‘Antidepressant’ Tagged Posts

Abuse of Antidepressant for Weight Loss Results in Seizures in Affected person With Bulimia Nervosa

Cassandra Pardini, PharmD October 03, 2018 Abuse should be considered among eating disorder patients who present with seizures A recently publish...


October 03, 2018

Abuse should be considered among eating disorder patients who present with seizures

Abuse should be considered among eating disorder patients who present with seizures

A recently published report in the International Journal of Eating Disorders describes the case of a 22-year old female patient who abused bupropion XR for the purpose of appetite suppression and weight loss.

The patient, who was suffering from bulimia nervosa and complex post-traumatic stress disorder, was admitted to the Jerusalem Mental Health Center for inpatient treatment of abuse of bupropion XR as well as a suicide attempt. Her past medical history was significant for anorexia nervosa, major depression, self-mutilation, multiple suicide attempts, and attention-deficit/hyperactivity disorder. The authors also noted that the patient had a history of abusing several other medications including benzodiazepines, sleeping pills, levothyroxine, and methylphenidate.

According to the authors, the patient obtained prescriptions for bupropion XR from psychiatrists and primary care physicians who were not aware of her past medical history. The patient began taking 300-450mg of bupropion XR daily, which she gradually increased to 1200–1500mg per day. Despite experiencing 2 grand-mal seizures after 6 months of abuse, the patient increased her bupropion dose to as much as 3-4.5g per day. During her most frequent abuse period, the patient reported experiencing headaches, tachycardia, anxiety, and insomnia. 

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Following an attempted suicide 1 year after her bupropion XR abuse began, the patient received treatment for pancreatitis, as well as psychiatric and eating disorder management over a 3 month period. Phenytoin was also prescribed to prevent future seizures. The patient was discharged taking fluoxetine, quetiapine, and phenytoin, and followed-up with a dietitian twice weekly as well as a psychotherapist once weekly. After not taking bupropion XR for nearly 1 year, the patient was readmitted and reported initiating bupropion XR again.

This case report demonstrates that bupropion XR may be an attractive medication for patients interested in losing weight. “Clinicians are reminded to screen for anorexia nervosa and bulimia nervosa histories prior to prescribing this medication, and to consider its abuse among eating disorder patients presenting with seizures,” the authors write. They added, “For patients abusing this medication, motivational interviewing in the context of a strong, ongoing therapeutic relationship might help some abusers achieve sustained periods of abstinence.”


Dagan Y, Yager J. Severe bupropion XR abuse in a patient with long‐standing bulimia nervosa and complex PTSD. 2018. Int. Journal of Eating Disorders. doi.org/10.1002/eat.22948

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Antidepressant Use for Insomnia: Is It Efficient?


Could 16, 2018

Low-dose doxepin and trazodone may provide small improvement in sleep quality

Low-dose doxepin and trazodone could present small enchancment in sleep high quality

Regardless of the widespread use of antidepressants for treating insomnia, the proof for his or her effectiveness stays restricted, in line with a brand new overview printed within the Cochrane Library.

For this examine, researchers recognized 23 randomized managed trials that included a complete of 2806 adults with a major prognosis of insomnia to look at the connection between antidepressant use and insomnia enchancment. The research included for evaluation in contrast antidepressant monotherapy (at any dose) with placebo, different insomnia medication (e.g. benzodiazepines), different antidepressants, ready checklist management, or “therapy as normal.”

Three of the research in contrast selective serotonin reuptake inhibitors (SSRIs) with placebo (N=135).  Enhancements in subjective sleep measures at 6 weeks (N=60; P=.03) and 12 weeks (N=27; P<.001) have been noticed with paroxetine in 2 of the research, nonetheless no variations have been seen within the fluoxetine examine (low high quality proof). 

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Tricyclic antidepressants (TCA) have been in contrast with placebo in 6 research (5 with doxepin and 1 with trimipramine; N=812). Pooled outcomes from four of those research indicated a average enchancment in subjective sleep high quality over placebo (standardized imply distinction [SMD] -Zero.39, 95% CI, -Zero.56 to -Zero.21). Moreover, TCAs have been related to improved sleep effectivity and elevated sleep time, however had little or no affect on sleep latency.

With regard to different antidepressants, three research (370 sufferers) involving trazodone have been pooled and indicated a average enchancment in subjective sleep outcomes (MD -Zero.34, 95% CI -Zero.66 to -Zero.02), nonetheless 2 research which measured polysomnography discovered little or no distinction in sleep effectivity (N=169; MD 1.38 proportion factors, 95% CI -2.87 to five.63).

A lot of the research have been small and had quick follow-up instances which restricted the findings. The authors said that there was too little knowledge relating to SSRIs to attract any conclusions however low-dose doxepin and trazodone use could probably provide a small enchancment in sleep high quality. There was additionally no proof to assist the usage of amitriptyline, or for long-term use of antidepressants for insomnia. As a result of restricted reporting, the authors have been unable to make conclusions on tolerability and security.

“Prime quality trials of antidepressants for insomnia are wanted to supply higher proof to tell scientific apply,” the authors concluded. “Moreover, well being professionals and sufferers ought to be made conscious of the present paucity of proof for antidepressants generally used for insomnia administration.”

For extra data go to Cochranelibrary.com.

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Antidepressant Drugs and Headache: Is There a Hyperlink?


Might 03, 2018

Risk ratios of headache reported as an adverse event were calculated and compared to placebo

Threat ratios of headache reported as an hostile occasion have been calculated and in comparison with placebo

A meta-analysis revealed within the Journal of Affective Problems discovered that stories of headache after beginning therapy with second-generation antidepressants “usually tend to be coincidental than a treatment-emergent aspect impact of those drugs.”

Researchers aimed to evaluate the danger of headache linked to frequent antidepressants and the affect of remedy class, pharmacodynamics, and dosage related to this threat. They recognized randomized, double-blind, placebo-controlled trials evaluating the efficacy of second-generation antidepressants in adults with nervousness, despair, or obsessive-compulsive problems. Threat ratios of headache reported as an hostile occasion have been calculated and in comparison with placebo. Subgroup analyses additional examined the consequences of drug class, dosage, indication, and receptor affinity on the danger of headache. 

In comparison with placebo, selective serotonin reuptake inhibitors (SSRIs) have been related to a considerably greater threat of headache (threat ratio [RR] 1.06, 95% CI: 1.00 to 1.13; P =.045). No important distinction within the threat of headache was noticed between SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) (RR zero.97, 95% CI: zero.88 to 1.06; P =.63). Furthermore, there was no important distinction within the threat of headache with use of second-generation antidepressants when stratified by indication, pharmacological properties, and drug dosage. 

Of the evaluated antidepressants, bupropion (RR 1.22, 95% CI: 1.06 to 1.41; P =.zero06) and escitalopram (RR 1.18, 95% CI: 1.01 to 1.37; P =.04) demonstrated a major affiliation with an elevated threat of headache vs placebo. 

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The authors observe that along with doable reporting bias, “the small variety of research that examined unwanted effects inside fixed-dose trials might have restricted the ability to look at the affiliation between remedy dosing and threat of headache.”

For extra info go to jad-journal.com.

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Which Antidepressant Works Finest?


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