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An expert, independent second opinion on more than 1,800 prescription drugs, over-the-counter medications, and supplements

Selective Serotonin Reuptake Inhibitors (SSRIs)


DISEASE AND DRUG FAMILY INFORMATION
Depression: When are Drugs Called For And Which Ones Should You Use?
Ironically, one of the kinds of depression that should not be treated with drugs is depression caused by other kinds of drugs. If someone is depressed and the depression started after beginning a new drug, it may well be drug-caused. Commonly used drugs known to cause depression include the following:

DRUG AND DIETARY SUPPLEMENT PROFILES

A comprehensive review of the safety and effectiveness of this drug. If the drug is not a Do Not Use product, information on adverse effects, drug interactions and how to use the medication are included.

paroxetine mesylate (BRISDELLE)
  • We list this drug as Do Not Use because it has questionable benefits for women with hot flashes but carries well-established risks, including depression.

WORST PILLS, BEST PILLS NEWSLETTER ARTICLES
Some SSRIs May Increase Arrhythmia Risk for Older Patients
April 2024
Learn about a recent study that found that the common antidepressants escitalopram (LEXAPRO and generics) and citalopram (CELEXA and generics) may increase the risk of arrhythmia (irregular heartbeat) in older adults taking the recommended dose. The drugs belong to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).
Drug Interactions for the Antidepressant Drug Desipramine (NORPRAMIN)
September 2023
Patients taking the oral antidepressant drug desipramine (Norpramin) should be aware that it has clinically important interactions with many other prescription medications. Public Citizen’s Health Research Group has designated desipramine, a tricyclic antidepressant, as a Limited Use drug; antidepressants in other drug classes are safer and better tolerated.
Review Study Challenges Use of Antidepressants for Chronic Pain
September 2023
A review study, published earlier in 2023 in The BMJ, found limited evidence of low or moderate quality supporting the effectiveness of antidepressants for several conditions associated with chronic pain, including fibromyalgia, neuropathic pain and chronic tension headache.
Important Drug Interactions for the Stomach-Acid–Suppressing Drug Cimetidine
August 2023
Patients taking the stomach-acid–suppressing drug cimetidine, which is available over the counter as a generic, should be aware of its clinically important interactions with many other prescription medications.
Mindfulness as an Alternative to the Antidepressant Medication Escitalopram for Anxiety Disorder
July 2023
A recent study compared mindfulness to escitalopram (LEXAPRO), a commonly prescribed antidepressant medication, for patients diagnosed with an anxiety disorder. Although the study found that mindfulness meditation works, time and effort are needed to successfully complete the necessary mindfulness sessions and do regular home practice.
Drugs That Cause Sensitivity to Sunlight
June 2023
Some drugs, including commonly used prescription and over-the counter medications, can cause photosensitivity, increasing the skin’s vulnerability to sunlight. Nonsteroidal anti-inflammatory drugs and antibiotics are the drug classes with the strongest evidence for photosensitivity.
Higher Risk of Withdrawal Symptoms With Antidepressants
May 2023
Learn about recent research assessing the risk of withdrawal symptoms following the discontinuation of antidepressants.
Important Drug Interactions for the Antifungal Drug Voriconazole
May 2023
Patients taking the antifungal drug voriconazole (VFEND), which is marketed in both oral and injectable forms, should be aware that it has clinically important interactions with many other prescription medications.
Drug and Food Interactions for the Thyroid Medication Levothyroxine
March 2023
Patients taking the widely prescribed hypothyroidism drug levothyroxine should be aware that it has clinically important interactions with many other prescription and over-the-counter medications, dietary supplements and even certain foods.
Drug-Induced Insomnia
March 2023
Learn about the numerous prescription and over-the-counter medications that can cause or exacerbate insomnia.
Important Drug Interactions for the Antidepressant Nortriptyline (PAMELOR)
February 2023
Patients taking the frequently prescribed antidepressant nortriptyline (PAMELOR) should be aware that it has clinically important and potentially dangerous interactions with many other prescription and over-the-counter medications.
Important Drug Interactions for Sotalol
January 2023
Patients taking the drug sotalol (BETAPACE, BETAPACE AF, SORINE, SOTYLIZE) should be aware that it has clinically important and potentially dangerous interactions with many other prescription medications.
Important Drug Interactions for the SSRI Medication Fluvoxamine
December 2022
Patients taking fluvoxamine (LUVOX), a selective serotonin reuptake inhibitor (SSRI), should be aware that it has clinically important interactions with many other prescription and over-the-counter medications.
Important Drug Interactions for the Antidepressant Citalopram (CELEXA)
October 2022
Patients taking the commonly prescribed antidepressant citalopram should be aware that it has clinically important and potentially dangerous interactions with many other prescription and over-the-counter medications.
Medications May Be Carefully Discontinued If Obsessive-Compulsive Disorder Remits
August 2022
A recent clinical trial indicates that many persons with obsessive-compulsive disorder who respond favorably to joint behavioral and drug treatment may then safely taper their medication use very slowly to elimination, though careful follow-up clinical monitoring is still essential.
Drug-Induced Sexual Dysfunction in Women
July 2022
Medications are a leading cause of sexual dysfunction in women. Knowing which drugs prescribed or recommended by your doctor can cause sexual dysfunction will allow you to take steps to prevent or minimize this common, often troubling adverse drug effect.
Important Drug Interactions for NSAIDs
May 2022
Patients taking any of the widely used nonsteroidal anti-inflammatory drugs (NSAIDs) should be aware that they all have clinically important interactions with many other medications.
Drug-Induced Sexual Dysfunction in Men
April 2022
Medications are a leading cause of sexual dysfunction in men. Knowing which drugs prescribed or recommended by your doctor can cause sexual dysfunction will allow you to take steps to prevent or minimize this common, often troubling adverse drug effect.
Fluoxetine (PROZAC) Not Effective for Preventing Depression Following a Stroke
February 2022
Results of a large, well-designed, randomized clinical trial recently published in a leading medical journal provided strong evidence that the commonly prescribed selective serotonin reuptake inhibitor antidepressant fluoxetine was not effective for preventing depression in the first six months after a stroke.
Important Drug Interactions for the Antidepressant Fluoxetine (PROZAC, SYMBYAX)
February 2022
Patients taking the commonly prescribed antidepressant fluoxetine should be aware that it has clinically important and potentially dangerous interactions with many other prescription and over-the-counter medications.
Why You Should Avoid the Herbal Supplement St. John’s Wort
December 2021
Learn why we have designated St. John’s wort, an herbal dietary supplement that is commonly available in capsules, tablets or teas, as Do Not Use.
Important Drug Interactions for the Antifungal Drug Itraconazole
November 2021
Patients taking the oral antifungal drug itraconazole (SPORANOX, TOLSURA) should be aware that it has clinically important interactions with many other prescription medications that can affect the safety or effectiveness of itraconazole or the interacting drugs.
Drug-Induced Hair Loss
October 2021
Learn about some of the commonly used medications that may lead to hair loss, also known as alopecia.
Medications That Cause Gastrointestinal Bleeding
September 2021
Gastrointestinal bleeding is a common cause of hospitalization and in severe cases can result in death. Find out which commonly used medications can cause gastrointestinal bleeding.
Important Drug Interactions for the Hypertension and Angina Drug Nifedipine
August 2021
Patients taking the widely prescribed calcium channel blocker nifedipine (PROCARDIA, PROCARDIA XL) should be aware that it has clinically important interactions with many other prescription medications.
Important Drug Interactions for the Abnormal Heart Rhythm Drug Amiodarone
July 2021
Patients taking the commonly prescribed abnormal heart rhythm drug amiodarone should be aware that it has clinically important interactions with many other prescription medications.
Important Drug Interactions for the Antibiotic Erythromycin
June 2021
Patients taking the commonly prescribed antibiotic erythromycin should be aware that it has clinically important interactions with many other prescription medications.
Drugs That Cause Neuroleptic Malignant Syndrome
May 2021
Neuroleptic malignant syndrome is a life-threatening neurological disorder most often caused by neuroleptic (antipsychotic) medications, which are used to treat schizophrenia and certain other psychiatric disorders, among other things. The syndrome also can be caused by certain other drugs used to treat nausea and depression, as well as by the sudden discontinuation of a dopamine agonist (drugs that are used most commonly to treat Parkinson’s disease).
Important Drug Interactions for the Seizure Drug Carbamazepine
March 2021
Patients taking the commonly prescribed epilepsy drug carbamazepine (CARBATROL, EPITOL, EQUETRO, TEGRETOL, TERIL) should be aware that it has clinically important interactions with numerous other prescription and over-the-counter medications.
Common Antidepressants Carry Very Small Risk of Birth Defects
January 2021
In this article, we review results of a new study that sheds further light on the association between the use of specific antidepressants during early pregnancy and the small risk of birth defects.
Important Drug Interactions for the Stomach-Acid–Suppressing Drug Omeprazole
October 2020
Patients taking the commonly used stomach-acid–suppressing drug omeprazole should be aware that it has clinically important interactions with many other prescription medications.
Driving Under the Influence Caused by Medications
September 2020
Although impaired driving usu¬ally is caused by alcohol or marijuana, many commonly used prescription and over-the-counter medications also can impair one’s ability to drive safely. Learn about several classes of medications that can cause this serious problem to protect yourself, your passengers and others who share the road with you.
Important Drug Interactions for the Anticoagulant Warfarin
August 2020
Patients taking the commonly used blood thinner warfarin (COUMADIN, JANTOVEN) should be aware that it has clinically important interactions with numerous other prescription and over-the-counter medications, as well as some dietary supplements.
Important Drug Interactions for the Antibiotic Azithromycin
July 2020
Patients taking the commonly prescribed antibiotic azithromycin (ZITHROMAX) should be aware that it has clinically important dangerous interactions with many other prescription medications.
Drug-Induced Liver Injury
May 2020
There are more than 1,000 prescription and over-the-counter medications, as well as certain herbal and dietary supplements, that are implicated in liver injury, and the list continues to grow.
Important Drug Interactions for the Antibiotic Clarithromycin
April 2020
Patients taking the commonly prescribed antibiotic clarithromycin (BIAXIN XL) should be aware that it has clinically important interactions with many other prescription medications.
Do Not Use Paroxetine (BRISDELLE) for Treatment of Hot Flashes
March 2020
Learn why women should avoid using BRISDELLE, the first and only nonhormonal drug approved by the FDA for treatment of hot flashes associated with menopause.
Important Drug Interactions for the Antifungal Drug Fluconazole
December 2019
Patients taking the commonly prescribed antifungal drug fluconazole (DIFLUCAN) should be aware that it has clinically important interactions with many other prescription medications. Some of these interactions can lead to an increased risk of fatal heart rhythm abnormalities.
An Update on Drug-Induced Parkinsonism
October 2019
Next to Parkinson’s disease, drug-induced parkinsonism is the second most common cause of parkinsonism, accounting for about 8-12% of all parkinsonism cases. Find out which commonly used drugs can cause this condition.
Important Drug Interactions for the Seizure Drug Phenytoin
September 2019
Patients taking the commonly prescribed epilepsy drug phenytoin (DILANTIN, PHENYTEK), one of the oldest epilepsy drugs, should be aware that it has clinically impor¬tant interactions with many other prescription and over-the-counter medications. Some of these interactions can lead to phenytoin toxicity, and others can lead to ineffective seizure control.
Numerous Drugs Have Dangerous Interactions with Alcohol
August 2019
Most U.S. adults drink alcohol at least occasionally. Many also take prescription or over-the-counter drugs that have the potential to inter¬act adversely with alcohol. Avoid serious harm by knowing which drugs should not be taken in combination with alcohol.
Taking These Medications With Grapefruit Can Be Dangerous!
June 2019
Read about the many prescription drugs that can interact in dangerous ways with grapefruit or grapefruit products.
Medications that Cause Taste Disorders
April 2019
Drugs are the most frequent cause of taste disturbances. In this article, we identify more than 60 commonly used prescription medications that have been linked to problems with taste.
Potentially Dangerous Lithium Drug Interactions
March 2019
Read about the many prescription medications that can interact in dangerous ways with lithium, the drug of choice for treating bipolar disorder, also known as manic depression.
Drug-Induced Restless Legs Syndrome
March 2019
Restless legs syndrome is a common neurological movement and sensory disorder that affects 5 to 10 percent of the population. In this article, we identify some of the many drugs that can cause or worsen this disorder.
Important Clopidogrel (PLAVIX) Drug Interactions
January 2019
Read about the many prescription and over-the-counter medications that can interact in dangerous ways with clopidogrel, a widely used anti-platelet drug.
New Research Shows Drugs Associated with a Risk of Depression Are Widely Used
October 2018
In this article, we summarize the results of a recent research study showing that use of medications that have depression as a potential adverse effect is very common. We also identify some of the many prescription medications that can cause depression symptoms, including suicidal thoughts or behavior.
Aripiprazole (ABILIFY) Drug Interactions
September 2018
Read about the more than two dozen medications that can have clinically important interactions with aripiprazole, one of the widely used newer atypical antipsychotic drugs that is approved by the FDA for treatment of several disorders including schizophrenia, bipolar disorder and depression.
Drug-Induced Tremor
July 2018
Tremor is the single most common movement disorder, affecting millions of people in the U.S. If you have tremors, could one of your drugs be the cause? Read this article to learn the answer.
Preventing Heat-Induced Death and Illness
June 2018
This article lists practical steps to take to avoid death, hospitalization or other medical problems caused by heat stress. It also identifies over 100 drugs that can impair your response to heat and thereby increase your risk of heat-induced illness and death.
Big Pharma Rings in New Year with More Price Gouging
March 2018
In his editor’s column, Dr. Michael Carome highlights the most recent wave of price hikes by major pharmaceutical companies at the start of 2018.
Drug-Induced Movement Disorders
February 2018
Abnormal involuntary movements (movement disorders) occur as adverse events associated with many widely used medications and can cause substantial hardship for affected individuals. Find out which drugs are associated with these adverse effects.
Drugs That Cause Weight Gain
December 2017
Weight gain is an adverse event associated with many widely used medications and may lead to significant overweight and obesity, especially in susceptible individuals. Find out which drugs have this adverse effect.
Researchers Fight to Undo a Depression Drug's Dark History
May 2017
We describe the troubling story of how a pharmaceutical company manipulated the scientific literature to inappropriately promote the use of citalopram (CELEXA) for the treatment of de¬pression in children and teens despite the fact that the drug was not approved by the FDA for this use.
Medications for Bipolar Disorder
March 2017
Bipolar disorder, also known as manic depression, is a serious chronic mental illness that afflicts approximately 5.4 million people in the U.S. In this article, we review the benefits and safety of several drugs that are commonly used to treat this disorder.
Drug-Induced Hair Loss
July 2016
For most people with hair loss, the condition usually is age-related or due to the genes they inherited from their parents. But for some patients, the cause of the problem can be found in the medicine cabinet. Learn about some commonly used medications that can cause hair loss.
Some SNRIs Useful for Depression; Avoid Others
March 2016
This article explores one of the newer classes of drugs for treating depression: serotonin-norepinephrine reuptake inhibitors (SNRIs). Find out which SNRIs are safe for treating depression and which should be avoided.
Anticholinergics May Increase Dementia Risk in Elderly
August 2015
Learn about recent evidence suggesting that anticholinergic drugs — which include many antidepressants, antihistamines and overactive bladder control medications — may increase the risk for developing Alzheimer’s disease and other types of dementia in the elderly.
Year in Review: Troubling New Drug Approvals of 2013
March 2014
Learn about new drugs approved by the FDA in 2013 that Worst Pills Best Pills has identified as dangerous or ineffective. The drugs include two for diabetes, two for chronic obstructive pulmonary disease and an over-the-counter drug for overactive bladder, among others.
How Effective Are Antidepressants for Depression?
February 2014
Some degrees of depression are less likely to respond to treatment with an antidepressant. This article reviews the evidence and evaluates 27 different antidepressants, labeling many as Do Not Use or Limited Use.
Do Not Use Paroxetine (BRISDELLE) For Treatment of Hot Flashes
January 2014
A newly marketed drug for treating hot flashes of menopause, BRISDELLE, is a lower dose of the familiar antidepressant PAXIL. This article discusses its risks and barely-evident effectiveness.
The Continuing Exploitation Of Menopausal Women
November 2013
This month will see the launch of yet another highly promoted drug to treat the hot flashes of menopause. Like almost all of its predecessors, it has clear risks and also lacks strong evidence of usefulness.
Updates: Migraine, Depression, Hypertension Drugs
December 2012
Topics discussed include evidence that overuse of migraine drugs may cause headache rather than relieve it. Also, a widely prescribed antidepressant, in higher doses, can cause heart arrhythmias, manifested as dizziness, palpitations or fainting. Finally, another widely used antidepressant can cause a life-threatening condition called neuroleptic malignant syndrome, which can include extremely high body temperature, fast heart rate, rapidly changing blood pressure and mental changes.
Settlement Not Enough to Deter Illegal Pharmaceutical Industry Behavior
August 2012
Find out how a seemingly large $3 billion criminal and civil penalty levied against GlaxoSmithKline — because of its small size relative to the drugmaker’s profits and the absence of jail time for any of the company’s officials — tacitly encourages drug companies to continue illegal activities.
Antidepressants and Dementia in the Elderly
August 2012
We review a recent study concerning the lack of evidence that antidepressants are effective in elderly, demented people. Find out the risks involved with antidepressant use in this population and learn about the safer, more effective nondrug approaches to treating depression in elderly adults.
Update on Grapefruit Juice-Drug Interactions
July 2012
This article updates and expands our earlier list of drugs that can have harmful interactions with grapefruit juice. The list now includes 82 different drugs.
Preventing Heat-Induced Death and Illness
June 2012
This article lists practical steps to take to avoid death, hospitalization or other medical problems caused by heat stress. It also contains a list of 123 drugs that can impair your response to heat.
Risk of Bleeding and Use of Antidepressants After Heart Attack
March 2012
The article discusses why taking certain antidepressants after a heart attack may increase the risk of bleeding. Find out which ones are the culprits.
Prescription Drugs and Increased Traffic Accident Risk
July 2011
The article reviews evidence that taking any of eight different classes of prescription drugs can significantly increase the risks of being involved in a traffic accident in which someone is injured. Find out what the classes of drugs are.
Antidepressants: Effective for Major Depression, Not for Minor Depression
May 2011
Find out the difference between major depression and minor depression and why antidepressants, which are effective with precautions for the former, are not effective for the latter.
Drug-Induced Acute Akathisia (Restlessness)
April 2011
The article lists 27 drugs that can cause akathisia, a condition characterized by muscular quivering and the inability to sit still. Other signs of the condition include fidgety movements, leg swinging while sitting, rocking from foot to foot or pacing and motor restlessness.
Neuroleptic Malignant Syndrome (NMS)
December 2010
The article describes the symptoms of the life-threatening neurological disorder neuroleptic malignant syndrome (NMS) and lists 40 different prescription drugs that have been found to cause it.
Corticosteroid Drug Interactions
November 2010
This article discusses 36 drugs that, when used by people also using a corticosteroid, can either cause toxic interactions with the steroid or decrease the steroid's effectiveness.
Drug-Induced Parkinsonism
October 2010
A study discovered that more than 1 out of every 10 people who went to a Parkinson’s disease center was found to have drug-induced Parkinsonism. These people were misdiagnosed as having the more common illness, Parkinson’s disease, which is irreversible and has unknown causes.
The Dangers of Combining Sleeping Pills With Other Medication
September 2010
The article list 34 other medications that can harmfully interact with sleeping pills, increasing their sedative properties and causing excessive sedation. Excessive sedation at night could increase the risk of falls, should the person get up in the night for some reason. Moreover, excessive sedation causing respiratory depression could be dangerous for people with certain disorders, such as lung disease.
Interactions With Cancer Drug Vincristine (ONCOVIN)
August 2010
The article lists 34 prescription drugs that can have harmful interactions with vincristine. Recognizing signs of toxicity from vincristine early, as described in the article, is urgent because most of the side effects are reversible when the interacting drug is stopped and the patient receives corrective treatment.
Dextromethorphan (DELSYM, ROBITUSSIN DM) for Cough: More Reasons to Avoid It
June 2010
Find out why you should not use cough products such as ROBITUSSIN DM that contain dextromethorphan. Also view a list of 22 other drugs that can have harmful interactions with dextromethorphan.
Oral Drugs for Diabetes: Avoiding Hypoglycemia
May 2010
After explaining the symptoms of low blood sugar (hypoglycemia) the article lists 42 prescription drugs that can interact with one or more diabetes drugs to increase the chance of hypoglycemia.
Smoke & Mirror Marketing (& Other Clever Big Pharma Tricks)
May 2010
The article reviews 12 prescription drugs, many of which are top-sellers, all of which are greatly overpriced in comparison to older "versions" of the same drugs. The patents on the old drugs expired so the "innovative" companies patented these new products, gaining a patent on them, and, for all practical purposes, using them as a license to print money. There is no evidence that any of the new ones are better than the now less-expensive, old versions.
Risk of Serious Gastrointestinal Bleeding With Newer Antidepressant Drugs
April 2010
This article discusses the greatly increased risk of bleeding with some widely-used antidepressant drugs and provides information that the FDA has not yet required be included in the patient Medication Guides for these drugs.
Aripiprazole (ABILIFY) Drug Interactions
April 2010
The article lists 53 drugs that can interact with the psychiatric drug ABILIFY to either increase the amount in the body, which can lead to toxicity, or decrease the amount rendering the drug less effective.
A New Old Drug for Depression: Desvenlafaxine (PRISTIQ)
March 2010
Find out how Pristiq and the older antidepressant drug, Effexor are, essentially, the same and why not to use the new one.
Quetiapine (SEROQUEL) Interactions With Other Drugs
February 2010
Quetiapine (SEROQUEL) can interact with 26 different drugs, increasing its blood levels and causing dangerous side effects such as slowed breathing, dizziness and fainting. The article also lists 10 other interacting drugs that can result in lower blood levels, rendering the drug less effective.
Oxycodone: Be Careful What You Take With It
September 2009
The article lists 24 drugs that can increase the toxicity of oxycodone if taken together with the drug and 11 other drugs that can weaken its effectiveness as a painkiller if they are simutaneously used.
Muscle Damage from Interactions Between Statins and Other Commonly Prescribed Drugs
July 2009
The article lists 38 prescription drugs that can harmfully interact with statin drugs. The article also advises that No matter what statin you are taking and regardless of any interacting drugs, you should notify your prescriber immediately if you develop muscle pain, weakness or a darkening of your urine. .
Alpha-Blockers for Prostate Enlargement: Some Important Drug Interactions
June 2009
Taking alpha-blockers in combination with drugs for erectile dysfunction and with other drugs can cause dizziness and fainting. In this article we will discuss alfuzosin (UROXATRAL), doxazosin (CARDURA), tamsulosin (FLOMAX) and terazosin (HYTRIN) and drugs with which they can have harmful interactions.
Tizanidine: Watch Out for Drugs Interacting With This Muscle Relaxant
October 2008
Tizanidine (ZANAFLEX) is a muscle relaxant for which more than 3.8 million prescriptions were filled in the U.S. last year. The article lists more than 64 drugs with which it can have dangerous interactions resulting in excess sedation, difficulty breathing or dangerously low blood pressure that can result in falling.
New Report Sheds Light on Serious Safety Problems with Anti-Smoking Drug Varenicline (CHANTIX)
July 2008
A recent study has found large numbers of reports of psychiatric adverse effects with varenicline (CHANTIX) including hundres of reports of suicidal acts, thoughts or behaviors; possible psychosis; and hostility or aggression.
Serotonin Syndrome Due to Drug Interactions
April 2008
The article lists more than 30 prescription drugs that can cause the serotonin syndrome.
Drug-Induced Eye Toxicity: 62 Drugs That Can Cause Eye Disease
April 2008
This article, based on a recent review in Drug Safety, lists 62 prescription drugs that can cause eye disease. The range of drug-induced eye diseases includes diseases of the eyelids, glaucoma, cataracts, retinal damage and optic nerve damage. As is true for drug-induced diseases in other parts of the body, you should consider newly developed eye symptoms beginning shortly after starting a new medication to be possibly drug-induced and consult a physician.
SSRIs Can Have Dangerous Interactions With Other Drugs
January 2008
More than 70 million prescriptions a year are filled for these popular antidepressants, including Prozac, Paxil, Zoloft, Luvox, Celexa and Lexapro. This article gives details about more than 60 other widely prescribed prescription drugs that can have harmful interactions if used with these antidepressants. The two different kinds of interactions are also discussed.
Research as Public Relations: Antidepressants and Suicide in Youth
October 2007
Because of evidence from a number of studies, the Food and Drug Administration (FDA) recently required a “black box” label for all SSRI (selective serotonin reuptake inhibitor) antidepressants indicating that use in children could lead to an increased risk of suicidal behavior. Now comes a study published in the prestigious American Journal of Psychiatry (Volume 164, pp. 1356-1363) purporting to show, in effect, the opposite: the FDA warnings had caused the rate of pediatric SSRI prescriptions to plummet and as a result young people are killing themselves due to lack of treatment. If this were true, it would be a clear example of the unintended consequences of regulation. The paper and its subsequent publicity appear to be little more than a public relations ploy. The editors of the AJP should not have allowed such gross misrepresentations to pass into print unscathed, and journalists who cited this study as if it deserved equal credence to the RCTs are just as guilty.
FDA Issues New Warnings For Muscle Spasm Drug Tizanidine (ZANAFLEX)
August 2007
The muscle spasm drug tizanidine (ZANAFLEX) combined with certain other drugs could cause serious complications such as drowsiness and can dramatically lower blood pressure, according to the Food and Drug Administration (FDA). The article lists 20 drugs to avoid if you are using Zanaflex so that you avoid these potentially dangerous interactions.
Older Adults May Have Low Blood Sodium Levels When Using the Antidepressant Venlafaxine (EFFEXOR)
August 2007
Patients over the age of 65 taking or considering taking venlafaxine (EFFEXOR) should ask their provider to check for low blood sodium levels within three to five days after treatment is started. Patients taking venlafaxine who are experiencing the symptoms of low blood sodium levels listed in the article should contact the prescriber as soon as possible. Patients should not discontinue taking venlafaxine without first consulting with their prescribing health care provider. Other antidepressants in the SSRI family such as PROZAC and PAXIL have also been found to cause low sodium levels.
FDA: All Antidepressants Should Carry Warnings About Risks of Suicidal Thoughts in Young Adults
July 2007
Because of new information about increased risks of suicidal thoughts associated with the use of a variety of antidepressants, people of all ages should be monitored closely with all antidepressants after the drugs are first prescribed, switched or when the dosage is changed. Do not stop using any antidepressants without first consulting the prescriber.
PUBLIC HEALTH ADVISORY: Migraine Drugs, Antidepressants May Cause Life-Threatening Interactions
October 2006
If you are taking triptans, SSRIs or SNRIs and experience the symptoms of serotonin syndrome listed in this article, you should seek medical attention immediately. This is because of the possibility of life-threatening reactions such as nausea, changes in blood pressure or hallucinations that may be caused by the interaction of migraine headache drugs, called triptans, and certain antidepressants.
PUBLIC HEALTH ADVISORY: Continuing Antidepressants During Pregnancy May Help Mother, Harm Baby: A Medical Dilemma
October 2006
Women who are pregnant and taking certain antidepressants take note: a recent study finds that you are more likely to have a recurrence of depression if you stop treatment during pregnancy, but another recent study suggests that taking certain antidepressants may harm your baby. Find out about this dilemma.
The Danger of Prescribing without Proof: Examples of Prescriptions for Drugs Not Shown to be Safe and Effective
July 2006
The article discusses numerous recent examples of the harm that has been caused by off-label prescribing, including the heart drugs amiodarone (Cordarone), many antipsychotic drugs, topiramate (Topamax)and several antidepressants.
Paxil and Birth Defects
December 2005
You should consult with your doctor immediately if you are taking paroxetine and are pregnant and particularly if you are in your first trimester. Suddenly stopping paroxetine and drugs like it may result in a withdrawal syndrome. See the warning statement above.
Successfully Pushing Paxil on Television
July 2005
A new study shows how direct-to-consumer advertising can increase the use of antidepressants for minor conditions.
Black Box Warning To Be Required On All Antidepressants Concerning Suicide Risk In Children And Adolescents
December 2004
Belatedly, the Food and Drug Administration (FDA) announced on October 15, 2004 that it is taking steps to inform parents and physicians about the risks of antidepressants when these drugs are used to treat major depressive disorder in children and adolescents.
Canadians Warned of Potential Adverse Effects of Maternal Use of Antidepressants on Newborns. American Mothers Still in the Dark
October 2004
The Canadian equivalent of the Food and Drug Administration (FDA), Health Canada, issued a public advisory on August 9, 2004 warning that newborns may be adversely affected when their mothers take one of the family of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and other newer anti-depressants during the third trimester of pregnancy.
Suicide Risk Added To The Professional Product Labeling For Eight Antidepressants
August 2004
At the request of the Food and Drug Administration (FDA), eight out of ten manufacturers of newer antidepressants have agreed to add a warning about the possibility of an increased risk of suicide associated with the use of these drugs. The warning will appear in the professional product labeling, or package insert, for these drugs.(listed in the article)
The Antidepressant Fluoxetine (Prozac) and Suicidal Ideation — Déjà vu 1991
May 2004
Fourteen years ago, in May 1991, the Health Research Group petitioned the Food and Drug Administration (FDA) to require a warning in the professional product labeling, or package insert, of fluoxetine (PROZAC) concerning the risk of suicidal impulses in patients using the drug. Fluoxetine belongs to the family of antidepressants known as selective serotonin re-uptake inhibitors, or SSRIs. Read the warning we asked for back then.
Grapefruit Juice and Prescription Drugs: Some Dangerous Interactions
February 2004
The January 5th issue of the Medical Letter, a widely respected source of independent information about pharmaceuticals and dietary supplements, has a review of the increasingly researched problem of the interaction between grapefruit juice and many prescription and over-the-counter drugs. Like most interactions between chemicals in the body, this one involves the impairment, by grapefruit juice, of the body’s ability to metabolize many drugs, leading to higher than expected — and sometimes dangerous — levels of these drugs.This article lists the drugs.
FDA Issues Public Health Advisory On Antidepressants And Suicide Risk In Children
December 2003
The Food and Drug Administration (FDA) issued a Public Health Advisory on October 27, 2003 about reports of suicidal thinking and suicide attempts in clinical trials of eight drugs in pediatric patients with major depressive disorder (MDD).
The Serotonin Syndrome: A Potentially Life-Threatening Adverse Drug Reaction — Fluoxetine (PROZAC), Escitalopram (LEXAPRO), Sibutramine (MERIDIA) And Other Drugs
September 2003
Canadian drug regulatory authorities reviewed reported cases of serotonin syndrome in the July 2003 issue of the Canadian Adverse Reaction Newsletter. The serotonin syndrome is a potentially life-threatening adverse drug reaction involving an excess of serotonin, a naturally occurring nerve transmitter.
Selling New Drugs Using Smoke and Mirror (Images)
March 2003
You should avoid these "new" single mirror images of old drugs, not out of concern about their safety or effectiveness, but because they are the same as the old drugs. In the long run, they cause economic harm both to individuals and to the health care system because they have come on the market with extended monopoly protection. Article lists some examples.
Do Not Use Until October 2005 Escitalopram (LEXAPRO) – The Sixth Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant
January 2003
Escitalopram (LEXAPRO) was approved by the Food and Drug Administration (FDA) in August 2002 and brings to six the number of selective serotonin reuptake inhibitor (SSRI) antidepressants now on the market in the U.S. The primary purpose for developing escitalopram appears to be nothing more than a strategy to protect sales as citalopram nears the end of its patent protection. In the long run, escitalopram will cause economic harm to individuals and the healthcare system.
Drug Induced Psychiatric Symptoms (Part 2)
November 2002
This is the second of a two-part series on drug-induced psychiatric symptoms that began in last month’s Worst Pills, Best Pills News. The information is based on the July 8, 2002 issue of The Medical Letter on Drugs and Therapeutics. Article lists drugs and adverse effects.
Drug Induced Psychiatric Symptoms
October 2002
This is the first of a two part series on drug induced psychiatric symptoms that is based on the July 8, 2002 issue of The Medical Letter on Drugs and Therapeutics. Regular readers of Worst Pills, Best Pills News will recognize The Medical Letter as a reference source written for physicians and pharmacists that we often use because of its reputation as an objective and independent source of drug information. The article lists the drugs and their psychiatric adverse effects.
Grapefruit Juice and Drug Interactions
June 2002
Grapefruit juice can interact with a number of therapeutically important drugs that could lead to the possibility of toxicity. These drugs are listed in the article.

ADDITIONAL INFORMATION FROM PUBLIC CITIZEN
Testimony to the FDA's Advisory Committee on Reproductive Health Drugs on paroxetine for menopausal symptoms (HRG Publication #2100)
Public Citizen strongly opposes the Food and Drug Administration’s (FDA’s) approval of paroxetine for treatment of menopause-related vasomotor symptoms (VMS, which includes hot flashes and flushing) due to the drug's questionable benefits and well-established risks.