tag:blogger.com,1999:blog-7772182113499451603.post8523087467691542444..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Not Taking AntidepressantsGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-7772182113499451603.post-26914837873056919102017-05-27T15:25:37.116-05:002017-05-27T15:25:37.116-05:00Thanks for the question Simon. In my experience t...Thanks for the question Simon. In my experience the less common adverse events would include:<br /><br />1. Serotonin Syndrome<br />2. Drug Induced Liver Disease<br />3. Rash<br /><br />I do try to thoroughly investigate any symptoms on the review of systems as a possible side effect. To that end, I routinely ask people about a number of symptoms at every visit and research what might be rare side effects while they are sitting in my office. I use Drug Facts and Comparisons for that purpose and will haul out the book and look up any rare side effects that are typically listed by symptom (+/- control comparisons) and/or system. I never doubt that a rare symptom could be present in the patient even though it is not in my reference. As I have previously posted, I encourage people not to tolerate any side effects and discontinue any antidepressants at the first sign of toxicity. I advise people that they should not "get used to" side effects.<br /><br />I hope to roll out a couple of posts soon on a Serotonin Syndrome handout that can be given to people to prevent problems. With this syndrome the diagnosis is problematic because the threshold for the diagnosis encompasses people who are having significant but typical serotonin related side effects and are at low risk for the full blown syndrome if the medication is immediately discontinued. The problem is that some of the research asks people for two symptoms and in doing so estimated the incidence at 1-2 people/10,000. To me that would more likely be the estimate of people with severe side effects from SSRI and SNRIs, but I don't consider the research to be that vigorous.<br /><br />The other post will be a medical review of systems (ROS) that I have developed over the years. Many EHR have a psychiatric review of systems that is worthless for anything other than billing and coding bullet points.<br /><br />When prescribing these medications or any FDA approved medications for that matter it is important to take into account that side effects and adverse effects are not vigorously investigated. That introduces a bias that physicians focus on positive effects and I think that is especially true in training. In the real world, identifying rare side effects and life threatening side effects is at least as important. In psychiatry, we don't treat people who are going to die from a medical cause so that risk benefit equation shifts to doing much less potential harm than other specialists. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-44631715916741561842017-05-26T22:36:50.177-05:002017-05-26T22:36:50.177-05:00George what do you find are some of the less commo...George what do you find are some of the less common adverse effects with SNRIs vs SSRIs?<br /><br />-SimonSimonhttps://www.blogger.com/profile/00479654709456729629noreply@blogger.com