| Or that if you take enough ssri drugs, you'll reverse bone loss (even though all the women taking those drugs have the lowest levels of bone density). Or how about the fact that ADHD is a "real" disease requiring treatment with amphetamine stimulants? Or that sunlight will kill you?
There are all sorts of idiot "facts" promoted by the mainstream media today. What's truly hilarious in all this is that Big Pharma and the FDA claim their pharmaceutical system of medicine is entirely "evidence based." You heard that right: It's all based on rock-solid, scientifically proven evidence. |
John J. Ratey, MD
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 I insisted that he try an antidepressant, and I put him on the ssri escitalopram (Lexapro). He had a severe reaction—he felt nauseated and started throwing up — and said he didn't want to try another.
He'd been physically active in the past, and I told him that he should really be exercising every day. I'd been talking about it all along, but after the Lexapro episode, I explained what an enormous effect exercise has on the brain, and I gave him several relevant studies in an appeal to his professional sensibility.
Two weeks later, he looked like a different man. |
Thomson Healthcare, Inc.
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 John's Wort before starting an ssri, and may be applied to nefazodone as well.
Nortriptyline: Concurrent use may result in decreased effectiveness of nortriptyline and possible increased risk of serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes). Clinical Management: Avoid concomitant use of St. John's Wort with nortriptyline.
Olanzapine: Concurrent use may result in reduced olanzapine efficacy. Clinical Management: Avoid concomitant use of olanzapine with St. John's Wort. If patients elect to remain on St. John's Wort, they should maintain consistent dosing. |
Ann Blake Tracy, Ph.D.
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| Eli Lilly and other major drug manufactures who are rushing to get their cut of the profits from the latest fad in anti-depressants by releasing their own version of an ssri, have apparently overlooked medical studies completed in the late 60's and early 70's...studies which link higher levels of the neurotransmitter serotonin to cravings for alcohol. As we have already stated, Prozac was the first in this new class of anti-depressants designed to chemically raise the level of brain serotonin. |
| It is unfortunate that it is not a common practice to check brain wave patterns through EEG's to see what might be happening with a Prozac or ssri patient's neurotransmitter action. Doctors report that the main reason this is not a standard procedure is that insurance companies refuse to pay for this simple procedure and doctors feel that patients would not want to handle the added expense. Surely if a patient was given this information he would want to know how a medication is affecting his brain function. It is a shame that insurance companies do not generally handle this expense. |
| Mixing alcohol with Prozac or any ssri can be very dangerous by magnifying the possibility of side effects. Beyond chemically inducing an overwhelming urge to drink in patients through chemically raising the serotonin level are additionally mixing alcohol with a powerful anti-depressant. Any physician is aware of the extreme dangers of this combination and its potential for producing psychotic behavior. This information raises serious overall questions about the efficacy of this new class of serotonergic drugs, especially in those patients with a family history of alcoholism or as Dr. |
| A mother in Colorado reported that her son was so violent on his ssri that she was afraid to be anywhere near him. The dog would cower and she saw him beat the dog with a stick. #4 A friend in Southern Utah was working with a woman on Paxil who seemed to target her rage on my friend. I warned her to quit her job and get away from the woman. She did not listen, but now wishes she had. Not long after that her children came running in the house to let her know their black lab was really sick. She rushed him to the vet and learned he was dying a horrifying death as a result of antifreeze poisoning. |
| I found that a significant number of those dying from heart failure in Utah were on an ssri. Since then we have gathered much proof in the way of scientific research to show why this is the case.
- - July, 1997: Mayo Clinic found that the increased serotonin, was causing a gummy glossy substance to build up on heart valves. Dr. |
Hyla Cass, M.D.
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 If combined with an ssri or 5-HTP, there's the (very slight) possibility of serotonin syndrome—headache, an increase in body temperature, and heavy sweating. Stop the St. John's wort and seek medical help if this occurs.
Dose: Start with one or two capsules of 300 mg of an extract with 0.3 percent hypericin, starting in the morning with breakfast. If it doesn't have a noticeable effect in a week, add another capsule at lunchtime, for a total of 900 mg daily. You can also take your entire dose in the morning, because the herb is quite long acting. |
| These people are more likely to respond poorly to ssri therapy, and respond better once folic acid is added.
Dose: 400-800 meg daily.
Other Nutrients for Boosting Your Mood
SAMe (S-adenosyl methionine)
SAMe (pronounced sammy) is a natural mood enhancer made by the body. It is essential in the manufacture of neurotransmitters.
Cautions: High doses may lead to irritability, anxiety, insomnia, or nausea. In people with bipolar disorder, SAMe (like any antidepressant) may trigger a manic episode, so they should be monitored carefully. |
Bottom Line Health
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| However, doctors have not had good evidence on the best course of action if a patient fails to respond to a particular ssri.
THE TRIAL—PART 1
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, the largest effectiveness study ever done on depression, examined the benefits of antidepressants in "real world" settings.
The trial looked at rates of remission (full recovery)—as opposed to response (partial relief of symptoms)—in people who had nonpsychotic major-depressive disorder. |
Thomson Healthcare, Inc.
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| John's Wort before starting a ssri, and may be applied to venlafaxine as well.
Verapamil: Concurrent use may result in reduced bioavailability of verapamil. Clinical Management: Caution is advised if St. John's wort and verapamil or similar calcium channel blockers are taken together. Monitor for continued effectiveness of the calcium channel blocker.
MINOR RISK
Barbiturates: Concurrent use may result in decreased central nervous system depressive effect of barbiturates. Clinical Management: If patients take St. |
Shannon Brownlee
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 Rates of pediatric prescriptions for the stimulant Ritalin, which is used to treat attention deficit hyperactivity disorder, have been going up dramatically along with rates of
* For anyone who has found relief from depression by taking an ssri, the fact that the drugs have proved no more effective than a sugar pill in clinical trials undoubtedly seems more than a little strange. The problem is the "placebo effect," the ability of placebos to make people feel better, a mysterious but common occurrence in medicine. |
Thomson Healthcare, Inc.
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| Safety and efficacy of hypericum extract STW-VI in comparison to the ssri citalopram was assessed using a double-blind, randomized, multicenter, placebo-controlled study design. Outpatients (n=388) suffering from moderate depression received hypericum extract (900mg/day), citalopram (20 mg/ daily), or placebo. The statistical significant therapeutic equivalence of hypericum extract STW3-VI to citalopram (p<0.0001) and the superiority of this hypericum extract over placebo (p<0.0001) was demonstrated. At the end of the treatment, 54.2% (hypericum extract), 55.9% (citalopram), and 39. |
| Caution is advised if 5-HTP and an ssri are used concomitantly. Monitor the patient for early signs of serotonin syndrome, such as anxiety, confusion, and disorientation. overdosage dosage
Daily Dose: For depression, dosage may be 50 mg three times a day. For insomnia, the dosage is usually 100-300 mg before bedtime. In primary fibromyalgia syndrome (PFS), 100 mg three times daily has been used. literature
Agren H, Reibring L, Hartvig P, et al. Low brain uptake of L-(llC)5-hydroxytryptophan in major depression: A positron emission tomography study on patients and healthy volunteers. |
| A total of 36 subjects, all of whom were diagnosed with some form of depression, received either 100 mg of 5-HTP three times per day, or 150 mg of fluvoxamine (an ssri) three times daily. The subjects were evaluated at 0, 2, 4, and 6 weeks, using four evaluation tools: the Hamilton Rating Scale for Depression (HRSD), a standard depression rating scale; a patient-performed self-assessment; the investigator's assessment of severity; and a global clinical impression. |
Marshall Editions
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 Venlafaxine (Effexor®), a combined ssri and norepinephrine reuptake inhibitor, can lift the mood. Side effects include anxiety and insomnia, as well as the inability to achieve orgasm. Other drugs used to treat depression include duloxetine and bupropion. Several other categories of antidepressant drugs exist and these tend to have more severe side effects.
Other therapies: Psychotherapy, cognitive behavioral therapy, and support groups are helpful options. |
| Effexor®, another ssri, has also been used for PTSD. Serotonin has a calming effect on the body and reduces feelings of aggression and anxiety. Anti-anxiety medication such as BuSpar® and benzodiazepines have also been used to treat PTSD.
TRADITIONAL CHINESE MEDICINE
Herbs: The following formula can reduce the stress to your liver, which, according to traditional Chinese medicine, is the organ that is most sensitive to traumatic stress. |
Thomson Healthcare, Inc.
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| The results showed that addition of Yohimbine to fluoxetine results in a more rapid onset of antidepressant action as compared to ssri alone (Sanacora et al, 2004).
Erectile Dysfunction
Yohimbine hydrochloride improved organic erectile dysfunction in 50% of subjects (n=9) ages 34 to 69 years. Eighteen subjects received Yohimbine hydrochloride 5.4 mg orally 3 times daily for 4 weeks and 10.8 mg orally 3 times daily for 4 more weeks. |
Ann Blake Tracy, Ph.D.
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| Extreme caution should be used with ECT (electric shock) or when prescribing any drug which enhances serotonin as a follow up medication to Prozac or any other ssri. How long a period of time between medications is safe is not yet known, even though some doctors presume to be sure that a few weeks or months is sufficient. The actual truth is - there is little research that has been completed that would give us an answer yet. |
Hyla Cass, M.D.
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| It likely enhances serotonin, like the ssri antidepressants, as well as dopamine and norepinephrine.
Cautions: It may cause allergic reactions, rashes, gastrointestinal upset, or sun sensitivity in some people. It can cause anxiety or insomnia if taken too close to bedtime. It can reduce the potency of digoxin (a heart medication, see Chapter 8), protease inhibitors (taken as treatment for AIDS, see Chapter 8) or cyclosporin (an immunosuppressant taken by organ transplant patients), or even birth control pills (see also, Chapter 8). Not recommended for use during pregnancy or nursing. |
Charles Barber
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 After effective treatment with either an ssri or with cognitive-behavioral techniques, investigators have found that there is a substantial decrease in this excessive activity in the right caudate nucleus. The stunning result: both psychotherapy and medication change the brain. This finding has been replicated in trials with people suffering from other psychiatric conditions. Paxil and cognitive-behavioral therapy, administered to separate groups of patients, each led to similar changes in the brains of people suffering from depression. |
J. Douglas Bremner
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 John's-wort to the ssri paroxetine showed it was better in reducing symptoms of depression in patients with severe major depression; 71% of patients treated with St.-John's-wort had a 50% reduction in symptoms compared to 60% of those on paroxetine.6 In this study, headache was the only side effect with St.-John's-wort that was more common than with placebo.
A second study funded by the NIH and performed by the Hypericum Depression Trial Study Group (HDTSG) showed that St.-John's-wort was no more effective than placebo but no worse than an antidepressant. |
Benjamin H. Natelson, M.D.
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 An added benefit of this particular ssri is that it can also relieve anxiety and sometimes improve sleep. When widespread pain and depression coexist, I choose to prescribe duloxetine (Cymbalta), a drug that alters both serotonin and norepinephrine. I will discuss Cymbalta further when I talk about how I manage severe nonmalignant pain in chapter 7.
The nice thing about using Lexapro is that the starting dose (10 mg) is very often the active dose. If depression remains, it's only one step to the maximum suggested dose of 20 mg. |
J. Douglas Bremner
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| EFFICACY
The ssri medications have not been shown to work better than the older tricyclics. In fact, they are actually less effective than is commonly believed.1 The Danish Study Group found that the older tricyclic medication clomipramine worked better for severe depression than paroxetine, although it had more side effects. A review from fifteen years ago showed that fluoxetine was only modestly more effective than placebo, with more than 80% of the improvement accounted for by a placebo effect. |
Charles Barber
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| While still retaining belief in their clinical efficacy when used with caution and oversight, Healy has since become one of the ssri industry's biggest attackers.
The commerce of mood certainly can make a lot of people wealthy, but apparently it doesn't solve all ills.
In 2003, the chief executive officer of Pfizer, Henry "Hank" McKinnell, sat in his corner office in midtown Manhattan. McKinnell was paid $9.7 million a year in earnings143 and ultimately received $200 million in retirement and deferred compensation.144
It was raining outside, and McKinnell was feeling blue. |
Gary Null and Amy McDonald
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 Although many case reports describe this association, few report the effect of rechallenge with another ssri. We present a case of an elderly patient who developed hyponatremia with sertraline and SIADH when rechallenged with fluoxetine.
Muscle changes in the neuroleptic malignant syndrome. Behan WM, Madigan M, Clark BJ, Goldberg J, McLellan DR. - University Department of Pathology, Western Infirmary, Glasgow, UK. wmblq@clin-med.gla.ac.uk. J Clin Pathol. 2000 Mar;53(3):223-7.
AIMS: To characterise the skeletal muscle changes in the neuroleptic malignant syndrome (NMS). |
Charles Barber
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| Radio talk show hosts began to talk semiknowl-edgeably about borderline personality disorder and the differences between ssri and MAOI antidepressants. The wife of the vice president of the United States, Tipper Gore, revealed in a national op-ed that she had suffered from clinical depression.1 In 1999, Bill Clinton convened a high-profile summit meeting on the nation's mental health, and his surgeon general released the first report on that topic. Even George W. |
J. Douglas Bremner
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| The doctor's natural response these days, more frequently than not, may be to get out a prescription pad and write a scrip for an ssri. In the past decade there has been a dramatic shift from the psychiatrist and appropriate therapy to Prozac as the "mind drug" of the general practitioner. Clearly there are a number of situations where a wait-and-see approach or a referral for counseling or psychotherapy would be the preferred approach.
Dr. |
| Andrew Mosholder, a psychiatrist at the FDA who reviewed data collected from ssri trials in childhood depression, became concerned about an increase in suicidal thoughts, but was specifically excluded by his superiors at the FDA from attending an FDA advisory panel meeting on drug treatment of childhood depression. As described in The Lancet (April 24, 2004, "Depressing Research"), after reviewing the evidence from clinical trials conducted by the drug companies, the Medicines and Healthcare Products Regulatory Agency (MHRA) of the United Kingdom (U.K. |
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