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Antidepressant–Drug Interactions are Potentially but Rarely Clinically Significant


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http://www.nature.com/npp/journal/v31/n8/full/1301069a.html

worth a glance by somebody smarter than I am put it where you think it should be

  Antidepressant–Drug Interactions are Potentially but Rarely Clinically Significant

 

The salient pharmacologic features of the selective serotonin reuptake inhibitors (SSRIs) discovered in the late 1980s included an in vitro ability to inhibit various cytochrome P450 enzymes (CYPs). Differences in potency among the SSRIs for CYP inhibition formed the basis of a marketing focus based largely on predictions of in vivo pharmacokinetic drug interactions from in vitro data, conclusions derived from case reports, and the extrapolation of the results of pharmacokinetic studies conducted in healthy volunteers to patients. Subsequently introduced antidepressants have undergone a similar post hoc scrutiny for potential drug–drug interactions. Concern for the untoward consequences of drug interactions led the FDA to publish guidance for the pharmaceutical industry in 1997 recommending that in vitro metabolic studies be conducted early in the drug development process to evaluate inhibitory properties toward the major CYPs. However, the prevalence of clinically significant enzyme inhibition interactions occurring during antidepressant treatment remains poorly defined despite millions of exposures. Although lack of evidence does not equate to evidence of absence, sparse epidemiological and post-marketing surveillance data do not substantiate a conclusion that widespread morbidity results from antidepressant-induced drug interactions. This commentary discusses points of uncertainty and controversy in the field of drug interactions, notes areas where inadequate data exist, and suggests explanations for a low prevalence of serious interactions. The conclusion is drawn that drug interactions from CYP inhibition caused by the newer antidepressants are potentially, but rarely, clinically significant.

Keywords: 

drug interactions, P450, P-glycoprotein, pharmacogenetics, drug transporters

 

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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The conclusion is drawn that drug interactions from CYP inhibition caused by the newer antidepressants are potentially, but rarely, clinically significant.

 

 

This is exactly what happened to me.

 

This is what Dr Lucire wrote on my report from the antibiotic and anti nausea drug.

 

'Blocking CYP450 2c9 gave N immediate sertraline (Zoloft) toxicity as the drug could not be metabolized. Zoloft had already inhibited 2c9 so it was not fully active if it ever was at all. The same thing happened with the other drug.

[*]At 15 years was put on 50mg of Zoloft for generalized anxiety and panic disorder.

[*]2006 Tried to withdrawal from 50mg . Doctor told me I would have no trouble. I tampered over about a month (50mg-0) which left me with severe and debilitating withdrawal symptoms. Doctors put my dose up to 75mg mistaking my withdrawal symptoms as a relapse. Stayed on Zoloft 75mg since 2006.

March 2015- adverse reaction between Zoloft (75mg) an antibiotic and anti nausea drug resulting in debilitating symptoms/recovery identical to withdrawal. Have not altered or changed dose since 2006.

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There are a long list of side effects from these drugs and pooped out that docs and we don't recognise hence we are often medicated to treat the side effects of the Ad... That is a point I want to make as many people are on cholesterol lowering drugs acid lowering drugs and many others.... to treat side effects.  

 

Everybody gets sick sometime and needs an antibiotic surely in years and years on an AD they have to think this will happen.  I am thinking it is happening a lot more than the powers that be suspect. 

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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Yes, I see what you mean. I think the frustrating part is that when you get really sick and you have no choice but to take medicine, Drs should at least be more aware of possible interactions and at least listen or further investigate their patients concern. You can't always avoid interactions but from experience I have found hospital pharmacists more knowledgable about drug interactions than Drs. One pharmacist was surprised that a dr would prescribe two seritongeric drugs as it results in serotonin syndrome.

[*]At 15 years was put on 50mg of Zoloft for generalized anxiety and panic disorder.

[*]2006 Tried to withdrawal from 50mg . Doctor told me I would have no trouble. I tampered over about a month (50mg-0) which left me with severe and debilitating withdrawal symptoms. Doctors put my dose up to 75mg mistaking my withdrawal symptoms as a relapse. Stayed on Zoloft 75mg since 2006.

March 2015- adverse reaction between Zoloft (75mg) an antibiotic and anti nausea drug resulting in debilitating symptoms/recovery identical to withdrawal. Have not altered or changed dose since 2006.

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NJJ i agree with you they seem to be fully aware of the horrors of wdl difficulty too where as the doctors arent i just dont understand it.

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Drug-drug interactions are very common and often clinically significant.
 

The Dangers of 'Polypharmacy,' the Ever-Mounting Pile of Pills

 

NY Times Apr 22, 2016

Research shows that a number of older adults take multiple prescription drugs, with many taking OTC medications and dietary supplements as well. According to a recent study in JAMA Internal Medicine, more than one-third of individuals aged 62–85 years took at least five prescription medications, while nearly two-thirds used dietary supplements and almost 40% used OTC drugs. The researchers calculated that more than 8% of older adults were at risk for a major drug interaction in 2005 and 2006, but that number increased to about 15% 5 years later. "We're not paying attention to the interactions and safety of multiple medications," said Dima Qato, the lead author of the paper and a pharmacist and epidemiologist at the University of Illinois at Chicago. "This is a major public health problem." In an accompanying commentary, Michael A. Steinman, a geriatrician at the University of California, San Francisco, pointed out that although drug interactions can occur in any age group, older people are at greater risk, with many treating multiple chronic diseases.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Found this in black and white just today

“PPIs,” whose Product information (PI) warns against their use in conjunction with drugs metabolized by CYP450 2C19

 

https://www.tga.gov.au/sites/default/files/review-tga-transparency-1101-submission-yolande-lucire2.pdf

 

12 years after I went to emerg after adding a ppi to my effexor and clexa ... doc had no clue said stop it for a couple days then restart it.. I now assume she knew and would be off shift in a day or two and I would be some other docs problem.... 

 

I also wonder what pills she was on. but I am like that suspicious by nature now... either that or too stupid to notice anything it depends on the day

 

peace all 

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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The Dangers of 'Polypharmacy,' the Ever-Mounting Pile of Pills

"“We spend an awful lot of money and effort trying to figure out when to start medications,” Dr. Alexander said, “and shockingly little on when to stop.”

 

Gee I wonder why that is

 

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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