SSRIs Carlat Reports | Carlat Publishing

Uncommon Tips

Uncommon Tips: Which Is Better—Citalopram or Escitalopram?

From The Carlat Psychiatry Report, Psychotic Depression

Topics: Anxiety | Citalopram | Depression | Escitalopram | SSRIs

Editor’s note: We’re pleased to introduce the new feature “Uncommon Tips.” In this series, Dr. Aiken will discuss little-known pearls about commonly used medications. The series starts with a comparison of citalopram and escitalopram. The rivalry between these two SSRIs began in 2002 when the Lundbeck pharmaceutical company split citalopram (

Clinical Update

Deprescribing Anti-Anxiety Medications in Older Adults

From The Carlat Geriatric Psychiatry Report, Anxiety

Our inclination may be to “not rock the boat” when a patient is stable and not misusing prescribed medication. However, tapering anti-anxiety medications in older adults is often a good idea when considering the risks of falls, sedation, and accidents. Which meds to taper? The risks of anti-anxiety medications increase with age. Here are some of t

Expert Q&A

Treating Anxiety Disorders in Children: The New AACAP Clinical Practice Guideline

From The Carlat Child Psychiatry Report, ADHD in Children and Adolescents

CCPR: Welcome, Dr. Abright. Tell us how the American Academy of Child and Adolescent Psychiatry (AACAP) created the Clinical Practice Guideline on the Assessment and Treatment of Anxiety Disorders in Children and Adolescents (Walter HJ et al, J Am Acad Child Adolesc Psychiatry 2020;59(10):1107–1124).Dr. Abright: The AACAP Committee on Quality Issues (

Research Update

SSRIs vs SNRIs in Pediatric Anxiety Disorders: Which Are More Tolerable?

From The Carlat Child Psychiatry Report, Substance Use in Children and Adolescents

REVIEW OF: Mills JA and Strawn JR, J Am Acad Child Adolesc Psychiatry 2020;59(11):1240–1251 STUDY Type: Meta-analysis For children with anxiety disorders and OCD, SSRIs produce faster and greater improvement than SNRIs (Strawn JR et al, J Am Acad Child Adolesc Psychiatry 2018;57(4):235–244.e2). Unfortunately, adverse effects slow down our dose

Research Update

SSRIs and Intracerebral Hemorrhage Risk

From The Carlat Hospital Psychiatry Report, Capacity Assessments

REVIEW OF: Kubiszewski P et al, JAMA Neurol 2020;e203142. Epub ahead of print. Depression after strokes is very common, affecting about 50% of stroke patients. Many such patients are treated with SSRIs, which are generally effective but potentially dangerous because they can increase the risk of bleeding due to impaired platelet aggregation. This is

Research Update

Can Antidepressants Prolong Survival in Cancer Patients?

From The Carlat Hospital Psychiatry Report, Capacity Assessments

Review Of: Shoval G et al, Depress Anxiety 2019;36(10):921–929 Many cancer patients experience depression, especially those with poor prognoses. Compared with euthymic patients, depressed cancer patients are less adherent to their cytotoxic medications, and this poor adherence can worsen their long-term survival. Yet surprisingly, some studies have

Research Update

Does Prozac Treat Repetitive and Stereotypical Behaviors in Children With Autism?

From The Carlat Child Psychiatry Report, Identity & Culture in Children and Adolescents

Review of: Reddihough DS et al, JAMA 2019;322(16):1561–1569 Restrictive, repetitive, and stereotypical behaviors in children and adolescents with autism spectrum disorder (ASD) are a common concern, and there are no FDA-approved medications for their treatment. We know that fluoxetine is effective in the treatment of obsessive-compulsive disorder i

Article

Suicidality and SSRI’s: An Update

From The Carlat Psychiatry Report, Antidepressants in Children

Topics: SSRIs | Suicidality

Just when we thought we could finally dismiss the notion that SSRIs cause suicidal ideation, along came the Brits! On June 10, 2003, the British counterpart of our FDA (in Britain, this is the MHRA--Medicines and Healthcare Products Regulatory Agency) issued a "Dear Colleague" letter announcing that Seroxat (the British version of Paxil) should not be u

Article

Breast-feeding and Antidepressants: An Update

From The Carlat Psychiatry Report, Antidepressants in Pregnancy and Lactation

Topics: Antidepressants | Pregnancy | SSRIs

There’s nothing like a close friend suffering psychiatric difficulties to motivate a psychiatrist to do some serious reading. Recently, your humble editor encountered this situation. The patient is a young woman with no psychiatric history who noted more than a normal amount of anxiety after the birth of her child. She found herself worrying consta

Article

SSRIs in Pregnancy: Third Trimester Concerns

From The Carlat Psychiatry Report, Antidepressants in Pregnancy and Lactation

Topics: Pregnancy | SSRIs

You may not know it, but this year marks a milestone in the world of SSRI teratology research. Ten years ago, JAMA published the first controlled study of Prozac exposure in pregnancy (1). The results? Neither Prozac nor tricyclics caused more birth defects than controls, but both antidepressants caused more neonatal complications. Ten years later, w

Expert Q&A

Dr. Victoria Hendrick on Using Meds in Pregnancy

From The Carlat Psychiatry Report, Antidepressants in Pregnancy and Lactation

Topics: Antidepressants | Pregnancy | SSRIs

TCR: Dr. Hendrick, there has been a lot of confusing and seemingly contradictory data about the safety of SSRIs during pregnancy. What’s your take? Dr. Hendrick: You’re right, it is confusing, but one reassuring and important point is that there is no evidence that the SSRIs or any other antidepressant are linked to an increased risk of congenital

Anecdotes From The Field

An OB/GYN Perspective

From The Carlat Psychiatry Report, Antidepressants in Pregnancy and Lactation

Topics: Antidepressants | Pregnancy | SSRIs

Roseann Gumina, M.D., is an obstetrician/gynecologist in private practice in Milwaukee, Wisconsin. Like most OB/GYNs, Dr. Gumina sees more pregnant women on antidepressants in a given year than most psychiatrists are likely to see in a lifetime, and her perspective is informative. “Generally, most women who have been on SSRIs will have already disc

Research Update

Can Buprenorphine Improve PTSD Symptoms?

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

Review of: Lake EP et al, Am J Addict 2019;28(2):86–91 For many years, the mainstay of treatment for PTSD has been the SSRI class of medications, but many of our patients still suffer crippling symptoms despite optimal antidepressant medication dosing. PTSD is often accompanied by opioid misuse, sometimes in an effort to self-treat the hyperarousal

Article

Treating Sexual Side Effects

From The Carlat Psychiatry Report, Depression

Topics: Antidepressants | Sexual Side Effects | SSRIs

Sexual side effects on SSRIs are so common that psychiatrist David Healy once argued these drugs more reliably lower libido than treat depression. Yet the problem isn’t limited to SSRIs, and it’s not unmanageable. In this article, I’ll look at some useful strategies to manage sexual dysfunction on antidepressants, antipsychotics, and mood stabiliz

Clinical Update

Antidepressants: When Dosage Matters

From The Carlat Psychiatry Report, Thyroid and Mental Illness

Topics: Antidepressants | Depression | SSRIs

When it comes to dosing antidepressants, it’s often assumed that more is better. While this is true for a few meds, most second-generation antidepressants don’t clearly work better at higher doses. In this article, I’ll review the evidence on antidepressant dose-response relationships and the optimal dose ranges for some antidepressants. First-ge

Research Update

Comparison of GI Side Effects of Antidepressants

From The Carlat Psychiatry Report, Therapy

REVIEW OF: Oliva V et al, Prog Neuropsychopharmacol Biol Psychiatry 2021;109:110266 TYPE OF STUDY: Meta-analysis of placebo-controlled trials Antidepressants often cause gastrointestinal (GI) side effects, but it’s not clear which ones are the worst actors. A recent meta-analysis helps to clarify the picture. The investigators searched the li

Expert Q&A

How to Come Off a Psych Med Part 1: Antipsychotics

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

TCPR: There are a lot of books on deprescribing from the antipsychiatry movement, but your book seems to take a different approach.Dr. Gupta: The biggest difference is that the authors of this book all acknowledge that there is a place for psychotropic medications. They can be extremely beneficial for the patient in the right situation. My concern is wi

How to Select an SSRI

From The Carlat Psychiatry Report, Practical Psychotherapy

On March 14, 2012, Lexapro became the last SSRI to lose its patent, closing the book on a quarter century of science and marketing that changed and sometimes confused the way we think about antidepressants. Now that the unpublished studies have come to light and the incentives to favor one drug over another have dried up, it’s a good time to take a so

Expert Q&A

Mood and Menopause

From The Carlat Psychiatry Report, Mood and Menopause

TCPR: When does perimenopausal depression tend to start?Dr. Nonacs: It’s during the transition into menopause that women are most vulnerable to depression. And that transition can actually take quite a while, like 5–7 years. TCPR: How does it present?Dr. Nonacs: Often they’ve had a history of depression, but have done fairly well up to this point

Research Update

Optimal Antidepressant Doses in Major Depression

From The Carlat Psychiatry Report, Bipolar II

Review of: Furukawa TA et al, Lancet Psychiatry;2019;6(7):601–609 Type of study: Systematic review and meta-analysis Most antidepressants do not have a linear response curve. In other words, the benefits level off as the dose goes up. If the dose gets too high, the side effects start to outweigh those diminishing returns. What’s not clear is whe