Selective serotonin reuptake inhibitors and brain hemorrhage

Posted on October 18, 2012 by Maurice Preter MD

Selective serotonin reuptake inhibitors and brain hemorrhage

A meta-analysis

  1. Daniel G. Hackam, MD, PhD, FRCPC and
  2. Marko Mrkobrada, MD, FRCPC

+ Author Affiliations


  1. From the Stroke Prevention and Atherosclerosis Research Centre (SPARC) (D.G.H.) and Clinical Trials Unit (M.M.), Robarts Research Institute, and Departments of Medicine (D.G.H., M.M.), Clinical Neurological Sciences (D.G.H.), and Epidemiology and Biostatistics (D.G.H.), Western University, London, Canada.
  1. Correspondence & reprint requests to Dr. Hackam: dhackam@uwo.ca

View Complete Disclosures

Abstract

Objective: We synthesized the epidemiologic evidence concerning selective serotonin reuptake inhibitor (SSRI) exposure and the risk of CNS hemorrhage.

Methods: We searched for controlled observational studies comparing SSRI therapy with a control group not receiving SSRIs. We used DerSimonian and Laird fixed effect models to compute summary risk associations.

Results: Intracranial hemorrhage was related to SSRI exposure in both unadjusted (rate ratio [RR] 1.48, 95% confidence interval [CI] 1.22–1.78) and adjusted analyses (RR 1.51, 95% CI 1.26–1.81). Intracerebral hemorrhage was also associated with SSRI exposure in both unadjusted (RR 1.68, 95% CI 1.46–1.91) and adjusted (RR 1.42, 95% CI 1.23–1.65) analyses. In a subset of 5 studies (3 of intracranial hemorrhage and 1 each reporting hemorrhagic stroke and intracerebral hemorrhage), SSRI exposure in combination with oral anticoagulants was associated with an increased risk of bleeding compared with oral anticoagulants alone (RR 1.56, 95% CI 1.33–1.83). When all studies were analyzed together, increased risk was seen across cohort studies (1.61, 95% CI 1.04–2.51), case-control studies (odds ratio [OR] 1.34, 95% CI 1.20–1.49), and case-crossover studies (OR 4.24, 95% CI 1.95–9.24).

Conclusions: SSRI exposure is associated with an increased risk of intracerebral and intracranial hemorrhage, yet given the rarity of this event, absolute risks are likely to be very low.

  • Received March 5, 2012.
  • Accepted June 7, 2012.
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Findings reveal brain mechanisms at work during sleep, and other sleep news from the SFN Annual meeting

Posted on October 17, 2012 by Maurice Preter MD

Sleepiness disrupts the coordinated activity of an important network of brain regions; the impaired function of this network is also implicated in Alzheimer’s disease (Andrew Ward, abstract 909.05).

via Findings reveal brain mechanisms at work during sleep.

Posted in Aging, epigenetics, Health, keto, Psychiatry/Neurology | Tagged , , , , |

From the Society for Neuroscience Meeting: Microglial acid-sensing t-cell death associated gene-8 (tdag8) receptor in co2 evoked behavior and physiology: Relevance to panic

Posted on October 16, 2012 by Maurice Preter MD

 

Their finding supports our position that panic/anxiety and predator stress/fear are two different phenomenological&biological animals. A true translational moment indeed.
Not sure if I am allowed to post the whole abstract, but the link is here.

 

Program#/Poster#: 68.14/V18
Presentation Title: Microglial acid-sensing t-cell death associated gene-8 (tdag8) receptor in co2 evoked behavior and physiology: Relevance to panic
Location: Hall F-J
Presentation time: Saturday, Oct 13, 2012, 2:00 PM – 3:00 PM
Authors: *L. E. LARKE1, J. RUSH1, K.-Y. LI2, I. LEWKOWICH3, R. W. PUTNAM2, R. SAH1;
1Psychiatry and Behavioral Neurosci., Univ. Of Cincinnati, Cincinnati, OH; 2Wright State Univ., Dayton, OH; 3Cincinnati Children’s Hosp. Med. Ctr., Cincinnati, OH

Our review is posted here. The abstract follows:

>>This review paper presents an amplification of the suffocation false alarm theory (SFA) of spontaneous panic (Klein, 1993). SFA postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively occur when the alarm is erroneously triggered. That panic is distinct from Cannon’s emergency fear response and Selye’s General Alarm Syndrome is shown by the prominence of intense air hunger during these attacks. Further, panic sufferers have chronic sighing abnormalities outside of the acute attack. Another basic physiologic distinction between fear and panic is the counter-intuitive lack of hypothalamic-pituitary-adrenal (HPA) activation in panic. Understanding panic as provoked by indicators of potential suffocation, such as fluctuations in pCO2 and brain lactate, as well as environmental circumstances fits the observed respiratory abnormalities. However, that sudden loss, bereavement and childhood separation anxiety are also antecedents of “spontaneous” panic requires an integrative explanation. Because of the opioid system’s central regulatory role in both disordered breathing and separation distress, we detail the role of opioidergic dysfunction in decreasing the suffocation alarm threshold. We present results from our laboratory where the naloxone-lactate challenge in normals produces supportive evidence for the endorphinergic defect hypothesis in the form of a distress episode of specific tidal volume hyperventilation paralleling challenge-produced and clinical panic.
Keywords
Affective neuroscience; Endogenous opioids; Panic disorder; Respiratory physiology; Separation Anxiety
<<
Ref: Preter M, Klein DF. Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids. Progress in Neuropsychopharmacology and Biological Psychiatry 32/3 (2008) 603-612.

 

 

Posted in Affective Neuroscience, epigenetics, News | Tagged , , |

“Clock-watching” and insomnia are linked to posttraumatic stress symptoms – packaged with a zolpidem ad!

Posted on October 16, 2012 by Maurice Preter MD

Just got this mass email. The ad next to it is for zolpidem – just the kind of stuff that might NOT benefit post-traumatic states. What’s the message here?

OCTOBER 2012

Advertisement

Editor’s note
Approximately 50% of chronic insomnia patients have a comorbid psychiatric disorder.1 Historically, the focus has been on depression, but in this issue we focus on insomnia’s relationship with other psychiatric disorders and symptoms.
Although posttraumatic stress disorder (PTSD) has been associated with insomnia, Krakow et al suggest the mediator of the insomnia-PTSD link is time monitoring (“clock-watching”). Nadorff et al describe a relationship between insomnia and suicidal ideation in older adults and that the mediator of this association is depressive symptoms.
Most insomnia patients don’t abuse hypnotics,2 but Ruiter et al document a 3-way relationship among personality disorders, insomnia, and hypnotic dependence. Finally, Haario et al found unhealthy behaviors—smoking, binge drinking, and inactivity—are a consequence of as well as risk factor for insomnia.
Together, these studies support the clinical wisdom of treating both conditions when patients present with insomnia and a comorbid disorder.—Thomas Roth, PhD, Director of Research and Chief of Sleep Medicine, Henry Ford Hospital, Detroit, MI

References
1. Insomnia: assessment and management in primary care. Washington, DC: National Institutes of Health; 1998.
2. Mendelson WB, Roth T, Cassella J, et al. The treatment of chronic insomnia: drug indications, chronic use and abuse liability. Summary of a 2001 New Clinical Drug Evaluation Unit meeting symposium. Sleep Med Rev. 2004;8(1):7-17.

“Clock-watching” and insomnia are linked
to posttraumatic stress symptoms
Krakow B, et al. J Nerv Ment Dis. 2012;200(9):821-825.
Researchers reviewed the medical charts of 1,078 patients who had poor sleep quality (51%), sleep-disordered breathing (26%), or insomnia (24%). Almost one-third reported moderate to severe posttraumatic stress symptoms (PSSs). Insomnia and time monitoring (“clock-watching”) severity were greater in patients with PSSs (n = 350) than in patients with minimal or no PSSs.
Read more
In older adults, insomnia is related
to suicidal ideation
Nadorff MR, et al. J Gerontol B Psychol Sci Soc Sci. Epub August 28, 2012.
Researchers surveyed 81 patients age ≥65 about their sleep habits, depressive symptoms, and suicidal ideation. Insomnia symptoms were related to suicidal ideation independent of nightmares, and depression mediated the relationship between insomnia symptoms and suicidal ideation.
Read more

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Posted in Forensic Neuropsychiatry, Health, Psychiatry/Neurology | Tagged , , , , , , |

Fresh off the press: Angst – Origins of Anxiety and Depression by Jeffrey P. Kahn, MD

Posted on October 15, 2012 by Maurice Preter MD

My friend and colleague Dr. Kahn just published his book on Anxiety. Thorough coverage of our work on panic disorder is gratefully acknowledged.

 

Angst
Origins of Anxiety and Depression
Jeffrey P. Kahn, MD
Clinical Associate Professor of Psychiatry Weill Cornell Medical College New York, NY

Posted in Psychiatry/Neurology |