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Side effects of the most "popular" anti-depressants
"Patients taking Prozac may experience a host of side effects, including sexual dysfunction, dry mouth, nausea, headache, diarrhea, nervousness, restlessness, agitation, increased sweating, weight gain, insomnia and drowsiness.
"Although antidepressants like Prozac are not technically considered to be addictive, at least in the sense of inducing cravings in patients, doctors say they do make users dependent. Drug dependency means that the body has adapted to a chemical to the point that it requires steady doses to normally function. Because of this, patients who abruptly stop taking antidepressant drugs are likely to experience withdrawal symptoms such as nausea, headache, dizziness and lethargy. Patients are warned to wean themselves off antidepressants slowly and under a doctor’s care.
"High doses of SSRIs often increase the severity of side effects, and one particular side effect can be fatal. The onset of Serotonin Syndrome, a condition in which too much of the mood elevator is present in the brain, can occur within minutes, producing high blood pressure, hyperthermia, high body temperature and an increased heart rate that can lead to shock. Serotonin Syndrome can arise when SSRIs act alone or in conjunction with other medications.
"Prozac is one of the few antidepressants approved for the treatment of depression in youths. Unfortunately, however, studies on children have linked the drug to increased suicidal thoughts and behavior. As a result, the FDA issued a public warning in October 2004, and two years later extended the advisory to include young adults as old as 24.
"When taken during the last half of pregnancy, some research links Prozac to a rare but serious lung problem known as persistent pulmonary hypertension of the newborn (PPHN). This condition arises when a newborn’s circulatory system does not properly adapt to breathing outside of the womb. According to the National Institute of Mental Health, a study of pregnant women published in 2009 found that the use of certain antidepressant medications may also increase the risk for premature birth. Heart defects of the septum have also been reported in newborns.
"Researchers are not only investigating physical birth defects that SSRIs have on fetuses, but the long-term neurological effects as well. In July 2011, a case study from the Archives of General Psychiatry linked the use of SSRIs during the first trimester of pregnancy to an increased risk of the baby developing an autism spectrum disorder (ASD)." Look at those side effects. Your body doesn't know what you do with itself. In order to become un-depressed, take a pill that can make you suicidal. Every school shooter in the 1990s was on one of the top three anti-depressants: Prozac, Ritalin and Luvox Luvox - the preferred drug taken by Columbine shooter, Dylan Klebold. As I did an on-site
investigation and obtained the autopsy report, Klebold's liver was rotting.
"Luvox has been studied thoroughly in clinical trials. In these studies, the side effects that occur in a group of people taking the drug are documented and are then compared to side effects that occur in another group of people not taking the medicine. As a result, it is possible to see what side effects occur, how often they appear, and how they compare to the group not taking the medicine.
"In these studies, some of the most common side effects of Luvox included: Nausea -- occurring in up to 40 of people Headaches -- up to 22 percent Drowsiness -- up to 22 percent Insomnia -- up to 21 percent (see Luvox and Insomnia) Weakness -- up to 14 percent Dry mouth -- up to 14 percent (see Luvox and Dry Mouth) Nervousness -- up to 12 percent Diarrhea -- up to 11 percent Dizziness -- up to 11 percent Constipation -- up to 10 percent Indigestion -- up to 10 percent Upper respiratory infections (similar to the common cold) -- up to 9 percent Ejaculation problems -- up to 8 percent (see Luvox Sexual Side Effects) Sweating -- up to 7 percent A loss of appetite -- up to 6 percent.
"Other common side effects (occurring in 2 percent to 5 percent of people) included: Impotence (erectile dysfunction or ED), difficulty achieving an orgasm, or a decreased sex drive (see Luvox Sexual Side Effects) Vomiting Shakiness (tremors) Anxiety or agitation Gas Flu-like symptoms (such as fatigue, fever, and body aches) Feelings of a forcefully or rapidly beating heart (palpitations) Toothaches and other tooth problems Flushing (redness of the skin, especially in the face) Taste changes Blurred vision Chills Trouble swallowing Muscle tension Depression Trouble breathing Yawning Bladder problems.
"These side effects were reported in adults taking Luvox. Children and teens usually have similar side effects. In addition, they may experience painful menstrual cramps, mood swings, and weight loss. Suicidal thoughts or behavior (see Luvox and Suicide) - Anxiety, agitation, or panic attacks. Hostility or Put that in a 17-year old and what do you have? Klebold was on it. He murdered five classmates and then killed himself. Eric Harris' autopsy is still sealed, but I believe he was probably one one or more anti-depressants. Harris was 18. He murdered eight people then killed himself. Ritalin Side Effects and WarningsUpdated August 21, 2012Schedule II Substance Brand Names: RITALIN, RITALIN LA, RITALIN SR Generic Name: METHYLPHENIDATE HCI (HYDROCHLORIDE) Category: CEREBRAL STIMULANTS Ritalin (methylphenidate) is an amphetamine-like prescription stimulant commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children and adults.
Many think Ritalin (methylphenidate) is safe, or mild, because so many children use it. However, the government classifies the psychoactive drug with cocaine and morphine because it is highly addictive.
Addiction Nervousness including agitation, anxiety and irritability Trouble sleeping (insomnia) Decreased appetite Headache Stomach ache Nausea Dizziness Heart palpitations Slowing of growth (height and weight) in children Seizures, mainly in patients with a history of seizures Eyesight changes or blurred vision High blood pressure Rapid pulse rate (and other heart problems) Tolerance (constant need to raise the dose) Feelings of suspicion and paranoia Visual hallucinations (seeing things that are not there) Depression Cocaine craving Dermatoses (infected or diseased skin) Urinary tract infection Infection or viral infection Elevated ALT enzyme levels in the blood (signaling liver damage) Methylphenidate drugs have been extensively abused. Extreme psychological dependence and severe social disability have resulted. Abuse of methylphenidate drugs may cause a sudden heart attack even in those with no signs of heart disease. Symptoms of overdose that require immediate medical assistance include: Restlessness Tremor Aggression Hallucinations Panic states Hyperreflexia (overactive reflexes, which can include twitching or spasms) Personality changes Symptoms of depression Seizures or abnormal EEGs High blood pressure Rapid heart beat Swelling of hands/feet/ankles (for example, numbing of the fingertips) Delusions Sweating Vomiting Dehydration Unexplained muscle pain Lower abdominal pain Rhabdomyolysis and kidney damage Chronic abuse can manifest itself as psychosis, often indistinguishable from schizophrenia "All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Paxil: "Anxiety; blurred vision; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; gas; increased sweating; increased urination; loss of appetite; nausea; nervousness; numbness or tingling of the skin; stomach upset; trouble sleeping; weakness; yawning.
"Seek medical attention right away if any of these SEVERE side effects occur when using Paxil: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bizarre behavior; black or bloody stools; chest pain; confusion; decreased concentration; decreased coordination; exaggerated reflexes; fainting; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; memory loss; new or worsening mental or mood changes (eg, agitation, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still); persistent or severe ringing in the ears; persistent, painful erection; red, swollen, blistered, or peeling skin; seizures; severe or persistent anxiety or trouble sleeping; severe or persistent headache or dizziness; significant weight loss; stomach pain; suicidal thoughts or attempts; tremor; unusual bone pain or unexplained swelling, tenderness, or bruising; unusual bruising or bleeding; unusual weakness; vision changes; worsening of depression.
"This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
"Side Effects by Body System - for Healthcare Professionals "Applies to: oral suspension; oral tablet; oral tablet, extended release - Gastrointestinal "A study of 26,005 antidepressant users has reported 3.6 times more upper GI bleeding episodes with the use of SSRIs relative to the population who did not receive antidepressant medications. Upper gastrointestinal tract bleeding was observed up to 3.2 times more frequently in patients receiving paroxetine.
"Gastrointestinal side effects have frequently included nausea (15% to 36%), dry mouth (4% to 36%), constipation (5% to 16%), diarrhea (6% to 19%), increased appetite (3%), decreased appetite (2% to 12%), flatulence (4% to 8%), vomiting (2% to 3%), oropharynx disorder (2%), taste perversion (2%), gingivitis (1%), and dyspepsia (2% to 13%). Bruxism, upper GI bleeding, colitis, dysphagia, eructation, gastritis, gastroenteritis, glossitis, increased salivation, rectal hemorrhage, ulcerative stomatitis, aphthous stomatitis, bloody diarrhea, bulimia, cholelithiasis, duodenitis, enteritis, esophagitis, fecal impaction, fecal incontinence, gum hemorrhage, hematemesis, ileitis, ileus, intestinal obstruction, melena, mouth ulceration, peptic ulcer, peritonitis , salivary gland enlargement, sialadenitis, stomach ulcer, stomatitis, tongue discoloration, tongue edema, loss of taste, and tooth caries have also been reported.
Nervous system "Chorea has been reported in 13 patients. One incidence of chorea occurred after a single dose of paroxetine.
"Severe psychomotor retardation and stupor have been reported in one patient.
"According to the manufacturer, one study reported that seizures occurred in 0.26% of patients treated with other commonly used antidepressants.
"In one study, paroxetine was found to decrease rapid eye movement (REM) sleep, increase REM latency, increase awakenings, and reduce actual sleep time. Another study found a decreased amount of REM sleep without a detrimental effect on subjective sleep quality.
"Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.
"Nervous system side effects have frequently included somnolence (9% to 24%), dizziness (7% to 14%), insomnia (8% to 24%), tremor (4% to 11%), nervousness (2% to 9%), paresthesia (1% to 4%), decreased libido in both male and female patients (3% to 15%), 'drugged' feeling (2%), confusion (1%), sleep abnormalities, abnormal dreams (1% to 4%), impaired concentration (2% to 4%), myoclonus (1% to 3%), amnesia (1% to 2%), tremor (4% to 8%), hypertonia (2% to 3%), and vertigo (2%). Abnormal thinking, alcohol abuse, ataxia, dystonia, dyskinesia, hypesthesia, hypokinesia, incoordination, paralysis, abnormal gait, akinesia, antisocial reaction, aphasia, choreoathetosis, circumoral paresthesias, convulsion, delirium, delusions, dysarthria, extrapyramidal syndrome, fasciculations, grand mal convulsions, hyperalgesia, meningitis, myelitis, neuralgia, neuropathy, nystagmus, peripheral neuritis, decreased reflexes, increased reflexes, stupor, torticollis, trismus, tardive dyskinesia, seizures, status epilepticus, serotonin syndrome, extrapyramidal symptoms (including akathisia, bradykinesia, cogwheel rigidity, dystonia, and hypertonia), changes in rapid eye movement (REM) sleep, chorea, psychomotor retardation, and stupor have also been reported.
Psychiatric "Other commonly used antidepressants induced mania in 11% of patients in one study.
"Pooled results from clinical trials report hallucinations in 22 of 9089 patients who received paroxetine and 4 of 3187 patients who received placebo.
"Psychiatric side effects have frequently included anxiety (2% to 5%), agitation (2% to 5%), depersonalization (3%), depression (2%), lack of emotion (2%), and emotional lability. Euphoria, hallucinations, hostility, increased libido, neurosis, paranoid reaction, antisocial reaction, delusions, drug dependence, hysteria, manic-depressive reaction, psychotic depression, and psychosis. Mania has been reported in up to 2% of bipolar patients.
Dermatologic "Seven cases of alopecia have been reported. In all cases, hair loss was eventually reversible.
"A case of cutaneous leukocytoclastic vasculitis has been reported following treatment with paroxetine. The patient originally developed the lesions after treatment with escitalopram. The lesions disappeared one week following discontinuation of escitalopram and reappeared upon rechallenge. When the patient was switched to paroxetine a similar reaction occurred.
"Dermatologic side effects have frequently included sweating (5% to 34%), rash (2% to 3%), photosensitivity (2%), eczema (1%), and pruritus. Acne, alopecia, contact dermatitis, dry skin, ecchymosis, herpes simplex, urticaria, erythema nodosus, erythema multiforme, exfoliative dermatitis, fungal dermatitis, furunculosis, herpes zoster, hirsutism, maculopapular rash, seborrhea, skin discoloration, skin hypertrophy, skin ulcer, decreased sweating, vesiculobullous rash, and toxic epidermal necrolysis have also been reported. Two cases of cutaneous vasculitis have also been reported. Dermatologic side effects reported postmarketing have included Stevens-Johnson syndrome.
Genitourinary "There are no controlled clinical data regarding sexual dysfunction with paroxetine use.
"There are several reports of priapism associated with paroxetine use. In cases in which outcome was reported, all patients fully recovered.
"Genitourinary side effects reported in males have included ejaculatory disturbance (13% to 28%), impotence (2% to 9%), and priapism. Genitourinary side effects reported in females have included anorgasmia, orgasmic disturbance, dysmenorrhea, eclampsia, menstrual disorder (2%), vaginitis (2%), amenorrhea, menorrhagia, abortion, endometrial disorder, female lactation, leukorrhea, mastitis, salpingitis, uterine spasm, vaginal hemorrhage, metrorrhagia, and vaginal moniliasis. Urinary tract infection (3%), sexual dysfunction, urinary frequency, urinary disorder, difficulty with micturition, urinary hesitancy, breast pain, breast atrophy, breast enlargement, fibrocystic breast, cystitis, dysuria, hematuria, nocturia, polyuria, pyuria, urinary incontinence, urinary retention, urinary urgency, epididymitis, kidney calculus, kidney pain, nephritis, oliguria, urethritis, urinary casts, and urolith have also been reported.
"The effects on blood pressure have been reported to be inconsistent.
"Cardiovascular side effects have frequently included palpitation (2% to 3%), vasodilation (2% to 4%), hypertension (2%), and tachycardia (including torsade de pointes). Bradycardia, hematoma, hypotension, postural hypotension, syncope, angioedema, angina pectoris, nodal arrhythmia, atrial fibrillation, bundle branch block, cerebral ischemia, cerebrovascular accident, congestive heart failure, heart block, low cardiac output, myocardial infarct, myocardial ischemia, phlebitis, supraventricular extrasystoles, thrombophlebitis, thrombosis, varicose vein, supraventricular tachycardia, vascular headache, vasculitic syndromes (including Henoch-Schonlein purpura), ventricular extrasystoles, and ventricular fibrillation have also been reported.
Endocrine "Paroxetine- induced hyponatremia may be more common in elderly female patients and those who are volume depleted or are receiving concomitant diuretic therapy.
"Endocrine side effects have included diabetes mellitus, goiter, hyperthyroidism, hypothyroidism, and thyroiditis. Hyperprolactinemia, hyponatremia, and the syndrome of inappropriate antidiuretic hormone (SIADH) are increasingly being associated with selective serotonin reuptake inhibitors including paroxetine. A case of severe life-threatening hyponatremia in a patient receiving paroxetine has been reported.
Hematologic "The mechanism of paroxetine- induced bleeding may be related to drug-induced platelet dysfunction.
"Hematologic side effects have included anemia, leukopenia, lymphadenopathy, purpura, abnormal erythrocytes, basophilia, increased bleeding time, eosinophilia, hypochromic anemia, iron deficiency anemia, leukocytosis, lymphedema, abnormal lymphocytes, lymphocytosis, microcytic anemia, monocytosis, normocytic anemia, thrombocythemia, thrombocytopenia, hemolytic anemia, and events related to impaired hematopoiesis (including aplastic anemia, pancytopenia, bone marrow aplasia, and agranulocytosis). Several cases have also been reported suggesting that paroxetine may cause bleeding in patients with normal bleeding times, platelet counts, prothrombin times, and partial thromboplastin times.
Other "A withdrawal syndrome, similar to that seen in other selective serotonin reuptake inhibitors, has been reported. Recent clinical trials by the manufacturer reported withdrawal events to be serious in 0.3% of patients who discontinued therapy with controlled-release paroxetine tablets. Patients discontinuing paroxetine have complained of vertigo, lightheadedness, gait instability, malaise, myalgia, middle insomnia, nausea, emesis, diarrhea, and/or visual phenomena (similar to that associated with migraine) during withdrawal. Two cases of behavioral syndromes including severe aggressive and suicidal impulsivity following paroxetine withdrawal have been reported. One case of withdrawal hypomania has been reported. One case of unilateral facial numbness with blurred peripheral vision has also been reported upon withdrawal.
"In one retrospective chart review of 352 patients who were supervised during tapering and discontinuation from serotonin reuptake inhibitor therapy, dizziness, lethargy, paresthesia, nausea, vivid dreams, irritability, and lowered mood were the most common symptoms reported. Patients with at least one qualitatively new symptom were defined in the paroxetine group at a rate of 17.2%.
"Patients should be monitored for symptoms when discontinuing treatment. A gradual reduction in dosage rather than abrupt discontinuation of therapy is recommended when possible. If intolerable symptoms occur following discontinuation of therapy, then resumption of the previous dose may be considered. Subsequently, discontinuation of therapy may be retried at a more gradual rate.
"Other side effects have frequently included headache (15% to 27%), asthenia (14% to 22%), infection (6% to 8%), abdominal pain (4% to 7%), chest pain (3%), back pain (3% to 5%), chills (2%), migraine (1%), and trauma (3% to 8%). Face edema, withdrawal syndrome, malaise, neck pain, adrenergic syndrome, cellulitis, moniliasis, neck rigidity, pelvic pain, sepsis, ulcer, ear pain, tinnitus, otitis media, deafness, pallor, hyperacusis, otitis externa, parosmia, Guillain-Barre syndrome, and neuroleptic malignant syndrome- like reaction.
Renal - Renal side effects have included acute renal failure.
"Respiratory side effects have frequently included respiratory disorder (7%), sinusitis (4% to 8%), yawn (2% to 5%), rhinitis (3% to 4%), increased cough (1% to 2%), bronchitis (1% to 2%), and pharyngitis (4%). Asthma, dyspnea, epistaxis, hyperventilation, pneumonia, respiratory flu, emphysema, hemoptysis, hiccups, lung fibrosis, pulmonary edema, pulmonary embolus, increased sputum, stridor, porphyria, laryngismus, and alteration in voice have also been reported.
Hypersensitivity "Hypersensitivity side effects have included allergic reactions in up to 2% of patients including allergic alveolitis and anaphylaxis.
"Hepatic side effects have included a single case of severe hepatotoxicity with jaundice. Hepatitis and abnormal liver function tests have been reported rarely.
"The manufacturer states that in placebo-controlled clinical trials patients receiving paroxetine experienced abnormal values on liver function tests at a rate equal to or less than that reported in patients receiving placebo. However, there have been postmarketing reports of patients developing elevated serum transaminases resulting in severe liver dysfunction, as well as, a few cases of elevated liver function tests resulting in death secondary to liver necrosis.
Ocular "Ocular side effects have frequently included blurred vision (4%), abnormality of accommodation (2%), and abnormal vision (2% to 5%). Conjunctivitis, eye pain, keratoconjunctivitis, mydriasis, amblyopia, anisocoria, blepharitis, cataract, conjunctival edema, corneal ulcer, diplopia, exophthalmos, eye hemorrhage, glaucoma, night blindness, photophobia, ptosis, retinal hemorrhage, optic neuritis, and visual field effect have also been reported.
Musculoskeletal "Musculoskeletal side effects have frequently included myopathy (2%), myalgia (2% to 5%), myasthenia (1%), and arthralgia (2%). Arthritis, arthrosis, bursitis, myositis, osteoporosis, generalized spasm, tenosynovitis, and tetany have also been reported. A single case of bruxism has been reported. Postmarketing reports have included restless legs syndrome.
"In one study using the healthcare data from the providence of Ontario, Canada reviewing 8239 patients treated for hip fractures, the adjusted odds ratio for hip fracture was 2.4 for exposure to selective serotonin reuptake inhibitors (including fluoxetine, fluvoxamine, paroxetine, and sertraline), compared to participants who had no exposure to antidepressants.
"Controlled studies reported an average weight loss of approximately 1 pound per patient versus smaller changes reported with placebo.
"The results of one study appear to indicate that treatment with selective serotonin reuptake inhibitors (i.e., paroxetine, sertraline, citalopram) may cause an increase in serum total cholesterol, HDL cholesterol, and/or LDL cholesterol. However, additional studies are necessary to confirm these findings.
"Numerous cases of hyponatremia have been reported following treatment with a selective serotonin reuptake inhibitor (SSRI). Risk factors for the development of SSRI- associated hyponatremia including advanced age, female gender, concomitant use of diuretics, low body weight, and lower baseline serum sodium levels have been identified. Hyponatremia tends to develop within the first few weeks of treatment (range 3 to 120 days) and typically resolves within 2 weeks (range 48 hours to 6 weeks) after therapy has been discontinued with some patients requiring treatment. The proposed mechanism for the development of hyponatremia involves the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) via release of antidiuretic hormone.
"Metabolic side effects have frequently included weight gain (3%) and weight loss (1%). Edema, peripheral edema, thirst, bilirubinemia, dehydration, gout, hypercalcemia, hypercholesteremia, hyperglycemia, hyperkalemia, hyperphosphatemia, hypocalcemia, hypoglycemia, hypokalemia, hyponatremia, porphyria, and ketosis have also been reported. In addition, increased levels of SGOT, SGPT, alkaline phosphatase, BUN, creatinine phosphokinase, gamma globulins, lactic dehydrogenase, and non- protein nitrogen (NPN) have been reported. An increase in serum cholesterol has been reported following use of paroxetine.
"General side effects including abnormal bleeding have been reported." Casey Anthony took Xanax. She called the phantom baby sitter who allegedly kidnapped her daughter, Zanny the nanny. I followed that trial on Court TV. She killed that precious two year old child and walked away because of a brain dead jury.
"Xanax has been studied thoroughly in clinical trials. In these studies, the side effects that occur in a group of people taking the drug are documented and are then compared to side effects that occur in another group of people not taking the medicine. This way, it is possible to see what problems occur, how often they appear, and how they compare to the group not taking the medicine.
"In these studies, some of the most common side effects of Xanax included: Drowsiness -- in up to 76.8 percent of people Fatigue and tiredness -- up to 48.6 percent Coordination problems -- up to 40.1 percent Irritability -- up to 33.1 percent Memory problems -- up to 33.1 percent Increased appetite -- up to 32.7 percent.
"Some other common side effects, occurring in 1 percent to 30 percent of people, included: Speech problems Changes in sex drive or other sexual problems (see Xanax Sexual Side Effects) Confusion Talkativeness Unusual dreams Feeling warm Constipation Increased salivation Nasal congestion Decreased appetite Weight loss or weight gain (see Xanax and Weight Gain) Difficulty urinating Menstrual problems Dry mouth. Serious Side Effects - Some side effects with Xanax, while occurring infrequently, are potentially serious and should be reported immediately to your healthcare provider. These include, but are not limited to: Depression (or worsening of existing depression) Lightheadedness, dizziness, or fainting Problems with balance or falling down Zoloft - Side Effects of Zoloft - for the ConsumerSide Effects of Zoloft - for the Consumer "All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Zoloft: Anxiety; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; increased sweating; loss of appetite; nausea; nervousness; stomach upset; tiredness; trouble sleeping; vomiting; weight loss.
"Seek medical attention right away if any of these SEVERE side effects occur when using Zoloft: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bizarre behavior; black or bloody stools; chest pain; confusion; decreased bladder control; decreased concentration; decreased coordination; exaggerated reflexes; fainting; fast or irregular heartbeat; fever; hallucinations; memory loss; new or worsening agitation, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still; persistent or severe ringing in the ears; persistent, painful erection; red, swollen, blistered, or peeling skin; seizures; severe or persistent anxiety or trouble sleeping; severe or persistent headache; stomach pain; suicidal thoughts or attempts; tremor; unusual bruising or bleeding; unusual or severe mental or mood changes; unusual weakness; vision changes; worsening of depression.
"This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
"Side Effects by Body System - for Healthcare Professionals "Gastrointestinal side effects including nausea are the most common adverse effects caused by sertraline. One report has suggested that as many as 30% of patients treated with sertraline experience nausea, although most other studies have suggested a lower frequency. Other reported gastrointestinal effects include dry mouth (14% to 20%), diarrhea (17%), constipation, upper GI bleeding, and dyspepsia.
"There are two cases in the literature in which the use of Lactobacillus acidophilus capsules were reported to have been very helpful in the treatment of persistent, sertraline-induced diarrhea.
"A study of 26,005 antidepressant users has reported 3.6 times more upper GI bleeding episodes with the use of SSRIs relative to the population who did not receive antidepressant medications. Upper gastrointestinal tract bleeding was observed in 4.1 times more frequently in patients receiving sertraline.
"Although sertraline usually causes stimulation, cases of sedation in some patients have been reported.
"In one case, a patient with an AV malformation in the region of the corpus callosum developed akathisia and a dystonic reaction following a two week exposure to sertraline.
"Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.
"Nervous system side effects including insomnia, somnolence, tremor, dizziness, headache, and fatigue have all been reported. The incidence of each of these effects ranges between 10% and 20% of treated patients. Akathisia, myoclonic jerking, and sleep abnormalities have also been reported. At higher doses, drowsiness often ensues. Increased alertness and enhanced cognition have been reported when sertraline is taken at low doses. Excitement has been reported less frequently. Sertraline-induced facial paresthesia has also been reported.
Psychiatric "Psychiatric side effects including agitation and changes to hypomania have been observed infrequently. Although the drug has been reported to be an effective agent in the treatment of panic attacks, several cases of sertraline- induced panic attacks have been reported.
General "General side effects including weight loss have been reported frequently.
"Genitourinary side effects including male sexual dysfunction (involving ejaculatory delay, impotence, and decreased libido) have been reported in as many as 21% of treated patients. In a study involving patients receiving sertraline (50 to 200 mg daily) for the treatment of generalized anxiety disorder, 17% of patients reported a decrease or loss of libido. Among male patients, nearly 18% experienced some type of sexual dysfunction including abnormal orgasm/anorgasmia (10%), ejaculation failure (6%), and erectile disturbance (1.5%).
"A single case of priapism has been reported in association with sertraline therapy. The patient was also taking lithium at the time.
"Hepatic side effects including reversible elevations in liver function tests have been reported to occur in about 0.5% of treated patients.
"Cardiovascular side effects including rare cases of hypertension, angina, and arrhythmias have been reported.
"Endocrine side effects including two cases of galactorrhea have been reported in association with sertraline therapy. Two cases of breast discomfort and enlargement without galactorrhea have also been reported.
"Case reports have suggested that sertraline, like other serotonin- specific reuptake inhibitors, may induce the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Seven cases of hyponatremia have been reported, four of which were associated with SIADH. Six of the seven patients were over 60 years of age.
"Other side effects including a withdrawal syndrome have been reported. In one retrospective chart review of 352 patients who were supervised during tapering and discontinuation from serotonin reuptake inhibitor therapy, dizziness, lethargy, paresthesia, nausea, vivid dreams, irritability, and lowered mood were the most common symptoms reported. Patients with at least one qualitatively new symptom were defined in the sertraline group at a rate of 1.5%.
"Other side effects including speech difficulties (which included stuttering and speech blockage) have been reported. At least one case of sertraline-related night sweats has also been reported.
"A case of withdrawal symptoms involving fatigue, abdominal cramps, insomnia, aching and chills has been reported following the abrupt discontinuation of sertraline. In another case, a patient developed dizziness and orthostatic hypotension on repeated attempts to discontinue the drug.
"The night sweats stopped within four days of discontinuation of sertraline therapy. When the patient was changed to fluoxetine, the sweating did not recur.
"Hematologic side effects including a case of septic shock secondary to agranulocytosis has been reported. A single case report has suggested that sertraline may improve platelet counts in patients with idiopathic thrombocytopenia purpura.
Ocular side effects including "abnormal vision" may occur in some patients according to one report. The specific abnormalities observed were not described by the authors.
"Dermatologic side effects including alopecia (1%) have been reported. A case of photosensitivity has also been reported.
"Musculoskeletal side effects may include increased odds of a hip fracture. In one study using the healthcare data from the province of Ontario, Canada reviewing 8,239 patients treated for hip fractures, the adjusted odds ratio for hip fracture was 2.4 for exposure to selective serotonin reuptake inhibitors (including fluoxetine, fluvoxamine, paroxetine, and sertraline), compared to participants who had no exposure to antidepressants.
"Renal side effects including a mean decrease in serum uric acid levels of approximately 7% have been reported.
"Metabolic side effects including hyponatremia have been reported in elderly patients. An increase in serum cholesterol has been reported following use of sertraline.
"The results of one study appear to indicate that treatment with selective serotonin reuptake inhibitors (i.e., paroxetine, sertraline, citalopram) may cause an increase in serum total cholesterol, HDL cholesterol, and/or LDL cholesterol. However, additional studies are necessary to confirm these findings.
"Numerous cases of hyponatremia have been reported following treatment with a selective serotonin reuptake inhibitor (SSRI). Risk factors for the development of SSRI- associated hyponatremia including advanced age, female gender, concomitant use of diuretics, low body weight, and lower baseline serum sodium levels have been identified. Hyponatremia tends to develop within the first few weeks of treatment (range 3 to 120 days) and typically resolves within 2 weeks (range 48 hours to 6 weeks) after therapy has been discontinued with some patients requiring treatment. The proposed mechanism for the development of hyponatremia involves the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) via release of antidiuretic hormone.
"Respiratory side effects have included upper respiratory tract infection. In a study involving 314 women with moderate to severe premenstrual syndrome, 6% to 10% of patients developed upper respiratory tract infection after receiving sertraline 25 to 50 mg daily. However, it should be noted that 7% of placebo- treated patients also developed upper respiratory tract infection." Side Effects of Lexapro - for the Consumer "All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Lexapro: Constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; headache; increased sweating; light-headedness when you stand or sit up; loss of appetite; nausea; stomach upset; tiredness; trouble sleeping.
"Seek medical attention right away if any of these SEVERE side effects occur when using Lexapro: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bizarre behavior; black or bloody stools; chest pain; confusion; decreased concentration; decreased coordination; fainting; fast, slow, or irregular heartbeat; hallucinations; memory loss; menstrual period changes; new or worsening agitation, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still; persistent or severe ringing in the ears;persistent, painful erection; red, swollen, blistered, or peeling skin; seizures; severe dizziness; severe or persistent anxiety or trouble sleeping; severe or persistent headache; shortness of breath; stomach pain; suicidal thoughts or attempts; tremor; unusual bruising or bleeding; unusual or severe mental or mood changes; unusual weakness; vision changes; worsening of depression.
"This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
Side Effects by Body System - for Healthcare Professionals"Nervous system "Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.
"At least one case of escitalopram-induced paroxysmal dystonia has been reported in the literature. A 44-year-old woman developed paroxysmal cervical-cranial dystonia after receiving several days of treatment with escitalopram. The paroxysmal movement disorders were characterized by cervical and oral contracture with sustained and painful laterocollis and twisting tongue movements. The episodes occurred several times a day lasting for several minutes and would resolve spontaneously. The day after escitalopram was discontinued, the paroxysmal symptoms resolved without recurrence.
"Nervous system side effects have been reported. In two fixed dose trials, dry mouth was reported at 4% with a dose of 10 mg/day and 9% with a dose of 20 mg/day. In those same two fixed dose trials, somnolence was reported at 4% with a dose of 10 mg/day and 9% with a dose of 20 mg/day. Additionally, dizziness was reported at 4% with a dose of 10 mg/day and 7% with a dose of 20 mg/day. Furthermore, increased sweating was reported at 3% with a dose of 10 mg/day and 8% with a dose of 20 mg/day. Paresthesia, light- headed feeling, migraine, tremor, sleep abnormalities, and vertigo have been reported frequently. Shaking, disequilibrium, tics, restless legs, carpal tunnel syndrome, twitching, faintness, hyperreflexia, muscle, involuntary muscle contractions, and increased muscle tone have been reported infrequently. Dystonia, extrapyramidal disorders, grand mal seizures, and seizures have been reported; however, a causal relationship with escitalopram has not been determined.
"Nervous system side effects reported during 6 months of continuous therapy (10 to 20 mg daily) have included headache (25%), insomnia (15%), and somnolence (11%).
Gastrointestinal "Gastrointestinal side effects including nausea (15%) and abdominal pain (2%) have been reported. In two fixed dose trials, diarrhea was reported at 6% with a dose of 10 mg/day and 14% with a dose of 20 mg/day. In those same two fixed dose trials, constipation was reported at 3% with a dose of 10 mg/day and 6% with a dose of 20 mg/day. Furthermore, indigestion was reported at 2% with a dose of 10 mg/day and 6% with a dose of 20 mg/day. Vomiting, flatulence, heartburn, toothache, gastroenteritis, abdominal cramping, and gastroesophageal reflux have been reported frequently. Bloating, increased stool frequency, abdominal discomfort, dyspepsia, belching, gagging, gastritis, and hemorrhoids have been reported infrequently. Gastrointestinal hemorrhage and rectal hemorrhage have been reported; however, a causal relationship with escitalopram has not been determined.
"Gastrointestinal side effects reported during 6 months of continuous therapy (10 to 20 mg daily) have included nausea (15%), diarrhea (11%), and dry mouth (11%).
General "General side effects including influenza-like symptoms (5%) and fatigue (5%) have been reported. In two fixed dose trials, insomnia was reported at 7% with a dose of 10 mg/day and 14% with a dose of 20 mg/day. In those same two fixed dose trials, fatigue was reported at 2% with a dose of 10 mg/day and 6% with a dose of 20 mg/day. Allergy, limb pain, increased or decreased weight, hot flushes, fever, and chest pain have been reported frequently. Edema of the extremities, bruise, nosebleed, chills, malaise, syncope, chest tightness, leg pain, edema, and asthenia have been reported infrequently.
"Psychiatric side effects including insomnia (9%), somnolence (6%), decreased appetite (3%), and decreased libido (3%) have been reported. Abnormal dreaming, yawning, increased appetite, lethargy, irritability, and impaired concentration have been reported frequently. Agitation, jitteriness, apathy, panic reaction, aggravated restlessness, nervousness, forgetfulness, attempted suicide, aggravated depression, feeling unreal, excitability, emotional lability, abnormal crying, depression, anxiety attack, depersonalization, suicidal tendency, bruxism, confusion, carbohydrate craving, amnesia, nervous tremulousness, and auditory hallucinations have been reported infrequently. Aggression, acute psychosis, and visual hallucinations have been reported; however, a causal relationship with escitalopram has not been determined.
"Respiratory side effects including rhinitis (5%) and sinusitis (3%) have been reported. Bronchitis, sinus congestion, coughing, sinus headache, and nasal congestion have been reported frequently. Asthma, shortness of breath, laryngitis, pneumonia, and tracheitis have been reported infrequently. Pulmonary embolism has been reported; however, a causal relationship with escitalopram has not been determined.
"Respiratory side effects reported during 6 months of continuous therapy (10 to 20 mg daily) have included upper respiratory tract infection (15%) and rhinitis (10%).
"Genitourinary side effects including urinary tract infection and urinary frequency have been reported frequently. Kidney stones, dysuria, and urinary urgency have been reported infrequently. In male patients ejaculatory disorder (primarily ejaculatory delay) (9%), decreased libido (4%), and impotence (3%) have been reported. Priapism has been reported with the use of all selective serotonin reuptake inhibitors. Genitourinary side effects in female patients have included decreased libido (2%) and anorgasmia (2%). Menstrual disorder, menorrhagia, spotting between menses, and pelvic inflammation has been reported infrequently.
"Genitourinary side effects reported during 6 months of continuous therapy have included ejaculation disorder (16%) and decreased libido (10%).
"Cardiovascular side effects including palpitation and hypertension have been reported frequently. Bradycardia, tachycardia, ECG abnormalities, flushing, and varicose veins have been reported infrequently. Angioedema, cardiac failure, deep vein thrombosis phlebitis thrombosis, atrial fibrillation, hypotension, myocardial infarction, orthostatic hypotension, QT prolongation, torsades de pointes, and ventricular tachycardia have been reported; however, a causal relationship with escitalopram has not been determined.
"Hypersensitivity side effects including anaphylaxis have been reported infrequently.
"Hematologic side effects including anemia and hematoma have been reported infrequently. Thrombocytopenia has been reported; however, a causal relationship with escitalopram has not been determined. Escitalopram does appear to inhibit platelet aggregation at therapeutic concentrations in vitro.
"Metabolic side effects including increased bilirubin, gout, hypercholesterolemia, and hyperglycemia have been reported infrequently. Serotonin syndrome has been reported; however, a causal relationship with escitalopram has not been determined.
"Musculoskeletal side effects including arthralgia, neck/shoulder pain, muscle cramp, and myalgia have been reported frequently. Jaw stiffness, muscle stiffness, arthritis, muscle weakness, arthropathy, back discomfort, joint stiffness, and jaw pain have been reported infrequently. Rhabdomyolysis has been reported; however, a causal relationship with escitalopram has not been determined.
"Dermatologic side effects including rash have been reported frequently. Acne, pruritus, eczema, alopecia, dry skin, folliculitis, lipoma, furunculosis, and dermatitis have been reported infrequently. Toxic epidermal necrolysis and urticaria have been reported; however, a causal relationship with escitalopram has not been determined. In addition, an intraoral lichenoid reaction on the buccal mucosa along with a dark pigmentation on the lower lip have been reported following use of escitalopram.
"Ocular side effects including blurred vision have been reported frequently. Eye irritation, conjunctivitis, abnormal vision, visual disturbance, dry eyes, eye infection, and dilated pupils have been reported infrequently. Diplopia has been reported; however, a causal relationship with escitalopram has not been determined.
"According to one case report, use of escitalopram resulted in uveal effusions and caused acute bilateral angle closure glaucoma in a 41- year- old woman.
"Otic side effects including ear ache and tinnitus have been reported. Abnormal gait and neuroleptic malignant syndrome has also been reported; however, causality has not been established.
"Other side effects including taste alteration have been reported infrequently."

Source: http://devvy.net/pdf2/october2012/Prozac.pdf

Imj225.dalbeth.fm

Internal Medicine Journal 2002; 32: 315–319Audit of the management of suspected giant cell arteritis in a large teaching hospitalN. DALBETH,1 N. LYNCH,1 L. McLEAN,2 F. McQUEEN1,2 and J. ZWI11 Auckland Healthcare and 2 Department of Molecular Medicine, University of Auckland, Auckland, New Zealand Abstract Results : The mean waiting time for biop

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