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MORE BAD NEWS ON ANTIDEPRESSANTS

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Here are a couple of recent news releases about medications in mental health. Not great news since the antidepressants do actually provide some good effects. But are patients being infomed about these side effects? You have a right to be well informed about side effects. My experience is that physicians are NOT informing patients like they ought.

After these two, I provide a few options.

Emory University issued the following news release:

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 Tuesday, 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.

“One of the strongest and best-studied factors that thickens someone’s arteries is age, and that happens at around 10 microns per year,” Shah says.

“In our study, users of antidepressants see an average 40 micron increase in IMT, so their carotid arteries are in effect four years older.”

Antidepressants’ effects on blood vessels may come from changes in serotonin, a chemical that helps some brain cells communicate but also functions outside the brain, Shah says.

The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), which increase the level of serotonin in the brain.

Other types of antidepressants also affect serotonin levels, and antidepressants can act on other multi-functional brain chemicals such as norepinephrine.

In the study, researchers saw higher carotid IMT in both participants who used SSRIs (60 percent of those who took antidepressants) and those who used other types of antidepressants.

Most of the serotonin in the body is found outside the brain, especially in the intestines, Shah notes.

In addition, serotonin is stored by platelets, the cells that promote blood clotting, and is released when they bind to a clot.

However, serotonin’s effects on blood vessels are complex and act in multiple ways.

It can either constrict or relax blood vessels, depending on whether the vessels are damaged or not.

“I think we have to keep an open mind about the effects of antidepressants on neurochemicals like serotonin in places outside the brain, such as the vasculature. The body often compensates over time for drugs’ immediate effects,” Shah says.

“Antidepressants have a clinical benefit that has been established, so nobody taking these medications should stop based only on these results.

This isn’t the kind of study where we can know cause and effect, let alone mechanism, and we need to see whether this holds up in other population groups.”

AND IF THAT WEREN’T ENOUGH . . .

Ken Pope sent this one around:

The *American Journal of Psychiatry* has scheduled an article for publication in a future issue: “Association of Cerebrovascular Events With Antidepressant Use: A Case-Crossover Study.”

The authors are Chi-Shin Wu, M.D., M.Sc., Sheng-Chang Wang, M.D., M.Sc., Yu-Cheng Cheng, M.Sc., and Susan Shur-Fen Gau, M.D., Ph.D.

Here’s how the article starts:

[begin excerpt]

Stroke is the second leading cause of death and the sixth leading cause of disease burden globally (1).

Depression is an independent risk factor for stroke and the leading cause of years lost to disability (1-3).

The prevalence of antidepressant use has increased in many countries, including the United States (4) and Taiwan (5).

Whether treating depression with antidepressants reverses depression- related cardiovascular complications remains inconclusive (6-9), and concerns about the cerebrovascular effects of antidepressants have increased since a growing body of evidence has shown that antidepressants (especially selective serotonin reuptake inhibitors) may induce bleeding complications (10-12) and vasoconstriction of the large cerebral arteries (13-15).

In this regard, the benefit-risk profile of the cerebrovascular effect of antidepressant use remains unclear (14).

[end excerpt]

Here’s an excerpt from the Discussion section:

[begin excerpt]

We found that antidepressant use was associated with a 48% greater risk of stroke, after taking confounding factors into account, and that the magnitude of associations was greater in high-potency inhibitors of the serotonin transporter than in low- and intermediate-potency inhibitors.

Our findings are in agreement with those of previous studies showing that antidepressant use was associated with an increased risk of stroke, both ischemic (21) and hemorrhagic (22) types.

[end excerpt]

Another excerpt:

[begin excerpt]

One new finding of this study is that the risk of stroke increased with average daily antidepressant dose.

The increasing trend was significant (p<0.001) across the three different time windows we used.

Another new finding is that the magnitude of stroke risk with antidepressant use varied according to the duration of antidepressant treatment.

[end excerpt]

One final excerpt: “Our results in this study have major clinical and public health implications deserving careful consideration. Our findings suggest that antidepressant use contributes to an  increased risk of stroke.”

The author note provides the following contact information: Dr. Gau, Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Rd., Taipei 10002, Taiwan; <gaushufe@ntu.edu.tw> (e-mail).

OH, WHAT SHALL WE DO?

We do have other options!

Just bear in mind that happiness and lifestyle changes are underutilized interventions that may be able to impact depression even more than either therapy or medication.

– Exercise and activity! Walk, jog, bike, or swim. Lift weights.

– Improve eating, eliminate all processed foods and stick with a Mediterranean diet. Eat red meat twice a month (NO MORE!) unless it is grass fed.

– Increase your intake of Omega-3 PUFAS. Eat fish or  ground flax seed or both. Take some fish oil capsules.  Generally 4 grams of fish oil a day is a fairly good antidepressant effect.

– Do more good deeds every day or perhaps once a week on  your “good deeds day.”

– Keep a gratitude diary and tell people you are grateful to them.

– Reach out: make more friends and spend more time with them.

– Deepen: share more intimate, warm times with close family members and close friends.

– Improve your sleep: Meditate every day, use sleep hygiene habits, learn the keys to better sleep. Go on my web site and get my book on better sleep habits.

 

Happily yours,

Lynn

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