Citation

Glass GS. Am. J. Forensic Psychiatr. 2007; 28(3): 59-76.

Copyright

(Copyright © 2007, American College of Forensic Psychiatry, Publisher R. Shlensky)

DOI

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PMID

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Abstract

The SSRI group of antidepressants represent an important advance in the treatment of mood and anxiety problems. Because they are difficult to overdose on, they have been marketed as if there were no adverse consequences to either taking them, or stopping them. Unfortunately, as their use has increased, there have been well documented reports of serious side effects which arise from these medications. These include: I) violent behavior, including suicide in a small group of patients, prompting a Black Box Warning to be added to the manufacturer's insert; 2) a cluster of symptoms, known as serotonin syndrome, which may arise from one or a combination of these medications; and 3) a constellation of symptoms, known as SSRI withdrawal syndrome, which arise when these medications are stopped abruptly, or even tapered. It is often difficult to determine whether the symptoms that are occurring in a patient on these medications are the product of one of these clinical syndromes, or the result of the mental condition which caused the SSRI medication to be prescribed. Unfortunately, the consequences of misdiagnosing and then mistreating these syndromes can be catastrophic to the patient, and have significant legal consequences to the physician. This article explores these three problems, and presents case examples to illustrate each one. Copyright 2007 American Journal of Forensic Psychiatry.

Language: en

Keywords

adult; human; violence; female; male; case report; insomnia; depression; anxiety; suicidal behavior; drug overdose; mood disorder; article; symptomatology; prescription; neuroleptic agent; amitriptyline; fluoxetine; mirtazapine; paroxetine; serotonin uptake inhibitor; tachycardia; tricyclic antidepressant agent; hallucination; vertigo; paranoia; anxiety disorder; panic; myoclonus; alprazolam; drowsiness; libido; gastrointestinal symptom; legal aspect; psychopharmacotherapy; confusion; health care cost; drug dependence; benzodiazepine derivative; seizure; diarrhea; nausea; tremor; drug withdrawal; hypotension; sweating; akathisia; disease exacerbation; diagnostic error; nightmare; drug information; drug marketing; disorientation; hypertension; side effect; hypomania; serotonin syndrome; withdrawal syndrome; agitation; flu like syndrome; autonomic dysfunction; hyperreflexia; drug half life; low drug dose; diaphoresis; shivering; ataxia; nystagmus; drug indication; muscle rigidity; malaise; blood pressure; dizziness; flushing; lethargy; sinus tachycardia; treatment response; drug dose reduction; mental concentration; memory disorder; hyperthermia; coordination disorder; drug dose increase; mydriasis; serotonin noradrenalin reuptake inhibitor; sensory dysfunction; adverse outcome; night sweat