Antidepressants
Antidepressant medications are often prescribed to treat panic at-tacks, or agoraphobia with panic attacks. There are four different types of antidepressants:
1. Cyclic antidepressants such as Elavil (amitriptyline), Tofranil (imipramine), Pamelor (nortriptyline), Surmontil [trimipramine), Xanax, Desyrel (trazodone), Sinequan (doxepin), Norpramin (desipramine), Vivactil (protriptyline), and Anafranil (clomipramine). According to Mindell and Hopkins, potential side effects or adverse reactions include dry mouth, blurred vision, problems focusing, increased eye pressure that can lead to glaucoma, dilation of the pupils, constipation, dysfunction of parts of the small intestine, urinary problems, drastic dips in blood pressure when going from lying to sitting or from sitting to standing, high blood pressure, heart rhythm abnormalities, congestive heart failure, stroke, electrocardiogram changes hallucinations, disorientation, impaired memory, feelings of unreality, delusions, anxiety, nervousness, restlessness; agitation, panic, insomnia, nightmares, mania, worsening of psychotic symptoms, drowsiness, dizziness, weakness, fatigue, headache, depression, excessive tension in the muscles or artery walls, sleep disorders, psychosomatic disorders, yawning, abnormal dreaming, migraines, depersonalization, irritability and mood swings, numbness, tingling, hyperactivity, lack of coordination, tremors, peripheral neuropathy (nerve changes in legs and arms), seizures, twitching, partial paralysis, allergic reactions (rash, itching, swelling), changes in blood-cell counts, nausea, vomiting, loss of appetite, diarrhea, flatulence, trouble swallowing, strange taste in the mouth, increased salivation, abdominal cramps, inflammation (stomach, throat, or esophagus), black tongue, indigestion, breast development and testicular swelling (in men), breast enlargement, spontaneous flow of milk, vaginitis and menstrual difficulties, changes in sex drive, painful ejaculation, voiding of urine during the night, cystitis, urinary-tract infection, changes in blood glucose levels, increase secretion of hormones (prolactin and vasopressin, an antidiuretic), pharnygitis, laryngitis, sinusitis, coughing, spasm of the breathing airways, nosebleed, shortness of breath, problems speaking, ringing of the ears, excessive tearing of the eyes, conjunctivitis, difference in the size of the pupils, inner-ear inflammation, eye allergy symptoms, nasal congestion, ex-cessive appetite, body-weight changes, increased sweating, high body temperature, flushing, chills, hair loss, dental problems, abnormal skin odor, chest pain, fever, bad breath, thirst, back pain and joint aches, and increased sensitivity to the sun.
Henry, age twenty-two, a college senior, suffered from panic at-tacks. His primary-care physician prescribed Elavil. After two months Henry began to experience confusion, disturbedconcen tration, extreme anxiety, and worry that someone was trying to break into his room and poison him. His roommate took him to the university hospital ER, where he was admitted to the psychiatric unit and diagnosed with schizophrenia. When Henry was taken off Elavil his symptoms disappeared and he was discharged from the hospital. He worked with a cognitive-behavioral therapist on an outpatient basis and learned how to stay calm during stressful school situations.
2. MAO-inhibitors include Nardil (phenelzine), Parnate (tranyl-cypromine), and Marplan (isocarboxazid).These drugs can cause serious or even fatal rises in blood pressure when combined with: (1) foods that contain the amino acid tyramine, such as wine and certain meat; (2) stimulants and antidepressants; (3) over-the-counter medications, such as decongestants. If you are taking an MAOinhibitor, you should be under close supervision by your physician. Be sure to watch for low blood pressure, extreme fevers, sexual dysfunction, daytime sleepiness, nighttime insomnia, muscle pain, and muscle spasms.
3. Selective serotonin reuptake inhibitors (SSRls) include Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine). These drugs are used primarily to treat panic disorder, agoraphobia (six to twelve months), and obsessive-compulsive disorder (long-term maintenance). The SSRls may also be used for generalized anxiety, especially when combined with depression.
According to Mindell and Hopkins, potential side effects include nervousness, insomnia, drowsiness, fatigue, weakness, tremor, increased sweating, dizziness, anxiety (especially with Prozac), headache (especially with Paxil), dry mouth (with Zoloft and Paxil), male sexual dysfunction (Zolofr), altered appetite and weight, and constipation (Paxil), and loss of appetite, nausea, diarrhea, occur at first, many individuals experience weight gain after a period of months, which may lead to obesity.
Over 40,000 reports of adverse effects from Prozac have been submitted to the Food and Drug Administration since it was first marketed. No other drug comes close, according to Breggin and Cohen. They also state that these drugs can produce effects similar to amphetamine or methamphetamine, including an artificial feeling of well-being or energy, anxiety, agitation, and insomnia. Effexor (see below) and Prozac are stimulating, while the others cause drowsiness or insomnia. Like the amphetamines, these drugs can cause manic psychoses, and can also lead to less caring and loving attention to family members, as well as sexual dysfunction with mates.
Withdrawal from xanax can lead to “crashing” into depression and suicidal thoughts and actions. Breggin and Cohen report seeing patients who became very disturbed and violent when dosage was reduced, and others who reported feeling tortured from within, which may be related to the drug’s ability to cause self-destructive or violent behavior.
Numerous suicide and homicide cases have involved individuals who took SSRIs for as little as a few days. Because the drugs can cause agitation and anxiety, they may lead to increased use of alcohol and other calming drugs. SSRIs can cause drowsiness or dizziness. Use caution when driving, performing tasks requiring alertness, or operating machinery.
In research studies, between 15 and 21 percent of those on SSRIs stopped taking them due to unpleasant side effects. Rash, fever, joint pain, abnormal changes in blood-cell counts, swelling, excessive excretion of protein in the urine (indicating liver or kidney damage), and elevated enzymes in the bloodstream (also indicating tissue damage) have occurred in some people taking Prozac. If you are prescribed this drug and experience any of these symptoms, you are probably sensitive to it and should contact your health-care practitioner immediately to stop taking it. If you don’t, you may end up having a life-threatening anaphylactic shock reaction. In these cases the life-threatening nature of the reaction trumps the potential “crashing” reaction.
Connie, a thirty-eight-year-old university professor, was prescribed Prozac for her anxiety about lecturing to large groups of students. When she went to have her annual physical, the lab tests came back positive for liver and kidney damage. Her doctor immediately took her off Prozac and told her never to take the drug again because she was probably sensitive to it.
Serotonin syndrome is caused by taking an overdose of SSRIs or by an interaction of SSRIs with other drugs. It can be fatal. Symptoms include hallucinations, confusion, agitation, fever, fluctuating blood pressure, stiffness, irregular heartbeats, and seizures.
The effects of withdrawal from these drugs can include dizziness, headaches, nausea, poor concentration, fatigue, moodiness, and mental fogginess. Allow at least two weeks to slowly withdraw from these drugs and do it under the supervision of a health-care professional familiar with their use.
Clinical trials of these drugs have only lasted for five to sixteen weeks, except in the case of Prozac, which has been tested for up to a year. In other words, the long-term effects of these drugs have not been studied in any systematic fashion.
Avoid these drugs if you have impaired liver function, tend to be manic, have a history of seizures, or are using diuretics. If you are diabetic, Prozac can affect insulin levels, and your drug dose may need to be readjusted.
