drdaviss@psychopharminfo.com
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Number 26
August 04, 2003
PPI Index: 114.0 (+3.9%)
Copyright 2003 by Steven R. Daviss, All Rights Reserved
This issue marks the six-month anniversary for the PsychopharmINFO Newsletter! I wanted to do something special to celebrate, so I've added TWO new features (woo-woo!). First, I added a TOP 10 MEDS box. This list makes it easy to see which meds are the PPI Index leaders. The PPI Index is a measure of consumer interest in brand-name psychopharm drugs. The formula for the PPI Index is classified double-top-secret and is kept in an underground government vault, but I can tell you that it takes into consideration the number of search engine hits and news articles that a drug is associated with.
The second feature I've added is a link to the news articles that are available in Google News for each medication. The number of news articles for that week will have the link in it. I hope you find these new features useful.
In the news this week, Apotex, an agent for the drug company, Torpharm, was approved by the FDA to begin marketing its generic version of Paxil (paroxetine) on July 31, 2003. This occured after several patent disputes by GlaxoSmithKline, the patent-holder for Paxil. This will not affect Paxil CR, the controlled release version of Paxil. Anyone on the Paxil brand can soon expect their insurance company to switch them to the generic, which the FDA has found to be therapeutically equivalent to the brand. Anyone interested in reviewing the FDA approval letter can find it at http://www.fda.gov/cder/foi/appletter/2003/75356ap.pdf.
There also remains a lot of buzz about last week's reports regarding the potential for Lexapro to treat compulsive shopping. Lexapro's PPI Index went up 2.5 points, which is a lot for one week. Click on Lexapro's news link to review these articles.
In HIGHLIGHTS this week: pindolol/Visken to speed up SSRI response; reviews on OCD drugs and on Lexapro/Celexa; two articles identifying why SSRIs cause nausea and a genetic link; cutting alcohol craving with Zyprexa; and cutting Zyprexa-related weight gain with Zantac. Finally, there is a Letter to the Editor about Lexapro withdrawal.
See you next week. =Steve
(by PPI Index; %=change from last week)
PPI %
Index change
1. Lexapro 63.4 +4.0
2. Paxil 57.5 +2.0
3. Effexor 45.8 +2.4
4. Wellbutrin 40.6 +4.0
5. Zoloft 39.7 +2.0
6. Prozac 37.7 +3.8
7. Celexa 27.6 -1.0
8. Strattera 27.1 -5.1
9. Zyprexa 19.2 +2.0
10. Seroquel 12.5 +3.7
*Only meds tracked by PsychopharmINFOPPI Index measures consumer interest in a branded drug.
TOP 10 GOOGLE NEWS MEDICATIONS*
(by number of hits; (#)=position last week)
Hits #
1. Prozac 475 (1)
2. Paxil 208 (2)
3. Zyprexa 114 (4)
4. Wellbutrin 106 (6)
5. Celexa 105 (3)
6. Abilify 85 (5)
7. Zoloft 82 (7)
8. Effexor 58 (8)
9. Strattera 45 (9)
10. Lexapro 41 (10)
*Only meds tracked by PsychopharmINFO
TOP 10 SEARCHES FOR MEDICATIONS*
(by search hits; %=change from last week, as per WordTracker**)
Hits %
1. Lexapro 6578 +1
2. Paxil 5422 -1
3. Effexor 4662 -1
5. Wellbutrin 3954 -1
4. Zoloft 3943 -1
6. Strattera 2724 -8
7. Celexa 2586 -3
8. Prozac 2475 -1
9. Zyprexa 1666 -1
10. Seroquel 1294 +1
*Only meds tracked by PsychopharmINFOWordtracker did not update their stats this week.
- SIDE EFFECTS & INTERACTIONS
- • NAUSEA
- -SSRIs
- • OBSESSIVE-COMPULSIVE SYMPTOMS
- -risperidone
- • PANCREATITIS/DIABETIC KETOACIDOSIS/HIGH TRIGLYCERIDES
- -mirtazapine
- • DIABETES
- -
- • INTERACTIONS
- -fluvoxamine - smoking/2D6
- -SSRIs - pindolol/Visken
Go To: ABILIFY | CELEXA | CYMBALTA | EFFEXOR | EMEND | GEODON | LEXAPRO | LUVOX | PAXIL | PROZAC | REMERON | RISPERDAL | SARAFEM | SEROQUEL | SERZONE | STRATTERA | WELLBUTRIN | ZOLOFT | ZYBAN | ZYPREXA
APREPITANT (Emend)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 1 2 77 0.8
2 WKS AGO 1 2 82 0.8
LAST WEEK 0 6 82 1.0
THIS WEEK 1 6 88 1.0
[No authors listed]
Aprepitant (Emend) for Prevention of Nausea and Vomiting Due to Cancer Chemotherapy.
Med Lett Drugs Ther. 2003 Aug 4;45(1162):62-63. No abstract available. [PubMed]
ARIPIPRAZOLE (Abilify)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 1 20 925 9.1
2 WKS AGO 4 21 925 9.3
LAST WEEK 0 79 925 11.2
THIS WEEK 0 85 921 11.3
None.
ATOMOXETINE (Strattera)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 0 8 3059 27.9
2 WKS AGO 1 9 2951 27.4
LAST WEEK 1 42 2951 28.5
THIS WEEK 0 45 2724 27.1
None.
BUPROPION (Wellbutrin, Wellbutrin SR, Wellbutrin XL, generic)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 5 194 3961 43.3
2 WKS AGO 1 178 3984 43.3
LAST WEEK 2 71 3984 39.0
THIS WEEK 1 106 3954 40.6
Altschuler EL, Kast RE.
Bupropion in Psoriasis and Atopic Dermatitis: Decreased Tumor Necrosis Factor-alpha?
Psychosom Med. 2003 Jul-Aug;65(4):719. No abstract available. [PubMed]
CITALOPRAM (Celexa)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 2 36 2639 25.2
2 WKS AGO 2 99 2655 28.1
LAST WEEK 7 103 2655 27.9
THIS WEEK 4 105 2586 27.6
[No authors listed]
There is a new antidepressant escitalopram (Lexapro) that is a cousin of citalopram (Celexa). How are these two different and does the newer drug have any advantages?
Harv Ment Health Lett. 2003 Jul;20(1):8. No abstract available. [PubMed]
Frahnert C, Rao ML, Grasmader K.
Analysis of eighteen antidepressants, four atypical antipsychotics and active metabolites in serum by liquid chromatography: a simple tool for therapeutic drug monitoring.
J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Aug 25;794(1):35-47. [PubMed]
El Khoury A, Tham A, Mathe AA, Aberg-Wistedt A, Stain-Malmgren R.
Decreased plasma prolactin release in euthymic lithium-treated women with bipolar disorder.
Neuropsychobiology. 2003;48(1):14-8. [PubMed]
Plenge P, Mellerup ET.
Pindolol and the acceleration of the antidepressant response.
J Affect Disord. 2003 Aug;75(3):285-9. [PubMed]
DULOXETINE (Cymbalta) (not yet released)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 1 3 141 1.4
2 WKS AGO 3 5 144 1.5
LAST WEEK 0 14 144 1.8
THIS WEEK 0 14 148 1.8
None.
ESCITALOPRAM (Lexapro)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 1 11 6435 58.4
2 WKS AGO 1 37 6492 61.0
LAST WEEK 1 38 6492 60.9
THIS WEEK 2 41 6578 63.4
[No authors listed]
There is a new antidepressant escitalopram (Lexapro) that is a cousin of citalopram (Celexa). How are these two different and does the newer drug have any advantages?
Harv Ment Health Lett. 2003 Jul;20(1):8. No abstract available. [PubMed]
Fabre V, Hamon M.
[Mechanisms of action of antidepressants: new data from Escitalopram]
Encephale. 2003 May-Jun;29(3 Pt 1):259-65. French. [PubMed]
FLUOXETINE (Prozac, Prozac Weekly, Sarafem, generic)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 3 413 2533 39.1
2 WKS AGO 9 292 2501 33.9
LAST WEEK 6 393 2501 36.3
THIS WEEK 6 475 2475 37.7
Frahnert C, Rao ML, Grasmader K.
Analysis of eighteen antidepressants, four atypical antipsychotics and active metabolites in serum by liquid chromatography: a simple tool for therapeutic drug monitoring.
J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Aug 25;794(1):35-47. [PubMed]
Paykel ES, Scott J, Teasdale JD, Johnson AL, Garland A, Moore R, Jenaway A, Cornwall PL, Hayhurst H, Abbott R, Pope M.
Prevention of relapse in residual depression by cognitive therapy: a controlled trial.
Arch Gen Psychiatry. 1999 Sep;56(9):829-35. [PubMed]
Kaplan A, Hollander E.
A review of pharmacologic treatments for obsessive-compulsive disorder.
Psychiatr Serv. 2003 Aug;54(8):1111-8. [PubMed]
Plenge P, Mellerup ET.
Pindolol and the acceleration of the antidepressant response.
J Affect Disord. 2003 Aug;75(3):285-9. [PubMed]
FLUVOXAMINE (Luvox, generic)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 1 2 386 3.6
2 WKS AGO 3 2 384 3.6
LAST WEEK 1 1 384 3.6
THIS WEEK 7 4 386 3.8
Frahnert C, Rao ML, Grasmader K.
Analysis of eighteen antidepressants, four atypical antipsychotics and active metabolites in serum by liquid chromatography: a simple tool for therapeutic drug monitoring.
J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Aug 25;794(1):35-47. [PubMed]
Ueda N, Yoshimura R, Shinkai K, Sakata Y, Nakamura J.
Higher Plasma 5-Hydroxyindoleacetic Acid Levels Are Associated with SSRI-Induced Nausea.
Neuropsychobiology. 2003;48(1):31-4. [PubMed]
Yoshida K, Naito S, Takahashi H, Sato K, Ito K, Kamata M, Higuchi H, Shimizu T, Itoh K, Inoue K, Suzuki T, Ohkubo T.
Monoamine Oxidase A Gene Polymorphism, 5-HT(2A) Receptor Gene Polymorphism and Incidence of Nausea Induced by Fluvoxamine.
Neuropsychobiology. 2003;48(1):10-3. [PubMed]
Gerstenberg G, Aoshima T, Fukasawa T, Yoshida K, Takahashi H, Higuchi H, Murata Y, Shimoyama R, Ohkubo T, Shimizu T, Otani K.
Effects of the CYP 2D6 Genotype and Cigarette Smoking on the Steady-State Plasma Concentrations of Fluvoxamine and Its Major Metabolite Fluvoxamino Acid in Japanese Depressed Patients.
Ther Drug Monit. 2003 Aug;25(4):463-468. [PubMed]
Kaplan A, Hollander E.
A review of pharmacologic treatments for obsessive-compulsive disorder.
Psychiatr Serv. 2003 Aug;54(8):1111-8. [PubMed]
Plenge P, Mellerup ET.
Pindolol and the acceleration of the antidepressant response.
J Affect Disord. 2003 Aug;75(3):285-9. [PubMed]
Saito Y, Matsui A, Kaneko K, Kimura S.
[Effect of selective serotonin reuptake inhibitor on the chronic rumination and vomiting of a severely handicapped patient]
No To Hattatsu. 2003 Jul;35(4):349-52. Japanese. No abstract available. [PubMed]
MIRTAZAPINE (Remeron, Remeron Soltabs, generic)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 1 14 1268 12.0
2 WKS AGO 0 20 1284 12.5
LAST WEEK 0 17 1284 12.4
THIS WEEK 2 20 1259 12.5
Frahnert C, Rao ML, Grasmader K.
Analysis of eighteen antidepressants, four atypical antipsychotics and active metabolites in serum by liquid chromatography: a simple tool for therapeutic drug monitoring.
J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Aug 25;794(1):35-47. [PubMed]
Chen JL, Spinowitz N, Karwa M.
Hypertriglyceridemia, acute pancreatitis, and diabetic ketoacidosis possibly associated with mirtazapine therapy: a case report.
Pharmacotherapy. 2003 Jul;23(7):940-4. [PubMed]
NEFAZODONE (Serzone, generic)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 0 11 506 5.0
2 WKS AGO 0 9 498 4.9
LAST WEEK 2 13 498 5.0
THIS WEEK 0 13 479 4.9
None.
OLANZAPINE (Zyprexa, Zyprexa Zydis)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 5 68 1692 17.9
2 WKS AGO 12 75 1688 18.3
LAST WEEK 3 97 1688 18.8
THIS WEEK 4 114 1666 19.2
Gargoloff PR.
[Mixed episode: complex recognition and complicated treatment]
Vertex. 2003;14 Suppl 1:35-6. Spanish. [PubMed]
Hutchison KE, Wooden A, Swift RM, Smolen A, McGeary J, Adler L, Paris L.
Olanzapine Reduces Craving for Alcohol: A DRD4 VNTR Polymorphism by Pharmacotherapy Interaction.
Neuropsychopharmacology. 2003 Jul 23 [Epub ahead of print] [PubMed]
Ahnaou A, Megens AA, Drinkenburg WH.
The atypical antipsychotics risperidone, clozapine and olanzapine differ regarding their sedative potency in rats.
Neuropsychobiology. 2003;48(1):47-54. [PubMed]
Lopez-Mato A, Rovner J, Illa G, Vieitez A, Boullosa O.
[Randomized, open label study on the use of ranitidine at different doses for the management of weight gain associated with olanzapine administration]
Vertex. 2003 Jun-Aug;14(52):85-96. Spanish. [PubMed]
PAROXETINE (Paxil, Paxil CR)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 3 338 5445 62.3
2 WKS AGO 5 150 5448 55.7
LAST WEEK 1 186 5448 56.4
THIS WEEK 5 208 5422 57.5
Frahnert C, Rao ML, Grasmader K.
Analysis of eighteen antidepressants, four atypical antipsychotics and active metabolites in serum by liquid chromatography: a simple tool for therapeutic drug monitoring.
J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Aug 25;794(1):35-47. [PubMed]
Ueda N, Yoshimura R, Shinkai K, Sakata Y, Nakamura J.
Higher Plasma 5-Hydroxyindoleacetic Acid Levels Are Associated with SSRI-Induced Nausea.
Neuropsychobiology. 2003;48(1):31-4. [PubMed]
Kaplan A, Hollander E.
A review of pharmacologic treatments for obsessive-compulsive disorder.
Psychiatr Serv. 2003 Aug;54(8):1111-8. [PubMed]
Plenge P, Mellerup ET.
Pindolol and the acceleration of the antidepressant response.
J Affect Disord. 2003 Aug;75(3):285-9. [PubMed]
Geller DA, Biederman J, Stewart SE, Mullin B, Farrell C, Wagner KD, Emslie G, Carpenter D.
Impact of comorbidity on treatment response to paroxetine in pediatric obsessive-compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials?
J Child Adolesc Psychopharmacol. 2003 Jul;13(2 Suppl):19-29. [PubMed]
QUETIAPINE (Seroquel)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 0 11 1246 11.6
2 WKS AGO 2 6 1279 12.0
LAST WEEK 4 9 1279 12.1
THIS WEEK 1 9 1294 12.5
Frahnert C, Rao ML, Grasmader K.
Analysis of eighteen antidepressants, four atypical antipsychotics and active metabolites in serum by liquid chromatography: a simple tool for therapeutic drug monitoring.
J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Aug 25;794(1):35-47. [PubMed]
RISPERIDONE (Risperdal, Risperdal M-Tab, Risperdal Consta)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 5 9 1027 9.6
2 WKS AGO 6 36 1050 11.0
LAST WEEK 4 32 1050 10.7
THIS WEEK 6 35 1037 10.9
Frahnert C, Rao ML, Grasmader K.
Analysis of eighteen antidepressants, four atypical antipsychotics and active metabolites in serum by liquid chromatography: a simple tool for therapeutic drug monitoring.
J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Aug 25;794(1):35-47. [PubMed]
Ahnaou A, Megens AA, Drinkenburg WH.
The atypical antipsychotics risperidone, clozapine and olanzapine differ regarding their sedative potency in rats.
Neuropsychobiology. 2003;48(1):47-54. [PubMed]
Cawley MJ, Guse TM, Laroia A, Haith LR, Ackerman BH.
Propofol withdrawal syndrome in an adult patient with thermal injury.
Pharmacotherapy. 2003 Jul;23(7):933-9. [PubMed]
Erlandsson K, Bressan RA, Mulligan RS, Ell PJ, Cunningham VJ, Pilowsky LS.
Analysis of D(2) dopamine receptor occupancy with quantitative SPET using the high-affinity ligand [(123)I]epidepride: resolving conflicting findings.
Neuroimage. 2003 Jul;19(3):1205-14. [PubMed]
Diler RS, Yolga A, Avci A, Scahill L.
Risperidone-induced obsessive-compulsive symptoms in two children.
J Child Adolesc Psychopharmacol. 2003 Jul;13(2 Suppl):89-92. [PubMed]
Gaete LE, Solis J, Venegas P, Carrillo MJ, Schatloff O, Saavedra I.
[Comparison of brand and generic risperidone]
Rev Med Chil. 2003 May;131(5):527-34. Spanish. [PubMed]
SERTRALINE (Zoloft)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 0 158 3981 42.1
2 WKS AGO 3 90 3994 40.1
LAST WEEK 2 67 3994 39.0
THIS WEEK 7 82 3943 39.7
Frahnert C, Rao ML, Grasmader K.
Analysis of eighteen antidepressants, four atypical antipsychotics and active metabolites in serum by liquid chromatography: a simple tool for therapeutic drug monitoring.
J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Aug 25;794(1):35-47. [PubMed]
Kaplan A, Hollander E.
A review of pharmacologic treatments for obsessive-compulsive disorder.
Psychiatr Serv. 2003 Aug;54(8):1111-8. [PubMed]
Mohr DC, Hart SL, Goldberg A.
Effects of treatment for depression on fatigue in multiple sclerosis.
Psychosom Med. 2003 Jul-Aug;65(4):542-7. [PubMed]
Plenge P, Mellerup ET.
Pindolol and the acceleration of the antidepressant response.
J Affect Disord. 2003 Aug;75(3):285-9. [PubMed]
Zoellner LA, Feeny NC, Cochran B, Pruitt L.
Treatment choice for PTSD.
Behav Res Ther. 2003 Aug;41(8):879-86. [PubMed]
Wagner KD, Cook EH, Chung H, Messig M.
Remission status after long-term sertraline treatment of pediatric obsessive-compulsive disorder.
J Child Adolesc Psychopharmacol. 2003 Jul;13(2 Suppl):53-60. [PubMed]
Franklin M, Foa E, March JS.
The pediatric obsessive-compulsive disorder treatment study: rationale, design, and methods.
J Child Adolesc Psychopharmacol. 2003 Jul;13(2 Suppl):39-51. [PubMed]
VENLAFAXINE (Effexor, Effexor XR)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 4 14 4629 42.2
2 WKS AGO 3 12 4689 43.5
LAST WEEK 0 49 4689 44.7
THIS WEEK 1 58 4662 45.8
Frahnert C, Rao ML, Grasmader K.
Analysis of eighteen antidepressants, four atypical antipsychotics and active metabolites in serum by liquid chromatography: a simple tool for therapeutic drug monitoring.
J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Aug 25;794(1):35-47. [PubMed]
ZIPRASIDONE (Geodon)
GOOGLE SEARCH
PUBMED NEWS ENGINE HITS PPI
ARTICLES ITEMS (WORDTRACKER) INDEX
3 WKS AGO 3 3 485 4.5
2 WKS AGO 0 11 472 4.7
LAST WEEK 2 15 472 4.8
THIS WEEK 0 15 477 5.0
None.
- PINDOLOL TO SPEED UP SSRI RESPONSE
- Pindolol (Visken) is a beta-blocker with serotonin-1A (5HT-1A) partial agonist which has been used to boost the effect of antidepressants. Both positive and negative results have come out of controlled trials. This one suggests why most positive studies have been with paroxetine/Paxil.
- REVIEW: OCD DRUGS
- Eight-page review of psychopharm treatments for obsessive-compulsive disorder.
- REVIEW: DIFFERENCES BETWEEN LEXAPRO AND CELEXA
- A review of some differences between escitalopram and citalopram.
- NAUSEA FROM SSRI'S RELATED TO METABOLITE
- Nausea is a common side effect from selective serotonin reuptake inhibitors. In one study, they measured blood levels of 5HIAA, a metabolite of serotonin, and compared it with feelings of nausea. Recall that most of the body's serotonin is in the gut. Those with nausea had more than twice as much 5HIAA than those without nausea. This may explain why mirtazapine/Remeron has less nausea, because it also blocks 5HT-3 receptors, preventing serotonin from stimulating the nausea receptors in the brain. In the other study, they found that those with abnormal genes for the enzyme that is responsible for breaking down serotonin into 5HIAA (monoamine oxidase or MAO-A) had lower levels of nausea.
- ZYPREXA CUTS ALCOHOL CRAVING
- Small study suggesting that olanzapine reduces baseline alcohol craving in alcohol addiction, and that those with a long version of the gene for the dopamine-4 receptor experience reduced craving after alcohol exposure. It remains to be shown whether testing for this gene will help determine how successful treatment with olanzapine will be for alcoholism.
- ZANTAC REDUCES WEIGHT GAIN FROM ZYPREXA
- This is an open-label study finding that the H1-blocker, ranitidine, reduced weight gain associated with olanzapine. There have been a number of similar reports, but so far no randomized, placebo-controlled, clinical trials.
Selected letters to the editor will be published here. Selection factors include conciseness, broad appeal, and originality. All questions will now be posted anonymously. Comments, questions, and observations on research articles, news items, top 10 lists, surveys, and other letters are preferred. Letters may be edited for clarity and brevity.
Send letters to: editor@psychopharminfo.com
Q: Do you have any info on how long it can take to come off antidepressants? I have been completely off escitalopram/Lexapro for five weeks, but feel very strange and weak! Is this a normal reaction?
A: Here are the results of a search on citalopram and withdrawal. 5 weeks is unusual, but not unheard of. You should discuss it with both your psychiatrist and your internist.
----------------------------
1: Int Clin Psychopharmacol. 2000 Nov;15(6):329-33.
An assessment of selective serotonin reuptake inhibitor discontinuation symptoms with citalopram.
Markowitz JS, DeVane CL, Liston HL, Montgomery SA.
The selective serotonin reuptake inhibitors (SSRIs) have recently been associated with a variety of somatic and psychiatric symptoms upon abrupt drug discontinuation. These symptoms have been variously termed SSRI withdrawal, or SSRI discontinuation syndrome. Although all of the available SSRIs have been reported to cause discontinuation symptoms, some appear to have a greater propensity to cause these adverse events than others. Data from a previously completed placebo-controlled, double-blind study designed to assess citalopram in depression relapse prevention were analysed to assess patients for the emergence of discontinuation effects following randomization to placebo after 8 weeks of active drug treatment. Side-effects that occurred during the first 2 weeks following randomization to active drug (n = 150) or placebo (n = 72) were measured using the UKU unwanted side-effect list. The proportion of patients that experienced one or more events over the 2-week period following randomization was similar in the two groups, and there was no association between citalopram dose prior to randomization and the reporting of symptoms. Most of the events that did occur were mild in intensity and none resulted in discontinuation from the study. Events occurring at a higher frequency in the placebo group were most associated with the central nervous system (CNS). These events may reflect a re-emergence of depressive symptoms, since only 14.8% of patients randomized to placebo who did not relapse experienced CNS events, a low symptom incidence that was non-significant (P = 0.562) compared to patients continuing treatment (10.9%).
Therefore, this assessment suggests that any symptoms associated with rapid discontinuation of citalopram are mild and transient, and emphasizes the significant role re-emerging depression and / or anxiety may play in the assessment and identification of SSRI discontinuation symptoms.
PMID: 11110008
----------------------------
2: J Clin Psychopharmacol. 2000 Oct;20(5):581-2.
A case of citalopram withdrawal.
Fernando AT 3rd, Schwader P.
PMID: 11001246
----------------------------
3: Med Clin (Barc). 2000 Mar 11;114(9):359.
[Withdrawal syndrome and cytalopram]
[Article in Spanish]
Sempere E, Martinez I, Martinez-Mir I, Rey A.
PMID: 10786343
----------------------------
4: Ther Drug Monit. 1999 Jun;21(3):263-6.
Erratum in: Ther Drug Monit 1999 Dec;21(6):682.
Pharmacokinetic consequences of a citalopram treatment discontinuation.
Voirol P, Rubin C, Bryois C, Kosel M, Buclin T, Baumann P.
In this pilot study, the pharmacokinetics of citalopram (CIT) were examined in five hospitalized depressed patients after an abrupt discontinuation of a treatment with 40 mg/d of this selective serotonin reuptake inhibitor (SSRI). During the 8-day study period, clinical ratings were regularly carried out. Between days 5 and 8, the patients were treated with clomipramine (75 mg/d). The enantiomers of CIT and its metabolites, demethyl-CIT (DCIT) and CIT-propionic acid derivative (CIT-PROP), were measured repeatedly from day 0 to day 8 by a stereoselective high-performance liquid chromatography (HPLC) procedure. The following drug plasma half-lives were measured (means +/- SD): R-CIT: 66+/-11 h; S-CIT: 42+/-13 h; R-DCIT: 228+/-148 h; S-DCIT: 93+/-35 h; R-CIT-PROP: 82+/-31 h; S-CIT-PROP: 186+/-93 h.
PMID: 10365634
----------------------------
5: Int Clin Psychopharmacol. 1996 Mar;11 Suppl 1:35-40.
Erratum in: Int Clin Psychopharmacol 1996 Jun;11(2):153.
The safety and tolerability of citalopram.
Muldoon C.
Since citalopram was first approved in 1989, it has been prescribed to an estimated > 600 000 patients. An integrated safety database has been prepared, including data from 3107 patients from 24 clinical trials. In placebo-controlled trials, nausea, dry mouth, somnolence, increased sweating, tremor, diarrhoea, and ejaculation failure, mostly of mild to moderate severity, occurred significantly (p < 0.05) more frequently with citalopram. The excess incidence of these events over placebo was always less than 10%. In pooled comparative studies, citalopram's tolerability profile was similar to that of other selective serotonin reuptake inhibitors (SSRIs) and superior to that of tricyclic antidepressants (TCAs). Spontaneous adverse event reports arising from clinical use have confirmed the safety profile defined during the trials programme. Specific monitoring of all serious adverse events from around 10 000 patients receiving citalopram in clinical trials (including small open studies) has indicated a low potential for convulsions and extrapyramidal effects. There is no evidence of withdrawal phenomena on abrupt discontinuation, no clinically relevant effects on cardiac or laboratory parameters, and little or no effect on psychomotor function. When taken in overdose alone, citalopram appears to have a relatively wide margin of safety. Citalopram has been well tolerated in both short- and long-term use, and the profile seen in trials has been confirmed in the clinic.
PMID: 8732443 [PubMed - indexed for MEDLINE]