Gem Posted July 2, 2012 Share Posted July 2, 2012 http://www.telegraph.co.uk/health/9367001/Safety-warning-over-Britains-most-common-antidepressant.html A warning has been sounded over antidepressant drugs taken by more than a million patients in Britain. By Laura Donnelly, Health correspondent 9:15PM BST 30 Jun 2012 A study for medical regulators found that the drugs increase the risk of heart problems which can cause sudden death.Doctors have been told to lower the maximum dose of the UK’s most widely prescribed antidepressant, Citalopram, for all patients. However, regulators have admitted that it is not clear whether the lower dose is safe — as this was not tested. Although GPs were informed of the health risk when it emerged last autumn, and may have explained the matter to patients, no public warning was issued. Last night, experts criticised the Medicines and Healthcare products Regulatory Agency (MHRA), the prescriptions watchdog, for failing to make a public announcement — as it has done over other alerts, such as the PIP breast implant scandal. Citalopram is used to treat depression, anxiety and obsessive compulsive disorders. More than 13 million prescriptions were issued in England and Wales last year — more than twice as many as those for Prozac-style antidepressants. In the study, carried out for the European Medicines Agency (EMA), it was found to be three times more likely to cause cardiac abnormalities than other types of antidepressants. The study of healthy volunteers found that the likelihood of electrical defects in the heart rose dramatically as the dose was increased. The abnormalities — known as QT prolongation — makes people vulnerable to heart arrhythmias and to Torsade de Pointes, a rare speeding of the heart rhythm which can be fatal. The research found the risk of Torsade de Pointes also rose threefold with the drug, when compared with the antidepressants fluoxetine (better known as Prozac), paroxetine (Seroxat) and sertraline (Lustral). A second study found that a variant of Citalopram known as escitalopram, often sold as Cipralex, for which a million prescriptions were issued last year, also increased risks to the heart. Prescriptions for antidepressants are normally issued for one to two months, meaning that between one million and two million patients are affected by the safety warnings. Peter Walsh, from Action Against Medical Accidents, a patient safety charity, criticised the failure by regulators to alert the public. Mr Walsh said: “We need assurances that the necessary steps to protect patients from adverse effects of these drugs have actually been put in place. It is particularly disappointing that there has been so little transparency with patients and the public about this.” In the study, electrocardiogram measurements showed that when volunteers were given a 60mg dose of Citalopram, it took twice as long for their hearts to recover from each beat, than when they were given a 20mg dose. As a result, the EMA issued advice that the maximum dose for the drug must be lowered from 60mg to 40mg, and to 20mg for elderly people, who are vulnerable to toxic effects from drugs. However, in documents seen by this newspaper, regulators admit that it is not clear whether a 40mg dose is safe, as the study did not examine such dosage.Similar patterns were found with escitalopram, at a dose of 30mg. It already has a maximum dose of 20mg, which remains unchanged, except for patients over 65, where the safe level is 10mg. Dr Amanda Varnava, a consultant cardiologist from Imperial College Healthcare trust, said: “I don’t think GPs should stop prescribing these drugs, but they do need to be more aware of the risks from upping the dosage.”Data obtained by this newspaper discloses 6,386 reports of cardiac problems and seizures among patients who took Citalopram.The reports, which were considered by the EMA, show 569 cardiac arrests and 112 sudden deaths among patients taking the pills. In 124 cases, patients suffered Torsade de Pointes. Since Citalopram started being prescribed in the UK in 1995, 8,600 adverse reactions have been reported to the agency, including 155 deaths. In total, 223 cardiac disorders were recorded and 1,703 disorders of the nervous system. An MHRA spokesman said its enforcement of the EMA’s recommended restrictions enabled health care professionals to give appropriate advice to their patients, and that the agency had ensured information leaflets were updated. I came off Seroxat in August 2005 after a 4 month taper. I was initially prescibed a benzo for several months and then Prozac for 5 years and after that, Seroxat for 3 years and 9 months. "It's like in the great stories Mr.Frodo, the ones that really mattered. Full of darkness and danger they were, and sometimes you didn't want to know the end because how could the end be happy? How could the world go back to the way it was when so much bad had happened? But in the end it's only a passing thing this shadow, even darkness must pass. A new day will come, and when the sun shines it'll shine out the clearer." Samwise Gamgee, Lord of the Rings, The Two Towers Link to comment Share on other sites More sharing options...
Moderator Emeritus Skyler Posted July 2, 2012 Moderator Emeritus Share Posted July 2, 2012 Prescriptions for antidepressants are normally issued for one to two months, meaning that between one million and two million patients are affected by the safety warnings. Peter Walsh, from Action Against Medical Accidents, a patient safety charity, criticised the failure by regulators to alert the public. Mr Walsh said: “We need assurances that the necessary steps to protect patients from adverse effects of these drugs have actually been put in place. It is particularly disappointing that there has been so little transparency with patients and the public about this.” Great article Gia, thanks. Though I'm very glad to see write-ups detailing some of the risks with AD treatment, I am concerned docs will respond by precipitously cutting doses by 50%, or abruptly switching patients to a different AD. As a further complication, some of the actions docs take in response are based primarily on liability concerns which makes the risk worse. Just thinking.. Schuyler As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule. Requip - 3/16 ZERO Total time on 25 years. Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.BENZO FREE 10/13 (started tapering 7/10) Total time on 25 years. Read my intro thread here, and check the about me section. "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin Link to comment Share on other sites More sharing options...
Administrator Altostrata Posted July 2, 2012 Administrator Share Posted July 2, 2012 Thanks, Gem. The US FDA warned against the 60mg citalopram dose about 6 months ago. I would consider 40mg to be rather high, also. 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. Link to comment Share on other sites More sharing options...
Moderator Emeritus Skyler Posted July 2, 2012 Moderator Emeritus Share Posted July 2, 2012 Oops.. Thanks Gem Sorry As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule. Requip - 3/16 ZERO Total time on 25 years. Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.BENZO FREE 10/13 (started tapering 7/10) Total time on 25 years. Read my intro thread here, and check the about me section. "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin Link to comment Share on other sites More sharing options...
Barbarannamated Posted July 2, 2012 Share Posted July 2, 2012 A definite concern about sudden decrease in dosage, Schuyler. This article appears to differentiate citalopram from "Prozac-style drugs". I thought both were SSRIs. ? Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc). Link to comment Share on other sites More sharing options...
bubbles Posted July 2, 2012 Share Posted July 2, 2012 Barb, I thought that too. I also wondered about the bit about prescriptions for 1-2 months? 2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012 January 2013 started Sertraline, over time worked up to 100mg July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg 2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg, July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg) 2021 Some time in about Jan/Feb realised probably on more like 1.8mg and poss mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4, continued monthly 10% drops until 1mg, then dropped 0.1mg monthly. May 2022,0.1mg, now dropping 0.01mg per week 29 August 2022 - first day of zero! My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/21/ Current: Armour Thyroid Link to comment Share on other sites More sharing options...
Administrator Altostrata Posted July 3, 2012 Administrator Share Posted July 3, 2012 All SSRIs affect heart rhythym; high-dose citalopram happened to get caught out. 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. Link to comment Share on other sites More sharing options...
Gem Posted July 5, 2012 Author Share Posted July 5, 2012 Yes it is very worrying Schuyler. It's also worrying that the EMA are prepared to say that the maxium should be 40mg when the study did not examine this dosage. It does sound like a high doasge too. I came off Seroxat in August 2005 after a 4 month taper. I was initially prescibed a benzo for several months and then Prozac for 5 years and after that, Seroxat for 3 years and 9 months. "It's like in the great stories Mr.Frodo, the ones that really mattered. Full of darkness and danger they were, and sometimes you didn't want to know the end because how could the end be happy? How could the world go back to the way it was when so much bad had happened? But in the end it's only a passing thing this shadow, even darkness must pass. A new day will come, and when the sun shines it'll shine out the clearer." Samwise Gamgee, Lord of the Rings, The Two Towers Link to comment Share on other sites More sharing options...
Administrator Altostrata Posted July 10, 2012 Administrator Share Posted July 10, 2012 From the NHS http://www.nhs.uk/news/2012/07July/Pages/antidepressant-citalopram-qt-heart-rhythm-safety-warning.aspx 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. Link to comment Share on other sites More sharing options...
UnfoldingSky Posted July 12, 2012 Share Posted July 12, 2012 What about people whom have reactions to lower doses? Is this info still relevant? Because I get occasional bouts where my heart speeds up, and this is six years after taking this poison. Does anyone know if there are tests that can catch whether or not you have Torsade de Pointes when your heart isn't actually speeding up? And is there anything people can DO that have this? I am not a medical professional and nothing I say is a medical opinion or meant to be medical advice, please seek a competent and trusted medical professional to consult for all medical decisions. Link to comment Share on other sites More sharing options...
Administrator Altostrata Posted July 12, 2012 Administrator Share Posted July 12, 2012 I found acupuncture to be very helpful to regulate heart rate and blood pressure. It could very well be a vestige of your severe adverse reaction to citalopram. Adverse reactions also destabilize the nervous system. 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. Link to comment Share on other sites More sharing options...
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