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Sunil paul Guttula


6 September 2020

Psychiatric care#1


The FDA admitted in 2007 that SSRIs can cause madness at all ages and that the drugs are very dangerous; otherwise daily monitoring wouldn’t be needed: “Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt .All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants”.

Therapeutic drug monitoring (TDM) could also be performed to optimize dosage regimens supported measurements of drug concentrations at designated intervals. The feedback from TDM can help doctors maintain a therapeutic concentration in a personal patient’s bloodstream while minimizing potential side effects.

In psychiatry, plasma concentrations of several drugs have been related to receptor occupancy. These findings suggest that TDM may add valuable information in the pharmacological management of psychiatric disease and, recently, consensus guidelines on TDM in psychiatry have been updated.

According to available evidence, these guidelines categorize TDM for the individual substances as “Strongly recommended,”“Recommended,”“Useful,” or “Potentially useful.” Indeed, TDM may be particularly appropriate in psychiatry for several reasons. First, the full clinical effects can often be expected only after several weeks of treatment. Therefore, optimal dosing may be hard to achieve within a reasonable time frame. Second, the effects cannot be as easily monitored as can, for example, the blood pressure in hypertension. In addition, many adverse effects are concentration dependent, and TDM can, for instance, be used to avoid extrapyramidal side effects of antipsychotics


Regular monitoring is recommended for the following drugs: Amitriptyline, Amitriptyline/Chlordiazepoxide, Amitriptyline/Perphenazine, Bupropion, Citalopram, Clomipramine, Desipramine, Desvenlafaxine, Doxepin, Duloxetine, Escitalopram, Fluoxetine, Fluoxetine/Olanzapine, Fluvoxamine, Imipramine, Milnacipran, Mirtazapine, Nefazodone, Nortriptyline, Paroxetine, Phenelzine, Protriptyline, Selegiline, Sertraline, Trazodone, Venlafaxine, Vilazodone.


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