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Selective serotonin-reuptake inhibitors (SSRIs) - Interactions and Warnings

Selective serotonin reuptake inhibitors increase the risk of upper GI bleeding, and this effect is potentiated by concurrent use of nonsteroidal anti-inflammatory drugs or low-dose aspirin, whereas an increased risk of upper GI bleeding could not be attributed to other types of antidepressants.
- Arch Intern Med 2003 Jan 13;163(1):59-64 -- Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study. -- Dalton SO, Johansen C, Mellemkjaer L, Norgard B, Sorensen HT, Olsen JH.

St John's wort may cause serotonin syndrome in sensitive patients. It is important to recognize and report adverse reactions to herbal remedies and to document that these treatments have side effects commensurate with their potent action on brain neurochemistry.
- Can J Psychiatry 2001 Feb;46(1):77-9 -- Adverse reactions to St John's Wort. -- Parker V, Wong AH, Boon HS, Seeman MV.

Physicians prescribing SSRIs need to consider drug-drug interactions and carefully monitor patients with severe affective disorders, comorbid medical conditions (especially cardiovascular disease), alcohol abuse, or a history of overdosing.
- Can J Psychiatry 2001 Apr;46(3):258-63 -- Who develops severe or fatal adverse drug reactions to selective serotonin reuptake inhibitors? -- Dalfen AK, Stewart DE.

Consult with your physician before using herbs and supplements especially those which may have an effect on mood or the brain.

The risk of using Zoloft in combination with other CNS active drugs has not been systematically evaluated. Consequently, caution is advised if the concomitant administration of Zoloft and such drugs is required. Concomitant use in patients taking monoamine oxidase inhibitors (MAOIs) or pimozide is contraindicated.
- FDA Medwatch and Pfizer label change.

Escitalopram is contraindicated in combination with irreversible monoamine oxidase inhibitors (MAOIs) and a period of at least 2 weeks should be allowed between discontinuation of escitalopram and commencement of an irreversible MAOI and vice versa.
- CNS Drugs 2003;17(5):343-362 -- Escitalopram : A Review of its Use in the Management of Major Depressive and Anxiety Disorders. -- Waugh J, Goa K.

Side effects:
  • Sexual problems--fairly common, but reversible, in both men and women. The doctor should be consulted if the problem is persistent or worrisome.
  • Headache--this will usually go away after a short time.
  • Nausea--may occur after a dose, but it will disappear quickly.
  • Nervousness and insomnia (trouble falling asleep or waking often during the night)--these may occur during the first few weeks; dosage reductions or time will usually resolve them.
  • Agitation (feeling jittery)--if this happens for the first time after the drug is taken and is more than temporary, the doctor should be notified.
  • Any of these side effects may be amplified when an SSRI is combined with other medications that affect serotonin. In the most extreme cases, such a combination of medications (e.g., an SSRI and an MAOI) may result in a potentially serious or even fatal "serotonin syndrome," characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems.
- National Institute of Mental Health (NIMH)

last update: November 2008

This information is not intended to be a substitute for professional medical advice. You should not use this material to diagnose or treat a health condition or disease without consulting with your healthcare provider.
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