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Post by Admin on Sept 28, 2015 18:41:15 GMT -4
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Post by Ajay Varughese MS3 on Sept 30, 2015 11:43:51 GMT -4
This article brings to light the topic of 5HT discontinuation syndrome which manifests as dizziness, anxiety, irritability, panic attacks, mood lability, decreased concentration, and Gi symptoms. According to an article I read online by Psychiatry Weekly 34.5% of patients experienced adverse reactions to abruptly stopping Paroxetine versus 13.5% of patients abruptly stopping a placebo which was measured using the DESS rating scale( discontinuation emergent signs and symptoms). From my understanding the brain is not fully developed by age 25 so are teenagers more prone to adverse reactions from Paxil than the general population? This article states that some teenagers experienced suicidal ideation after stopping the medication and in my opinion this medication shouldn't have been approved initially due to the drugs already increased propensity to have adverse reactions. In conclusion, in my opinion there should be adequate and more comprehensive screening to prevent such reactions from withdrawal of SSRI's. It's good that clinicians were able to withdraw Paxil but will this affect the credibility of those who approved the drug in the first place and its maker? We will have to see. In the mean time hopefully there will be a domino effect of checking and rechecking medications that were initially deemed safe.
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Post by Peter Nowd on Sept 30, 2015 20:24:01 GMT -4
The article in the New York Times, “Antidepressant Paxil Is Unsafe for Teenagers, New Analysis Says” raises many concerns regarding how medical research is conducted. And this article details how the drug Paxil to treat depression may be dangerous for teenagers. There are multiple reasons for why researchers have come up with this conclusion. Many teenagers who stop taking Paxil may go through harsh withdrawals and many cases become violent. Thus, if a patient is not compliant with Paxil, this could lead to poor outcomes. Furthermore, the exact sciences of the effects of Paxil in the growing brain are unknown. Introducing chemical changes while the brain is still maturing could have drastic side effects on the patient. This article demonstrates the importance of a multifactorial peer-reviewed research program that utilizes all data provided from dissimilar prospective from different researches to come to a conclusion regarding medication safety.
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Post by Ramin Ahmad on Sept 30, 2015 20:39:22 GMT -4
From reading this article, I found that the new research on Paxil is an interesting way to raise awareness on other drugs and there adverse reactions on the market. For example, the drug Alendronate which belongs to the class of drugs called Bisphosphonates are first line treatment for osteoporosis. Bisphosphonates adverse effects are esophagitis, osteonecrosis of the jaw, atrial fibrillation, and osteomalacia. All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. In the terms of this article, patients who are given medication with serious side effect profiles should be watched closely with monthly follow ups. This article brings up a very pertinent point on stopping a medication suddenly. Patients should be educated on the withdrawals that they may experience. I believe there should be more extensive research done on the manipulation of neurotransmitters and there effects on teenagers.
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Post by Veneetha Malakkla on Sept 30, 2015 21:34:46 GMT -4
This article is interesting. Medical research is always improving and changing. It’s critical to be updated with the current medical research. The article mentions that a “reanalysis of a 2001 study found that, Paxil, the antidepressant, is not safe for teenagers.” It claims that there have been potential suicide risks for adolescents and children but less risky in adults that are over 25 years old. I feel that when we are younger we are still growing and learning to mature. Younger patients are more likely to be medication non-compliant and therefore it increases the risk of withdrawals due to inadequately being tapered off and leads to more incidences of suicides. This article brought up some very interesting points and we as clinicians need to be mindful and aware of this topic but I also believe we should continue further medical research regarding this statement.
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Post by arijanasabic on Sept 30, 2015 22:27:56 GMT -4
This article is interesting as it sheds light on how research for new drugs is conducted and how easy it is to have a drug FDA approved. I believe it is very important to re-analyze many studies of drugs that are on the market now as our understanding of the drug’s mode of action and the human brain is growing each day. Even though studies on Paxil’s effect have been positive, it is still important to consider how this drug affects not only the human brain, but a growing/immature brain. Just because something may be beneficial, it should not be used if it puts children and teenagers in danger of withdrawals or serotonin syndrome, especially when these can be avoided by using other drugs which may not be as hazardous to an immature brain as Paxil. I believe the scientific world should spend more time re-analyzing drugs that have been on the market for a long time, as our understanding and knowledge of brain chemicals has grown and may prevent numerous side effects that individuals face each time they take a psychiatric medication. We should aim to improve the medications and minimize the side effects, instead of looking to make money by offering medications such as Paxil to our children and teenagers, which have been proven to cause more harm than good.
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Post by Gily Raz on Sept 30, 2015 22:38:49 GMT -4
At the core of Medicine should always be evidence-based research. As such, Medicine is in a constant state of checks and balances, to which providers must learn to rapidly adapt. Old evidence is constantly replaced by new, and we must remain up to date with treatment recommendations so as to amend our patient management. The New York Times article on Paxil published this week serves as another reminder that although current drugs on the Market and approved by the FDA are the 'best we've got,' they remain largely controversial. That said, reading the actual research study from 2001, and also the one published in 2015 would be particularly interesting, especially to compare the power of each study, the statistical significance, and possible errors. Yet still, the concept of suicidal ideation as an adverse effect of anti-depressant medications remains an interesting topic, serving as a sort of "chicken or the egg" argument -- does Depression breed Suicidal ideation, or is it instead the weaning off of anti-depressants and subsequent neurotransmitter fluctuations that is the culprit? Perhaps the answer lies in the individual hormone fluctuations themselves: increase in cortisol levels, decrease in serotonin, etc.
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Post by Ramez Ghanbari on Sept 30, 2015 23:54:01 GMT -4
The field of psychiatry is highly dependent on evidence-based medicine. Whether it was the introduction of Paxil in early 1990s, ketamine infusion or deep brain stimulation in recent years, in treating major depression, these groundbreaking approaches have significant positive impact in the field. I am neither part of the collaborators who wrote the original paper, Keller et al., 2001, nor involved in the group that reanalyzed the same data recently. But, although it is a good idea to go back reassess and “self-correct”, ourselves as the author suggests, we have to keep in mind that most studies could have a totally different outcome depending on the type of analytic measures, statistics, being used – this is highly dependent on the method of analysis. As for suicidal ideations that were experienced by patients, we see this specially a few weeks after the introduction of SSRIs. This is due to the fact that a lot of these patients improve in their secondary symptoms, such as energy levels. But, they still have core symptoms of depression, suicidal ideations. So, the result is a patient with an elevated energy level, but still with suicidal ideations. As you can imagine, this period of treatment becomes very important, and demands a special attention. This is no surprise that these medications come with black-box warnings.
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Post by Travina Varghese on Oct 1, 2015 7:05:18 GMT -4
Another interesting read for this week.
Re-analysis of a study completed 14 years ago showed that Paxil is unsafe for teenagers. Evidence-based medicine often dictates medical practice for various illnesses. Our understanding of the human body and mind is ever evolving. With this new understanding, it becomes imperative to conduct new trials and reanalysis of older trials to ensure that the medications prescribed and the practices followed are safe and appropriate.
We often educate patients when starting them on medications of the possible side effects as well as how to cope / counteract those side effects. However, non-compliance, suddenly stopping a medication without appropriate tapering, binge drinking of alcohol, illicit drug abuse – each of these can have an effect on the human brain that is not fully-developed, and these possibilities are common among late teens and early adults (population younger than 25 years). Clinicians should continue to closely watch patients as medications and dosages are altered, while consistently counseling and encouraging patients to be compliant and steer clear of behaviors that will negatively interact with their medications and place them at risk of serious side effects.
Paxil has one of the higher incidences of SSRI withdrawal syndrome when stopped suddenly. And with such a high risk of suicidal thoughts and suicidal behavior in teenagers, it makes sense to pause and re-evaluate.
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Tatjana Radmilovic MS3
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Post by Tatjana Radmilovic MS3 on Oct 1, 2015 10:33:01 GMT -4
Reading this article how antidepressant Paxil is unsafe in teenagers was to me slightly unclear. It was missing some important facts of exactly “how” the drug creates this dangerous side effect. One of the things I wished this article talked about is cultural background of their participants. I do believe teenagers from United States of America differ from the teenagers such as England, France, China and etc. Additionally, I would like to know what type of environment these teenagers are being raised such as do they come from two parents or single parent household? What is the highest completed education level inside the home their live at. Is there a genetic or physiological component? Once we understand all these cultural and social background, only then I believe we can start discussing how Paxil is unsafe in teenagers.
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Alicia Capilla Crespillo
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Post by Alicia Capilla Crespillo on Oct 1, 2015 11:53:31 GMT -4
It is interesting that 14 years ago a study showed that antidepressant Paxil was safe and effective for teenagers and that a current new analysis concludes exactly the opposite. Who is telling the truth? Which analysis is more accurate and reliable? This article makes me think beyond paxil, what would happen if nowadays new analysis said that several “safe drugs” are ineffective and useless ?
This is not only about science but also about huge pharmaceutical companies and their interests, and personally, I believe this is a really BAD combination. Clinical studies are supposed to be the key to prove and demonstrate that a drug is effective, secure and better than other drugs already in the market. But there is always a little trap that researchers can use to embellish the results. As an example from the article, <Dr. Healy said that five of six adverse events labeled “emotional lability” in the original study involved suicidal thinking or behavior>. Sure! If people saw suicidal behavior instead of emotional liability (a really ambiguous word), who would dare to take the pill to treat their depression if the medication itself makes you feel miserable?
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Post by Paul Moody on Oct 1, 2015 12:11:36 GMT -4
This article shows that the science of medicine is always changing! I believe the practice of revisiting past research and continuing new research is invaluable to the practice of medicine. Although this specific article should shine a light on a larger notion which in my opinion is the over use of antidepressants in adolescence. Many "normal" life experiences are shared across generations and are not always pleasant. However I feel that many times when life is "hard" for our patients that as providers we can be to quick to reach for pharmaceutical relief! I believe the use of antidepressants in adolescence is very important but should be very limited. So concerning this article I believe it is great to revisit research and correct any mistakes that may have been made. I do however believe there is a larger discussion that needs to take place regarding the use of these medications as a whole.
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Post by Nicole Tipton MS3 on Oct 1, 2015 14:04:39 GMT -4
Paxil is an antidepressant that is commonly used to treat depression in teens and children. Paxil had never been approved as a treatment for pediatrics so it has been used off-label. Recently the FDA put out a statement that the use of paxil in teens has led to suicide in this population. There are many different theories on why this medication can cause an increase in suicide. First of all, the antidepressants can start having symptomatic changes to such as more sleep, increase energy but the depressed mood can take up to 4 month to take effect. This increase of energy will then lead to the energy to actually commit suicide. This warning brought to the forefront the importance of keeping up with medicine and making sure as a physician we know the standard of care.
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Post by Ibtesam Haider on Oct 1, 2015 14:44:24 GMT -4
Medicine is an ever-changing field of science which requires evidence-based research to validate studies. Facts and data are imperative to support hypotheses and this particular case study is no different when it comes to drug approval and safety. If an antidepressant is a stimulant which can cause manic episodes where it has extreme side effects, then it needs to be monitored carefully. Patients under a medication such as Paxil needed to be on follow up appointments and psychotherapies so their progress was monitored very closely because the “secondary measures” which were improved might have brought about unnecessary and unwanted risks on the test subjects. If new studies are disputing older results, Paxil should not be given to adolescents who are experiencing suicidal and homicidal ideations as major side effects – with some actually succeeding in carrying out their plans. Moreover, it was documented that these unexplained side effects started manifesting soon after taking Paxil or while becoming addicted to it, so an educated conclusion can be reached by stating that the drug atleast had a part to play in these side effects, if not completely responsible for it.
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Post by Tanzina Nowrin on Oct 1, 2015 15:58:49 GMT -4
This is an eye opening article which proves that, statistical datas are used in many ways to gain favorable opinion, decisions and approval. During the eight weeks trial, the Paxil group did not perform well compare to the other two groups who were taking placebo pills and Imipramine, against depression questionnaire which was the main focus of the study. However; the proponent of Paxil argues that Paxil did better in the “secondary” measures. Secondary measures were not as strong as the primary measure and were inconclusive. Researcher sometimes skewes data and ignore unfavorable data in order to get the medicine on the market. I think its time to reevaluate the earlier study and find the effectiveness of Paxil by looking into the patient level data. It would be also beneficial if all the finding of a trial are made public before a medicine is approved by FDA and prescribed by the doctors.
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