CLINICO-BIOCHEMICAL STUDY OF SAFETY AND TOLERABILITY OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) IN A TERTIARY MEDICAL COLLEGE IN WEST BENGAL

Abstract

INTRODUCTION:Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that selectively increase the levels of serotonin in the synaptic cleft by blocking its uptake by serotoninergic neurons. They are now extensively used to treat various psychiatric disorders like depression, panic disorders, obsessive compulsive disorders and are now being evaluated in the treatment of a number of other psychiatric disorders like bulimia nervosa and social phobia. In this scenario we try to elucidate the serum electrolyte level, serum serotonin level, renal function test and platelet count to check out the changes as in different papers demonstrated that there are variations in different parameters of renal function occurred with chronic administration of SSRI. Objectives: To evaluate serum electrolyte level, serum serotonin level, renal function tests and platelet count of patients with major depressive disorder on chronic SSRI therapy and screen for any adverse drug reactions (if any) Materials and Methods: A cross-sectional observational study conducted in the Department of Psychiatry, Department of Biochemistry and Department of Pharmacology of Medical College and Hospital, Kolkata . The study protocol was approved by the Institutional Ethics Committee. Written consent was obtained from the subjects included in the study. Results and Discussion: After evaluating the biochemical parameters, it was observed that long term (more than 6 months) SSRI therapy can cause decline Platelet count (29.76%) and Serum Sodium Levels i.e. Hyponatremia (29.76%); whereas the serum serotonin levels (17.86%) were found to be elevated. Further, a negative correlation of -0.605 was observed between the serum sodium levels (in subjects with hyponatremia) and the duration for which the subjects were taking SSRI whereas a positive correlation of +0.407 was observed between the serum serotonin levels (in subjects with above normal serum serotonin levels) and the duration for which the subjects were taking SSRI. A number of adverse drug effects were reported. 28 subjects (33.33%) reported at least any one of the following symptoms like Headache, Sedation, Dizziness, Anxiety, Agitation. 12 subjects (14.28%) reported having recurring suicidal thoughts. 21 subjects (25.00%) reported GIT Problems like nausea/ vomiting/ constipation/ dyspepsia. 13 subjects (15.48%) reported reduction in sleep time while 20 subjects (23.81%) reported reduction in appetite. Sexual Problems like decreased libido, ejaculation difculty or impotence was reported by 19 subjects (22.62%). 25 subjects (29.76%) reported that they had gained weight after the therapy. Discontinuation Symptoms were reported by 59 subjects (70.24%). Conclusion: The hemogram of patients on SSRI therapy should be monitored from time to time and their biochemical parameters should be evaluated to prevent any untoward adverse effects in the subjects. The patients on SSRI therapy should be closely monitored for adverse effects like sexual problems, GITproblems, CNS manifestations, suicidal thoughts, discontinuation symptoms among others.