mg/day) or placebo pill. MEASUREMENTS: Baseline Stroop Color-Word Test and weekly 24-item Hamilton Rating Scale for Depression assessments. RESULTS: Citalopram-treated patients with DRI did significantly worse than placebo-treated patients with DRI. Conversely, citalopram-treated patients without DRI did significantly better than placebo-treated patients without DRI. CONCLUSION: Patients with late-life depression and DRI respond worse to selective serotonin reuptake inhibitor (SSRI) than placebo. These findings suggest that there may be a deleterious interaction between DRI and antidepressant medication in late-life depression and that the mechanism of SSRI and placebo response is different. (...)

Antidepressants may delay breast milk production
reuters.com 1.2.2010
NEW YORK (Reuters Health) - Widely used antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may delay a woman's breast milk production soon after giving birth, a new study hints.

In a survey of 431 women who gave birth at one U.S. medical center, researchers found that seven of the eight women on SSRIs did not have their breast milk come in within the typical 72 hours of giving birth. On average, their full breast milk production was delayed by about a day compared with other mothers.

In a separate part of the study, the investigators also found that SSRI medication affected the functioning of human cell samples from the breast tissue lining, and appeared to alter breast milk production in lab mice.

After giving birth, women produce a precursor to breast milk called colostrum until their full breast milk comes in; if that shift does not happen within 72 hours, researchers consider it "delayed secretory activation." (...)

Antidepressants Linked to Breastfeeding Problems in New Mothers
insciences.org 1.2.2010
(SACRAMENTO, Calif.) — New mothers who take common antidepressant drugs may not just be suppressing depression. They also may be suppressing their milk production in the early postpartum period, according to a new study.

Published in the February issue of the Journal of Clinical Endocrinology & Metabolism, the study found that new mothers taking certain antidepressants may experience a condition called “delayed secretory activation," or a delay in the initiation of complete milk secretion. (...)

Mothers on Antidepressants Less Likely to Breast-Feed: Study (Mindre sannsynlig at mødre på antidepressiva ammer)
health.yahoo.com 13.3.2012
New: Now the email button gives you a quick and easy way to start a conversation.

TUESDAY, March 13 (HealthDay News) -- Women who take selective serotonin reuptake inhibitor antidepressants, or SSRIs, during pregnancy are much less likely to breast-feed their babies, researchers have found.

The new study was conducted by researchers associated with the Connecticut Pregnancy Exposure Information Service (CPEIS), a state-funded service that provides women with information about exposures during pregnancy and breast-feeding.

The study authors analyzed data from 466 pregnant women who contacted the CPEIS' California affiliate over 10 years with questions about a wide variety of exposures.

The results showed that women who took an SSRI at any time during pregnancy were about 60 percent less likely to breast-feed than women who took no antidepressants. (...)

Antidepressants May Complicate Breast-Feeding (Antidepressiva kan komplisere amming)
businessweek.com 27.1.2010
SSRIs appear to delay lactation in new moms, researchers find (...)

"The breasts are serotonin-regulated glands, meaning the breasts' ability to secrete milk at the right time is closely related to the body's production and regulation of the hormone serotonin," study co-author Nelson Horseman, of the University of Cincinnati, said in a news release from the Endocrine Society.

He said this means that SSRIs may "impact serotonin regulation in the breast, placing new mothers at greater risk of a delay in the establishment of a full milk supply." (...)

(Anm: Serotonin Transport and Metabolism in the Mammary Gland Modulates Secretory Activation and Involution. Journal of Clinical Endocrinology & Metabolism 2009 (December 4).)

Why Antidepressants Don't Work for Everyone
health.yahoo.com 21.1.2010
Scientists think two things -- biological factors and stressful life events -- cause the mental disorders. Antidepressants (such as Prozac) are available to treat them, often by increasing serotonin levels, but they don't always work. (...)

In the study, researchers used mice to investigate the way the brain deals with serotonin. The brain's mechanism for handling serotonin appears to be related to levels of so-called "autoreceptors," the study authors found. Mice with higher levels didn't respond to treatment with antidepressants, but they did better when the levels went down, the study showed. (...)

Army officer blames medication mixup for shoplifting incident
content.usatoday.com 18.1.2010
A U.S. Army lieutenant colonel facing court-martial on a shoplifting charge blames the Army for mistakenly reducing the medicine he takes to curb his urge to steal.

Lt. Col. Rodney Page, a 28-year Army veteran, admits to stealing $37 worth of challenge coins at the Fort Benning, Ga., post exchange but says he is a kleptomaniac, the Army Times reports.

"That impulse is so strong that it just overrides your common sense," Page, 58, tells the Times in recalling the theft. "I am ethical, even though I have this problem. I've never taken anything from anyone I know. You can leave money on the table; I'm never going to touch it." (...)

When Hair Loss Strikes, a Doctor Is a Girl’s Best Friend
nytimes.com 15.1.2010
(...) I’ll never know for sure, because both stress and certain antidepressants can cause hair loss. But after a couple of months, my hair stopped coming out and my life was back to normal.

Besides antidepressants, beta blockers and anti-acne prescriptions can also temporarily disrupt the growth cycle of your hair. And take note: medications with testosterone, which women may take to increase their sex drive, can also cause hair loss. (Ask any balding man and he’ll be sure to tell you that his abundance of testosterone is to blame.) (...)

Håndtering av seponeringsreaksjoner
Tidsskr Nor Legeforen 2010; 130:37-8 (14.1.2010)
Leger bør ha kjennskap til viktige seponeringsreaksjoner for å kunne håndtere avslutning av legemiddelbehandling.

Leger er ofte tilbakeholdne med å avslutte medikamentbehandling, selv om nytten av legemidlet er usikker og pasienten bruker mange legemidler samtidig, med økt risiko for interaksjoner. Dette kan skyldes respekt for behandling iverksatt av kolleger, frykt for forverring av grunnsykdom eller bekymring for forholdet til pasienten. Seponering er ofte mindre problematisk enn forventet og kan være assosiert med helsegevinst (1). (...)

Vil ha psykisk syke ut i jobb
ukeavisenledelse.no 14.1.2010
- Legene gjør psykisk syke sykere, sier Robert Eriksson (Frp), som også er leder av arbeids- og sosialkomiteen på Stortinget.

Frps helsepolitiske talsmann sier flere psykisk syke bør jobbe fremfor å gå på antidepressiva.

Han sier til Dagsavisen at legene velger minste motstands vei, nemlig sykmelding og beroligende medisiner og antidepressiva.

- Dette er en praksis jeg tar sterkt avstand fra. Det må bli slutt på å sykeliggjøre alle som har en tung periode, sier Eriksson. (...)

Charles Nemeroff And The House That Glaxo Built? (Charles Nemeroff og huset som Glaxo bygget?)
pharmalot.com 4.1.2010
Charles Nemeroff, the controversial psychiatry professor who became a subject of a US Senate Finance Committee inquiry into academic research and pharma industry influence, is joining the University of Miami’s Miller School of Medicine. Of course, this means leaving his previous job at Emory University in Atlanta and so he’s just purchased a $1.9 million house in the Coconut Grove section of Miami. The 5,204-square-foot home has six bedrooms and seven bathrooms, according to BlockShopper. (...)

Grassley’s probe prompted Emory to suspend Nemeroff’s work on an NIH grant and asked him to step down as chair of psychiatry while it studied his conduct (look here). And the Department of Health and Human Services Office of Inspector General began an inquiry into Emory’s handling of the matter (see this). Meanwhile, Pascal Goldschmidt, the Miller school dean, recently told The Miami Herald that he read reports from Emory about Nemeroff’s activities and found nothing to indicate that payments the psychiatrist received had in any way influenced his research results.

In any event, the new home appears big enough to house plenty of consulting materials. (...)

Psychiatrist spends $1.91M on Miami 6BD
southflorida.blockshopper.com 30.12.2009
Dr. Charles B. Nemeroff and Gayle Nemeroff bought a six-bedroom, seven-bath home at 1780 Espanola Dr. in Miami from David and Carolyn Shulevitz for $1.91 million on Dec. 4. (...)

Dr. Nemeroff is a geriatric psychiatrist and an associate at the Emory University Winship Cancer Center. He joined the faculty of Emory University in 1991 and he is also affiliated with Wesley Woods Geriatric Hospital in Atlanta. (...)

JAMA analysis questions antidepressant drug benefits (JAMA-analyse stiller spørsmål om antidepressiva og nytteverdi)
pharmatimes.com 7.1.2010
Another meta-analysis has cast doubt on the effectiveness of drug therapy as a strategy for tackling depression, specifically the less severe forms of the disease.

The study published in the Journal of the American Medical Association (JAMA) found that in six trials involving treatment with paroxetine (GlaxoSmithKline’s Paxil, Seroxat), the genericised imipramine or placebo, the benefits of medication versus placebo were “non-existent to negligible” among patients with mild, moderate or even severe symptoms of depression, whereas in patients with very severe depression the effects were substantial. (...)

The Hull researchers concluded that the antidepressants did not have clinically significant effects in mildly depressed patients or in most patients with very severe depression when compared with placebo. They had used Freedom of Information legislation to access data on the SSRIs submitted as part of approval applications but not subsequently made public. (...)

Study: Most Antidepressants No Better Than Placebos
newsmaxhealth.com 6.1.2010
Mild to severe depression might be better treated with alternatives to antidepressant drugs, which do not help patients much more than an inactive placebo, researchers said Tuesday. (...)

More than 164 million prescriptions for antidepressants were written in 2008, totaling nearly $10 billion in U.S. sales, according to IMS Health. Global sales were twice that. (...)

Association of FKBP5 Polymorphisms With Suicidal Events in the Treatment of Resistant Depression in Adolescents (TORDIA) Study
Am J Psychiatry Published December 15, 2009
(...) Conclusions: The FKBP5 genotypes associated with suicidal events in this study have been reported by others to cause the greatest degree of glucocorticoid receptor subsensitivity. These results are consistent with those of other studies linking alterations in the hypothalamic-pituitary-adrenal axis with suicidal behavior. The small number of events and lack of a placebo condition make these results preliminary. Replication with a larger sample and a placebo condition is needed to assess whether these events are related to treatment. (...)

Key Target Of Clinical Depression Missed By Most Antidepressants
medicalnewstoday.com 10.12.2009
A key brain protein called monoamine oxidase A (MAO-A) - is highly elevated during clinical depression yet is unaffected by treatment with commonly used antidepressants, according to an important study published in the Archives of General Psychiatry. The study has important implications for our understanding of why antidepressants don't always work. (...)

New Horizons: Psychologists Call For Fewer Drugs, More Therapy For All Depressed People, UK
medicalnewstoday.com 9.12.2009
The British Psychological Society has welcomed the announcement of the government's New Horizons strategy to combat depression.

Ms Sue Gardner, the President of the Society, says: 'the Society fully supports the New Horizons initiative and is proud to be involved in the prevention and treatment of distress as well as the enhancement of psychological well-being. (...)

Can antidepressants change someone's personality?
guardian.co.uk 8.12.2009
Taking antidepressants may change aspects of a person's personality, as well as lifting their mood, new research has claimed. A study found that people's tendencies for being neurotic or extroverted changed even more than their mood during antidepressant treatment. (...)

You may find the idea of drugs that change your personality disturbing. In fact, it's important to bear in mind the research is only looking at specific aspects of personality that are closely associated with mood, such as extroversion. (...)

Her er de mest stressende jobbene
e24.no 28.11.2009
Dette er jobbene for deg som liker å ha det litt hektisk. (...)

Disse stresser mest:

1. Kirurg
2. Kommersiell pilot
3. Fotojournalist
4. Annonseselger
5. Eiendomsmegler
6. Allmennpraktiserende lege
7. Avisjournalist
8. Legesekretær (...)

Bruk av antidepressiva under svangerskapet kan gi barn med hjerteproblemer
aftenposten.no 4.11.2009
Det viser en undersøkelse foretatt ved UMC Utrecht som omfatter nærmere 39.000 barn opp til ett år. Resultatet er publisert i siste utgave av det medisinske tidsskriftet BJOG.

Blant barna med mødre som brukte antidepressiva forut for og under hele svangerskapet, var det fem ganger så mange som måtte gjennomgå et større hjerteinngrep i løpet av sitt første leveår enn i gruppen der mødrene ikke brukte eller hadde brukt noen slike medikamenter. (...)

Bleak Britain: Anti-depressant prescriptions soar even though illness declines
dailymail.co.uk 24.10.2009
Prescriptions for anti-depressants have soared despite fewer patients being diagnosed with depression, research shows.

It reveals the number of prescriptions issued by GPs for drugs including Prozac and Seroxat has more than doubled over the past 11 years.

And it warns the dramatic rise is largely down to more than two million patients taking antidepressants for years at a time - many of them young women. (...)

Professor Kendrick, who led the study, said: 'We estimate more than two million people are taking antidepressants long-term, in particular women aged between 18 and 30.

'Our previous research found although these drugs are said not to be addictive, many patients found it difficult to come off them, due to withdrawal symptoms including anxiety.

'Many wanted more help from their GP to come off the drugs. We don't know how many really need them and whether long term use is harmful. This has similarities to the situation with Valium in the past.' (...)

SSRIs and congenital defects (SSRIer og medfødte defekter)
Letters
BMJ 2009;339:b4292 (21 October)
Kvinner bør gi informert samtykke før oppstart med SSRIer (Women should give informed consent before starting SSRIs)
(...) One of the best signals of teratogenicity is an increased rate of spontaneous abortions and a key reason for induced abortion is congenital malformations.1 Data on SSRIs in 1998 showed that the rate of abortion (spontaneous and induced) was nearly twice as high in those who had taken SSRIs in the first trimester of pregnancy (1.7, 1.1 to 2.9). (...)

Sleep-related breathing and sleep-wake disturbances in ischemic stroke.
Neurology. 2009 Oct 20;73(16):1313-22.
BACKGROUND: Sleep-related breathing disturbances (SDB) and sleep-wake disturbances (SWD) are often neglected in stroke patients. Recent studies suggest that they are frequent and have an impact on stroke outcome. (...)

CONCLUSIONS: Sleep-related breathing disturbances and sleep-wake disturbances are frequent conditions that affect stroke outcome. In view of existing treatment options, these conditions deserve the neurologist's awareness. (...)

GlaxoSmithKline told to pay family $2.5m after jury finds paroxetine caused son’s heart defects (GlaxoSmithKline pålagt å betale familie 2,5 millioner dollar etter at jury finner at Seroxat (paroxetine) forårsaket sønnens hjertedefekter)
BMJ 2009;339:b4266 (15 October)
A Philadelphia jury has found that the antidepressant paroxetine (marketed as Paxil in the United States and Seroxat in the United Kingdom) caused heart defects in a child, Lyam Kilker, whose mother Michelle David took the drug while pregnant. The jury has awarded the family $2.5m (£1.5m; 1.7m) in compensation.

The trial was the first of about 600 US lawsuits that claim that paroxetine caused birth defects in infants born to mothers who took the drug while pregnant (BMJ 2009;339:b3967, doi:10.1136/bmj.b3967). (...)

Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database
BMJ 2009;339:b3999 (15 October)
Objective To explore the reasons behind the recent increase in antidepressant prescribing in the United Kingdom. (...)

Conclusions The rise in antidepressant prescribing is mainly explained by small changes in the proportion of patients receiving long term treatment. Previous clinical guidelines have focused on antidepressant initiation and appropriate targeting of antidepressants. To address the costly rise in antidepressant prescribing, future research and guidance needs to concentrate on appropriate long term prescribing for depression and regular review of medication. (...)

Glaxo Ordered to Pay $2.5 Million for Paxil Defects (Update3) (Glaxo dømt til å betale 2,5 millioner dollar for Seroxat-fødselsskader)
Bloomberg.com 13.10.2009
Oct. 13 (Bloomberg) -- GlaxoSmithKline Plc must pay $2.5 million over claims that its Paxil antidepressant caused birth defects, a Pennsylvania jury concluded in the first of 600 such cases to come to trial. (...)

More to treating depression than popping pills (Behandling av depresjon er mer enn å spise en masse piller)
suburbanchicagonews.com 8.10.2009
Program looks at homing in on source of problems

ELGIN -- Instead of relying on Prozac or Zoloft to kick depression to the curb, some local medical professionals are suggesting a more holistic approach.
"You need to find the underlying problem behind depression," Gabriel Bardan, a local mental health professional said. "Many general practice physicians would just identify the problem and send the patient home with medicine or send them to receive psychotherapy." (...)

"But there are millions of causes of depression," Bardan said from one's genetic makeup to their eating habits. (...)

Bardan said the comprehensive approach to depression also has many positive side benefits including weight loss, better eating habits, thyroid and memory function improvement and more energy in the morning. (...)

Eldre med psykiske lidelser på pilletoppen
finnmarken.no 5.10.2009
Eldre med psykiske lidelser er en glemt gruppe innen psykiske helsetjenester.

Eldre med psykiske lidelser er de største forbrukerne av antidepressiva og er en glemt gruppe innen psykiske helsetjenester.

Det mener president Tor Levin Hofgaard i Norsk Psykologforening.

- Eldre over 65 år står bak nærmere halvparten av legemidler mot søvnvansker og angst, og en fjerdedel av det totale forbruket av antidepressiva. Det er en fallitterklæring at piller synes å være et såpass utbredt tilbud til eldre mennesker med psykiske lidelser, sier Hofgaard til NTB. (...)

Probable fluoxetine-induced carotidynia (Sannsynlig karotidyni forårsaket av fluoxetine)
The Lancet 2009;374(9695):1061-1062 (26 September)
Carotidynia is a focal cervical pain that involves the anatomical territory of the affected carotid artery and often radiates to the ipsilateral side of the face or ear. On the basis of medical history and age, carotidynia has been conventionally classified into classic (non-migrainous), migrainous, and vascular variants. 1 To our knowledge, iatrogenic carotidynia is an unknown or at least unreported phenomenology. (...)

(Anm: carotidynia (en.wikipedia.org).)

(Anm: Carotidynia: a pain syndrome. J Fam Pract. 1994 Jul;39(1):71-5.)

(Anm: MR Imaging of Patients with Carotidynia. American Journal of Neuroradiology 21:766-769 (4 2000).)

(Anm: karotidyni; smerter i hals og nakke med stråling til kjevevinkel og tinning, halsårene (karotidane) er svært såre å ta på; finst helst hos yngre kvinner
EN carotidynia Kilde: Norsk medisinsk ordbok.)

Antidepressants In Early Pregnancy May Cause Heart Defect (Antidepressiva tidlig i svangerskapet kan forårsake hjertedefekt)
injuryboard.com 25.9.2009
Taking antidepressants such as Prozac, early in a pregnancy may harm the health of the fetus, according to a new study.

Many woman take antidepressants during pregnancy with no effect, but Prozac (fluoxetine), among others, may double the risk of a heart defect if taken early in the pregnancy, finds this study out of Aarhus University, Denmark, which looked at nearly half a million children born there between 1996 and 2003.

Prozac increased the risk, as did Zoloft and Celexa. So did using more than one antidepressant at a time reports Reuters.

This study will be published in the online British Medical Journal, September 25. (...)

Tvivl om antidepressiv medicin
videnskab.dk 21.9.2009
En kritisk artikel i det højt ansete, videnskabelige tidsskrift The New England Journal of Medicine har sat spørgsmålstegn ved effekten af 'lykkepiller'. (...)

Kun positive resultater publiceret
Faktisk var der nøjagtig lige mange undersøgelser med positive resultater (36), som med direkte negative resultater (24) samt tvivlsomme resultater (12), der hverken var klart positive eller negative med hensyn til en tydelig virkning af den antidepressive medicin. (...)

Resultater 'fordrejet'
Det amerikanske forskerhold bag den omtalte kritiske gennemgang af forskningen vedrørende effekten af antidepressiv medicin mener altså, at resultaterne bliver "fordrejet" i en retning til fordel for medicinalindustrien, der producerer denne medicin, dels ved at negative resultater holdes skjult, og dels ved at negative eller tvivlsomme resultater fremstilles som om de var positive, selvom det - ifølge forskerholdets egne analyser - ikke var tilfældet. (...)

Ingen effekt av citalopram hos barn med autisme
Tidsskr Nor Legeforen 2009; 129:1725 (10.9.2009)
Barn med autisme har ofte en repetitiv atferd som virker forstyrrende. Men behandling med citalopram er ikke virksomt. (...)

Nå er en slik undersøkelse gjennomført ved seks spesialistsentre i USA (1). 149 barn og ungdommer i alderen 5–17 år deltok. Halvparten fikk citalopram, dosert etter alder og vekt, i 12 uker. Resten fikk placebo.
Det var ingen statistisk signifikante forskjeller mellom gruppene, verken når det gjaldt global bedring eller intensitet av repetitiv atferd. Derimot hadde barna som fikk aktivt medikament, signifikant flere bivirkninger i form av aggresjon, uro og søvnforstyrrelser. (...)

(Anm: Antidepressiva (REM-søvn). (mintankesmie.no).)

SSRI - bivirkninger og effekt ved langtidsbruk.
relis.no 3.9.2009 (RELIS – regionale legemiddelinformasjonssentre)
(...) Spørsmål
Har det kommet noe informasjon om negative effekter etter mange års bruk av SSRI? Spørsmålsstiller har også inntrykk av at opplevelsen av effekt blir mindre med tid, og lurer på om det kan skyldes en viss tilvenning eller at en glemmer intensiteten av symptomene før oppstart? Henvendelse fra psykiater. (...)

(Anm: SSRI-er mer enn fordobler risiko for diabetes (mintankesmie.no).)

Antidepressant Use Rises in 10-Year Period
Psychiatr News 2009;44(17):8 (July 17) (American Psychiatric Association)
The rate of antidepressant use doubled from 1996 to 2005, while the use of psychotherapy declined. In more recent years, other data on antidepressant use indicate that this trend has flattened or reversed.

Antidepressant medications have gained wider acceptance and popularity, accompanied by declining use of psychotherapy, in the treatment of depression in the United States from 1996 to 2005, a study published in the August Archives of General Psychiatry demonstrates. (...)

IMB advises against 'Seroxat' in pregnancy (IMB advarer mot Seroxat i svangerskapet)
irishtimes.com 18.8.2009
THE IRISH Medicines Board (IMB) has advised women who want to become pregnant and are taking the antidepressant Seroxat to discuss the risks and benefits of continued treatment beforehand with their doctor.

It has also advised that pregnant women who are taking the antidepressant should not stop their treatment without seeking advice from their doctors.
Some studies have found an increased risk of birth defects, particularly heart defects, associated with the use of Seroxat during the first three months of pregnancy. These findings are not new, but last week Irish psychiatrist Prof David Healy, who is based in Wales, said he believed many GPs still prescribed Seroxat to women without adequately informing them of the risks. (...)

A number of legal actions will soon begin in the US over the antidepressant. Lawyers representing women suing GlaxoSmithKline claim the manufacturer knew, or should have known, about the birth defects more than 10 years ago because of research findings. (...)

SSRI babies need monitoring (SSRI-spedbarn trenger overvåking)
6minutes.com.au 13.8.2009
Newborns exposed to antidepressants in late pregnancy are at risk of discontinuation symptoms and are more likely to suffer from jaundice, a Victorian study finds.

In more than 50 pregnant women who took part in a prospective study, newborns exposed to SSRI antidepressants showed more symptoms including reflux, poor sleeping and feeding, crying, sneezing and tremor than those who were not exposed.

Neonates that were exposed to antidepressants were also more likely to be admitted to special care nurseries, reflecting difficulties in diagnosing antidepressant discontinuation syndrome, the report authors say in the Australian and New Zealand Journal of Psychiatry (43:846-54)
.
“Symptoms such as tremor, irritability and jitteriness may be easily confused with convulsions, which may result in misdiagnosis and significant associated morbidity for the infant,” they say. “This suggests the need to clarify diagnostic criteria for the neonatal to improve identification and management.”

(Anm: Serotonin discontinuation syndrome following in utero exposure to antidepressant medication: prospective controlled study. Australian and New Zealand Journal of Psychiatry 2009;43(9):846–854) (August).)

Data show "alarming" rise in oral cancers among people in their 40s (Data viser "alarmerende" økning i oral kreft blant mennesker i førtiårene)
BMJ 2009;339:b3293 (12 August)
The incidence of oral cancers, such as cancers of the mouth, tongue, and lip, in the United Kingdom has risen by around a quarter in the past decade among people in their 40s, new figures show.

The data, from Cancer Research UK, show that from 1996 to 2006 the annual number of cases of oral cancer in men in their 40s rose from 2470 to 3540 (equivalent after adjustment for population change and annual fluctuation to a rise in incidence of 25%), while that of women in their 40s rose from 1352 to 1785 (equivalent to a rise of 24%).

In men and women of all ages rates of oral cancer have risen by more than 45% since records began in 1975.

Each year in the UK around 5000 new cases of oral cancer are diagnosed and around 1800 people die from the disease. However, if it is caught early, treatment is highly successful. (...)

GPs Have Difficulty Separating Those With And Without Depression In Primary Care (Allmennpraktiserende leger har vanskeligheter med å skille mellom de som har og ikke har depresjon innen primærhelsetjenesten)
medpagetoday.com 30.7.2009
(...) The study pooled 41 trials with a robust outcome standard of a semi-structured interview to assess depression. The researchers found that GPs were able to recognize about half of people who had clinical depression. For a typical GP trying to spot depression in an urban practice and seeing 100 cases over two days, there would be 20 true cases of depression. The GP would correctly diagnose 10 people as depressed but miss about the same number with depression. Of the remaining 80 non-depressed patients, he/she would be likely to over-diagnose 15 people (around 20%) and correctly reassure a further 65 (around 80%). In a rural setting, false positives per 100 cases would outnumber true positives by around three to one (17 vs 5). (...)

Dear Tanya: Is psychotherapy to blame for our daughter’s lack of contact?
women.timesonline.co.uk 21.7.2009
We don’t understand why our daughter has distanced herself from her family

My husband and I have two daughters in their late thirties. The elder one began having counselling/ psychotherapy three years ago to get to the root of the depression that she has had on and off since her teens.

About ten years ago, when she was working as a nurse in Australia, her fiancé suddenly married someone else. She had counselling there and then returned (reluctantly, she said) to live with us. Clinical depression was diagnosed, she was prescribed Seroxat and had 18 months of cognitive behavioural therapy. She returned to nursing locally. (...)

Obesity Linked to Anti-Depressants, Study Shows (Fedme linket til antidepressiva, ifølge studie)
weightlosssurgerychannel.com (25.7.2009)
Obesity may be linked to anti-depressants, a recent study shows. While the researchers concluded that depression itself does not appear to increase the risk of obesity, they did find a link between obesity and the use of a specific type of antidepressant medications: the serotonin-reuptake-inhibiting antidepressants, or SSRIs. These include Paxil and many other widely-used antidepressant drugs.

Clinical depression is a serious disease that affects millions of people in North America. Researchers have concluded that depression in itself does not appear to increase the risk of obesity. But can the drugs used to treat depression be a factor? Some researchers think so. A recent study out of the Hotchkiss Brain Institute of the University of Calgary and the School of Public Health of the University of Alberta examined data from the Canadian National Population Health Survey, a 10-year-long study of a representative sample of household residents in Canada. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Pasient fikk feil medisin i dagevis
nrk.no 21.7.2009
Fikk tunge antidepressiva ment for annen pasient.

Les også: Sykehjem refses for medisinhåndtering

Pasienten ble utskrevet fra Sykehuset Østfold i januar i år. Etter hjemkomsten ble hun slapp og svimmel.

Etter hvert var hun svært dårlig. Familien fryktet at hun skulle dø. (...)

Nå ber de Statens Helsetilsyn om å vurdere reaksjoner overfor Rygge kommune, samt overfor de ansatte som har håndtert saken.

«Vi stiller spørsmål ved om papirene som fulgte pasienten fra Sykehuset Østfold ble lest ved hjemkomst, i lys av at ingen opplysninger gjenfinnes i journalen.» (...)

SSRI Disappoints as Treatment for Common Autism Symptom (SSRI skuffer som behandling for vanlig autisme)
Psychiatr News 2009;44(14):2 (July 17) (American Psychiatric Association)
Psychiatr News July 17, 2009
Although a study fails to find that citalopram can counter repetitive behaviors in autistic children, it is an example of the type of autism-treatment trials that are now being undertaken.

The selective serotonin reuptake inhibitor (SSRI) antidepressant citalopram failed to subdue repetitive behaviors in autistic children, a study reported in the June Archives of General Psychiatry found. (...)

Common meds can lead to cognitive impairment in older people (Vanlige legemidler kan føre til kognitiv svekkelse hos eldre mennesker)
courier-journal.com 9.7.2009
They're used for some of the most common ailments around — allergies, nausea, depression, itching, urinary incontinence and lack of sleep, just to name a few.
But they also could affect your mental sharpness, especially if you're over the age of 65.

The culprit: drugs, such as Benadryl, Detrol and Paxil, that have so-called "anticholinergic effects," or put another way, can affect cognitive performance.

Dr. Malaz Boustani of Indiana University co-authored a paper about the drugs recently. He thinks more people need to be aware that medications with anticholinergic effects can lead to cognitive impairment in older people, though it's unclear whether there's a long-term impact on the brain. (...)

(Anm: The cognitive impact of anticholinergics: A clinical review. Clin Interv Aging. 2009; 4: 225–233. (June 9).)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

(Anm: kognitiv; det som har med fornuft, oppfatning (sansning) og tenkning å gjøre; skilles fra det som omhandler følelser (emosjoner, affekter) og viljesliv ...
Kilde: Store norske leksikon.)

(Anm: What Are Anticholinergic Effects? (Hva er antikolinerge effekter?) (merck.com).)

(Anm: Legemidler som kan gi delirium hos eldre. Tidsskr Nor Lægeforen 2005; 125:2366-7 (8.9.2005).)

Sertraline-Induced Rhabdomyolysis in an Elderly Patient with Dementia and Comorbidities (July/August). (Zoloft-indusert rabdomyolose hos en eldre pasient med demens og samtidige sykdommer)
Ann Pharmacother. 2009 Jun 30. [Epub ahead of print]
(...) DISCUSSION: The Naranjo probability scale indicated a probable relationship between sertraline treatment and the onset of rhabdomyolysis. No relationship between amisulpride and rhabdomyolysis was found. Furthermore, rechallenge with sertraline caused CK and myoglobin to again increase, which was reversed following a discontinuation of sertraline. The patient's other comorbidities and medications have not been suggested as possible interactions with sertraline that can cause rhabdomyolysis. Genetic defects of sertraline demethylation and/or P-glycoprotein binding or concurrent circumstances may explain the onset of rhabdomyolysis in this particular patient.

CONCLUSIONS: This patient's rhabdomyolysis was probably induced by sertraline therapy. (...)

(Anm: rhabdomyolysis ; rabdomyolyse, ødeleggelse av skjelettmuskulatur. Årsaker Rabdomyolyse sees ved kirurgisk skade, trykkskade på grunn av redusert bevissthet, iskemi (lokal blodmangel) på grunn av nedsatt sirkulasjon, etter kramper, og i forbindelse med hypertermi (overoppheting) og forgiftninger. (...) Kilde: Store norske leksikon.)

(Anm: rabdomyolyse; nedbryting eller oppløysing av tverrstripete muskulatur som gir auka innhald i serum av myoglobin og ymse muskelvevsenzym; kan stundom koma som skadeverknad ved bruk av glutetimid, amfetamin, salisylat, fencyclidin, teofyllamin eller andre medikament eller pga virussjukdommar, slangebit, sterk muskelrøyning m v; kan vera årsak til farleg hyperkalemi, kan gi nyresvikt pga myoglobinopphoping i nyrene; kan stundom skuldast mangel på carnitinpalmityltransferase, eit enzym i feittstoffskiftet; jf Meyer-Betz' sjukdom
EN rhabdomyolysis Kilde: Norsk medisinsk ordbok.)

Rhabdomyolysis and Acute Kidney Injury
NEJM 2009;361:62-72 (July 2)
Rhabdomyolysis — literally, the dissolution of striped (skeletal) muscle — is characterized by the leakage of muscle-cell contents, including electrolytes, myoglobin, and other sarcoplasmic proteins (e.g., creatine kinase, aldolase, lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase) into the circulation. Massive necrosis, which is manifested as limb weakness, myalgia, swelling, and, commonly, gross pigmenturia without hematuria, is the common denominator of both traumatic and nontraumatic rhabdomyolysis. (...)

Case Report
Citalopram-Induced Bleeding Due to Severe Thrombocytopenia
Psychosomatics 50:297-298, May-June
BACKGROUND: In case reports and observational studies, serotonin reuptake-inhibitors (SSRIs) have been linked to an increased risk of bleeding, possibly due to platelet dysfunction as a consequence of serotonin-uptake blockade into platelets. OBJECTIVE: The authors propose that bleeding as a result of SSRI use may also be caused by other mechanisms. (...)

CONCLUSION: As this case report shows, drug-induced immune thrombocytopenia may present another possible mechanism for bleeding in SSRI-treated patients. (...)

Antidepressants Cause Suicide and Violence in Soldiers (Antidepressiva forårsaker selvmord og vold hos soldater)
huffingtonpost.com 20.6.2009
Here are the starting facts: Death by suicide is at record levels in the armed services. Simultaneously the use of antidepressant drugs is also at record levels, including brand names like Prozac, Zoloft, Paxil, Celexa and Lexapro.

According to the army, in 2007 17% of combat troops in Afghanistan were taking prescription antidepressants or sleeping pills. Inside sources have given me an even bleaker picture: During Vietnam, a mere 1% our troops were taking prescribed psychiatric drugs. By contrast, in the past year one-third of marines in combat zones were taking psychiatric drugs.

Are the pills helping? The army confirms that since 2002 the number of suicide attempts has increased six-fold. And more than 128 soldiers killed themselves last year. (...)

Nasty effects as patients quit drug (Alvorlige virkninger idet pasienter slutter med legemidlet)
nzherald.co.nz 6.6.2009
Patients taking a common anti-depressant have told of considering taking their own lives and experiencing other nasty side-effects when trying to quit the drug.

Nine people contacted the Weekend Herald to relate bad experiences of anti-depressants, after an article last week about Jude Pinkerton and the reactions she suffered.

The 22-year-old spoke out about paroxetine hydrochloride after she descended into a mental "fog" and twice tried to commit suicide before being taken off the drug in April.

She said she was recovering, but still believed she was suffering its ill-effects.
Three who emailed the Weekend Herald complained of serious problems when quitting paroxetine.

One, who asked not to be named, said she had been unable to stop taking the drug - she started in 2004 - because when she tried to quit, the side-effects were so bad.

"Even by reducing dosage very slowly over many months I eventually reached a point of having extremely severe withdrawal symptoms including suicidal feelings, akathisia [restlessness], shaking, vomiting and inability to sleep or eat. I have basically become a drug addict. (...)

Pharma Pill Pushers Use Suicide Ruse - Again (Legemiddelpushere bruker selvmordsknep - igjen)
lawyersandsettlements.com 4.6.2009
Nearly every year, researchers on drug company payrolls publish some ridiculous study with claims that more people may be dying from suicide due to a black box warning about an increased risk of suicide in young people on the labels of SSRI and SNRI antidepressants as a ruse to increase sales of drugs.

Judging from a new study out this month, with a June 2, 2009 headline on WebMD stating: “Are Antidepressant Warnings Causing Harm?”, apparently this year is no exception even though in the US there were 164.2 million prescriptions dispensed for antidepressants in 2008, compared to 143 million in 2004, according to IMS Health, a healthcare information company.

The study, published in the Archives of General Psychiatry, claims there has been a drastic drop in the diagnosis of depression in adults and kids. (...)

Common medicines may harm seniors' mental ability (Vanlige legemidler kan skade eldres "mentale evner")
reutershealth.com 15.6.2009
NEW YORK (Reuters Health) - Legemidler hyppig brukt av eldre mennesker kan forårsake forvirring, demens og kognitive problemer, bekrefter en ny analyse av 27 studier. (- Drugs frequently taken by older people can cause confusion, dementia and other cognitive problems, a new analysis of 27 studies confirms.)

Many doctors prescribe these medications, known as anticholinergics, to their older patients, Dr. Malaz Boustani of the Regenstrief Institute in Indianapolis, one of the authors of the research review, told Reuters Health. "Unfortunately their use is very, very high in our health care system ... especially among those who are 65 and older."

Drugs with anticholinergic effects range from over-the-counter antihistamines like Benadryl to prescription medications used to treat urinary incontinence (oxybutinin, sold as Ditropan) and antidepressant medications such as paroxetine (Paxil), Boustani explained. These drugs, he said, have one thing in common: they can impair the function of the cholinergic system, which is essential for attention, concentration, and memory.

While it's long been suspected that anticholinergic medications impair cognitive function in older people, Boustani told Reuters Health, "there wasn't any systematic, standardized way of looking at the evidence."

To fill this gap in knowledge, he and his colleagues identified 27 studies in which researchers measured anticholinergic activity of medications that patients were taking and the effect on cognitive performance. (...)

(Anm: The cognitive impact of anticholinergics: A clinical review. Clin Interv Aging. 2009; 4: 225–233. (June 9).)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

(Anm: What Are Anticholinergic Effects? (Hva er antikolinerge effekter?) (merck.com).)

(Anm: kognitiv; det som har med fornuft, oppfatning (sansning) og tenkning å gjøre; skilles fra det som omhandler følelser (emosjoner, affekter) og viljesliv ...
Kilde: Store norske leksikon.)

(Anm: antikolinerge midler, midler som hemmer det parasympatiske nervesystem (parasympatolytika) eller virkningen av acetylkolin og andre kolinerge stoffer på muskarinreseptorer (muskarinfølsomme kolinerge reseptorer) både perifert og i sentralnervesystemet. (...) Brukes bl.a. for å motvirke spasmer i glatt muskulatur (steinsmerter, kolikksmerter), for å hemme spyttsekresjon (bl.a. under generell anestesi), ved parkinsonisme, ved astma (ipatropin til inhalasjon), bevegelsessyke (skopolamin) og forgiftning med nervegass. Kilde: Store norske leksikon.)

(Anm: Legemidler som kan gi delirium hos eldre. Tidsskr Nor Lægeforen 2005; 125:2366-7 (8.9.2005).)

Some Antidepressants May Increase Risk of Breast Cancer Return (Enkelte antidepressiva kan øke risikoen for at brystkreft kommer tilbake)
depression.about.com 2.6.2009
About half a million U.S. women take tamoxefin, a drug which cuts in half the chances of breast cancer recurrence. Of these, many also take antidepressants for hot flashes, due to the fact that hormone replacements are not considered wise after breast cancer. It has long been known that certain antidepressants affect the amount of tamoxefin's active form available in the bloodstream. What was not known, however, was whether these antidepressants could also affect a woman's risk of a cancer recurrence. A new study reported at a cancer conference in Florida on May 29, 2009 provided an answer to this question.

The study reported that using certain antidepressants - including Prozac, Paxil and Zoloft - can almost completely cancel out any cancer-preventing benefit from tamoxefin. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Celexa May Not Help Kids With Autism (Celexa hjelper ikke barn med autisme)
healthfinder.gov 1.6.2009
Study finds no benefit, and more side effects, but not all agree.

MONDAY, June 1 (HealthDay News) -- In contrast to the assumptions of some doctors, new research suggests that the antidepressant Celexa does not help relieve repetitive behaviors often seen in children and teens with autism.
But the findings still need to be confirmed by other studies, and at least one autism specialist said the drug has worked well in his patients of preschool age, who are younger than those in the study.

"The jury is still out on how autism should be treated," said the specialist, Dr. Andrew Zimmerman, a pediatric neurologist and director of medical autism research at the Kennedy Krieger Institute in Baltimore.

Antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, are a common treatment for autism and given to perhaps 30 percent of children with the condition, said Dr. Bryan King, lead author of the study. Other common treatments, he said, include antipsychotic drugs, which calm people who use them, and stimulants such as Ritalin, which reduce hyperactivity and impulsive behaviors. (...)

(Anm: Lack of Efficacy of Citalopram in Children With Autism Spectrum Disorders and High Levels of Repetitive Behavior. Arch Gen Psychiatry. 2009;66(6):583-590 (June).)

Some Antidepressants May Thwart Tamoxifen's Effect on Breast Cancer (Enkelte antidepressiva motarbeider effekten av Tamoxifen ved brystkreft)
healthfinder.gov 31.5.2009
Women should seek alternatives to SSRIs for hot flashes, studies suggest.

SUNDAY, May 31 (HealthDay News) -- Common antidepressants that many breast cancer survivors use to dampen the hot flashes caused by taking tamoxifen may actually boost the odds of the disease's return, new research warns. (...)

Many breast cancer survivors take the drug tamoxifen to reduce their odds for recurrence. But tamoxifen often causes hot flashes, a side effect that can be controlled with selective serotonin reuptake inhibitor (SSRI) antidepressants such as paroxetine (Paxil) or fluoxetine (Prozac). Besides working on the neurotransmitter serotonin, these drugs inhibit an enzyme called 2D6, necessary to convert tamoxifen into its main active metabolite, endoxifen. (...)

Tamoxifen and Antidepressants Combo Increase Risk of Breast Cancer Return
aboutlawsuits.com 1.6.2009
Results of a new study show that some popular antidepressants, like Zoloft, Paxil and Prozac, can negate the effectiveness of the breast cancer drug tamoxifen, substantially increasing the risk that the tumors may return.

A tamoxifen study by Medco Health Solutions, which was presented Saturday at a meeting of the American Society of Clinical Oncology, found that a certain class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), negate much of the effectiveness of tamoxifen, doubling the chance that the breast cancer will return when compared to women taking tamoxifen alone. (...)

Effect of a single dose of citalopram on amygdala response to emotional faces
The British Journal of Psychiatry (2009) 194: 535-540.
(...) Results
Volunteers treated with citalopram displayed a significantly reduced amygdala response to fearful facial expressions compared with placebo.

Conclusions
Such an immediate effect of an SSRI on amygdala responses to threat supports the idea that antidepressants have an earlier onset of therapeutically relevant effects than conventionally thought. (...)

APA: Heart Risks May Impair Depression Treatment
medpagetoday.com 22.5.2009
SAN FRANCISCO, May 22 -- Cardiovascular risk factors may be linked to lack of response to antidepressant treatment, researchers found.

Patients with diabetes, dyslipidemia, hypertension, and obesity were twice as likely to be unresponsive to antidepressant medication as other patients (P<0.05 to 0.01), Dale D'Mello, M.D., and Alric Hawkins, M.D., both of Michigan State University in East Lansing, reported at the American Psychiatric Association meeting.

The lack of response was not significantly more common among smokers, though.

The researchers' preliminary cohort study also revealed that those with comorbid cardiovascular risk factors were older at onset of depression and had tried -- unsuccessfully -- a greater number of antidepressant drugs. (...)

Psychiatric Drugs Might Raise Cardiac Death Risk (Psykiatriske legemidler kan øke risiko for hjertedød)
healthfinder.gov 14.5.2009
But other medical factors could also be at play, researchers note. (...)

The study doesn't reveal specifically which psychiatric drugs were examined, but it does say that those who died of cardiac death were more likely to have taken one of three types.

Almost 11 percent of those who suffered sudden cardiac death took antipsychotics, compared to 1.4 percent of those who survived heart attacks.

The numbers for antidepressants were 7.4 percent and 3 percent, respectively, and 18.4 percent and 5 percent for benzodiazepines, which include drugs such as Xanax. (...)

Antidepressants inhibit P2X4 receptor function: a possible involvement in neuropathic pain relief
7thspace.com 23.4.2009
Neuropathic pain is characterized by pain hypersensitivity to innocuous stimuli (tactile allodynia) that is nearly always resistant to known treatments such as non-steroidal anti-inflammatory drugs or even opioids. It has been reported that some antidepressants are effective for treating neuropathic pain.

However, the underlying molecular mechanisms are not well understood. We have recently demonstrated that blocking P2X4 receptors in the spinal cord reverses tactile allodynia after peripheral nerve injury in rats, implying that P2X4 receptors are a key molecule in neuropathic pain. (...)

Results: Antidepressants strongly inhibited ATP-mediated Ca2+ responses in P2X4 receptor-expressing 1321N1 cells, which are known to have no endogenous ATP receptors. Paroxetine exhibited the most powerful inhibition of calcium influx via rat and human P2X4 receptors, with IC50 values of 2.45 microM and 1.87 microM, respectively.

Intrathecal administration of paroxetine produced a striking antiallodynic effect in an animal model of neuropathic pain. Co-administration of WAY100635, ketanserin or ondansetron with paroxetine induced no significant change in the antiallodynic effect of paroxetine. (...)

(Anm: paroksetin (paroxetine); markesføres i Norge under handelsnavn som bl.a. Seroxat; Paxil i USA.)

Broward child's suicide raises questions about medication
miamiherald.com 21.4.2009
A Broward foster child who killed himself last week had been prescribed powerful psychiatric drugs, some of which the FDA does not approve for children. (...)

Sex, Love, and SSRIs
psychologytoday.com 3.4.2009
Can Prozac keep you from falling—and staying—in love? How SSRIs wreak havoc on courtship. (...)

Tragedie lå bak isbjørnhopp
dagbladet.no 13.4.2009
Kvinne (32) får behandling for pyskiske problemer.

HOPPET INN I ISBJØRN-BASSENGET: En 32 år gammel kvinne hoppet i går inn til isbjørnene i Berlin Zoo. (...)

Bak hoppet skuler det seg imidlertid en tragedie. Den 32 år gamle kvinnen som hoppet behandles nå for bittsår på armene og bena, i tillegg til skrubbsår, men hun behandles også for psykiske problemer, melder BZ, Berlins største avis. (...)

The long goodbye: The challenge of discontinuing antidepressants
ama-assn.org 9.3.2009
Tapering slowly is the mantra for pruning these regimens, but some patients may still experience withdrawal symptoms. (...)

Stopping medicine suddenly can lead to withdrawal
chron.com 8.3.2009
Starting a new medicine is easy. Stopping can be hell.
Mention the word “withdrawal” and images of dope addicts or alcoholics come to mind: a junkie trying to kick a heroin habit or a wino going through the hallucinations and shakes of delirium tremens. (...)

Antidepressant Use Tied to Cardiac Death in Women (Antidepressiva knyttet til hjertedød hos kvinner)
nlm.nih.gov/medlineplus 9.3.2009
MONDAY, March 9 (HealthDay News) -- Women who use antidepressants appear to be at heightened risk for sudden cardiac death, although the exact nature of the link remains unclear, researchers say. (...)

The link between depression and heart trouble is more likely physical than psychological, Whang added. "We found that women who had worse depressive symptoms had higher rates of risk factors such as hypertension, diabetes and smoking," he said. (...)

The findings were published in the March 17 issue of the Journal of the American College of Cardiology.

The researchers relied on data on more than 63,000 American women in the Nurses Health Study. And while the research team did find a link between depression and heart risk, the incidence of sudden cardiac death was associated more strongly with the use of antidepressant drugs than with symptoms of depression. (...)

Drugs for Depression May Increase Risk of Upper Gastrointestinal Haemorrhage in the Elderly: Presented at AAGP
docguide.com 8.3.2009
HONOLULU -- March 8, 2009 -- Elderly patients who use selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs) are at 2- to 3-times greater risk of having an upper gastrointestinal haemorrhage (UGIH) compared with patients who do not take these agents, according to a large analysis of Medicare patients presented here at the American Association for Geriatric Psychiatry (AAGP) 22nd Annual Meeting. (...)

Lett depresjon? Da skal du ha terapi, ikke lykkepiller
aftenposten.no 5.3.2009
(...) Ingen piller, ingen bivirkninger
- Kognitiv adferdsterapi gir like gode resultater som legemidler, både når det gjelder symptomer og muligheten for å bli frisk. I motsetning til legemidlene gir kognitiv terapi ingen bivirkninger, konstaterer den svenske Socialstyrelsen.
- Også den langsiktige effekten er bedre. Risikoen for tilbakefall er mindre hos dem som har fått kognitiv terapi, sier professor Lars von Knorring, som har ledet det dokumentasjonsarbeid som ligger bak de nye retningslinjene i Sverige. (...)

Antidepressants may also suppress love and romance
nbr.co.nz 26.2.2009
While antidepressants are already known to cause libido-inhibiting side effects, a new theory suggests they also fundamentally alter the chemistry of love and romance.

Wired reports that selective serotonin reuptake inhibitors (SSRIs) – the most commonly prescribed antidepressants – are widely known to cause sexual dysfunction, but they may also snuff the first sparks between two people otherwise destined to ride into the sunset on a white horse, and prevent couples from bonding.

Rutgers University biological anthropologist and pioneer of the modern science of love Helen Fisher said to Wired, "There's every reason to think SSRIs blunt your ability to fall and stay in love." (...)

Anti-depressants: just how safe are they?
telegraph.co.uk 20.2.2009
Hard times ahead will see many of us reach for anti-depressants. But are they safe, asks Victoria Lambert.

When millionaire philanthropist Sir Peter Lampl went missing last week, his family and friends blamed his disappearance on a change of medication. Sir Peter had been complaining that the anti-depressants he was taking, following the breakdown of his marriage, had affected his golf. However, after being issued with a different prescription, he suffered an instant change in his personality, according to his father, Fred Lampl. (...)

Happy Pills in America: From Miltown to Prozac
The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers
Before Prozac: The Troubled History of Mood Disorders in Psychiatry
NEJM 2009;360:841-844 (February 19)
Happy Pills in America: From Miltown to Prozac
By David Herzberg. 279 pp., illustrated. Baltimore, Johns Hopkins University Press, 2009. $45. ISBN 978-0-8018-9030-7.
The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers
By Andrea Tone. 298 pp., illustrated. New York, Basic Books, 2009. $26.95. ISBN 978-0-465-08658-0.
Before Prozac: The Troubled History of Mood Disorders in Psychiatry
By Edward Shorter. 304 pp. New York, Oxford University Press, 2009. $29.95. ISBN 978-0-19-536874-1. (...)

Psychiatrists, as well as other physicians who treat patients with psychiatric problems, rely on a class of drugs that is probably no better than the tranquilizers and antidepressants it replaced. (...)

Rise in number of pregnant women receiving anti-depressants
timesonline.co.uk 17.2.2009
The prescribing of anti-depressants to pregnant women has risen dramatically in the decade and a half, a study suggests.

The proportion of pregnancies in which anti-depressant were prescribed jumped four-fold between 1992 and 2006, from 0.8 per cent to 3.3 per cent, said researchers at University College London.

Over the entire study period, 4.8 per cent of pregnant women received anti-depressants at some stage during their pregnancy, with SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Seroxat accounting for four in every five prescriptions. (...)

What Is The Cause Of Depression?
apakistannews.com 16.2.2009
Before you can figure out how to treat or cure your depression, you need to pinpoint the causes of depression. Just identifying the cause of any problem is often half the battle. Because if you know what caused the problem, it’s much easier to figure out how to fix it. (...)

Men Must Contend With a Biological Clock, Too
healthfinder.gov 14.2.2009
Older males face higher risk of fathering children with medical problems, research finds. (...)

"We know after age 30, testosterone levels decline about 1 percent per year," said Fisch, author of the book The Male Biological Clock.

Research done at the University of Washington has found that "as men age, DNA damage occurs to their sperm," said Dr. Narendra P. Singh, a research associate professor in the department of bioengineering, who co-authored a study on the subject.

Several other studies point to problems in the offspring of older fathers, as well as older men experiencing fertility problems. (...)

AstraZeneca gets rights to new TRI antidepressants
pharmatimes.com 9.2.2009
AstraZeneca is linking up with the USA’s Mayo Clinic and Virginia Tech and has licensed-in a portfolio of early-stage novel antidepressants. (...)

AstraZeneca noted that current antidepressants such as selective serotonin and dual serotonin/norepinephrine reuptake inhibitors “only address the imbalances of one or two neurotransmitters in the brain”. However TRIs also act on the dopamine neurotransmitter, so the potential is there to “deliver a superior antidepressant in terms of greater efficacy and an improved side effect profile”, said Mayo’s Elliott Richelson, co-inventor of the technology. (...)

Rexahn Pharmaceuticals, Inc. Initiates Clinical Trial Of Serdaxin(TM) To Treat Depression
medpagetoday.com 5.2.2009
Rexahn Pharmaceuticals, Inc. (NYSE Alternext US: RNN), a leader in development of innovative therapeutics for life-threatening and life-debilitating diseases, announced today that it has initiated a Phase IIa clinical trial for Serdaxin(TM), for the treatment of major depressive disorder (MDD). The Serdaxin Phase IIa study calls for the recruitment of up to 100 patients to evaluate its preliminary efficacy in treating MDD. (...)

Serdaxin's mechanism is distinct from standard of care antidepressants (e.g. reuptake inhibitors such as SSRIs) by acting as a dual enhancer of serotonin and dopamine levels in the brain, and achieving onset of effect in less than two days based on animal studies. (...)

Glaxo Warns of a Charge, Hints at Pact
online.wsj.com 30.1.2009
GlaxoSmithKline PLC warned that its 2008 earnings will be hit by a $400 million legal charge, in a sign that the pharmaceutical company could be approaching a settlement in a five-year-old federal investigation into marketing of antidepressants and other drugs.

Glaxo said the charge was related to the ongoing investigation, which is looking at "marketing and promotional practices for several products for the period 1997 to 2004." Those products include the antidepressants Wellbutrin SR, according to the company; Paxil is another, according to people familiar with the matter. (...)

Zoloft and Cipralex top list of antidepressants in meta-analysis
pharmatimes.com 29.1.2009
A meta-analysis of 12 second-generation antidepressants suggests that the treatments that shows the best balance in terms of efficacy, tolerability and cost are Pfizer’s Zoloft and Lundbeck/Forest Laboratories' Cipralex/Lexapro.

The meta-analysis, which has been published in The Lancet, was carried out by Andrea Cipriani of the University of Verona, Italy and colleagues. The researchers reviewed 117 studies from 1991 to 2007 involving 25,928 people with major depression. (...)

They found that Zoloft (sertraline), Cipralex (escitalopram), Organon’s Remeron (mirtazapine) and Wyeth’s Effexor (venlafaxine) were “significantly more efficacious” than Eli Lilly/Boehringer Ingelheim’s Cymbalta (duloxetine), Lilly’s Prozac (fluoxetine), Solvay’s Luvox (fluvoxamine), GlaxoSmithKline’s Paxil/Seroxat (paroxetine) and Pfizer’s Edronax (reboxetine). (...)

(Anm: reboxetine (Edronax) (felleskatalogen.no).)

Slik ser den tidligere fotballstjernen Paul «Gazza» Gascoigne ut.
side2.no 6.1.2009
Britiske Channel 4s dokumentar om Gascoigne har vekket debatt allerede før den ble sendt på TV. (...)

Sex offenders volunteer for 'chemical castration' drug treatment
telegraph.co.uk 27.12.2008
Sex offenders are being given drugs which lower their libido and make it difficult for them to reoffend, in a voluntary scheme introduced by Jack Straw, the Justice Secretary.

So far 11 men have put themselves forward for the pioneering project, according to the Ministry of Justice.

Those receiving the treatment, which has been dubbed “chemical castration”, include prison inmates and offenders who have been released from custody and are living in the community.

They are being given Prozac, which reduces their sex drive, or other categories of drugs known as anti-androgens.

Ministers are now being asked to set up a national clinic dedicated to handing out the medication to paedophiles and rapists who volunteer for the treatment. (...)

Emory will punish psychiatrist Nemeroff (Emory vil straffe psykiater Nemeroff)
ajc.com 23.12.2008
Chairmanship taken away, outside income to be vetted

Emory University on Monday permanently stripped Dr. Charles B. Nemeroff of his department chairmanship and placed severe restrictions on the internationally known psychiatrist’s extracurricular activities.

Emory’s announcement followed an internal investigation into $800,000 in payments made to Nemeroff by the global pharmaceutical company GlaxoSmithKline between January 2000 and January 2006. Nemeroff received the payments for more than 250 speeches he made to other medical professionals. (...)

Studies: Half of Antidepressant Users Suffer Sex Problems
foxnews.com 15.12.2008
For many people, the choice between having a good sex life and not being depressed can be difficult. Because often, it’s one or the other.

A lack of libido hasbeena known side effect of selective serotonin reuptake inhibitors, or SSRIs, such as Prozac, but new research suggests the side effects are more common than previously suggested and affect half or more patients, The Boston Globe reported.

Recent articles in medical journals say there are some cases where these sexual side effects linger even after the patient goes off of the medication.
"This is such an upsetting issue," said Aline Zoldbrod, a Lexington, Mass. (...)

FOXSexpert: 4 Common Drugs That Sabotage Your Sex Life
foxnews.com 11.12.2008
(...) 2. Antidepressants
It seems like a no-win situation when it comes to antidepressants. On or off them, those dealing with depression can’t get in the mood. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like Zoloft, Prozac, and Paxil, impact brain circuits involved in lust, decreasing sexual desire and arousal and impairing one’s ability to achieve orgasm or delay climax. These drugs can also lead to ejaculatory disturbances and impotence in males.

As if that isn’t enough, it is suspected that these drugs short-circuit your primitive brain systems as well, affecting one’s desire to mate and fall in love. This is because antidepressants may have a negative effect on dopamine, a brain chemical involved in lust and attraction.

In reclaiming your sexual self, know that of the antidepressants, Wellbutrin is known for having the fewest adverse sexual side-effects. This is in part because the drug acts a lot like amphetamine. You can also ask your doctor about using a safe, over-the-counter alternative.¨(...)

Samband mellan melatonin och diabetes
dn.se 7.12.2008
Svenska forskare har hittat ett samband mellan sömnhormonet melatonin och utvecklingen av vuxendiabetes.

Vad är det här?Om du kommenterar och länkar den här artikeln i din blogg, så kommer det inlägget att länkas till härifrån.

- DET HÄR ÄR ETT HELT NYTT koncept. Tidigare har vi bara vetat att melatonin påverkar vår sömnrytm, säger Leif Groop, professor i endokronologi (hormonsjukdomar) vid Lunds universitet och ledare för universitetets diabetescentrum som har gjort studien.

Han och hans forskare har funnit en genetisk skillnad som påverkar en melatoninreceptor på insulinproducerande betaceller i bukspottkörteln. Den genetiska förändringen innebär att melatonin bromsar utsöndringen av insulin mer effektivt, rapporterar de i tidskriften Nature Genetics. (...)

Grönt ljus för ny antidepressiv medicin
dn.se 25.11.2008
Snart kommer en ny sorts antidepressiv medicin ut på marknaden. Den sägs kunna rätta till en störd dygnsrytm, men vägen till godkännande har inte varit rak och biverkningar på levern manar till försiktighet.

EXPERTGRUPPEN CHMP inom den europeiska läkemedelsmyndigheten har beslutat att ge grönt ljus för Valdoxan, ett preparat i en helt ny klass som ska hjälpa mot svår depression hos vuxna. Den aktiva substansen kallas agomelatin och påverkar halterna av de båda ämnena serotonin och melatonin i hjärnan. (...)

Via just inverkan på melatoninsystemet — det som skiljer Valdoxan från de befintliga antidepressiva läkemedlen — ska medicinen kunna hjälpa mot sömnsvårigheter och störd dygnsrytm som är vanliga vid depression.

Bland biverkningarna finns bland annat huvudvärk, illamående, trötthet och ironiskt nog även insomningsproblem och ett abnormt sömnbehov. Tecken på försämrad leverfunktion fanns också hos en del försökspersoner, så CHMP betonar att alla patienter måste övervakas och genomgå levertester under tiden som de medicinerar. (...)

Sildenafil as Treatment for Antidepressant-Induced Sexual Dysfunction
JAMA. 2008;300(20):2365 (November 26)
To the Editor: In their randomized controlled trial, Dr Nurnberg and colleagues1 showed that sildenafil can be an effective option for the treatment of selective or nonselective serotonin reuptake inhibitor (SRI)–induced sexual dysfunction in women. However, treating one medication-induced adverse effect with another medication is not the only treatment option available. This approach can further increase the occurrence of adverse effects and potentially augment patient drug costs. (...)

Pharmaceutical Industry Hustlers - Part II (Legemiddelindustri-svindlere)
by Evelyn Pringle
scoop.co.nz 19.11.2008
Pushers of SSRI Antidepressants
To gain approval for treating children, all a drug company has to do is submit two positive studies to the FDA to prove a medication is safe and effective for kids. However, after 20 years of feeding the new generation of antidepressants to tens of thousands of kids in clinical trials, the only one ever approved is Prozac.

Collectively, these antidepressants are referred to as SSRI's (selective serotonin reuptake inhibitors) and include Paxil, Zoloft, Celexa and Lexapro. When the term SSRIs is used, it often refers to their chemical cousins Effexor, Wellbutrin and Cymbalta as well. (...)

Antidepressants may reduce male fertility (Antidepressiva kan redusere menns fruktbarhet)
endocrinetoday.com 18.11.2008
ASRM 64th Annual Meeting
Treatment with paroxetine was associated with increased DNA fragmentation in sperm, according to study results presented at the American Society for Reproductive Medicine 64th Annual Meeting in San Francisco.

“In volunteer male patients with normal semen parameters, paroxetine induced abnormal sperm DNA fragmentation in a significant proportion of patients. … The fertility potential of a substantial proportion of men on paroxetine may be adversely affected by these changes in sperm DNA integrity,” wrote the researchers from Massachusetts General Hospital and Weill Medical College of Cornell University.

They enrolled 35 healthy men aged 18 to 65 years in the prospective clinical trial. Volunteers were assigned daily paroxetine for five weeks in varying doses: week one, 10 mg; week two, 20 mg; weeks three and four, 30 mg; and week five, 20 mg. The researchers analyzed semen at baseline, weeks two and four and one month after treatment with paroxetine was stopped.

Treatment with paroxetine increased the mean DNA fragmentation score from 13.8% at baseline to 30.3% (P=.0002). Before starting treatment with paroxetine, 9.7% of men had a fragmentation score ≥30% compared with 50% of men at week four (P=.001).

The drug was associated with an OR of 9.33 (95% CI, 2.3-37.9) for abnormal DNA fragmentation, which persisted after adjustment for age and BMI (P=.0003).

Up to 35% of men reported significant changes in erectile function and up to 47% reported ejaculatory problems while receiving paroxetine, according to volunteer responses from the Brief Sexual Function Inventory. However, partial recovery of sexual function was observed one month after cessation of paroxetine. (...)

Father Wonders if Paxil caused Two Holes in Daughter's Heart (Far undrer på om Seroxat forårsaket to hull i datterens hjerte)
lawyersandsettlements.com 11.11.2008
Lebanon, IN: Mark's daughter was born with two holes in her heart. Although his wife was not taking Paxil during her pregnancy, he was. He wonders if the heart defects, which match the Paxil-related birth defects, may be related to his use of the antidepressant. He can find no other plausible explanation.

Mark has depression, and his doctor prescribed the selective serotonin receptor inhibitor (SSRI) Paxil, also called paroxetine, in the hope that it would help. Mark had been taking the drug for about 3 months when his wife became pregnant. "I started taking Paxil around April 2005, and our daughter was conceived in August," Mark said. (...)

Antidepressant treatment may reduce male fertility
reuters.com 10.11.2008
NEW YORK (Reuters Health) - Treatment with paroxetine (Paxil), which belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressant drugs, increases DNA fragmentation in sperm, according to research presented today at the 64th annual meeting of the American Society for Reproductive Medicine in San Francisco. (...)

Pharmaceutical Industry Hustlers – Part I (Legemiddelindustri-svindlere)
Column: Evelyn Pringle
scoop.co.nz 6.11.2008
SSRI Antidepressants Pushers
After twenty long years, it appears that the epidemic in mental disorders in America might be coming to an end. It won't happen because of any great medical breakthrough but rather because the perpetrators of the greatest healthcare fraud in history are finally being exposed. The demolition of the giant "psycho-pharmaceutical complex" appears to be on the horizon.

For far too long, the focus has been on the drugmakers only. In recent months, the spotlight has shown where it belongs - on the highly-paid opportunists responsible for fueling the epidemic in prescribing of psychiatric drugs by doctors in every field of medicine and the research institutions that enabled the process.

The antidepressants known as selective serotonin reuptake inhibitors, or SSRI's, such as Prozac, Paxil, Zoloft, Celexa and Lexapro are at the center of the storm. These drugs have been prescribed to more Americans than any other class of medications over the past two decades. Cymbalta, Effexor and Wellbutrin are often referred to as SSRI's, but they are slightly different chemically. However, the drugs all carry similar side effects and warnings.
The top sales pitch for SSRI's has been the "chemical-imbalance-in-the-brain" myth. "There is no evidence whatsoever that depression is caused by a biochemical imbalance," says Dr Peter Breggin, one of the world's leading experts on psychiatric drugs and author of the new book, "Medication Madness."

People take for granted pronouncements such as, "You have a biochemical imbalance," and "mental disorders are like diabetes," he explains in the book.
"In reality," Dr Breggin writes, "these are not scientific observations - they are promotional slogans, so adamantly repeated in the media and by individual psychiatrists that people assume them to be true." (...)

Probe into anti-depressants being conducted 'in secret'
theaustralian.news.com.au 1.11.2008
THE Therapeutic Goods Administration is investigating the adverse effects of SSRI anti-depressants, a widely prescribed group of drugs that includes the well-known brands Prozac and Zoloft.

The TGA confirmed in a statement to The Weekend Australian that it had established a special expert panel of psychiatrists and epidemiologists to review a number of cases involving patients who had had adverse reactions to these drugs. It is believed hundreds of cases will be reviewed.

"Although there has not been a jump in adverse events from SSRIs, there has been community concern about potential overuse," the TGA said.

Medicare figures show that, since 1990, when Prozac first appeared on pharmacy shelves, there have been almost 10,000 reports of suspected adverse reactions to SSRIs received by the TGA's Australian Adverse Drug Reactions Advisory Committee. (...)

Ökat psykofarmakabruk i Norden granskas
norden.org 20.10.2008
Allt mer antidepressiv medicin ges till barn och gamla i Norden. Orsakerna till detta granskas av Nordiska akademin för forskning om psykisk hälsa på Nordiska högskolan för folkhälsovetenskap, NHV.

Nyligen samlades nordiska läkare, apotekare, sociologer och psykologer till workshop vid Nordiska högskolan för folkhälsovetenskap (NHV).

- Vi tittar på varför antidepressiva medel ges allt längre ned och allt högre upp i åldrarna i samtliga nordiska länder, säger docent Lars Fredén, föreståndare för Akademin på NHV.

I hela västvärlden växer också antalet ADHD-diagnoser. Procenttalet för hur många barn som diagnostiserats samt medicinerats skiljer sig dock tydligt åt mellan de nordiska länderna, även geografiskt inom länderna.

- Vi vill kartlägga bakgrunden till dessa skillnader, säger Lars Fredén vidare. (...)

Another Poorly Regulated "Derivative"--the Antidepressant Pristiq
opednews.com 19.10.2008
Once again Wyeth has disappointed investors.

It is withdrawing application for European approval of its new antidepressant Pristiq, a derivative of its antidepressant Effexor (desvenlafaxine) on rumors it won't be approved by the European Medicines Agency.

Of course many wonder why Pristiq was approved in the US either--14 months after the FDA ordered a new safety study because of elevated liver enzymes and cardiovascular events in test subjects. (...)

Less than 10 years after its 1993 US approval, Effexor, a serotonin-norepinephrine reuptake inhibitor (SNRI), was found to cause greater toxicity in overdoses and greater suicidality and serotonin syndrome than comparable drugs.

Worse, Effexor's lead investigator has been Charles "Conflict of Interest" Nemeroff whose audacious web of pharmaceutical financing ushered him to the front page of the New York Times in October and stripped him of his Department of Psychiatry and Behavioral Sciences chair at Emory University a week later.

"Surely you remember that...Wyeth-Ayers Pharmaceuticals has funded a Research Career Development Award program in the department," wrote Nemeroff in defense of his stipends to the medical school dean of Emory in 2000.

At the 2002 American Psychiatric Association annual meeting in Philadelphia, Nemeroff proclaimed that Effexor XR, the controlled release form of Effexor, achieved long-term remission in 67 percent of recurring depression patients.

But a warning letter to former Wyeth CEO Robert Essner from the FDA calls Nemeroff's research which subsequently appeared in the Journal of Clinical Psychiatry and Biological Psychiatry flawed. (...)

Like credit derivatives, Effexor salesmen know more about short term effects--money!--than its long term effects like extreme withdrawal sequela described by patient, Bruce Stutz and psychiatrist-turned-drug rep, Daniel Carlat, in two different articles in the New York Times magazine last year.

"There was another problem: one of Effexor's side effects. Patients who stopped the medication were calling their doctors and reporting symptoms like severe dizziness and lightheadedness, bizarre electric-shock sensations in their heads, insomnia sadness and tearfulness. Some patients thought they were having strokes or nervous breakdowns and were showing up in emergency rooms," writes Carlat, a clinical professor of psychiatry at Tufts University School of Medicine who was paid by Wyeth to promote Effexor to other doctors.

"At the Wyeth meeting in New York, these withdrawal effects were mentioned in passing, though we were assured that Effexor withdrawal symptoms were uncommon and could usually be avoided by tapering down the dose very slowly. But in my practice, that strategy often did not work, and patients were having a very hard time coming off Effexor in order to start a trial of a different antidepressant," he says.

And like AIG, Fannie and Freddie and other derivative abusers, this is not the first time Wyeth has played fast and loose with the truth.(...)

Drug overdose teen 'begged for help'
news.com.au 12.10.2008
TEENAGER Melanie Boyd begged her friends to call for help after taking a lethal cocktail of booze and drugs, an inquest was told. (...)

In a twist, it emerged that the girls who snorted lines of a white powder, popped up to eight anti-depressants and pain killers, and slammed shots of rum had not taken speed, or crystal meth, as believed by police. (...)

Kellie Pickler: I Battled A Year-Long Depression
people.com 9.10.2008
(...) "Everything in my professional life seemed great," says the former American Idol contestant, 22. "But in my personal life, I was just crumbling."

Anti-depressants made her "crazy," she says, and the side effects forced her to quit the pills. (...)

- Frist den eller mist den
vg.no 5.10.2008
Advarsel: Menn kan miste muligheten til å få ereksjon hvis de går lenge uten sex. (...)

Normalt sett har menn i gjennomsnitt tre ereksjoner i søvne per natt, hvilket er nok til å opprettholde reisningsfunksjonen.

Men dersom du for eksempel går på sovemedisin, hjertemedisin eller tar antidepressive midler, forsvinner nattlige ereksjoner.

Søvnen blir ikke dyp nok, ifølge Mortensen. Det samme gjelder prostataopererte, nevrologisk syke, rusavhengige og menn med diabetes. (...)

- Du kan få penis til å virke igjen ved å pumpe den opp med vakuumpumpe tre ganger i uken, men dette er en møysommelig prosess.

- Går i dvale
Penis består av delikate svamplegemer som trenger oksygentilførsel. Det fås gjennom ereksjon. Uten oksygen vil dens elastiske fibre omdannes til bindevev, ifølge Purvis.

- Bindevevet gjør penis slapp. Du kan sammenligne det med et punktert bildekk, sier Purvis. (...)

I will sue over Toran
stuff.co.nz 28.9.2008
Dead teen's mum vows to fight

THE mother of troubled teen Toran Henry let down by mental health services is to launch a legal claim against those who treated her son. (...)

Toran was medicated in haste with Prozac and in the absence of proper assessment "There was no documented diagnosis of depression in a case where depression was not all that clear cut," the report says. (...)

Suicide attempt a depressing drug side effect
theaustralian.news.com.au 20.9.2008
THIS is a story that can be interpreted in more ways than one. It's about a 14-year-old Melbourne schoolgirl whom we'll call Sarah. When you're 14, you don't want the rest of the world knowing your business, especially not the bit about the time you overdosed and wound up in hospital. (...)

The evidence, according to them, is lying on the dining table in their lounge room the day the mother and I meet. It is an empty packet of the antidepressant Zoloft. Their daughter took half a 50mg tablet for three days, as instructed by her doctor, then on the fourth day emptied the rest of the packet down her throat in one long gulp. (...)

Antidepressant warnings scared parents, doctors
reuters.com 9.9.2007
(...) Psychiatrists say the 8 percent increase in youth suicides in 2004 is the inevitable byproduct of those warnings, and caution that the trend may continue. (...)

While the U.S. Food and Drug Administration's "black box" warnings on antidepressants were not recommended until late 2004, they were preceded by a series of public health warnings in both the United States and Europe. (...)

Dr. Andrew Leon of Cornell University in New York, who served on the FDA panel that approved the black box advisory, said it is too early to link the warnings and the spike in suicides. (...)

Gibbons this week published a study in the American Journal of Psychiatry that found a 22 percent decrease in youth antidepressant prescription rates between 2003 and 2005 in both the United States and the Netherlands. (...)

Antidepressants impair driving ability in the depressed (Antidepressiva svekker kjøreferdigheter hos deprimerte)
telegraph.co.uk 17.8.2008
Depressed people who take medication such as Prozac to control their condition have a significantly impaired ability to drive, a study has claimed. (...)

Antidepressant Use Tied to Poorer Driving (Bruk av antidepressiva knyttes til dårligere kjøring)
washingtonpost.com 17.8.2008
SUNDAY, Aug. 17 (HealthDay News) -- Taking prescription antidepressants while still highly depressed could impair driving ability, a new study suggests. (...)

People taking antidepressants who were highly depressed registered markedly worse scores on some driving skills than those not taking antidepressants, the team found. This appeared tied to poorer concentration and a weakened ability to react well to situations that divided their attention and relied on memory skills. (...)

Government to test moms for baby blues?
worldnetdaily.com/ 30.7.2008
Bill pushes mental screening, dangerous antidepressant drugs (...)

'Side Effects' humanizes antidepressant debate ("Sideeffekter" menneskeliggjør debatt om antidepressiva)
usatoday.com 25.7.2008
Whether powerful medicines marketed by pharmaceutical companies do more harm than good is one of the trickiest controversies in a world filled with scientific data.

Side Effects, by investigative journalist Alison Bass, grapples with the controversy over drugs used to treat depression, with a focus on Paxil, Prozac and Zoloft.

No matter how vigorously the pharmaceutical manufacturers defend their products, one conclusion is inescapable: Some people who ingest antidepressants become suicidal. Is the percentage of suicides small enough to justify the continued marketing of the drugs? If the answer is yes, how should the warnings to medical professionals and patients be worded? (...)

Paxil: Patient told it Was Safe (Seroxat: Pasient fortalt at det var trygt)
lawyersandsettlements.com 22.7.2008
Ontario, NY: Along with the women who have had babies born with serious birth defects because they were exposed to Paxil prior to birth are women whose babies have not yet appeared to have suffered serious effects.

owever, many of these women fear that just because problems have not yet surfaced does not mean they will not in the future. They worry that their children will suffer serious side effects later in life because of their exposure to Paxil. (...)

Brown official named in report
boston.com 21.7.2008
Excerpts from the Globe's blog on the Boston-area medical community.
Dr. Martin Keller, head of psychiatry at Brown University, may be the next target of congressional investigations into the cozy relationship between some doctors and pharmaceutical companies. (...)

A spokesman for Grassley's office said the senator is looking into 30 physicians from up to 20 universities, but wouldn't comment on any specific doctors. (...)

Disputing 'Side Effects'
John E. Kraus, MD, PhD
Senior Director, Neurosciences Medicines Development Center, GlaxoSmithKline
boston.com 20.7.2008
I am writing to express my disappointment at the inflammatory review of Alison Bass's book, "Side Effects" ("The unhealthy ties that bind FDA to drug firms," July 5). Judging by the statements in the review, "Side Effects" is inaccurate and does not reflect the facts related to paroxetine as we know them and as have been shared publicly.

Among the numerous inaccuracies, GlaxoSmithKline rejects any suggestion that it withheld drug trial information. Results were submitted to regulators in a timely manner, presented publicly, published in scientific journals, and have been made available on the company's website. (...)

Helen Fisher: The brain in love
exchangemagazine.com 16.7.2008
(...) Her latest research raises serious concerns about the widespread, long-term use of antidepressants, which may undermine our natural process of attachment by tampering with hormone levels in the brain. (...)

Venlafaxine Joins SSRIs in Risk for Upper GI Bleeding
medpagetoday.com 7.7.2008
In a retrospective case-control study of 1,321 patients with upper gastrointestinal bleeding and 10,000 age- and sex-matched controls, cases were significantly more likely than controls to be current users of selective serotonin reuptake inhibitors (OR 1.6, 95% CI 1.2 to 2.1), the investigators reported in the July issue of Archives of General Psychiatry. (...)

Patients taking serotonin reuptake inhibitors and NSAIDS, without acid-suppressing drugs, were even more heavily over-represented among cases (OR 9.1, 95% CI 4.8 to 17.3).

"The results obtained in the present study support the hypothesis that selective serotonin reuptake inhibitors as a group increase the risk of upper gastrointestinal tract bleeding," the researchers wrote. (...)

(Anm: Risk of Upper Gastrointestinal Tract Bleeding Associated With Selective Serotonin Reuptake Inhibitors and Venlafaxine Therapy Arch Gen Psychiatry. 2008;65(7):795-803.)

Antidepressants Can Change The Way Depressed People See The World In Just Four Hours
medicalnewstoday.com 5.7.2008
A single antidepressant tablet makes a depressed person see the world in a more positive light just four hours after swallowing it, a new study has shown. (...)

The unhealthy ties that bind FDA to drug firms
boston.com 5.7.2008
In her new book Alison Bass obeys the most important rule of investigative journalism: She follows the money wherever it leads. In "Side Effects," her examination of mammoth pharmaceutical companies and their pursuit of profits at any cost, she exposes the dark web of researchers, doctors, and regulators feeding at the Big Pharma trough and undermining public health in the process. The term for what Bass discovers is "systematic funding bias." As she makes abundantly clear, medical professionals taking money from Big Pharma tend to give Big Pharma what it wants. (...)

Antidepressant Risks
businessweek.com 26.6.2008
A mother's case against Pfizer (...)

Dobbelt så mye:
Jenter bruker mest antidepressiva
p4.no 19.6.2008
Det viser tall P4 har hentet fra Reseptregisteret.

Ifølge statistikken er det dobbelt så mange jenter som gutter i alderen 10-19 år bruker medisinen.

-Jenter har lavere terskel for å kontakte lege, sier Jørgen Bramness, psykiater ved Folkehelseinstituttet, til P4. (...)

Sex Differences in Stroke Risk Among Older Patients With Recently Diagnosed Atrial Fibrillation
JAMA. 2012;307(18):1952-1958 (May 9)
Context Stroke is a serious complication associated with atrial fibrillation (AF). Women with AF are at higher risk of stroke compared with men. Reasons for this higher stroke risk in women remain unclear, although some studies suggest that undertreatment with warfarin may be a cause. (...)

Conclusion Among older patients admitted with recently diagnosed AF, the risk of stroke was greater in women than in men, regardless of warfarin use. (...)

Depression in elderly linked to falls
sciencealert.com.au 19.6.2008
Older people who have depression or are taking anti-depressants have an increased risk of falls, New Zealand and Australian researchers have found.
Research published this week in PLoS ONE suggests people with depression and those taking antidepressants, especially SSRI’s, are 50 per cent more likely to fall than other older people (...)

While using antidepressants was a significant risk for falls, the highest risk (66 per cent increase in falls) was seen when older people used SSRI’s, the most frequently prescribed antidepressant (6 per cent of people took this medication). (...)

Paxil and Other Drugs to Get Labeling Change (Endringer av prepataomtaler for Seroxat og andre legemidler)
lawyersandsettlements.com 2.6.2008
Rockville, MD: The FDA has determined that current labeling for drugs like Paxil is too confusing. The organization has now proposed a change to drug labeling to make it more clear which drugs are safe for women who are pregnant and/or breastfeeding. Although the move will likely help many women in the future, it comes too late for those who took Paxil and other SSRIs while pregnant. (...)

Impotens kan være farlig
dinside.no 21.5.2008
Menn med diabetes og erektil dysfunksjon (ED), kan ha større risiko for å få alvorlige hjerteproblemer, viser en ny studie fra det kinesiske universitetet i Hong Kong. (...)

Siege Barrister shot dead by police had been taking anti-depressants
dailymail.co.uk 11.5.2008
Barrister Mark Saunders had been taking anti-depressant drugs for several months, it has been revealed

The wealthy barrister shot dead by police marksmen at his luxury home had been taking anti-depressant drugs for several months.

Friends of Mark Saunders, 32, who was killed by at least five bullet wounds, have revealed that he had been on prescription drugs for depression and had behaved "erratically" when drinking alcohol, as he did on the day he died. (...)

Suspect in Everett killing held on $300,000 bail
heraldnet.com 9.5.2008
(...) Iseman met with Nunley and his mother. There was never any indication the man could become violent, Iseman said. Nunley suffers from some mental health problems and may have been mixing alcohol and medication for depression, Iseman said. (...)

Who Are We? Coming of Age on Antidepressants
nytimes.com 15.4.2008
“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.” (...)

Surge in antidepressant use touches off health debate
startribune.com 15.4.2008
The most widely prescribed drugs in the United States are not for pain or cholesterol management, heartburn or hypertension.
They're for depression.

Doctors last year wrote 232.7 million prescriptions for antidepressants, more than any other therapeutic class of medication, according to the latest data from IMS Health, a market research firm. That represents an increase of 25 million prescriptions since 2003 and translates into an estimated 30 million patients in the United States who spent $12 billion on antidepressants in 2007. (...)

Sexgale ældre bliver kastreret med lykkepiller
bt.dk 9.3.2008
Gamle kan være så demente, at de mister hæmningerne og får ustyrlig lyst til sex. Lægerne giver dem lykkepiller og anden medicin, som kan lægge låg på lysterne. (...)

Meta-analysis shows difference between antidepressants and placebo is only significant in severe depression
BMJ 2008;336:466 (1 March)
New generation antidepressants achieve almost no benefit compared with placebo in mild to moderate depression, with slightly more benefit in severe depression but only because of less response to placebo, a meta-analysis of clinical trial data has shown.

Researchers analysed all available data from clinical trials submitted to the US Food and Drug Administration for the licensing of four selective serotonin or serotonin-noradrenaline reuptake inhibitors—fluoxetine (Prozac), venlafaxine (Efexor), nefazodone (Serzone), and paroxetine (Seroxat, Paxil). (...)

Anti-depressants ‘no better than dummy pills'
telegraph.co.uk 27.2.2008
Millions of Britons are taking anti-depressants for no reason, according to a study that found they made little difference to the condition. (...)

- Antidepressiva virker ikke
nrk.no 26.2.2008
Antidepressiva som Prozac og Seroxat virker ikke stort bedre enn juksemedisin, viser en internasjonal studie som universitetet i Hull i England har ledet. (...)

Svært viktig
Doktor Kim Kendall, som er visedirektør ved British Royal College psykiatriske forskningsavdeling, sier undersøkelsen er svært viktig.

- Jeg mener det er for farlig å la medisinprodusenter med økonomiske motiver holde tilbake opplysninger som viser at produktene er skadelige eller virkningsløse, sier han.

Prozac er verdens mest utbredte medsin mot depressjoner og 40 millioner på verdensbasis har brukt medisinen. (...)

- Lykkepillen fungerer ikke
vg.no 26.2.2008
(...) INGEN EFFEKT: En ny undersøkelse setter spørsmålstegn ved virkningene av Prozac og andre antidepressiver. (...)

En omfattende britisk undersøkelse av antidepressiver konkluderer med at de ikke har noen betydelig klinisk effekt. (...)

- Ikke slutt
I studien, som ble ledet av prosessor Irving Kirsch, ble 47 tidligere kliniske forsøk analysert. Dette var både publiserte og upubliserte forsøk, som var registrert hos FDA (The Food and Drug Administration).

Psykiater Jørgen Bramness ved Folkehelseinstituttet, synes det er positivt at det gjøres undersøkelser på dette feltet. Samtidig understreker han at folk som går på disse medisinene ikke må kutte dem ut. (...)

Professoren som ledet arbeidet med studien, Irving Kirsch, mener disse nye oppdagelsene gjør at man må sette spørsmålstegn ved lisensieringen av slike medisiner. (...)

Antidepressant drugs don't work – official study
independent.co.uk 26.2.2008
By Jeremy Laurance, Health Editor
They are among the biggest-selling drugs of all time, the "happiness pills" that supposedly lift the moods of those who suffer depression and are taken by millions of people in the UK every year.

But one of the largest studies of modern antidepressant drugs has found that they have no clinically significant effect. In other words, they don't work.

The finding will send shock waves through the medical profession and patients and raises serious questions about the regulation of the multinational pharmaceutical industry, which was accused yesterday of withholding data on the drugs. (...)

90-åringer på pilletoppen
nrk.no 4.2.2008
(...) På sykehjem bruker over 40 prosent av pasientene antidepressiva, ifølge studier som er gjort av psykiater Geir Selbekk ved Sykehuset Innlandet. Han er bekymret. (...)

Deprimerte 90-åringer på pilletoppen
vg.no 4.2.2008
Eldre i 80-90-årsalderen tar mest piller mot depresjon her i landet, viser tall fra Folkehelseinstituttet. (...)

Toxicitet vid överdosering av nya antidepressiva
Läkartidningen 2008;105(3):125-127 (16.1.2008)
Genomgång av epikrismaterial visar olika svår symtombild för olika medel (...)

Förutom selektiva serotoninåterupptagshämmare (SSRI) har flera nya antidepressiva läkemedel introducerats på den svenska marknaden de senaste två decennierna. Venlafaxin (Efexor) och mirtazapin (Remeron) godkändes i mitten av 1990-talet, medan reboxetin (Edronax) och duloxetin (Cymbalta) är de senaste tillskotten. (...)

EKG-förändringar utan cirkulatorisk påverkan, såsom måttligt breddökade QRS-komplex, QT-förlängning och ospecifika ST–T-förändringar, sågs hos 15 procent av patienterna. (...)

I gruppen med allvarliga symtom var djup medvetslöshet, upprepade kramper och pulmonell aspiration vanligt. (...)

Rabdomyolys, sannolikt toxiskt utlöst, sågs i 1 fall, och rapporter om sådan muskelskada finns också publicerade [8]. (...)

Withdrawal Symptoms From Paroxetine May Last For A Long Time (Seponeringssymptomer fra Seroxat (paroxetine) kan vare i lang tid)
medicalnewstoday.com 17.1.2008
(...) Now researchers at the University of Bologna headed by Prof. G.A. Fava confirm their account in an article published in the December 2007 issue of the International Journal of Neuropsychopharmacology. (...)

Now researchers at the University of Bologna headed by Prof. G.A. Fava confirm their account in an article published in the December 2007 issue of the International Journal of Neuropsychopharmacology. (...)

Patients were assessed with the Discontinuation-Emergent Signs and Symptoms (DESS) checklist 2 wk, 1 month and 1 yr after discontinuation. Nine of the 20 patients (45%) experienced a discontinuation syndrome, which subsided within a month in all but three patients who had been taking paroxetine for a long time. Discontinuation syndromes appeared to be fairly common even when performed with slow tapering and during clinical remission. In some cases disturbances persisted for months after discontinuation. (...)

A Pro-Prozac Nation?
jewishexponent.com 17.1.2008
After all these years, what do we (...)

He was alternately sweating, then shivering uncontrollably. His symptoms continued to worsen; for about a week, he was unable to work and -- of greater concern -- to sleep. (...)

A psychiatrist confirmed the source of the problem: Alex, who had been prescribed the antidepressant Prozac 16 years earlier to treat mild depression, had decided that he'd been on the medication too long and had cut his daily 40 mg dosage in half. The troubling array of symptoms stemmed from Alex's decreasing his Prozac intake. (...)

Major Depressive Disorder
NEJM 2007;358:55-68 (January 3)
Depression is related to the normal emotions of sadness and bereavement, but it does not remit when the external cause of these emotions dissipates, and it is disproportionate to their cause. (...)

Depression is a heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism. This review presents the major current approaches to understanding the biologic mechanisms of major depression. (...)

Late-life depression and mortality: influence of gender and antidepressant use
The British Journal of Psychiatry (2008) 192: 12-18
(...) Results
Depressed men using antidepressants had the greatest risk of dying, with increasing depression severity corresponding to a higher hazard risk. Among women, only severe depression in the absence of treatment was significantly associated with mortality.

Conclusions
The association between depression and mortality is gender-dependent and varies according to symptom load and antidepressant use. (...)

Slapp penis gir Parkinsons
side2.no 26.12.2007
Manglende evne til ereksjon kan gi økt risiko for Parkinsons sykdom, hevder studie. (...)

Erectile dysfunction may precede Parkinson's (Erektil dysfunksjon kan innlede Parkinsons)
reuters.com 26.12.2007
NEW YORK (Reuters Health) - Results of a study suggest an association between erectile dysfunction and an increased risk of developing Parkinson's disease.

The autonomic nervous system, which regulates involuntary bodily functions like heart rate and digestion, is often affected in Parkinson's disease, and erectile function, which is controlled by the autonomic system, is commonly compromised, the study team notes in a report.

"An important question," according to Dr. Xiang Gao, of Harvard School of Public Health, Boston, Massachusetts, and colleagues, "is whether erectile dysfunction precedes the onset of motor symptoms of Parkinson's disease." (...)

SOURCE: American Journal of Epidemiology, December 2007. (...)

Always aroused: A good thing gone awry
msnbc.msn.com 6.12.2007
With newly identified condition, women are constantly on fire (...)

Drug group campaigner to meet PM
huntspost.co.uk 28.11.2007
Prime Minister Gordon Brown is to meet a woman from Huntingdon, who has been campaigning for five years to highlight potential problems with anti-depressants.

Janice Simmons set up the Seroxat User Group in 2002 after discovering that her second husband Jon was addicted to the drug.

Since then thousands of people have contacted her website and the group has provided information to people from all over the world. (...)

Pilots 'safer on anti-depressants'
news.com.au 30.11.2007
(...) The study used Civil Aviation Safety Authority (CASA) records between 1993 and 2004, and compared the 481 pilots who reported medication use with the same number of pilots who did not take medication.

Each group had a total of five accidents, defined as serious injury, death or major aircraft damage during the period.

The medicated pilots had 18 incidents of pilot error reported to CASA, while the other group had 15, an insignificant difference. (...)

Gradual 10% Dose Reductions Dramatically Reduce Antidepressant Discontinuation Symptoms: Presented at CPA
MONTREAL, CANADA -- November 20, 2007 -- Ten percent weekly reductions in dose over 10 weeks can diminish discontinuation effects associated with many antidepressants of the selective serotonin reuptake inhibitor (SSRI) class. In fact, using this protocol can allow patients to discontinue SSRI therapy even if they were unable to using standard dose reduction techniques. (...)

I thought I was dying
guardian.co.uk 19.11.2007
It began with a twinge. Then came the palpitations and plummeting weight. Before long Laura Dinning was planning her goodbyes to her family. Yet doctors still hadn't got a clue what was wrong with her (...)

New life inside the depressed brain
boston.com 19.11.2007
Neuron growth may be key to mood disorder treatments, studies find (...)

Columbia University researchers gave three other exiled monkeys the antidepressant Prozac, and they showed no signs of depression. Later examination showed that in a key area deep in the monkeys' brains - the seahorse-shaped hippocampus - myriad new cells had sprouted. (...)

Neurogenesis pioneer Dr. Fred Gage, of the Salk Institute, cautioned against oversimplifying the link with depression. At this point, it is not clear that the link between neurogenesis and depression is actually one of cause and effect. (...)

In mice, it takes three or four weeks for new neurons to mature - about as long as it takes for people with depression to feel antidepressants kick in. Many researchers had assumed that the time scale must be the same in humans, but Kohler found that in monkeys, new neurons took a good 24 weeks to mature.

"We would only expect it to be longer in humans," he said. (...)

Paedophiles offered 'happy pills' to curb their sex drive (Pedofile tilbudt "lykkepiller" for å dempe sexlyst)
dailymail.co.uk 14.11.2007
Det er kommet frem at pedofile tilbys gratis Prozac som alternativ til "kjemisk kastraksjon". (Paedophiles are to be offered free Prozac as a softer alternative to 'chemical castration', it has emerged.)

The Government secured headlines this summer when it promised offenders would be given - on a voluntary basis - strong medication to curb their sex drive.

However, these drugs, which amount to chemical castration by making it difficult to have sex, have a number of side-effects which could deter potential users. (...)

Stor risiko at investere i Lundbeck
business.dk 14.11.2007
På trods af et flot tredjekvartalts-regnskab fra Lundbeck, er der stadig stor risiko ved at investere i den danske medicinalkoncern, vurderer Sydbank-analytiker. (...)

Lundbeck har både depressionskandidaten Lu21004 og Lu 24530 i pipelinen (nye produkter under udvikling, red.), der har potentialet til at opretholde indtjeningen efter patentudløb i 2012 og 2014.

Men imidlertid er begge projekter stadig er forbundet med en betydelig risiko, mener Rune Majlund Dahl. Næste indikation af, hvorvidt Lundbecks indtjening kan opretholdes af de to depressionskandidater efter 2012, kan nemlig først offentliggøres tidligst ultimo 2009. (...)

When medication harms, not heals
smh.com.au 10.11.2007
(...) The US Food and Drug Administration ordered drug companies to put "black box warnings" on
10 of the popular selective serotonin reuptake inhibitors in 2004, advising doctors to closely monitor patients in the first few weeks of therapy for "worsening depression and suicidal thinking". It also advised that patients be observed for "certain behaviours that are known to be associated with these drugs, such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, hypomania, and mania". (...)

FDA issues non-approvable letter for GlaxoSmithKline Fabre-Kramer's gepirone ER
pharmatimes.com 5.11.2007
GlaxoSmithKline has suffered a setback with the news that US regulators have rejected the antidepressant gepirone ER, which the UK drugs giant licensed from Fabre-Kramer Pharmaceuticals earlier this year. (...)

Bid for 3rd trial for PSL convicted killer opens with testimony from Harvard psychiatrist
tcpalm.com 25.10.2007
FORT PIERCE — A Harvard Medical School psychiatrist testified Thursday morning that the possibly dangerous side effects of the antidepressant Zoloft weren’t widely known when Victor Brancaccio was twice tried and convicted of murder. (...)

Genes Might Predispose Antidepressant Users to Suicidal Thoughts
dentalplans.com 27.9.2007
Someday, DNA tests might spot those most at risk, experts say (...)

Tyson pleads guilty to drug possession, DUI
azcentral.com 24.9.2007
(...) According to a court document, Tyson admitted to being an addict.

Tyson also told police that he used marijuana that day and was taking the antidepressant Zoloft. (...)

Serotoninergic agonists increase plasma levels of beta-endorphin and beta-lipotropin in humans
Journal of Clinical Endocrinology & Metabolism 2007;59:1138-1142
(...) The responses evoked by oral administration (mean peak values after 130 and 240 min) were not dose dependent. Fluoxetine (15 and 30 mg orally) a blocker of SE reuptake, induced a significant dose-related rise in plasma beta-EP and beta-LPH levels in a group of seven normal men (P less than 0.01) (mean peak values after 150 min). (...)

Sex, Love, and SSRIs
psychologytoday.com 13.9.2007
Can Prozac keep you from falling—and staying—in love? How SSRIs are wreaking havoc on courtship. (...)

Experimental Antidepressants Offer Faster Relief
healthfinder.gov 6.9.2007
But initial research involved only rats; clinical trials involving people are next step. (...)

The new study looked at a new class of drugs known as serotonin4 (5-HT4) receptor agonists, which have a more specific effect.

"SSRIs interfere with the serotonin system and increase naturally transmitted serotonin to help the system readjust itself," Frye explained. "The new drugs act only on one receptor. They're more selective." (...)

For the study, the researchers tested two serotonin receptor agonist compounds, called RS 67333 and prucalopride, in rats, comparing the drugs against the action of Celexa. (...)

The new drugs, however, may have side effects. "There are potential side effects, and that's where the rub could be with clinical trials," Frye said. (...)

Damp, Moldy Houses May Contribute To Depression
medicalnewstoday.com 24.8.2007
Living in a damp and moldy house can contribute to depression independently of other personal and housing characteristics.

Based on a study of almost 6,000 adults living in eight European cities, researchers found that dampness and mold in a home is associated with elevated risk of depression. This heightened risk seemed to be due to both a perceived lack of control over the housing environment and physical health problems that are likely to be related to mold exposure. (...)

Åbent opgør i Lundbecks topledelse
business.dk 22.8.2007
Lundbecks koncernchef, Claus Bræstrup, har ingen planer om at trække sig i 2009. Bestyrelsesformand Flemming Lindeløv har en anden opfattelse. »Jeg har aldrig hørt Claus Bræstrup udtrykke ønske om at forlænge sin kontrakt,« siger Lindeløv. (...)

Drug treatment is proposed to manage child sex offenders
BMJ 2007;334:1343 (30 June)
New proposals on the management of those who commit sexual offences against children in England and Wales will include the use of drug treatments, said the home secretary, John Reid. The drugs, to reduce libido, would be given on a voluntary basis.

The drugs envisaged are of two types: antidepressants of the selective serotonin reuptake inhibitor (SSRI) class and hormonal treatments designed to reduce testosterone concentrations. (...)

What's chemical castration?
guardian.co.uk 14.6.2007
(...) But the choice of treatment is difficult. Side effects are a problem with hormonal drugs, including, sometimes, the irreversible growth of breasts. Reid spoke in the vaguest of terms, but mentioned both "hormonal medication" and "one of the newer antidepressant drugs" - the SSRIs (selective serotonin reuptake inhibitors), which include Prozac and Seroxat. (...)

ASCO: No Antidepressant Benefit for Cancer Patients Lacking Major Depression
medpagetoday.com 3.6.2007
CHICAGO, June 3 -- Unless cancer patients have major depression, antidepressants don't seem to do anything for them, Australian researchers have found.

Sertraline (Zoloft) did not lead to less depression, anxiety, or fatigue, or to a better overall quality of life than did placebo for those with advanced cancer, reported Martin R. Stockler, M.B.B.S., M.Sc., of the University of Sydney in Australia, and colleagues. Action Points

Explain to interested patients that the study suggests cancer patients without an indication for antidepressant treatment should not receive it. (...)

(Anm: Are antidepressants taking the edge off love? (latimes.com 30.7.2007)
Sure, we know about the sexual side effects of SSRIs. But researchers now wonder if that's the only aspect of romance the drugs can influence. (...)

Any drug that has sexual side effects, Thomson says, could well blunt other chemicals the brain uses to intently focus on one person or to work up the obsession necessary to fall in love in the first place.

Then there was the 42-year-old single woman who had not been on a date in the eight years she had been taking an antidepressant. "She had not felt any desire [to date] for at least that period of time," he says. (...)

At that time, reports were that only about 6% of patients suffered sexual side effects, but the low rate is now understood to have resulted because doctors failed to ask questions about sex and patients were reluctant to bring it up. A later analysis put that figure at about 30%, and a 2001 study at as high as 73%. It is one of the top reasons that people stop taking the drugs. (...)

(Anm: Love is blue. (magicvalley.com 13.8.2007).)

More Studies Examine SSRI and Birth Defects
lawyersandsettlements.com 20.5.2007
Seattle, WA: More studies are now being done to determine the link between certain types of antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), and birth defects. (...)

Top Army Recruiter Says 'Enough is Enough'
newschannel5.com 9.5.2007
A top Army official says "enough is enough."

That's his reaction to a NewsChannel 5 investigation that caught Army recruiters and their Dishonorable Deceptions. (...)

He was re-enacting the real-life story of Pvt. Jay Mallard, who killed himself during basic training after -- his family says -- a recruiter urged him to lie about his long-term dependence on antidepressants. (...)

THE NEW MIDDLE AGES (DE NYE MIDDELALDRENDE)
Self-Nonmedication ("Selv-ikke-medisinering")
nytimes.com 6.5.2007
(...) Drug-company brochures and Web sites reported that the symptoms of going off antidepressants were usually mild and short-lived — a week or two. They all recommended tapering off, preferably by half-steps, in consultation with a doctor. I thought about calling my psychiatrist, but it had been four years, and I didn’t want to return to the place, physically or mentally, where I had gone through so much pain. I also knew my psychiatrist well enough to know that he didn’t take his job lightly and would have most likely asked me to come in. But I couldn’t afford more sessions. (...)

Over the next several days they came in handy, especially at night, when I would wake up feeling dizzy, almost seasick, disoriented and in a heavy sweat, the pillow soaked. One night, awake and not eager to go back to lying restlessly in bed, I went online, typed in “Effexor withdrawal” and found bulletin boards full of pained, plaintive and sometimes angry posters who had quit taking their medication and were suffering a broad but surprisingly consistent range of symptoms: dry mouth, muscle twitching, sleeplessness, fatigue, dizziness, stomach cramps, nightmares, blurred vision, tinnitus, anxiety and, weirdest of all, what were referred to as “brain zaps” or “brain shivers.” While there were those who went off with few or no symptoms at all, others reported taking months to feel physically readjusted. In the face of those symptoms, many despaired, gave up and returned to the drugs.

By the end of the second week, I felt confident that I could continue on 75 milligrams a day. But then my symptoms became more physical: the chills at night and the cold sweats continued. I felt tingling in my shoulders and hands, spasms in my legs. These came and went, seemingly with no reason. And then one night as I lay back to go to sleep, I felt a quick spasm in my head as if an electrical current had suddenly been sent through a circuit somewhere inside my brain. Two more followed in quick succession. With each came a wave of nausea. I sat up. They seemed to disappear. They returned. I realized these were the brain zaps, and over the next few weeks they would come, with no distinguishable pattern, several times a day.

Coping with the ever-changing and seemingly capricious symptoms was beginning to exhaust me. I couldn’t stick to any sleep schedule. I couldn’t think clearly. I was becoming unfocused, agitated and unable to sit long enough to read or work. The stress of anxiety and sleeplessness that I’d almost forgotten seemed to be returning. And that scared me. (...)

Cardiotoxicity associated with accidental bupropion ingestion in a child
Pediatr Emerg Care. 2007 Apr;23(4):234-7
Bupropion, an atypical antidepressant commonly used for depression and smoking cessation, is well known to cause seizures in both therapeutic use and overdose, but cardiac effects have been reported as minimal, usually sinus tachycardia. We describe an ingestion of bupropion estimated to be greater than 2 g by a 3-year-old boy that resulted in seizures. (...)

Sex, Love, and SSRIs
psychologytoday.com 3.4.2007 (Psychology Today Magazine)
Can Prozac keep you from falling—and staying—in love? How SSRIs are wreaking havoc on courtship. (...)

Approximately 70 percent of people taking SSRIs suffer from sexual side effects. But these drugs may also compromise the ability to feel love. (...)

Girls critical after taking antidepressants
abc.net.au 9.4.2007
Two young girls are in a critical condition after taking antidepressant medication at Dubbo in the central west of New South Wales. (...)

Kleptomania Not Inhibited by SSRI (SSRI hemmer ikke kleptomani)
medpagetoday.com 15.3.2007
STANFORD, Calif., March 15 -- Despite hopes that selective serotonin reuptake inhibitors can help control chronic kleptomania, a small randomized trial of one agent yielded no more than a placebo response. (...)

(Anm: Lykkepille mot stjeling (tv2.no 22.3.2007). Lykkepiller mot kleptomani (vg.no 22.3.2007).)

Opiates of the masses
BY ADAM SOBSEY
indyweek.com 7.3.2007
Are drugs and fundamentalism just antidotes to money?

"If many remedies are prescribed for the same illness, you can be sure the illness has no cure." —Anton Chekhov (...)

- Lyver om dødelige piller
mozon.no 15.2.2007
Mektige legemiddelselskaper jukser med forskningen og lyver om livsfarlige bivirkninger, mener den britiske professoren David Healy. Her er metodene de bruker: (...)

Beskylder legemiddelbransjen for juks
mozon.no 15.2.2007
Den engelske professoren David Healy beskylder legemiddelindustrien for en rekke alvorlige forhold. - Vi ønsker åpenhet, sier bransjen. (...)

Pharmaceutical industry condemned by psychologist
netdoctor.co.uk 30.1.2007
The pharmaceutical industry has been criticised by a leading psychologist for misrepresenting the efficacy of the anti depression drug Seroxat.

Patients have been "betrayed" by the misrepresentation of the drug, said Dr David Healy, the director of psychological medicine at the University of Cardiff.

Skandale-sykehuset
nettavisen.no 26.1.2006
Tre ganger er psykiatriske pasienter fra Ryhov sykehus blitt innblandet i drapssaker. Nå skal sykehuset granskes. (...)

SSRI hjälper inte mot rökning
dagensmedicin.se 24.1.2007
Det nya antirökläkemedlet vareniklin kan öka möjligheten att sluta röka upp till tre gånger. Däremot har antidepressiva SSRI-preparat ingen effekt. Det visar en färsk granskning av olika rökavvänjningsmetoder. (...)

Obesity, dyslipidemia, and diabetes with selective serotonin reuptake inhibitors: the Hordaland Health Study
J Clin Psychiatry. 2006 Dec;67(12):1974-82
(...) CONCLUSION: We have shown that use of at least some SSRIs is associated with clinical and biochemical elements of the metabolic syndrome. Our data indicate differences in the metabolic side effect profile among various SSRI drugs, although treatment bias might have influenced these results. We suggest that patients taking SSRIs be carefully monitored for obesity and dyslipidemia. (...)

Antidepressants and Driving
youtube.com 29.12.2006
Comments & Responses (...)

Taste perceptions may aid depression treatment
reuters.co.uk 19.12.2006
- Taste sensitivity is altered by changing levels of so-called neurotransmitters that are thought to be involved in depression, British investigators report. (...)

Antidepressants may affect driving ability
reutershealth.com 14.12.2006
People taking antidepressant medication may find their driving skills impaired, German researchers warn.

"Psychomotor disturbances can frequently be found in depressed patients and may have an important influence on the ability to drive," Dr. Alexander Brunnauer and colleagues point out in the Journal of Clinical Psychiatry. "Additionally, effects of sedation, as seen with some antidepressants, probably impair driving performance." (...)

Panel to Debate Antidepressant Warnings
nytimes.com 13.12.2006
Public health officials, psychiatrists, grieving parents and outraged former patients will fill a hotel ballroom in Silver Spring, Md., this morning to argue the most bitterly divisive question in psychiatry: do the drugs that doctors prescribe to relieve depression make some people more likely to attempt suicide? (...)

Growth in the Antidepressant Drug Market Will Be Constrained by Patent Expiries of Market Leaders, Including Pfizer's Zoloft and GlaxoSmithKline's Wellbutrin
prnewswire.com 11.12.2006
Arrival of Four Classes of Novel Agents Will Account for 30% of the Market (...)

Losing your sense of taste could be sign of depression
chinadaily.com 6.12.2006
Taste is linked to the brain chemicals which control our moods, a study found.

When levels of these chemicals fall, which is thought to happen when a patient is suffering depression, our sense of taste is blunted.

But boosting levels of the mood-enhancing chemicals serotonin and noradrenaline improves sense of taste, according to the researchers. (...)

Anti-depressants not for cancer
news.com.au 30.11.2006
ANTI-depressants taken by thousands of Australians with advanced cancer do nothing to improve quality of life, a world-first Australian study has concluded. (...)

Florida has no list of foster kids on psychiatric drugs
miami.com 23.9.2006
An official of Florida's family safety program has revealed that the state still doesn't know how many foster kids are on psychiatric medications. (...)

Advocates have claimed for years that such drugs -- most of which have never been tested on children -- routinely are used as ''chemical restraints'' to control the behavior of unruly children.

''It is critical that the [computer] database be accurate and up to date to assure that we are able to monitor all children taking these medications,'' wrote Patricia Badland, who heads up the Department of Children & Families' family safety program. (...)

Study links violence with antidepressants
guardian.co.uk 12.9.2006
The antidepressant drugs known as SSRIs, which include the British best-seller Seroxat, may precipitate a small number of individuals into violence, according to a paper published today on the Public Library of Science: Medicine website. (...)

Anti-depression drug could help ‘early’ men
edmontonsun.com 9.9.2006
-- A short-acting version of a drug used to treat depression helps alleviate premature ejaculation in those severely affected by the condition, improving sexual satisfaction for both the men and their female partners, U.S. researchers say. (...)

Dapoxetine belongs to a class of drugs called selective serotonin re-uptake inhibitors (SSRIs), which are prescribed for depression under such brand names as Prozac, Paxil and Zoloft.

Dapoxetine was specifically developed for premature ejaculation, based on a side-effect of delayed ejaculation associated with its longer-acting SSRI cousins. (...)

Dr. Jim Wright of the University of British Columbia isn't so sure about using Dapoxetine for this purpose. He said SSRIs for depression can have significant side-effects - including preventing ejaculation entirely - and they carry warnings about increasing suicidal thoughts and possibly violent outbursts.

"My first reaction is: Should we be using a side-effect of a drug for another indication?" Wright said from Vancouver. "And potent drugs that we're still learning about but that we're concerned about in terms of their major side-effects, including increasing the risk of suicide." (...)

(Anm: Healy D, Herxheimer A, Menkes DB. Antidepressants and Violence: Problems at the Interface of Medicine and Law. PLoS Med. 2006 Sep 12;3(9). (PDF).)

SSRI antidepressants increase risk of internal bleeding
healthsentinel.com 31.8.2006
Selective serotonin reuptake inhibitors, commonly known as SSRIs, are the most widely used antidepressants in the world. In fact, some figures show that as many as 3 to 4 out of every 100 people are taking these drugs on any given day. Drugs known as SSRIs include Celexa (citalopram), Prozac (fluoxetine), Luvox (flovoxamine), Paxil (paroxetine), Zoloft (sertraline), and Anafranil (clomipramine).

There has been a great deal of debate on the increased suicide risk in both adults and adolescents with the use of SSRIs. However, a much less recognized adverse effect of these medications is the increased risk of upper gastrointestinal (GI) bleeding. (...)

Doubt over antidepressant risks
bbc.co.uk 20.8.2006
Seroxat has been linked to poor development
A common antidepressant may be safe for pregnant women to use, despite fears it could put babies at risk.
Seroxat had been linked to heart abnormalities, and the US watchdog issued a warning on the link last year. (...)

The research carried out by the University of Ulm team studied 119 women treated with Seroxat between 1999 and 2005 and compared their pregnancies to 645 women not exposed to the drug.

Three abnormalities were reported after exposure to the drug: club feet, a large port wine mark and neck muscle spasms.

But, in the non-drug group, there was a similar rate of abnormalities, with 25 out of 557 babies affected.

The only way in which the Seroxat group differed was that more decided to terminate their pregnancies. (...)

Dr Wolfgang Paulus, director of the Institute of Reproductive Toxicology at the University of Ulm, who led the research, said: "We found that the rate of congenital abnormalities was not increased after using paroxetine in early pregnancy. (...)

"Any evidence linking use of a drug to damage to the unborn baby must be taken very seriously but, while remaining acutely aware of the risks anti-depressants may pose to some individuals, we must be careful not to deprive people of vital medications." (...)

Zoloft does not prevent post-stroke depression
reuters.co.uk 17.8.2006
NEW YORK (Reuters Health) - In non-depressed patients who have recently suffered a stroke, prophylactic treatment with Zoloft (also called sertraline) does not prevent the onset of depression in the following 6 months, according to results of a study. (...)

(Anm: Preventing depression after stroke: Results from a randomized placebo-controlled trial. J Clin Psychiatry. 2006 Jul;67(7):1104-9.)

Hyponatremia Associated with Selective Serotonin-Reuptake Inhibitors in Older Adults
Ann Pharmacother. 2006 (Aug 8)
(...) CONCLUSIONS: Practitioners should be on the alert for this potentially life-threatening adverse event, especially in older adults with other risk factors for developing hyponatremia. (...)

Dop mot depresjoner
mozon.no 9.8.2006
Partydopet ketamin kan bli utgangspunkt for en effektiv medisin mot depresjoner.

Ketamin er fortsatt et relativt ukjent narkotika i Norge. Stoffet som kan sammenliknes med ecstasy, har evnen til å endre humøret og forårsake hallusinasjoner og hukommelsestap.

Den medisinske bruken av ketamin har så langt begrenset seg til et bedøvelsesmiddel til bruk på dyr. Men nå mener en gruppe amerikanske leger at stoffet også kan være til nytte i behandlingen av alvorlige depresjoner. (...)

Negligence trial begins in circuit court, doctor called to testify
cadillacnews.com 26.7.2006
CADILLAC - A man who suffered respiratory depression and went into a coma shortly after taking several prescription drugs brought his former physician to court Tuesday. (...)

Blanchard's attorney, David R. Johnson, told the jury Blanchard diagnosed Manke with chronic back pain from a re-injury, insomnia and depression. Based on the diagnoses and speaking with the Mankes for about an hour, she prescribed three medications: Remeron for sleep and depression, Effexor for depression and Methadone for pain. (...)

F.D.A. Takes Action on Antidepressants and Migraine Drugs
nytimes.com 20.7.2006
WASHINGTON, July 19 (AP) — The Food and Drug Administration asked Wednesday that manufacturers of Prozac and similar antidepressants change their labels to include information about an uncommon but life-threatening lung problem that can affect babies born to mothers who take the drugs during pregnancy.

The agency also issued an alert about the possible risk of combining antidepressant medications with common migraine drugs called triptans, saying a life-threatening condition called serotonin syndrome might occur when the drugs are combined.

The agency said it was seeking more information on both risks. (...)

Lykkepille uten effekt
mozon.no 15.6.2006
Lykkepillen Prozac gis ofte til personer med spiseforstyrrelsen anoreksi. Men nå viser en ny studie at pillen ikke kan forebygge tilbakefall av den alvorlige sykdommen. (...)

- De nye funnene, sammen med tidligere studier, viser at den vanlige praksisen å gi antidepressiva til pasienter med anoreksi, sannsynligvis ikke gir nok fordeler, enten pasienten er undervektig eller i ferd med å legge på seg, konkluderer rapporten.

Behandling bør heller konsentrere seg om atferdsterapi og psykologisk intervensjon, som man vet kan ha en effekt, sier forskerne.
Studien er publisert i tidsskriftet Journal of the American Medical Association denne uken. (...)

Should children be given Prozac?
dailymail.co.uk 13.6.2006
Experts say it can stunt growth, damage young brains and even trigger suicide. Yet now the controversial anti-depressant Prozac is about to be prescribed to youngsters of just eight. JEROME BURNE investigates:

James was ten when he was first put on the antidepressant Prozac. His mother was an invalid, and after his father left home, the pressure of caring for his mother had become overwhelming. (...)

Fluoxetine After Weight Restoration in Anorexia Nervosa
JAMA. 2006;295:2605-2612 (June 14)
Fluoxetine Treatment of Anorexia Nervosa: Important but Disappointing
Results (...)

(Anm: Scott J. Crow. JAMA 2006;295 2659-2660.)

Antidepressant Approved for Winter Blues
forbes.com 12.6.2006
An antidepressant won federal approval Monday as the first drug to treat seasonal affective disorder, the wintertime blues that can strike when the days grow short.

Wellbutrin XL can be used in the prevention of major depressive episodes in patients with a history of seasonal affective disorder, often called SAD, the Food and Drug Administration said. SAD is characterized by recurrent major depressive episodes during the fall and winter.

The FDA approved Wellbutrin XL - the extended release version of bupropion HCL in tablet form - in 2003. The original version of the drug won approval in 1985. (...)

Antidepressants Do Prevent Suicides, Researchers Contend
forbes.com 12.6.2006
-- Countering recent reports that they might boost suicide risk in users, a major new study finds that antidepressants known as selective serotonin reuptake inhibitors (SSRIs) have actually saved thousands of lives by preventing suicides since they were introduced in 1988. (...)

Tough curbs on Prozac prescribed for children
guardian.co.uk 12.6.2006

• Antidepressant only to be used with counselling
• Drug manufacturer must continue to monitor safety (...)

Effect of antidepressant drugs on 6-OHDA-treated mice in the FST
Eur Neuropsychopharmacol. 2006 Jun 4; [Epub ahead of print] Links
There is growing evidence suggesting that dopamine could be indirectly involved in the appearance of behavioural effects of antidepressants. (...)

Rage Disorder More Common Than Thought
forbes.com 5.6.2006
MONDAY, June 5 (HealthDay News) -- A little-studied mental illness marked by episodes of angry, potentially violent outbursts like those seen in road rage or spousal abuse is more common than previously thought, researchers report.
In fact, the illness, known as intermittent explosive disorder (IED), may affect as many as 7.3 percent of American adults -- up to 16 million people -- in their lifetimes. In a given year, the disorder affects almost percent of Americans, or 8.6 million adults, the researchers found.

Intermittent explosive disorder may also predispose people to other mental illnesses, such as depression and anxiety, and substance abuse problems.
The findings of the study, funded by the National Institute of Mental Health, appear in the June issue of the Archives of General Psychiatry. (...)

Laguna 'stepped out of his body'
ironwooddailyglobe.com 5.5.2006
Mania can be brought on by anti-depressants because of the overload of serotonin on the brain, Burrows said.

Asked if the drugs should be taken by a person with a bi-polar disorder, she responded, "Absolutely not. Just one of these drugs could trigger a manic episode."

The manic episode could go along with depression, or it could be independent of depression," she testified. "You could have anxiety along with it."
Taking four drugs would increase the risk for bi-polar disorder sufferers, she added.

Burrows testified people in a psychotic state "could come up with a plan to kill people."

District Attorney Marty Lipske outlined Laguna's activities prior to the shooting.
"Is it possible for a psychotic person to be that organized?" he asked.
"Oh, yes. They are fully caught up in their own minds," Burrows said. (...)

Terapi bedre enn lykkepiller
bt.no 28.5.2006
Tre ukers gruppeterapi er like effektivt mot sosial fobi som et år med lykkepiller.
En doktorgradsavhandling fra Karolinska Institutet i Sverige avdekke at effektene av tre ukers gruppebehandling er like effektivt som et helt års bruk av nyere antidepressive legemidler.

Dette er gode nyheter for de rundt 13 prosentene av den svenske befolkningen som lider av sosial fobi eller sosial angst. (...)

Terapi mer effektivt än läkemedel mot social fobi
ki.se 24.5.2006
Tre veckors gruppbehandling med kognitiv beteendeterapi (KBT) är lika effektiv mot social fobi som ett års behandling med "antidepressiva" läkemedel, visar ny forskning från Karolinska Institutet. Men bäst fungerar individuell behandling.

Omkring 13 procent av svenskarna lider av social fobi. Vanliga symtom är rädsla för uppmärksamhet och att bli bedömd eller avvisad i sociala sammanhang, vilket leder till undvikande av sådana situationer. Social fobi kan vara väldigt handikappande både privat och i yrkeslivet och måste behandlas för att inte bli kronisk. (...)

FDA Warns On Adult Suicides and Antidepressants (FDA advarer mot antidepressiva og selvmord blant voksne.)
Forbes 1.7.2005
Food and Drug Administration utstedte fredag advarsel nummer to om at mennesker som tar antidepressive legemidler skal overvåkes for tegn på selvmordstanker og forverret depresjon. (The U.S. Food and Drug Administration on Friday issued a second warning that people taking antidepressant drugs be monitored for signs of suicidal thoughts and deepening depression.)

Det nye råd er en følge av bekymringer for en link mellom bruk av antidepressiva og selvmord blant barn. Og det er også en følge av tiltak i mars 2004, da FDA sa der var en liten, men reell øket risiko for suicidal atferd hos voksne og barn som tar disse legemidler. De beordret da produsentene å anføre en advarsel i omtalen for alle antidepressiva som inngående forklarer de forhøyede risikoer. (...) (The new advisory follows concern about a link between antidepressant use and suicide among children. And it also follows action taken in March 2004, when the FDA said there was a small, but real increased risk of suicidal behavior in adults and children taking these drugs. It then ordered manufacturers to place a warning on the labels of all antidepressants detailing those heightened risks.)

Depression, heart ailments tied
newsobserver.com 24.4.2006
Doctors seeking cause of linkage (...)

Depression not tied to diabetes control in elderly
reutershealth.com 18.4.2006
- There is no strong relationship between depression in elderly patients with diabetes and the degree to which they control their blood sugar levels, researchers report. (...)

Diabetes Care April 2006. (...)

FDA Officials Explain Route To Antidepressant Warnings
psychiatryonline.org 7.4.2006
(...) With regard to the overall pooled risk of an SRE for each drug (most drugs were investigated in more than one clinical trial), risk ratios ranged from drugs associated with no SREs at all (nefazodone and bupropion) to the highest risk (pooled RR=8.84) associated with venlafaxine (see chart on page 24). Among the nine drugs, venlafaxine was the only one whose elevated risk reached statistical significance. (...)

A Depression Switch?
nytimes.com 2.4.2006
Deanna Cole-Benjamin never figured to be a test case for a radical new brain surgery for depression. Her youth contained no traumas; her adult life, as she describes it, was blessed. (...)

Antidepressants May Fight Colorectal Cancer
forbes.com 27.3.2006
-- A pioneering study supports a theory that a widely used class of antidepressant drugs can also fight cancers, such as colorectal cancer, Canadian researchers report.

The drugs, called selective serotonin reuptake inhibitors (SSRIs), include such popular medications as Prozac, Paxil and Zoloft. The study was based on reports that serotonin, the body chemical linked to depression, also promotes the growth of cancer cells, said Dr. Jean-Paul Collet, professor of biostatistics and epidemiology at McGill University in Montreal. (...)

Pain reactivity in 2-month-old infants after prenatal and postnatal serotonin reuptake inhibitor medication exposure.
Pediatrics 2005;115(2):411-25
CONCLUSIONS: Blunted facial-action responses were observed among infants with prenatal SSRI exposure alone, whereas both prenatal and postnatal exposure was associated with reduced parasympathetic withdrawal and increased parasympathetic cardiac modulation during recovery after an acute noxious event. These findings are consistent with patterns of pain reactivity observed in the newborn period in the same cohort. Given that postnatal exposure via breast milk was extremely low and altered biobehavioral pain reactivity was not associated with levels of maternal reports of depression, these data suggest possible sustained neurobehavioral outcomes beyond the newborn period. This is the first study of pain reactivity in infants with prenatal and postnatal SSRI exposure, and our findings were limited by the lack of a depressed nonmedicated control group, small sample size, and understanding of infant behaviors associated with pain reactivity that could have also have been influenced by prenatal SSRI exposure. (...)

Cognition not directly affected by depression
NEW YORK (Reuters Health) - There appears to be no association between depressive symptoms and subsequent cognitive decline in older adults, according to the findings of a study conducted by researchers in Pennsylvania. (...)

The dementia-free group experienced minimal cognitive decline over time, whereas marked decline occurred in subjects who later developed dementia, the team reports in the Archives of General Psychiatry. No association was observed between depressive symptoms and the rate of cognitive decline over time in either group.

"If an older person is depressed and performs poorly on cognitive tests, the two may well be related," Ganguli said in an interview. "However, if the person continues to decline cognitively over time, that decline is likely not due to depression; it is more likely due to an incipient dementia which will manifest itself down the line."

"Once we separate out the effect of an underlying dementia, depression does not seem to lead to further cognitive decline," she notes.

SOURCE: Archives of General Psychiatry, February 2006. (...)

Arbejde er et vigtigt middel mod depression
netdoktor.com 10.2.2006
Arbejde er et vigtigt middel mod depression, mener de to speciallæger i psykiatri Jesper Karle og Lars Aakerlund. I et nyt behandlingsforsøg i samarbejde med Depressionsforeningen skal de nu dokumentere sammenhængen.

”Vi kan se på vores behandlingsresultater, at jo før en person kommer i behandling, desto kortere er sygeframeldingen. En stor del af de patienter, vi har haft, har været i fare for at blive sygemeldt. Og vi ser det som vores opgave at være med til at forhindre den, fordi det er en del af kuren, at medarbejderne opretholder et så højt aktivitetsniveau som muligt. Det kan for eksempel ske ved en delvis sygemelding eller ved en fleksibel tilrettelæggelse af arbejdet”, siger Lars Aakerlund.

De to behandlere har siden 2003 behandlet omkring 800 patienter i deres praksis, Psykiatrisk Privatklinik. Men en bevilling på 880.000 kr. fra Beskæftigelsesministeriet vil du nu systematisere og deres erfaringer og samle den viden der findes i forhold til at fastholde mennesker med depression på arbejdsmarkedet. (...)

Depression therapy 'no help to diabetics'
theaustralian.news.com 1.2.2006
EVEN though many patients with diabetes are also depressed, which may complicate their efforts at managing their diabetes, better treatment of their depression seems to have no effect on how they deal with their diabetes.

In their report in the Annals of Family Medicine, Dr Elizabeth H B Lin and her associates point out that diabetics are roughly twice as likely as the general population to have depression.

Patients with both disorders tend to have worse blood sugar control, more severe symptoms and complications due to diabetes, and to use health care resources at a higher rate. (...)

Debate on antidepressants and pregnancy
smh.com 1.2.2006
(...) But it said several recent reports have found a possible tie between some drugs and a heart malformation and some distress among newborns exposed in the womb.

"The goal of the obstetrician and the psychiatrist is to use the safest drugs that are effective for the patient," said Jennifer Wu, an obstetrician at Lenox Hill Hospital in New York.

Instead of eliminating antidepressants during pregnancy, she said, "a better approach would be to reduce medications down to a single agent and to use the lowest effective dose possible". (...)

Psychomotor Slowing as a Predictor of Fluoxetine Nonresponse in Depressed Outpatients
Am J Psychiatry 163:73-78, January 2006
(...) CONCLUSIONS: Psychomotor slowing may identify a subgroup of depressed patients who have a dopaminergic deficit that is unresponsive to fluoxetine monotherapy and who should therefore receive an alternative treatment. (...)

Continuity of Antidepressant Treatment for Adults With Depression in the United States
Am J Psychiatry 163:101-108, January 2006
(...) RESULTS: A majority of the patients discontinued antidepressant therapy during the first 30 days (42.4%). Only 27.6% of the patients continued antidepressant therapy for more than 90 days. (...)

Therapies: A Dose of Dolphins for Moderate Depression
The New York Times 6.12.2005
Researchers working in Honduras have taken an unusual approach to treating mild to moderate depression: they teamed their patients up with dolphins. (...)

Dolphins help treat depression (Delfiner hjelper i behandling av depesjon)
BMJ 2005;331 (26 November)
Dolphins can help alleviate symptoms of depression after two weeks of treatment. In a single blind trial, Antonioli and Reveley (p 1231) randomised 30 people with mild or moderate depression without psychotic features to an outdoor nature programme featuring water activities—with or without bottlenose dolphins. Participants who got to play with the dolphins showed significantly greater reduction in the mean severity of depressive symptoms than those who only enjoyed other aspects of nature. None of the participants took any antidepressant or anxiolytic drugs for the four weeks before or during the study. (...)

Delfiner lindrer depresjoner
mozon.no 27.11.2005
Å bade sammen med delfiner kan lindre depresjoner, viser ny forskning. (...)

Forskere ved universitetet i Leicester i Storbritania har nylig gjennomført en undersøkelse der 30 mennesker med depresjon var med..

I løpet av fire uker sluttet pasientene med antideprisiver og psykologtimer. Den ene halvparten fikk omsorg for delfiner ved et forskningsititutt i Honduras. Snorkling med delfinene var en viktig del av programmet.

Den andre halvparten fylte dagene med friluftsaktiviteter, blant annet med snorkling på korallrev. Denne gruppen var ikke sammen med delfiner i løpet av oppholdet.

To uker ut i programmet hadde alle pasientene fått en mye bedre sinnstilstand. Størst forbedring fant forskerne i gruppen som svømte med delfiner. Vanlige symptomer på depresjon var vesentlig mer redusert i denne gruppen enn i kontrollgruppen. (...)

Depression behandles med computerterapi
netdoktor.com 25.11.2005
Computerassisteret kognitiv terapi mod depression kan måske blive fremtidens løsning på problemet med tids- og personalemangel til at give behandlingen. Kognitiv er nemlig en af de mest effektive behandlinger til en lang række alvorlige psykiske sygdomme som depression, angst og tvangsforstyrrelser (OCD). Behandlingsformen er udviklet i Storbritannien, hvor den er på vej til at få det blå stempel af myndighederne.

Metoden går ud på, at patienten møder op i klinikken hos sin egen læge, når diagnosen er stillet, og arbejder med en række øvelser på computeren. Øvelserne bygger på principperne i kognitiv terapi, og en pakke består typisk af otte sessioner af en times varighed. Sideløbende har patienten en ugentlig samtale hos sin læge, og under øvelserne kan patienten altid få kontakt med en sygeplejerske. Der hører også øvelser med til programmet som patienten kan lave derhjemme. (...)

Psych disorders common with erectile dysfunction
abcnews.go.com 25.11.2005
NEW YORK - NEW YORK (Reuters Health) - Most men who seek treatment for erectile dysfunction (ED) have one or more psychiatric disorders, suggests a small study conducted in Greece.

"The current study demonstrates that psychiatric morbidity is highly prevalent in patients with ED," conclude study investigators.

The study, which is reported in The Journal of Urology, featured 103 men with ED who underwent a battery of tests for the presence of psychiatric illness.

The men ranged in age from 20 to 76 years and the majority had either moderate or severe ED, lead author Dr. Dimitrios Mallis and colleagues, from Aristotle University of Thessaloniki, note. (...)

Spiser piller uten nytte
aftenposten.no 23.11.2005
250.000 dansker spiser piller mot depresjon, men bare hver femte har noen glede av lykkepillene.

Samtidig sliter svært mange med bivirkninger, skriver København-avisen Politiken.

Et hovedproblem er at stort sett alle undersøkelser av pillenes virkninger er sponset av selskapene som lager pillene, sier avdelingslege Mats Lindberg i København. Han påpeker også at mange får en form for abstinens når de slutter å ta slike piller.

Psykologen Thomas Nielsen ved universitetet i Århus påpeker ifølge Politiken at bruk av lykkepiller også kan gi nedsatt livsglede og nedsatt seksuell lyst. Terapi er på lengre sikt et bedre virkemiddel enn medisiner, understreker Nielsen. (...)

Depressionspiller virker kun på hver femte
politiken.dk 23.11.2005
Kun hver femte, der tager depressionspiller, får det bedre af medicinen. Desuden har pillerne en række bivirkninger.

Flere eksperter sår nu tvivl om effekten af de depressionspiller, der hver dag bliver spist af en kvart million danskere. (...)

»Problemet er, at vi ikke kan vide, hvem der får gavn af pillerne. Stort set al den hidtidige viden om lykkepillernes effekt stammer fra undersøgelser, der er sponseret af den industri, der fremstiller pillerne,« fortæller afdelingslæge Mats Lindberg fra Institut for Rationel Farmakoterapi til metroXpress.

»Desuden har der vist sig en række bivirkninger ved lykkepillerne som hovedpine, kvalme og seksuelle problemer,« fortæller Mats Lindberg. (...)

Lykkepiller virker kun for hver femte
dr.dk 23.11.2005

Danske hunder på lykkepillen
26.6.2005
Stadig flere danske hunder går på lykkepiller. Nå slår dyrlegene alarm.
- Det er grusomt. Folk som tilbyr hunden sin et liv der dette er nødvendig, burde ikke fått lov til å eie en, sier formannen i Dansk Kennel Klub, Jørgen Hindse Madsen. (...)

Lykkepille kan øke selvmordsfaren
NRK 28.2.2005
Statens Legemiddelverk har i 15 år hatt informasjon om at antidepressivaet Seroxat kan øke selvmordsfaren. Da Seroxat ble sluppet på markedet i 1993 informerte myndighetene ikke om dette. En regner med at 400.000 nordmenn har brukt antidepressiva som Seroxat. (...)

AMA Opposes Restrictions On SSRI Use In Youngsters
Psychiatric News July 15, 2005 Volume 40 Number 14 © 2005 American Psychiatric Association
The House of Delegates adopts an APA-AACAP resolution endorsing the training of investigators to study the effects of psychotropic drugs in children, adolescents, and young adults. (...)

Male GPs depression pills 'bias'
BBC 21.7.2005
Many patients said exercise helped the most
e GPs are far more likely to prescribe antidepressants than fee doctors, a mental health charity says.

A survey of 200 GPs by the Mental Health Foundation found 61% of e GPs would first offer pills to people with mild or moderate depression.
Only 37% of fee GPs questioned said they would suggest medication first, with more favouring counselling. (...)

But 60% said their GPs had offered them antidepressants, 42% counselling.

Only 2% per cent were offered exercise on prescription.

Half of those who had taken antidepressants reported "troubling" side effects. (...)

Inquest probing suicide of foster teen
CBC.ca 8.7.2005
A coroner's inquest in Fredericton is examining whether the province's child welfare system failed a troubled teenager who killed herself two years ago.

It's also considering whether the use of anti-depressant drugs may have played a role in Heather White's decision to end her life. (...)

MedWatch - The FDA Safety Information and Adverse Event Reporting Program
UPDATE 07/08/2005
FDA notified healthcare professionals about the availability of updated Healthcare Professional and Patient Information Sheets for antidepressant medications that were the subject of a June 30, 2005 Public Health Advisory issued about the risk of suicidality (suicidal thinking or behavior) in adults being treated with antidepressant medications. (...)

Antidepressant Tied to Attempted Suicides
The New York Times 2.7.2005
Federal drug regulators said yesterday that an antidepressant drug, Cymbalta, was linked to "a higher than expected rate of suicide attempts" among women taking it to treat a type of incontinence.

A review of Cymbalta, made by Eli Lilly, found that 11 of nearly 9,000 women taking it for urinary incontinence tried to commit suicide, said Dr. Sandra L. Kweder, deputy director of the Office of New Drugs in the Food and Drug Administration.

The review was the first in a series of advisories that the agency plans on antidepressants, in an effort to be more open and to speak directly to patients. The agency released a general public health advisory on Thursday that repeated prior warnings that antidepressants might lead some patients to become suicidal. (...)

FDA Reviews Data for Antidepressant Use in Adults (FDA gjennomgår data for bruk av antidepressiva hos voksne.)
FDA Talk Paper 1.7.2005
Som reaksjon på nylige vitenskapelige publikasjoner som rapporterer muligheten for økt suicidal atferd hos voksne behandlet med antidepressiva, har FDA oppnevnt et offentlig helseråd (PHA) for å oppdatere pasienter og helsepersonell med den siste informasjon om dette. (In response to recent scientific publications that report the possibility of increased risk of suicidal behavior in adults treated with antidepressants, the U.S. Food and Drug Administration (FDA) has issued a Public Health Advisory (PHA) to update patients and healthcare providers with the latest information on this subject.)

Alt før publikasjonen av de nylige rapporter, har FDA allerede startet prosessen med gjennomgåelse av tilgjengelige data for å avgjøre hvorvidt der er en økt risiko hos voksne som tar antidepressiva. Byrået har bedt produsentene om å skaffe informasjon om sine forsøk som bruker en tilnærming liknende det som ble brukt i evalueringen av risiko for suicidal atferd hos den pediatriske befolkning som tar antidepressiva. Dette forsøk vil involvere hundrevis av kliniske forsøk og kan ta mer enn ett år å ferdigstille. (...) (Even before the publication of these recent reports, FDA had already begun the process of reviewing available data to determine whether there is an increased risk of suicidal behavior in adults taking antidepressants. The Agency has asked manufacturers to provide information from their trials using an approach similar to that used in the evaluation of the risk of suicidal behavior in the pediatric population taking antidepressants. This effort will involve hundreds of clinical trials and may take more than a year to complete.)

Insomnia Can Cause Depression
CBS 24.6.2005
(WebMD) Insomnia has long been thought of as a symptom of depression, but new research shows it may actually trigger the mental disorder.

In one study, depressed seniors with insomnia were 17 times more likely to remain depressed after a year than patients who were sleeping well. The findings were presented Tuesday at the 19th Annual Meeting of the Associated Professional Sleep Societies in Denver. (...)

FDA Public Health Advisory
Suicidality in Adults Being Treated with Antidepressant Medications
Date created: June 30, 2005
Several recent scientific publications suggest the possibility of an increased risk for suicidal behavior in adults who are being treated with antidepressant medications. (...)