Month: May 2023

Citalopram and escitalopram: adverse cardiac outcomes in medically ill inpatients

By Dr Artin Mahdanian

Serotonin selective reuptake inhibitors (SSRIs) have widely replaced older tricyclic antidepressants (TCAs) in the treatment of depression and anxiety over the years, given their safer cardiac profile [Glassman, 1998]. Even at therapeutic doses, TCAs commonly cause a slowing of intraventricular conduction through their sodium-channel blocking properties, leading to prolonged PR, QRS and QT intervals [Pacher…

Selective Serotonin Re-Uptake Inhibitors and Hyponatremia in Acutely Medically-Ill Inpatients

By Dr Artin Mahdanian

Abstract Background: Selective Serotonin Reuptake Inhibitors (SSRIs) have become the mainstay of treatment for depression, anxiety, and many other conditions. However, they have been associated with an increased risk of hyponatremia. Little is known about the risk of SSRI-associated hyponatremia in certain potentially at-risk populations, such as patients with acute medical illnesses. Objective: The main objective of…

Are Serotonergic Antidepressants Associated With a Lower Risk of Cerebrovascular Accidents?

By Dr Artin Mahdanian

TO THE EDITOR: Serotonergic antidepressants are one of the most commonly prescribed psychiatric medications. The literature suggests that serotonergic antidepressants may be protective against ischemic cerebrovascular accidents (CVAs),1, 2 which has been thought to be due to effects on platelet activation and aggregation.3 However, the clinical relevance of the association between serotonergic antidepressants and CVAs has been challenged…

Sleep Hygiene Instructions

By Dr Artin Mahdanian

Sleep Hygiene Instructions Many aspects of modern life can be quite disruptive for a good night’s sleep and there are many things that you can do to improve the quality of your sleep.  Listed below are some helpful tips — things to avoid and things to do to help ensure you get a good night’s…

Health Canada Warning on Citalopram and Escitalopram–Its Effects on Prescribing in Consultation-Liaison Psychiatry

By Dr Artin Mahdanian

Abstract Background: Reports have suggested that citalopram and escitalopram may prolong the QTc interval, leading Health Canada to issue a warning to limit their dosages in 2012. Little is known about the effects of this warning and similar ones (e.g., by the Food and Drug Administration) on antidepressant prescribing in inpatients with acute medical illness, who…

Serotonergic antidepressants and increased bleeding risk in patients undergoing breast biopsy

By Dr Artin Mahdanian

Abstract Objectives: Recent investigations have shown that serotonergic antidepressant (SAd) use may increase the risk of peri-operative bleeding events. Our objective was to evaluate the possibility of a similar association in patients undergoing radiologic breast biopsies. Methods: We used data from 3890 patients undergoing 6300 biopsy procedures between January 2011 and October 2014 in the Breast Clinic…

Serotonergic antidepressants and perioperative bleeding risk: a systematic review

By Dr Artin Mahdanian

Abstract Introduction: Serotonergic antidepressants (SAds) are known to increase bleeding events, with a number of recent studies investigating this risk in surgical settings. Our main objective was to synthesize the current evidence to evaluate the clinical importance of SAd-related bleeding risk in the perioperative period. Methods: A systematic review of MEDLINE, Embase and PsychINFO until November 2013…