Psycho-Babble Medication Thread 89439

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SSRIs could cause strokes?

Posted by manowar on January 9, 2002, at 12:10:54

Hi guys,
Seriously, my intention is not to freak anyone out, but the article below came out today from PsychiatryMatters.MD. The article provided a link to this article in Neurology.org. Here's the link if you want to view it-- http://www.neurology.org/cgi/content/abstract/58/1/130

Here's a quote taken from the "Neurology" article:
"Serotonin (5-hydroxytryptamine) is a potent vasoconstrictor amine."

I've never heard about that before. I always knew that SSRIs cause headaches for some people (me incl.), but no one ever told me that SSRIs had vasoconstrictor properties.

If you experience headaches while taking SSRIs, this may be a concern. You may want to talk to your doctor.

I hope this article is wrong, because so many people depend on SSRIs, but I strongly believe that everyone should be an informed consumer.

If anyone thinks I was irresponsible to put this info on "Psycho-babble", I'm sorry, but dammit, I'm tired of being lied to. Remember this one--"SSRIs only cause sexual dysfunction in 5% of patients" (I think they said 5%-it could have been 15%), when the truth was that SSRIs cause dysfunction in almost half of the people that take them.

Anyway, this is the article from PsychiatryMatters.MD--

09 January 2002

Serotonergic drugs 'could cause strokes'
People who take serotonin-enhancing drugs, including some antidepressants, decongestants, dieting pills, and the class A drug ecstasy, may be at increased risk of suffering a stroke, the findings of a case study suggest. The researchers urge doctors to ask patients if they have been using these drugs before commencing treatment.

The team, led by Aneesh Singhal, from Massachusetts General Hospital, Boston, reports in the journal Neurology on patients who experienced severe headaches, seizures and stroke after taking multiple serotonergic drugs for complaints such as depression, obesity, and migraine.

The first, a woman, experienced a 'worst ever' headache and blurred vision two days after taking an over-the-counter decongestant while taking the selective serotonin reuptake inhibitor sertraline, together with trazodone, thioridazine, clonazepam, and a treatment for asthma.

Another woman experienced an 'explosive' headache and nausea after taking a similar cold remedy on top of the SSRI paroxetine and clonazepam.

Imaging tests performed after the symptoms began revealed that both women had suffered several strokes. The researchers realized that the strokes were due to narrowing of blood vessels in the brain, presumably by the serotonin-enhancing drugs. After discontinuation of the drugs the headaches subsided, and over the following three months there was gradual normalization of cerebral blood flow.

'At presents our data suggest that it may be important to question individuals taking serotonergic drugs about the development of sudden-onset headaches,' the authors stress. 'If vasoconstriction is suspected, serotonergic agents should be discontinued.'

Peace,

Tim

 

Re: SSRIs could cause strokes?

Posted by cmcdougall on January 9, 2002, at 12:38:19

In reply to SSRIs could cause strokes?, posted by manowar on January 9, 2002, at 12:10:54

I had a significant increase in the frequency of migraine headaches while on EffexorXr. I took effexor for 18 months and had 1-3 migraines per week. Stupid me - since I was used to having migraines I never connected the increase to my effexor use. Since getting off the effexor my migraines (also shoulder and neck pain) have been greatly reduced. I now only have a 'bad' (confined to bed) migraine 2 or 3 times per month, the 'knots' under my shoulder blades are completely gone, and my stiff neck is MUCH improved.

Weird thing is, effexor is touted as a migraine prophylactic. Huh!

My last MRI showed several white spots. The neuro said he couldn't tell if they were from little strokes or migraines. GREAT! We have to take these drugs so we don't feel like killing ourselves, then we have to worry that the drugs might kill us.....


> Hi guys,
> Seriously, my intention is not to freak anyone out, but the article below came out today from PsychiatryMatters.MD. The article provided a link to this article in Neurology.org. Here's the link if you want to view it-- http://www.neurology.org/cgi/content/abstract/58/1/130
>
> Here's a quote taken from the "Neurology" article:
> "Serotonin (5-hydroxytryptamine) is a potent vasoconstrictor amine."
>
> I've never heard about that before. I always knew that SSRIs cause headaches for some people (me incl.), but no one ever told me that SSRIs had vasoconstrictor properties.
>
> If you experience headaches while taking SSRIs, this may be a concern. You may want to talk to your doctor.
>
> I hope this article is wrong, because so many people depend on SSRIs, but I strongly believe that everyone should be an informed consumer.
>
> If anyone thinks I was irresponsible to put this info on "Psycho-babble", I'm sorry, but dammit, I'm tired of being lied to. Remember this one--"SSRIs only cause sexual dysfunction in 5% of patients" (I think they said 5%-it could have been 15%), when the truth was that SSRIs cause dysfunction in almost half of the people that take them.
>
> Anyway, this is the article from PsychiatryMatters.MD--
>
> 09 January 2002
>
> Serotonergic drugs 'could cause strokes'
> People who take serotonin-enhancing drugs, including some antidepressants, decongestants, dieting pills, and the class A drug ecstasy, may be at increased risk of suffering a stroke, the findings of a case study suggest. The researchers urge doctors to ask patients if they have been using these drugs before commencing treatment.
>
> The team, led by Aneesh Singhal, from Massachusetts General Hospital, Boston, reports in the journal Neurology on patients who experienced severe headaches, seizures and stroke after taking multiple serotonergic drugs for complaints such as depression, obesity, and migraine.
>
> The first, a woman, experienced a 'worst ever' headache and blurred vision two days after taking an over-the-counter decongestant while taking the selective serotonin reuptake inhibitor sertraline, together with trazodone, thioridazine, clonazepam, and a treatment for asthma.
>
> Another woman experienced an 'explosive' headache and nausea after taking a similar cold remedy on top of the SSRI paroxetine and clonazepam.
>
> Imaging tests performed after the symptoms began revealed that both women had suffered several strokes. The researchers realized that the strokes were due to narrowing of blood vessels in the brain, presumably by the serotonin-enhancing drugs. After discontinuation of the drugs the headaches subsided, and over the following three months there was gradual normalization of cerebral blood flow.
>
> 'At presents our data suggest that it may be important to question individuals taking serotonergic drugs about the development of sudden-onset headaches,' the authors stress. 'If vasoconstriction is suspected, serotonergic agents should be discontinued.'
>
> Peace,
>
> Tim

 

Re: SSRIs could cause strokes?

Posted by OldSchool on January 9, 2002, at 14:05:26

In reply to SSRIs could cause strokes?, posted by manowar on January 9, 2002, at 12:10:54

> Hi guys,
> Seriously, my intention is not to freak anyone out, but the article below came out today from PsychiatryMatters.MD. The article provided a link to this article in Neurology.org. Here's the link if you want to view it-- http://www.neurology.org/cgi/content/abstract/58/1/130
>
> Here's a quote taken from the "Neurology" article:
> "Serotonin (5-hydroxytryptamine) is a potent vasoconstrictor amine."
>
> I've never heard about that before. I always knew that SSRIs cause headaches for some people (me incl.), but no one ever told me that SSRIs had vasoconstrictor properties.
>
> If you experience headaches while taking SSRIs, this may be a concern. You may want to talk to your doctor.
>
> I hope this article is wrong, because so many people depend on SSRIs, but I strongly believe that everyone should be an informed consumer.
>
> If anyone thinks I was irresponsible to put this info on "Psycho-babble", I'm sorry, but dammit, I'm tired of being lied to. Remember this one--"SSRIs only cause sexual dysfunction in 5% of patients" (I think they said 5%-it could have been 15%), when the truth was that SSRIs cause dysfunction in almost half of the people that take them.
>
> Anyway, this is the article from PsychiatryMatters.MD--
>
> 09 January 2002
>
> Serotonergic drugs 'could cause strokes'
> People who take serotonin-enhancing drugs, including some antidepressants, decongestants, dieting pills, and the class A drug ecstasy, may be at increased risk of suffering a stroke, the findings of a case study suggest. The researchers urge doctors to ask patients if they have been using these drugs before commencing treatment.
>
> The team, led by Aneesh Singhal, from Massachusetts General Hospital, Boston, reports in the journal Neurology on patients who experienced severe headaches, seizures and stroke after taking multiple serotonergic drugs for complaints such as depression, obesity, and migraine.
>
> The first, a woman, experienced a 'worst ever' headache and blurred vision two days after taking an over-the-counter decongestant while taking the selective serotonin reuptake inhibitor sertraline, together with trazodone, thioridazine, clonazepam, and a treatment for asthma.
>
> Another woman experienced an 'explosive' headache and nausea after taking a similar cold remedy on top of the SSRI paroxetine and clonazepam.
>
> Imaging tests performed after the symptoms began revealed that both women had suffered several strokes. The researchers realized that the strokes were due to narrowing of blood vessels in the brain, presumably by the serotonin-enhancing drugs. After discontinuation of the drugs the headaches subsided, and over the following three months there was gradual normalization of cerebral blood flow.
>
> 'At presents our data suggest that it may be important to question individuals taking serotonergic drugs about the development of sudden-onset headaches,' the authors stress. 'If vasoconstriction is suspected, serotonergic agents should be discontinued.'
>
> Peace,
>
> Tim

Keep in mind this is just one study. There are a gazillion studies out there on everything under the sun. You can always find one study to contradict another study. Furthermore, many "studies" are poorly done and slanted or biased by the people who did them. This is a particularly bad problem in the field of mental illness research where subjective psychology based methods of diagnosis are used.

There are many, many people who are personally biased against the use of psychiatry medications to begin with. This personal bias may show up in many so called "studies" you read about that relate to these medications, but in subtle ways.

I dont put a lot of stock in many "studies" done in psychiatry related stuff. For example in this study I could come back and say that increasing serotonin decreases headaches and makes irritated blood vessels in the head relax. This has been my personal experience. Ive found that SSRIs oftentimes cause headaches in the first week or two Im on them, but this subsides and then the increased serotonin makes headaches go away.

Also, since SSRIs have a calming, relaxing or anti-anxiety effect on many people the chances of them having a stroke would probably be lower.

Old School

 

Re: SSRIs could cause strokes?

Posted by Kat26 on January 9, 2002, at 16:51:53

In reply to Re: SSRIs could cause strokes?, posted by OldSchool on January 9, 2002, at 14:05:26

Yikes, I hope this study isn't right! I have had more headaches still taking Prozac (for about a year now). I remember just one occasion where I had a REALLY STRONG headache, and felt nauseous etc... hey maybe that was a stroke??? I don['t think so, though. was trying to remember if I had taken any over the counter drug that day, but I don't think I have. I only remember eating something that really made me feel nauseous (a more likely cause).
Also... since I have been on Prozac, I bruise more easily, it seems to me. My blood was checked etc... seems to be ok. I just don't take Aspirin for my eadaches now, because that makes the bruising worse. I take Tylenol.

Kat

 

Re: SSRIs could cause strokes? » OldSchool

Posted by manowar on January 9, 2002, at 17:18:23

In reply to Re: SSRIs could cause strokes?, posted by OldSchool on January 9, 2002, at 14:05:26

Hi Old School,

Yeah, of course you’re right. Everyone is different, and responds to meds differently. AND-this is not from a study at all, really. It seems that it is just based on observations from a few Neurologists that-- based on some clinical cases, are concerned that serotonergic drugs COULD cause strokes.

Here is part of the article from “Neurology”:
--Note: I’ve inserted the numbers as references.
*******************************
Cerebral vasoconstriction and stroke after use of serotonergic drugs
A. B. Singhal, MD, V. S. Caviness, MD, A. F. Begleiter, MD, E. J. Mark, MD, G. Rordorf, MD and W. J. Koroshetz, MD
From the Departments of Neurology (Drs. Singhal, Caviness, Begleiter, Rordorf, and Koroshetz) and Pathology (Dr. Mark), Massachusetts General Hospital, Boston, MA.
Address correspondence and reprint requests to Dr. A.B. Singhal, Stroke Service, VBK-802, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; e-mail: asinghal@partners.org

1) Serotonin (5-hydroxytryptamine) is a potent vasoconstrictor amine. The authors report three patients who developed thunderclap headache, reversible cerebral arterial vasoconstriction, and ischemic strokes (i.e., the Call–Fleming syndrome). 2) The only cause for vasoconstriction was recent exposure to serotonergic drugs in all patients, and to 3) pseudoephedrine in one patient. 4) These cases, and the literature, suggest that the use of serotonin-enhancing drugs can precipitate a cerebrovascular syndrome due to reversible, multifocal arterial narrowing.
*******************************************
Again, above is a copy of part of the article from “Neurology”. I’ve used the numbers, to be able to refer to the sentences from the above article.

Some points of concern and a few questions:

1) “Serotonin (5-hydroxytryptamine) is a potent vasoconstrictor amine”
--This seems to be more a statement of fact than an opinion or an assumption. That concerns me. Why haven’t we --as patients been informed this in the past? Or, is that something that has slipped me, which everyone else knows?

2) “The only cause for vasoconstriction was recent exposure to serotonergic drugs in all patients, and to pseudoephedrine in one patient.”
--This seems to be another statement of fact. I wouldn’t know how the writer of the article came to his conclusion, but he seems to be very sure of himself.
(Of course, what doctor IS NOT sure of himself-even if he is WRONG? I've yet to meet him/her. hehehe)

3) What is pseudoephedrine?

4)”These cases, and the literature, suggest that the use of serotonin-enhancing drugs can precipitate a cerebrovascular syndrome due to reversible, multifocal arterial narrowing.”
--Pretty strong statement- huh?

AND-- what do they mean "and the literature"--is there literature out there that suggest that the use of serotonin-enhancing drugs can precipitate a cerebrovascular syndrome due to reversible, multifocal arterial narrowing?

Question: what is cerebrovascular syndrome? Is that just a fancy name for a stroke?

Question 2: What is multifocal arterial narrowing? Does that just mean that in many areas of the brain, the blood vessels constrict?

Of course, these journal articles are not for public consumption. I happen to get the journals because I like to be ‘in the know’ as much as possible. I don’t think this article from “Neurology” or the article from “PsychiatryMatters.MD” was intended to startle anyone. They are just published to raise awareness to other physicians, that there COULD be a problem based on un-controlled studies.

I would doubt very seriously, though, that there would be a bias against serotonergic agents by a group of Neurologists.

Just a thought: I don't know anything about 'vasodilators', but maybe could they be considered while taking SSRIs?

--Tim


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