Tuesday, December 25, 2007

The Black Box Warning the FDA Failed to Put on all Anti-depressants

There is a valid black box warning to put on all anti-depressants. Naturally, the craven academics have failed to put it on. It supercedes their idiotic, PC, and cowardly warning about suicidality.

All anti-depressants, including the most sedative, amitriptylline, cause about 5% of patients to get agitated. This applies to dosage increases as well, even no agitation took place on lower doses.

This is a form of akathesia, from the inhibition of dopamine by increased serotonin tone in the first 24 hours.

All patients require this warning. It worsens over time, in the vast majority of people. If agitated the first or second day, stop the anti-depressant. Return to get another anti-depressant.

If someone is very depressed and suicidal, add very uncomfortable restlessness and agitation, some may injure themselves to seek relief.

A tiny number of patients, such as 1 in a 1000, reported an onset of suicidal ideas after a specific anti-depressants, long before this irresponsible warning. All in my practice, stopped the anti-depressant on their own, returned for an alternative.

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