Side Effects Of Selective Serotonin Reuptake Inhibitors Research Articles

The effect of drug holidays on sexual dysfunction in men treated with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine: an 8-week open-label randomized clinical trial

IntroductionSelective serotonin reuptake inhibitors (SSRIs) are widely used for the treatment of various mental disorders. Sexual dysfunction is one of the most common side effects of SSRIs, and often leads to poor adherence and treatment discontinuation. While several strategies have been employed to manage SSRI-induced sexual dysfunction, drug holidays has not been extensively studied for this purpose. This clinical trial aims to assess the effect of drug holidays on sexual dysfunction in married men under treatment with SSRIs other than fluoxetine (as its long half-life makes drug holidays ineffective).MethodsThis 8-week double-center, randomized, open-label, controlled trial was conducted in the outpatient clinics of Iran Psychiatric Hospital and Tehran Institute of Psychiatry, from January 2022 to March 2023. We included married men aged between18 and 50 years who had experienced sexual dysfunction during treatment with SSRIs, other than fluoxetine. The Male Sexual Health Questionnaire (MSHQ) and the 28-Question General Health Questionnaire (GHQ-28) were used for the assessment of sexual function and mental health status. The drug holidays group was instructed not to take their medications on the weekends. The control group was asked to continue their regular medication regimen without any changes. Both groups were assessed at baseline, and weeks 4 and 8.ResultsSixty-three patients were included and randomly assigned to the drug holidays group (N = 32) or the control group (N = 31). Fifty patients (25 in each group) completed the trial. Drug holidays significantly improved erection, ejaculation, satisfaction, and the overall sexual health of the participants (P < 0.001). No significant change was observed in their mental health status. No major side effects were recorded.ConclusionsDrug holidays significantly improved the MSHQ scores in ‘erection’, ‘ejaculation’, ‘satisfaction’ and ‘total’ in married men with sexual dysfunction induced by SSRIs, other than fluoxetine, without causing any significant changes in their mental health status. Further research is needed to reach a certain conclusion.Trial registrationThe trial was registered at the Iranian Registry of Clinical Trials on 2021.10.25 (www.irct.ir; IRCT ID: IRCT20170123032145N6) before the trial.

Safety and efficacy of LibidUp-PE supplement on premature ejaculation: A randomized, placebo-controlled double-blind, crossover study

Premature ejaculation (PE) is the most common male sexual dysfunction. Selective serotonin reuptake inhibitors (SSRIs) are currently recommended for PE. However, the side effects of SSRIs, such as nausea, vomiting, and xerostomia, pose challenges to clinicians. Simultaneously, evidence indicates that psychological and behavioral treatments are often insufficient. LibidUp-PE is a nutraceutical designed to enhance sexual wellness and contains a combination of essential amino acids to boost stamina and vigor, addressing concerns like erectile dysfunction (ED). This study aimed to assess the safety and efficacy of LibidUp-PE in the treatment of PE. In this crossover, double-blind, placebo-controlled trial, 76 patients with PE were randomly divided into two groups. Group A received LibidUp-PE, whereas Group B received a placebo for 12 weeks. Following a 2-week wash-out period, the groups switched treatments for another 12 weeks. Intravaginal ejaculatory latency time (IELT) and post-ejaculatory refractory time (PERT) were measured as the primary outcomes to evaluate PE improvement. Plasma serotonin levels were measured as secondary parameters using enzyme-linked immunosorbent assay. The results showed that LibidUp-PE significantly improved the IELT score, increasing from 0.8 ± 0.2 min to 2.9 ± 1.1 min (p < 0.01). PERT scores also significantly decreased from 15.8 ± 1.7 min to 5.6 ± 0.6 min after 12 weeks of LibidUp-PE treatment. Plasma serotonin levels significant increased from 93.6 ± 7.8 ng/mL to 168.4 ± 12.8 ng/mL (p < 0.001) with LibidUp-PE treatment. In contrast, no significant improvements were observed in the placebo group. Notably, none of the participants withdrew their consent due to adverse reactions, which is indicative of the safety and tolerability of LibidUp-PE. In conclusion, 12-week treatment with LibidUp-PE demonstrated a beneficial effect in reducing PE symptoms, as reflected by improved IELT, reduced PERT, and increased plasma serotonin levels. Therefore, LibidUp-PE could be a promising solution for individuals with PE.

Confounding by Indication in Studies of Selective Serotonin Reuptake Inhibitors.

Selective serotonin reuptake inhibitors (SSRIs) are used worldwide as the first-line pharmacological treatment for depression. Although SSRI use can increase the risk of suicide, fractures, and infertility, the nature of these relationships is controversial. This review reports confounding by indication and confounding by severity for SSRI side effects in previously published observational studies. The PubMed and Google Scholar databases were searched for English-language articles published from 2005 to 2022. SSRIs are often prescribed for depressive symptoms, and depression is associated with an increased risk of side effects. Therefore, confounding by indication, whereby patients are selected for a particular treatment depending on their diagnosis or severity of illness, may lead to erroneous treatment conclusions, resulting in an adverse outcome. The side effects of SSRIs that can be considered due to confounding by indication or severity include suicide, fractures, infertility, atrial fibrillation, stroke, autism spectrum disorder, and congenital malformation. When prescribing SSRIs for depression, physicians must consider confounding by indication and severity in the management of side effects. In addition, medication discontinuation should be carefully considered when side effects occur during the treatment.

In-hospital predictors of post-stroke depression for targeted initiation of Selective Serotonin Reuptake Inhibitors (SSRIs)

BackgroundAlthough SSRIs are no longer widely prescribed for post-stroke motor recovery, fluoxetine demonstrated beneficial effects on post-stroke depression (PSD). Given the potential side effects of SSRIs, targeted initiation among individuals at highest risk for PSD warrants consideration. While previous studies have identified stroke severity and psychiatric history as factors associated with PSD, its predictability remains unknown. In this study, we investigate inpatient predictive factors to better identify individuals who might derive the most benefit from targeted initiation of SSRIs.MethodsWe performed a retrospective analysis of a prospectively-collected registry of adult patients presenting with acute ischemic stroke to a tertiary referral urban academic comprehensive stroke center between 2016–2020. Patients were seen 4–6 weeks post-discharge and administered the PHQ-9 (Patient Health Questionnaire-9) to screen for PSD (PHQ-9 ≥ 5). Demographics, history of depression, stroke severity, and inpatient PHQ-9 scores were abstracted. Logistic regression was used to determine factors associated with PSD and an ROC analysis determined the predictability of PSD in the inpatient setting.ResultsThree hundred seven individuals were administered the PHQ-9 at follow-up (mean age 65.5 years, 52% female). History of depression (OR = 4.11, 95% CI: 1.65–10.26) and inpatient PHQ-9 score (OR = 1.17, 95% CI: 1.06–1.30) were significantly associated with PSD. Stroke severity, marital status, living alone, employment, and outpatient therapy were not associated with PSD. The ROC curve using a positive inpatient PHQ-9 achieved an area under the curve (AUC) of 0.65 (95% CI: 0.60–0.70), while the AUC was 0.72 (95% CI: 0.66–0.77) after adding history of depression.ConclusionsHistory of depression and a positive inpatient PHQ-9 appear to be most strongly predictive of long-term PSD. Initiating SSRIs only in those individuals at highest risk for PSD may help reduce the burden of stroke recovery in this targeted population while minimizing adverse side effects.

Selective Serotonin Reuptake Inhibitors and Associated Bleeding Risks: A Narrative and Clinical Review.

Major Depressive Disorder (MDD) is a major cause of disability worldwide and is associated with serious lasting impairment. A leading hypothesis of the pathophysiology of MDD is the monoamine deficiency hypothesis which suggests that depression is caused by depletion of serotonin, norepinephrine, or dopamine in the central nervous system. Serotonin is the most widely studied neurotransmitter in the pathophysiology of depression, with studies showing that reduced central serotonin synthesis leads to depressive symptoms in individuals at risk for depression. Selective Serotonin Reuptake Inhibitors (SSRI) inhibit serotonin reuptake and subsequently increase the amount of serotonin available in synapses. Common side effects of SSRIs include increased suicidality of patients under the age of 25, sexual dysfunction, anxiety, dizziness, weight gain, gastrointestinal distress, and headache. Other side effects include prolonging the QT interval, coagulopathy, and the risk of serotonin syndrome, as well as SSRI discontinuation syndrome. Sites of increased bleeding related to SSRI use have been reported to occur in the upper gastrointestinal tract, as well as intracranially. Based on the current literature, three studies have found that SSRIs are not associated with increased bleeding and/or increased perioperative risk, while others have demonstrated that SSRIs are associated with an increased risk in perioperative use. The inhibition of serotonin reuptake can affect platelet aggregation since platelets also express the serotonin transporter. SSRIs can result in decreased storage of serotonin in platelet dense granules. Increased serotonin can also increase gastric acid secretion, which increases the risk for ulceration. SSRIs in combination with NSAIDs also show a significantly increased risk of upper GI bleeding. Some studies show an increased bleeding risk from 30% to 70% when taking a combination of vitamin K antagonists and SSRIs in hospitalized patients. Related to the high prevalence of conditions that are treated with SSRIs, the bleeding risk associated with this class of medication merits further study.

Risks of Digestive System Side-Effects of Selective Serotonin Reuptake Inhibitors in Patients with Depression: A Network Meta-Analysis.

PurposeSelective serotonin reuptake inhibitors (SSRIs) are the preferred treatments for depression. The most common adverse drug reactions are symptoms involving the digestive system, leading to low compliance in patients with depression. Therefore, it is important to assess the safety of SSRIs with respect to the digestive system. Several meta-analyses have compared the risks of digestive side effects of SSRIs and other antidepressants. We aimed to compare the risks of various SSRIs (fluoxetine, escitalopram, citalopram, paroxetine, and sertraline) for adverse reactions of the digestive system.MethodsSystematic searches returned 30 randomized controlled trials (n = 5004) of five antidepressants and placebos.ResultsFluoxetine had the lowest probability of digestive side effects, ranking fifth at 0.548. Sertraline had the highest probability of digestive side effects, with a probability of 0.611. For gastrointestinal tolerability, escitalopram was better than paroxetine (odds ratio [OR] =0.62, 95% confidence interval [CI] 0.43–0.87) and sertraline (OR=0.56, 95% CI 0.32–0.99).ConclusionFluoxetine exhibited distinct advantages compared to other SSRIs, while sertraline had the greatest likelihood of digestive system side effects. These findings will help doctors understand the relative advantages of various antidepressants.

Selective serotonin reuptake inhibitors and spermatogenesis

Introduction. According to the WHO data, depression is a common disease among women and men of reproductive age. One line of the correction of depressive disorders is selective serotonin reuptake inhibitors (SSRIs). The ingestions have shown that using SSRIs harms sperm quality. The literature date of evaluation of male fertility after discontinuation of antidepressants is quite limited.Purpose of the study. To evaluate the influence of Fluoxetine intake on semen parameters, sperm DNA fragmentation and hormonal status.Materials and methods. Twenty-five men (mean age - 35.2 ± 4.5 yo) with depression were included in the study. Fluoxetine (20 mg per day) was prescribed to all the patients for 12 wk. Semen parameters, sperm DNA fragmentation, sex hormones levels were measured before-after treatment and 3 mo behind discontinuation.Results. After 12 weeks of the treatment the mean semen volume decreased from 3.1 ± 0.7 to 2.9 ± 0.7 ml (p = 0.638), sperm concentration - from 39.4 ± 18.5 to 34.3 ± 16.8 mln/ml (p = 0.384), sperm motility decreased from 41.7 ± 7.6 to 35.5 ± 7.8% (p &lt; 0.05), the mean percent of normal morphology form - from с 12.7 ± 2.8 to 10.7 ± 2.2% (p &lt; 0.001). Sperm DNA fragmentation increased 16.2 ± 4.9 to 22.2 ± 4.3% (p &lt; 0.001). The mean semen volume, sperm concentration, motility, percentage of normal morphology increased and reverted to the normal levels after 3 mounts of drug discontinuation. Sperm DNA fragmentation index decreased, and it had the values less than before the treatment that positively correlated with the reduction of depression's symptoms. It was not significant dynamics in hormonal parameters before and after the therapy.Conclusion. Using fluoxetine has a reversible negative effect on male fertility. It is important to inform the patients about the temporary side effects of SSRIs in fatherhood planning cases.

Acute caffeine reverses the disruptive effects of chronic fluoxetine on the sexual behavior of female and male rats.

Sexual side effects of chronic treatment with selective serotonin reuptake inhibitors (SSRIs) in humans include anorgasmia and loss of sexual desire and/or arousal which interferes with treatment compliance. There are few options at present to reduce these effects. Because orgasm and desire are mediated in part by activation of sympathetic arousal, we asked whether the sympathomimetic effects of acute caffeine treatment could reverse these effects. The present study examined whether acute treatment with caffeine (CAF; 10 or 20mg/kg, ip) versus vehicle could ameliorate the disruption of appetitive and consummatory measures of copulatory behavior produced by chronic fluoxetine (10mg/kg, sc) in adult, sexually active female or male rats. Sexually experienced female or male rats received daily injections of FLU over a 24-day period and were tested for sexual behaviors five times at 4-day intervals during this period in bilevel pacing chambers. Females had been ovariectomized and given hormone replacement with estradiol benzoate and progesterone prior to each test. Males were left gonadally intact. Four days after the final FLU test, rats were randomly assigned to one of the three doses of CAF and received ip injections of CAF or the saline vehicle 60min before testing. Chronic FLU reduced solicitations and lordosis over time in females and reduced the number of ejaculations in males. Both doses of CAF restored solicitations and lordosis in females and ejaculations in males. On their own, both doses of CAF increased females' pacing behavior and the number of mounts and intromissions in the males. Stimulation of sympathetic outflow by CAF may constitute a readily accessible on-demand treatment for the sexual side-effects of SSRIs.

Selective serotonin reuptake inhibitors for functional independence and depression prevention in early stage of post-stroke: A meta-analysis.

The efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) for functional independence and depression prevention in early stage of post-stroke (within 1 month after stroke onset) are still unclear. Relevant randomized controlled trials (RCTs) comparing early SSRIs therapy with placebo were sought from PubMed, Cochrane Library, Medline, and Embase. Primary outcomes were functional independence and depression occurrence. Secondary outcomes contained the improvement of Fugl-Meyer motor scale (FMMS) score and adverse events. We used fixed or random effects model to pooled effect estimates. And we chose risk ratio (RR) or mean differences (MDs) with the 95% confidence intervals (CIs) for data analysis. We included 10 RCTs with total 5370 patients. The outcome of functional independence showed no significant difference between SSRIs and placebo group (RR, 1.28; 95% CI, 0.96-1.72; P = .10; I = 92%). However, depression occurrence differed significantly between these 2 groups, which favored SSRIs group (RR, 0.78; 95% CI, 0.67-0.90; P = .001; I = 23%). In addition, we observed that the side effects of SSRIs were seizure and nausea. Except psychiatric disorders/insanity rate was less in SSRIs group than placebo group (RR, 0.66; 95% CI, 0.48-0.90; P = .009) (I = 0%), other adverse events were revealed non-significant in our meta-analysis. Our meta-analysis revealed that early SSRIs therapy were effective to prevent post-stroke depression. However, SSRIs did not improve patient's post-stroke functional independence. In addition to increase the occurrence of seizure and nausea, SSRIs were relatively safe.

The association of obesity and coronary artery disease genes with response to SSRIs treatment in major depression.

Selective serotonin reuptake inhibitors (SSRIs) are first-line antidepressants for the treatment of major depressive disorder (MDD). However, treatment response during an initial therapeutic trial is often poor and is difficult to predict. Heterogeneity of response to SSRIs in depressed patients is partly driven by co-occurring somatic disorders such as coronary artery disease (CAD) and obesity. CAD and obesity may also be associated with metabolic side effects of SSRIs. In this study, we assessed the association of CAD and obesity with treatment response to SSRIs in patients with MDD using a polygenic score (PGS) approach. Additionally, we performed cross-trait meta-analyses to pinpoint genetic variants underpinnings the relationship of CAD and obesity with SSRIs treatment response. First, PGSs were calculated at different p value thresholds (PT) for obesity and CAD. Next, binary logistic regression was applied to evaluate the association of the PGSs to SSRIs treatment response in a discovery sample (ISPC, N = 865), and in a replication cohort (STAR*D, N = 1,878). Finally, a cross-trait GWAS meta-analysis was performed by combining summary statistics. We show that the PGSs for CAD and obesity were inversely associated with SSRIs treatment response. At the most significant thresholds, the PGS for CAD and body mass index accounted 1.3%, and 0.8% of the observed variability in treatment response to SSRIs, respectively. In the cross-trait meta-analyses, we identified (1) 14 genetic loci (including NEGR1, CADM2, PMAIP1, PARK2) that are associated with both obesity and SSRIs treatment response; (2) five genetic loci (LINC01412, PHACTR1, CDKN2B, ATXN2, KCNE2) with effects on CAD and SSRIs treatment response. Our findings implicate that the genetic variants of CAD and obesity are linked to SSRIs treatment response in MDD. A better SSRIs treatment response might be achieved through a stratified allocation of treatment for MDD patients with a genetic risk for obesity or CAD.

Management of Side-Effects of Selective-Serotonin Re-Uptake Inhibitors in Children and Adolescents

Management of Side-Effects of Selective-Serotonin Re-Uptake Inhibitors in Children and Adolescents

Evidence of ocular side effects of SSRIs and new warnings

ABSTRACT FROM: Chen H, Lin C, Lai S, et al. Association of selective serotonin reuptake inhibitor use and acute angle-closure glaucoma. J Clin Psychiatry 2016;77:e692–6.[OpenUrl][1] Acute angle-closure glaucoma (AACG) may...

Sexual Dysfunction Due to SSRI Antidepressants: How to Manage?

Abstract Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of commonly prescribed antidepressants in clinical practice. Sexual dysfunction is a common side effect of SSRIs, which often goes unrecognized but adversely affects the quality of life of the patient. This review takes a look at the occurrence of sexual dysfunction among patients receiving SSRIs from a clinical viewpoint. The review explores into the possible reasons of such a dysfunction and the differential diagnoses to be entertained while dealing patients receiving SSRIs and experiencing sexual dysfunction. The review discusses the management strategies for addressing such dysfunction due to SSRIs, including cessation or reduction of dose, changing to another antidepressant, augmentation with another antidepressant, additional use of medications for erectile dysfunction and use of other add-on strategies. The choice of a specific strategy should be customized to individual needs of the patient.

Physician perception regarding side-effect profile at the onset of antidepressant treatment: a survey of Israeli psychiatrists and primary care physicians.

BackgroundOne of the major factors affecting treatment compliance and outcome in patients is the wide range of side effects (SEs) associated with antidepressants. In the present study, we aimed to assess the extent to which Israeli primary care (PC) physicians and psychiatrists discuss the SEs of selective serotonin reuptake inhibitors (SSRIs) with patients prior to the onset of treatment.MethodsA cross-sectional questionnaire survey was conducted among PC physicians (N = 123) and psychiatrists (N = 105). Questionnaires were distributed using a mixed-modality design, combining a web survey and in-person delivery of questionnaires.ResultsA significant percentage of our respondents reported that they rarely discuss psychological (60 %) or severe (29 %) SEs of SSRIs. Nearly half (41 %) admitted to avoiding discussion of impact on suicidal ideation. Specialists were noted to discuss and evaluate SEs significantly more than residents, and Psychiatrists more than PC physicians. Specifically, psychiatrists more often discussed the possibility of sexual dysfunction (t (225) = 2.23; p < 0.05) and suicidal ideation (t (225) = 2.11; p < 0.05).ConclusionsIt seems that PC physicians and psychiatrists surveyed in this study do not share sufficient information regarding the SEs of SSRIs with their patients at the onset of treatment. In improving this practice, the integration of proper SE management into educational interventions has potential in enhancing compliance and improving expertise and level of care.

Escitalopram induced syndrome of inappropriate antidiuretic hormone in elderly: an interesting scenario

Selective serotonin reuptake inhibitors (SSRI) are the first line drugs used in the treatment of endogenous depression. Though clinically well tolerated in elderly, hyponatremia is one of the recognized side effects and its pathophysiology may be linked to syndrome of inappropriate antidiuretic hormone (SIADH). This side effect of SSRIs is a serious one since it can cause death also, if not diagnosed at the onset. This is an interesting case of an elderly patient who developed hyponatremia which further related to SIADH induced by escitalopram, an SSRI. The patient had symptomatic improvement in depression within one month but symptoms of hyponatremia appeared and then deteriorated again. Severe hyponatremia, serum hypo-osmolality, urine osmolality, and measurable levels of plasma antidiuretic hormone suggested SIADH. The hyponatremia improved after stoppage of the offending drug along with conservative medical therapy in hospital. Clinicians should be aware of this uncommon but significant side effect of escitalopram and monitor high-risk patients for the development of SIADH.

Adjuvant Rosa Damascena has a Small Effect on SSRI-induced Sexual Dysfunction in Female Patients Suffering from MDD.

Treating major depressive disorders (MDD) with selective serotonin-reuptake inhibitors (SSRIs) may impact negatively on sexual function. On the other hand, a satisfying sexual life is associated with overall life satisfaction. Therefore, managing this negative side effect of SSRIs may have an important role in the treatment of MDD. In a former study, adjuvant Rosa damascena oil improved sexual dysfunction in male patients suffering from both MDD and SSRI-induced sexual dysfunction (SSRI-I SD). The aim of the present study was to test whether the same pattern of results would be observed among female patients suffering from both SSRI-I SD and MDD. In a double-blind, randomized and placebo-controlled clinical trial, a total of 50 female patients (mean age: 34 years) treated with an SSRI and suffering from MDD and SSRI-I SD were randomly assigned either to the verum (Rosa damascena oil) or to the placebo condition. Patients completed self-ratings of depression and sexual function at baseline, 4 weeks later, and at the end of the study 8 weeks after its start. Sexual desire, sexual orgasms, and sexual satisfaction increased over time. Patients in the verum group reported decreased pain. Overall sexual score increased in the verum as compared to the placebo condition. Whereas in male patients suffering from both MDD and SSRI-I SD adjuvant Rosa damascena oil improved sexual function, data on female patients are less robust and suggest only modest effects on female sexual function.

Efficacy of Acupuncture Treatment of Sexual Dysfunction Secondary to Antidepressants

Antidepressants including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) are known to cause secondary sexual dysfunction with prevalence rates as high as 50%-90%. Emerging research is establishing that acupuncture may be an effective treatment modality for sexual dysfunction including impotence, loss of libido, and an inability to orgasm. The purpose of this study was to examine the potential benefits of acupuncture in the management of sexual dysfunction secondary to SSRIs and SNRIs. Practitioners at the START Clinic referred participants experiencing adverse sexual events from their antidepressant medication for acupuncture treatment at the Mood and Anxiety Disorders, a tertiary care mood and anxiety disorder clinic in Toronto. Participants received a Traditional Chinese Medicine assessment and followed an acupuncture protocol for 12 consecutive weeks. The acupuncture points used were Kidney 3, Governing Vessel 4, Urinary Bladder 23, with Heart 7 and Pericardium 6. Participants also completed a questionnaire package on a weekly basis. The questionnaire package consisted of self-report measures assessing symptoms of depression, anxiety, and various aspects of sexual function. Significant improvement among male participants was noted in all areas of sexual functioning, as well as in both anxiety and depressive symptoms. Female participants reported a significant improvement in libido and lubrication and a nonsignificant trend toward improvement in several other areas of function. This study suggests a potential role for acupuncture in the treatment of the sexual side-effects of SSRIs and SNRIs as well for a potential benefit of integrating medical and complementary and alternative practitioners.

The association between suicidality and treatment with Selective Serotonin Reuptake Inhibitors in older people with major depression: a systematic review

The association between suicidality and treatment with Selective Serotonin Reuptake Inhibitors in older people with major depression: a systematic review

Effects of selective serotonin reuptake inhibitors on motor neuron survival

Effects of selective serotonin reuptake inhibitors on motor neuron survival Lily B Anderson1, Phaedra B Anderson1, Thea B Anderson1, Amy Bishop2, James Anderson21Cherokee Labsystems, Huntsville, AL USA; 2Department of Biology, University of Alabama in Huntsville, Huntsville, AL, USAAbstract: Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and paroxetine are prescribed to relieve clinical depression and a variety of other disorders. Recently tardive dyskinesia, as well as other movement disorders, have been found to be a clinical side effect of SSRIs. In light of these emerging side effects, we asked if motor neurons were affected by SSRI. Motor neurons were challenged with fluoxetine and paroxetine at clinically relevant doses as well as at lesser and greater doses. Ethanol was used as a negative control and another group of cells was left untreated. As expected, in alcohol-treated cells, there was significant decrease in cell survival and neurite outgrowth. In untreated cells there was no effect in either cell survival or neurite outgrowth. In fluoxetine-treated motor neurons there was ∼52% cell death while in paroxetine-treated cells there was 14% cell survival and both SSRIs caused significant loss of the percentage of neurite-bearing cells. Both SSRIs decreased cell survival in a dose-dependent manner. This study is provocative enough to call for further in vivo studies.Keywords: fluoxetine, paroxetine, motor neurons, NSC34, neurotoxicity, SSRI

Upper gastrointestinal bleeding in a patient with depression receiving selective serotonin reuptake inhibitor therapy

Background:Serotonin plays an important role in the normal clotting phenomenon and is released by platelets. Platelets are dependent on a serotonin transporter for the uptake of serotonin, as they cannot synthesize it themselves. Selective serotonin reuptake inhibitors (SSRIs) block the uptake of serotonin into platelets and can cause problems with clotting leading to bleeding.Aim:This case report highlights the occurrence of upper gastrointestinal bleeding in the index case on initiating SSRI therapy for depression and the prompt resolution of the same on its discontinuation on two separate occasions.Conclusion:SSRIs may cause upper gastrointestinal (GI) bleeding. Physicians should be aware of the same and should try to rule out previous episodes of upper GI bleed or the presence of other risk factors which might predispose to it before prescribing SSRIs; they should also warn the patients about this potential side effect. Also, the presence of thalassemia trait in the index patient deserves special attention and needs to be explored to see if it might in any way contribute in potentiating this side effect of SSRIs.