Safety psychotropic agents

It would be useful for pharmaceutical physicians to have some examples of medical products that have been the subject of serious adverse reactions requiring regulatory action. In the following subsections a number of products have been selected that illustrate different drug safety problems. Major attention has been paid to psychotropic agents because they are widely used and have been the subject of regulatory evaluation and action over the past several years which has resulted in restrictions to use and in some cases withdrawal from the market. 

A related issue is that many psychotropics are known to lower the seizure threshold. Therefore increased care is warranted when these agents are used in conjunction with TMS. However, Turnier-Shea and colleagues (213) reviewed their experience with 82 patients on various medication combinations who also received a total of 986 TMS treatments. There were no seizures reported, and the authors suggest that the concomitant use of some antidepressants and TMS should not be prohibited. Here, SF-rTMS may be preferable to HF-rTMS given that most reports of seizures involved the latter approach and because SF-rTMS may induce neuronal inhibition rather than excitation (191, 205). Imaging and EEG data in combination with clinical studies should provide more information about the effectiveness and safety of different frequencies. 

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