5/16/2000 – Long-Term Side Effects Surface With SSRIs

The following are excerpts from Clinical Psychiatry News about long-term
adverse effects of SSRIs. They could have learned this YEARS earlier by
reading my book, Prozac: Panacea or Pandora? but at least they are FINALLY
talking about it and as many of you have asked, I thought you would want this
reference.

Dr. Ann Blake Tracy, Executive Director,
International Coalition For Drug Awareness

From Clinical Psychiatry News

Long-Term Side Effects Surface With SSRIs

Author: Carl Sherman, Contributing Writer
[Clinical Psychiatry News 26(5):1, 1998. © 1998 International Medical News
Group.]

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Insomnia, weight gain, sexual dysfunction emerge as problems affecting
compliance.

NEW YORK — Physicians are seeing long-term side effects with selective
serotonin reuptake inhibitors far in excess of what was expected from
clinical trial data, Dr. Norman Sussman said at a psychopharmacology update
sponsored by New York University.

If these particular side effects — sleep disturbances, sexual dysfunction,
and weight gain — are problematic for patients, one of the newer non-SSRI
antidepressants may be a better choice, he said. Of course, these drugs have
their own particular side effect profiles.

When SSRIs first appeared a decade ago, their favorable side effect profile
was a key selling point. They were clearly safer and easier to use than
tricyclics and monoamine oxidase inhibitors and, above all, better tolerated
by patients.

But experience has shown that some side effects are more common and
problematic than initially expected, said Dr. Sussman, director of the
psychopharmacology research and consultation service at Bellevue Hospital
Center in New York. . . . adverse effects that persist as long as the patient
takes the medication, such as sexual dysfunction and sleep disturbances. Also
particularly troubling are those, like weight gain, that don’t even develop
until late in treatment. “These are the ones that are not in the insert,
which is based on short-term studies,” Dr. Sussman said.

Significant insomnia affects 15%-20% of patients taking SSRIs, twice the rate
with placebo. Polysomnography has consistently found that these drugs cause
activation during the night: In addition to insomnia, bruxism, sweating, and
periodic limb movement are common. Vivid dreams and nightmares also occur.
With ongoing treatment, increasing numbers of patients report lethargy and
fatigue, he said.

“There are a lot of data showing that people who sleep poorly are more likely
to relapse and that suicide risk is higher,” he said. . . .

Sexual dysfunctions are among the most distressing SSRI side effects.
Decreased libido and delayed or absent orgasm are the best known, but there
are others, such as the “yawning-excitement syndrome.” Patients experience
sexual arousal when they yawn, often progressing to orgasm. “This is probably
underreported. Patients often say, ‘If you hadn’t asked me, I wouldn’t have
mentioned it,’” he said.

Perhaps the most unexpected SSRI-related problem to emerge has been weight
gain, which often begins only after several months of therapy. This side
effect has not been shown to be frequent or severe in controlled studies but
has been reported to occur in 18%-50% of patients in some open-label studies.

Because this runs counter to the image of the drug, many physicians and
patients are unprepared to deal with it. “Some physicians tell patients, ‘I
can’t understand why you’re gaining weight — you’re on an SSRI,’” Dr.
Sussman said.

Greg Keuterman, a spokesman for Eli Lilly & Co., manufacturer of Prozac
(fluoxetine), declined to comment except to point out that “this is anecdotal
evidence.”

“We’re approved by the FDA for long-term treatment of depression,” he added.

Pfizer Inc., the maker of Zoloft (sertraline), and SmithKline Beecham
Pharmaceuticals, the maker of Paxil (paroxetine), did not respond to requests
for comment.

These observations do contrast with what the clinical trials submitted to the
Food and Drug Administration by pharmaceutical companies show, Dr. Sussman
said. It would be nice if these long-term side effects were studied in
clinical trials comparing different antidepressants. . . .

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