SSRIs seizures caused

These adverse effects bear some similarity to those of the SSRIs. Although these adverse effects rarely require discontinuation, aggravation of psychosis and seizures caused by this agent do (427, 462, 463 and 464). In contrast to the SSRIs and venlafaxine, bupropion usually does not cause sexual dysfunction. As such, bupropion may be an alternative for patients bothered by these adverse effects (465). Bupropion may also be a useful antidote for SSRI-induced sexual dysfunction (4 53, 455, 466, 467). 

Newer antidepressants (eg, fluoxetine, paroxetine, citalopram, venlafaxine) are mostly SSRIs and are generally safer than the tricyclic antidepressants and monoamine oxidase inhibitors, although they can cause seizures. Bupropion (not an SSRI) has caused seizures even in therapeutic doses. Some antidepressants have been associated with QT prolongation and torsade de pointes arrhythmia. SSRIs may interact with each other or especially with monoamine oxidase inhibitors to cause the serotonin syndrome, characterized by agitation, muscle hyperactivity, and hyperthermia (see Chapter 16). 

There is a large evidence base for the antidepressant efficacy of venlafaxine, but fewer studies have been carried out in anxiety disorders. The best evidence is for GAD (Allgulander et al. 2001) and anxiety symptoms associated with depression (Silverstone and Ravindran 1999). Side-effects on initiation of therapy are similar to those of SSRIs, with nausea being the most common. Higher doses can cause raised blood pressure. A discontinuation syndrome similar to that seen with SSRIs has been reported. Toxicity causes cardiac conduction problems, seizures and coma, and venlafax-... 

In general, SSRI doses of 50 to 75 times the common daily doses result in minor symptoms. Higher doses cause serious symptoms of seizure, arrhythmias, and decreased consciousness only doses greater than 150 times the common daily therapeutic dose can result in death (Barbey and Roose, 1998). Overdose in combination with alcohol or other drugs increases toxicity and accounts for most fatalities involving the SSRIs. Nevertheless, compared to TCA medications, which annually results in 100 to 150 fatal overdoses reported to the American Association of Poison Control Centers (AAPCC), the SSRI agents accounted for only 16 fatal overdoses reported to that organization between 1987 and 1996 (Barbey and Roose, 1998). 

SSRIs cause a wide range of neurological impairments. Spigset (1999) found the following neurological reports in order of frequency parethesias, headache, dizziness, tremor, seizures, acute dystonia, dyskinesia, muscle cramps, muscle weakness, parkinsonism, muscle stiffness, akathisia, myoclonus, extrapyramidal reactions, increased muscle tone, and migraine. There have been reports of irreversible tardive dyskinesia caused by SSRIs (see subsequent section). 

Bulimic patients have a low mortality rate, but they may suffer the consequences of electrolyte disturbances if they engage in frequent and/ or aggressive purges. The electrolyte disturbances can cause fatigue, seizures, and death in extreme cases. Unlike anorexia nervosa, studies have shown that specific treatments can be effective in bulimia nervosa. Cognitive-behavioral therapy (CBT) is one such intervention, with reported remission rates of 25-50% for bulimic patients (Walsh, 2001). The most effective medications are the SSRIs, which typically require antiobsessional doses to be effective. Often the therapist will want to start with CBT, and if this is not sufficiently effective alone, then consultation can be obtained to add an SSRI to the treatment regimen. 

LITHIUM SSRIs Lithium may enhance the pharmacologic effects of SSRIs and potentiate the risk of serotonin syndrome. Excessive somnolence has been reported with fluvoxamine. However, there are reports of both T and l plasma concentrations of lithium. There are reports of lithium toxicity and of serotonergic effects Lithium is a direct stimulant of 5-HT receptors, while SSRIs i the reuptake of 5- HT these are considered to t the effects of serotonin in the brain. Seizures are a neurotoxic effect of lithium and could occur even with plasma lithium concentrations within the normal range. SSRIs and lithium may have additive effects to cause seizures Be aware of the possibility of serotonin syndrome. Also need to monitor lithium levels with appropriate dose adjustments during co-administration > For signs and symptoms of serotonin toxicity, see Clinical Features of Some Adverse Drug Interactions, Serotonin toxicity and serotonin syndrome... 

A potentially fatal serotonin syndrome with high fever, seizures, and coma, analogous to that caused by SSRIs and MAOIs, can occur with clomipramine and SSRIs, presumably... 

Limited effectiveness and toxicity are the major reasons for switching a patient from one antidepressant drug to another. SSRIs are sometimes superior to tiicychcs in their clinical efficacy, and in this case amitriptyline had not proved effective after a reasonable trial (8 weeks). At that time, the depressive symptoms in this patient included feelings of worthlessness and possibly suicidal ideation. Tricyclic overdose is especially dangerous in depressed patients, who often use medications close at hand in attempting suicide. Ingestion of just a 2-week supply of amitriptyline can cause severe hypotension, cardiac arrhythmias, seizures, coma, and death ( one-prescription lethal ). 

A. Central nervous system. The usual presentation after overdose includes ataxia, sedation, and coma. Respiratory depression may occur, especially with co-ingestion of alcohol or other drugs. These agents, particularly bupropion, can cause restlessness, anxiety, and agitation. Tremor and seizures are common with bupropion but occur occasionally after overdose with an SSRI. 

Some, but not all, reports indicate that carbamazepine serum levels can be increased by fluoxetine and fluvoxamine. Toxicity may develop. Citalopram, paroxetine and sertraline do not normally affect carbamazepine, but there is an isolated case of raised carbamazepine levels with sertraline. Citalopram, paroxetine and sertraline levels may be reduced by carbamazepine. The use of carbamazepine with an SSRI has, rarely, led to effects such as hy-ponatraemia, the serotonin syndrome, and parkinsonism. Consideration should be given to the fact that SSRIs have been known to cause seizures. 

Tramadol may cause seizures and SSRIs can reduce the seizure threshold, thus if both are taken together the risk is increased. The serotonin syndrome , (p.9), seems to develop unpredictably in some patients given two or more serotonergic drugs (in this case, tramadol and SSRIs). 

Relative history of seizure disorder, bipolar disorder (may induce mania), urinary retention, narrow-angle glaucoma, delirium, hyperthyroidism, bradycardia (or drugs that cause bradycardia), or electrolyte disturbance (esp. K+ or Mg ). Use caution in conjunction with other antidepressants (including MAOIs and SSRIs), other anticholinergic medications, drugs that increase plasma levels (phenothiazines, haloperidol, cimetidine), or drugs that lower seizure threshold (esp. tramadol). Use caution in elderly, children/adolescents. 

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