I'd be grateful if anyone could direct me to evidence-based guidelines/recommendations on managing anxiety/depression in patients with SSRI sensitivity, i.e., patients who have difficulty tolerating SSRI's because of problematic side-effect that appear suggestive of serotonin syndrome, and other antidepressants including mirtazapine and venlafaxine appear to cause similar difficulties? Would buspirone or quetiapine be appropriate in such situations?
Dear friend,
The following links may be useful to you:
Serotonin Syndrome: Symptoms, Causes, Diagnosis, Treatment (webmd.com)
www.cnn.com/2010/HEALTH/expert.q.a/06/22/serotonin.syndrome.raison/index…
Wondering why you can't tolerate antidepressants? (pillcheck.ca)
Best Regards
Thanks very much for your response.
I have seen those links, but I was wondering if there were any formal guidelines? I'm also wondering if quetiapine would be appropriate in these situations? Or does it also carry the risk of serotonin toxicity?
To patients where anxiety is dominating, I think I would have tried CBT treatment
I suggest that rather than medication, your patients practice Transcendental Meditation. It provides significant improvements in depression, and naturally increases serotonin levels. For example, see:
Orme-Johnson, DW; Barnes, VA; Rees, B; & Tobin, J. The effects of different meditation techniques on PTSD: a systematic review and meta-analysis.
As a side benefit, the skin improves, as does creativity, and intelligence. People feel happier within themselves. Also their immunity to other diseases (such as viruses) is strengthened. Stress levels fall. It is easy to learn (if you can find a teacher) and practice, and the patient becomes responsible for their own progress, for it can be done wherever they are having once learnt. TM is simple, natural, effortless, and enjoyable to do, taking just 20 minutes morning and evening.
Dear Venugopal
In this case, you can use nonpharmacological therapies such as meditation-based exercises, music, various psychotherapies, etc., which cause balance in the function of neurotransmitters, including serotonin.
- A team of scientists in Canada these last 2 years measuring the change in levels of stress, depression, anxiety, and anger in veterans, found 38.24% decrease in depression within 12 weeks of learning TM. Over the same period there was also a 25.42% decrease in depression in their family members.
- This chart from Bellehsen et al, shows a very large effect size of TM in their recent randomised controlled study on reducing depression.
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