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Year : 2012  |  Volume : 3  |  Issue : 3  |  Page : 287-288  

Antidepressants


Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Kadhirkamam, Puducherry, India

Date of Web Publication7-Aug-2012

Correspondence Address:
G Sivagnanam
Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Kadhirkamam, Puducherry
India
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How to cite this article:
Sivagnanam G. Antidepressants. J Pharmacol Pharmacother 2012;3:287-8

How to cite this URL:
Sivagnanam G. Antidepressants. J Pharmacol Pharmacother [serial online] 2012 [cited 2014 Sep 2];3:287-8. Available from: http://www.jpharmacol.com/text.asp?2012/3/3/287/99452


   News Top


  • Newer antidepressants 'raise bleeding risk'
  • SSRIs linked with gestational hypertension
  • Newer antidepressants 'less safe in the elderly'
  • Government advisors call for rethink of GP antidepressant use in dementia patients
  • Study finds SSRI antidepressant side effects outweigh their benefits [1]



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In the present day context, antidepressants are most commonly prescribed in depression and generalized anxiety disorders, not to mention a host of other neuropsychiatric and off-label indications. Thus, the magnitude of antidepressant prescriptions would equate in terms of billions of dollars each year. Apart from the depression caused on health economy, the emerging reports of serious adverse effects caused by the more commonly used group - SSRIs is by itself depressing.

SSRI and bleeding

Antidepressants with high affinity for the serotonin transporter have been found to confer modestly elevated risk for gastrointestinal and other bleeding complications. Hence, antidepressants with lower serotonin receptor affinity may be preferred in patients at greater risk for such complications. [2] Those at high risk with a greater chance of bleeding complications when on SSRIs include, elderly patients, those with a past history of upper gastrointestinal bleeding and those on NSAIDs or aspirin. [3]

Most patients with ischemic heart disease, especially postmyocardial infarction are on antiplatelet drug therapy. Antidepressants are often prescribed to treat depression in them. Addition of SSRI increases the risk of bleeding by 57%, compared with dual antiplatelet (aspirin + clopidogrel) therapy alone. It has also been found that non-SSRI antidepressants did not substantially increase this risk. [4]

SSRIs have earlier been reported to be associated with an increased risk of bleeding and subsequent need for blood transfusion during orthopedic surgery. Inhibition of serotonin-mediated platelet activation has been suggested as a cause for bleeding. [5] However, in a recent study on patients undergoing total hip arthroplasty who were on serotonergic antidepressants, it was found that though the intraoperative blood loss was significant; it was clinically unimportant. [6]

SSRIs and pregnancy complications

Serotonin has been suggested to play an important role in the etiology of preeclampsia through its vascular and hemostatic effects. [7] SSRIs inhibit the synthesis of nitric oxide, a vasodilator that appears to play a role in vascular tone and reactivity both in utero and during postnatal life. [8] Several studies have suggested that SSRIs may be associated with a greater risk for prematurity and/or fetal growth restriction and these associations may be mediated through an elevated risk of preeclampsia. [9]

SSRIs and stroke

In a recent observational study, SSRIs have been found to be associated with an increased risk of several adverse outcomes, one among them being stroke/transient ischemic attack compared with tricyclic antidepressants. [10]

Antidepressants and dementia

In patients with dementia, antidepressants are commonly prescribed for treating depression, which is commonly seen in them. In a recent study, it has been found that there was not only absence of benefit compared with placebo but there was an increased risk of adverse events. The researchers have suggested reconsideration of the present practice of use of antidepressants as first-line treatment of depression in Alzheimer's disease. [11]
"Serotonin, an ancient chemical, is found in plants and animals. It has been implicated in the regulation of diverse physiological functions like emotion, development, neuronal growth and death, platelet activation, clotting process, attention, electrolyte balance, and reproduction. Antidepressants, by disrupting serotonin, could be the cause of many adverse health effects. Antidepressants have adverse effects on sexual life, increase the risk of hyponatremia, bleeding, stroke, and death in the elderly. Thus, it is viewed that antidepressants generally do more harm than good (side effects outweigh their benefits) by disrupting a number of adaptive processes regulated by serotonin. It may be emphasized that greater caution is needed while prescribing antidepressants". [12]

 
   References Top

1.Available from: http://www.pulsetoday.co.uk/clinical-news [Last accessed on 2012 May 09].  Back to cited text no. 1
    
2.Castro VM, Gallagher PJ, Clements CC, Murphy SN, Gainer VS, Fava M, et al. Incident user cohort study of risk for gastrointestinal bleed and stroke in individuals with major depressive disorder treated with antidepressants. BMJ Open 2012;2:e000544.  Back to cited text no. 2
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3.Yuan Y, Tsoi K, Hunt RH. Selective serotonin reuptake inhibitors and risk of upper GI bleeding: confusion or confounding? Am J Med 2006;119:719-27.  Back to cited text no. 3
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4.Labos C, Dasgupta K, Nedjar H, Turecki G, Rahme E. Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. CMAJ 2011;183:1835-43.   Back to cited text no. 4
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5.Movig KL, Janssen MW, de Waal Malefijt J, Kabel PJ, Leufkens HG, Egberts AC. Relationship of serotonergic antidepressants and need for blood transfusion in orthopedic surgical patients. Arch Intern Med 2003;163:2354-8.  Back to cited text no. 5
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6.van Haelst IM, Egberts TC, Doodeman HJ, Traast HS, Burger BJ, Kalkman CJ, et al. Use of serotonergic antidepressants and bleeding risk in orthopedic patients. Anesthesiology 2010;112:631-6.  Back to cited text no. 6
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7.Bolte AC, van Geijn HP, Dekker GA. Pathophysiology of preeclampsia and the role of serotonin. Eur J Obstet Gynecol Reprod Biol 2001;95:12-21.   Back to cited text no. 7
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8.Abman SH. New developments in the pathogenesis and treatment of neonatal pulmonary hypertension. Pediatr Pulmonol Suppl 1999;18:201-4.  Back to cited text no. 8
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9.Toh S, Mitchell AA, Louik C, Werler MM, Chambers CD, Hernández-Díaz S. Selective serotonin reuptake inhibitor use and risk of gestational hypertension. Am J Psychiatry 2009;166:320-8.  Back to cited text no. 9
    
10.Coupland C, Dhiman P, Morriss R, Arthur A, Barton G, Hippisley-Cox J. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 2011;343:d4551.  Back to cited text no. 10
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11.Banerjee S, Hellier J, Dewey M, Romeo R, Ballard C, Baldwin R et al. Sertraline or mirtazapine for depression in dementia (HTA-SADD): A randomised, multicentre, double-blind, placebo-controlled trial. Lancet 2011;378:403-11.  Back to cited text no. 11
    
12.Andrews PW, Thomson JA Jr, Amstadter A, Neale MC. Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Front Psychol. 2012;3:117.  Back to cited text no. 12
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