Neurological effects SSRIs

These data are reassuring, but the studies, although prospective, were not large. The current data suggest that SSRIs are unlikely to produce overt effects on infant development however, subtle effects on neurological and psychological development are hard to exclude (92). 

Withdrawal symptoms in the 2 weeks after sudden discontinuation of citalopram have been examined in a double-blind, placebo-controlled study (24). Withdrawal symptoms were overall mild, but neurological and psychiatric disturbances were 2-3 times as common in patients randomized to placebo than in those randomized to continue with citalopram. The authors pointed out that withdrawal symptoms were particularly common in patients who were randomized to placebo who also had depressive relapses. This shows the difficulty of disentangling the effects of depressive relapse from those of pure treatment withdrawal. However, it is also possible that acute withdrawal of medication induces an abnormal neu-robiological state, in which both depression and abstinence symptoms are more likely to occur. It would be wise to warn patients about the possible effects of missing doses of the shorter-acting SSRIs. 

PROTEASE INHIBITORS SSRIs t adverse effects of fluoxetine, paroxetine and sertraline when co-administered with ritonavir (with or without lopinavir). Cardiac and neurological events have been reported, including serotonin syndrome Ritonavir is associated with the most significant interaction of the protease inhibitors due to potent inhibition of CYP3A, CYP2D6, CYP2C9 and CYP2C19 isoenzymes Warn patients to watch for t side-effects of SSRIs and consider 1 dose ofSSRI... 

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