On August 25, 2011 the FDA warned that Celexa (Citalopram) should not be used at dosages higher than 40mg per day. Studies have shown that high doses can cause abnormal changes in the electrical activity of the heart, which can be fatal.  Patients with existing heart conditions, or those prone to low potassium or magnesium levels are at an even higher risk factor.

In July 2011 a study in the British Medical Journal (BMJ) stated that all Selective Serotonin Reuptake Inhibitors (SSRIs) are more likely to cause death and issues such as heart attack, stroke, falls and seizures in older populations.

The FDA also warned that mixing antidepressants with migraine drugs can trigger a life-threatening condition called Serotonin Syndrome.

SSRIs have been shown to alter neurobehavioral development in the fetus and have been linked to an increased risk of autism.

Although antidepressants are the most popular prescription medication in the United States, most patients are not aware of the risks.  Celexa  was created in 1989 and went generic in 2003 after the patent expired. It has taken 22 years for the FDA to obtain enough evidence to issue the latest warning. This is another example of how a potentially unsafe medication is approved and yet the dangers are not realized for years.

Written by Alesandra Rain, Point of Return, August 30, 2011

May 31, 2011 10:22 a.m. EDT

Editor’s note: Americans have been led to believe — by their doctors, by advertisers and by the pharmaceutical industry — that there is a pill to cure just about anything that ails them. This week, the networks of CNN go deep into the politics and the pills.

(CNN) – For Alesandra Rain, it all started with sleeplessness. In 1993 she was having marital troubles and her business wasn’t doing well. Anxiety kept her up at night, so her general practitioner prescribed sleeping pills.

“It worked fabulously. I felt very relaxed and I would sleep better,” Rain remembers. “I thought this was certainly the right prescription for me.”

Then a few weeks later, another symptom developed.

“It was so unusual. I started having bronchitis and lung infections,” she recalls. She went to a pulmonologist who prescribed an antibiotic.

Another complication soon followed.

“My heart started skipping beats, so I was referred to a cardiologist,” explains Rain, who says other than a series of surgeries after a car accident, she had been completely healthy until this point in her life. The cardiologist ran a few tests and prescribed medication to treat arrhythmias.

It didn’t end there.

Eventually she developed seizures. At this point, she was already taking at least six different prescriptions from three separate specialists. She went to see a neurologist who prescribed an anti-seizure medication on top of that.

“My whole day became pills and doctors and shots,” she says.

Rain’s insomnia returned as things continued to spiral out of control. Despite all the testing and prescriptions, she says no one could figure out the problem. She was put on temporary disability. Depression followed.

“When I finally got to a shrink of course I was depressed, because no one could figure out what was wrong with me! It never occurred to me that it might be the pills themselves.”

Too many drugs, too little communication

At her worst, Rain was under the care of a general practitioner, pulmonologist, cardiologist, pain management specialist and a psychiatrist. She was spending more than $900 a month, taking 12 different types of medication, amounting to about a thousand pills a month.

“That’s what I call prescription multiplication,” says Michael Wincor, an associate professor of clinical pharmacy, psychiatry and the behavioral sciences at the University of Southern California.

He says it is not uncommon for patients to receive multiple prescriptions from different specialists, each focusing on a specific symptom. Wincor says it can be potentially dangerous for the patient, especially if the various physicians aren’t communicating with one another.

“A patient could have adverse effects and think the medical condition is getting worse, when in fact it is a side effect of several different medications which are all interacting in a negative way,” Wincor says. “When you’re on more than 20 drugs all at the same time, you’d want to question whether or not that’s really necessary.”

According to the Kaiser Family Foundation, prescription drug usage in the United States is continuing to rise. A recent report finds the number of prescriptions filled each year increased by 39% between 1999 and 2009, and the amount of money spent was $234 billion in 2008. The average American fills 12 prescriptions each year.

“Many side effects from drug interactions (not all) are exacerbations of known side effects of the single drugs that are made worse by the two drugs together,” says Dr. Russ Altman, a professor of bioengineering, genetics and medicine at Stanford University.

He co-authored a study in the journal Clinical Pharmacology and Therapeutics that found a widely prescribed antidepressant used in conjunction with a common cholesterol-lowering medication caused unexpected increases in blood sugar levels.

Altman says most drugs are tested and approved independently, and it can be difficult to predict the side effects of drug combinations.

“It is very hard to find these in advance of release of the drug, because sometimes these effects will only manifest in the context of large numbers of patients,” he explains.

“I don’t think people really understand the nature of medication; the (drugs) will, by definition, have some toxic, collateral side effects,” says Dr. Douglas Bremner, a professor of psychiatry and behavioral sciences at Emory University. His 2008 book “Before You Take that Pill” warned patients of the risks and benefits of some commonly prescribed drugs.

Bremner says medications clearly do a lot of good and are needed in many situations, but warns that when a patient is on too many at once, there are serious questions about whether the therapeutic benefits outweigh the collateral. “When you end up on 12 prescription medications you need to seriously look at what the situation is,” he says. “At that point, there’s no way of knowing what’s causing what anymore.”

“I don’t want to do this anymore”

Wincor recommends patients fulfill all their prescriptions at one pharmacy, especially if they are receiving treatment from multiple practitioners.

“Often the pharmacist is the best point person because they’re the last stop before the prescription hits the hand of the patient and are ready to be taken.”

He says the most important thing is to have one person who is keeping track of the various drugs and how they could interact.

If you can’t have a single overall manager of treatment, experts suggest keeping a list of all your prescriptions and showing the list to any physician introducing a new medication.

Altman says, when possible, introducing new medications one at a time can help you recognize side effects and interactions earlier. You can potentially trace them to the most recent drug added, he says.

Bremner also advises patients to check out websites like Medication.com and Askapatient.com and read the experiences others have had with the medication you have just been prescribed. “Patients should become more educated about the effects and not just blindly take what is given to them.”

Alesandra Rain says she reached her tipping point in 2003.

“I opened my medicine cabinet and saw it lined with prescription pill bottles,” she remembers. “I looked at myself in the mirror. My skin was gray, I was hunched over in pain, my eyes were swollen and I had no quality of life. I thought, ‘I don’t want to do this anymore.’ ”

She decided to quit taking all her prescriptions cold turkey — something neither she nor other experts recommend for any patient. “You can’t go cold turkey off that many pills without doing some damage,” Rain says. She eventually enrolled in a drug rehab facility that helps victims of substance abuse.

Today, Rain runs a company called Point of Return, which educates patients about the effects of prescription medications and helps them outline an “exit strategy” for safely tapering off highly addictive varieties of prescription drugs.

“I spent 10 years on the pills before I realized there was no exit strategy. It was always more drugs, never less.” says Rain, who later learned the cause of her initial insomnia was a B-12 vitamin deficiency. She is now taking one daily multivitamin. “My life became nothing but a bag of pills, and I just thought there has to be a different way.”

Written by Sabriya Rice, CNN Medical Producer

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Study Suggests Max Doses of Opiate Drugs Increase Accidental Death Rates

Prescription painkillers may be FDA-approved and doctor-recommended, but that doesn’t protect patients from the risk of lethal, accidental overdose, especially for those prescribed high doses.

Adding to the growing concern over abuse and over prescribing of painkillers, a new study published Tuesday finds that those on high or maximum doses of prescription opioid pain relievers are at a significantly increased risk of accidental, lethal overdose.

A high-dose cocktail of prescription pain killers, sedatives, mood regulators and muscle relaxants meant to help Alesandra Rain, 53, cope with chronic pain left her on the verge of overdose for years.

"I was liberally prescribed painkillers and anxiety meds and nearly died from the combination of pills. Several times I OD’ed inadvertently, once [while] in the hospital [and] my breathing stopped," she says.

"You lose track of what you’re taking because a lot of the time I was advised to ‘take as needed.’ My sister says she would stay up all night with me to make sure I kept breathing" when it appeared she had taken too much, Rain says.

After surviving a car crash at age 19, Rain underwent 34 surgeries in attempts to fix injuries to her crushed legs and spine. As time when on and her pain persisted, she was prescribed higher and higher doses of painkillers, but the pain persisted. She became so desperate that she had a device implanted in her spine to help control the pain.

The abuse and overuse of prescription painkillers and sedatives have become a major medical issue as the rate of overdose deaths from these drugs increased by a staggering 124 percent, according to the Centers for Diseases Control and Prevention. From 2004 to 2008, emergency room visits associated with prescription drug overdose more than doubled, and among those aged 45 to 54, these overdoses are now the second leading cause of accidental death, according to the Substance Abuse and Mental Health Services Administration.

"Based on recent evidence, it seems we have been guilty of promiscuous prescribing in the context of non-cancer pain," says Dr. Richard Deyo, professor of Family Medicine and Internal Medicine at Oregon Health and Science University.

"[The] CDC now estimates that there are 13,000 deaths a year related to unintentional overdoses involving opioids.”

Medicated Americans: High Dose Leads to Overdose in Some Cases

When it comes to chronic and/or severe pain, opioid painkillers, including morphine and morphine-like drugs such as OxyContin, Codeine, and Vicodin, are among the most powerful tools in a doctor’s arsenal. They are also among the most addictive and potentially dangerous, doctors note.

Because they are more likely to lead to addiction and abuse than other non-opioid painkillers, many physicians are reticent to prescribe them at all, referring patients instead to pain specialists, says Dr. Lloyd Saberski, medical director of Advanced Diagnostic Pain Treatment Centers in New Haven, Conn.

At the same time, other physicians are prescribing these painkillers without proper monitoring tactics such as requiring regular office visits, timely (not early) refills, and urine drug testing, according to a study published last month in the Journal of General Internal Medicine.

Tuesday’s study only adds to the concern that these drugs are not being properly managed and patients not properly monitored. The study, published in the Journal of the American Medical Association, looked at more than 150,000 veterans on opioid prescription painkillers and found a link between those who were given high doses and those who suffered accidental fatal overdoses.

"Until recently, many have taught that there is no unsafe maximal dose of opioids, as long as doses are increased gradually. However, there is growing evidence that this is often not a terribly effective approach, and the safety concerns are growing," says Deyo.

"In the past, patients and physicians thought that the solution to pain was to give ever increasing doses of opioid medications [and] the risk of higher doses has been viewed as ‘only’ sleepiness or sedation, and rarely respiratory problems," says Dr. Timothy Collins, assistant professor of Medicine/Neurology at Duke University.

This research suggests that adverse outcomes, especially accidental overdose, could be in part related to the high doses given to some patients, which should cause physicians to reconsider whether higher doses are really the answer to patients’ pain complaints, he says.

Unhooked on Drugs: Getting Off Opiates

For Rain, the escalating doses of painkillers and other meds were not the answer to her chronic pain. After 25 years on multiple medications, the breaking point came when her doctors, in hopes of finally managing her constant pain, suggested a morphine pump to deliver powerful painkillers directly and regularly into her spinal cord fluid.

"I was already on so many pills, so I’m not sure why this was where I drew the line, but I went cold turkey," she says. Eight years ago Rain checked herself into a drug rehab center where she would be supervised while she went through withdrawal. She also went through years of intensive physical therapy to treat the many musculo-skeletal problems she had developed from her injuries, contributing to her pain.

Today, she says she has no pain, and has started a nonprofit, Point of Return, in California in hopes of helping others kick their dependence on painkillers.

If opioids are not improving the pain at a reasonable dose, another treatment should be discussed, adds Collins. view article

Written By COURTNEY HUTCHISON, ABC News Medical Unit, April 6, 2011

Rehab, Jail and Death Realistic Fates for Fired Actor, Experts Say, as Skeptics Say It’s All for Show

Actor Charlie Sheen last night took to his online program, "Sheen’s Korner," to lament his recent firing from "Two and a Half Men" and blast his former bosses. Sheen has dismissed widespread suspicion that addiction or mental illness might be fueling his antics, claiming earlier to be on the drug "called Charlie Sheen" and not bi-polar but "bi-winning."

But his increasingly erratic behavior, which cost him his job Monday on the hit CBS comedy, has many health professionals concerned about his well-being even as skeptics say it’s all for show.

"When addicts are high on drugs, or a manic person is high due to the biochemical changes in his brain, they reject help because they truly believe that they are ‘winners’ who know better than everyone else what is best for them," said Dr. Carole Lieberman, a psychiatrist at the University of California, Los Angeles.

But the job loss and the removal of his 2-year old twins, Max and Bob, from his home last week might signal the end of Sheen’s "winning" streak.

Eric Braun, a friend of Sheen’s, told GQ magazine "there are just three options" left for the fired actor: "rehab, jail or death."

Mental health experts agree. "Frankly, we really don’t know what leads one person to a specific end," said Dr. Eric Caine, chair of psychiatry at the University of Rochester Medical Center. "No doubt, this man is a mess and his ‘destiny’ may not be a happy one." While Sheen’s conduct in media interviews and in his online show has shocked viewers, psychiatrists say they’ve seen it all before. "There is nothing so unusual about what we are seeing — for those of us in the mental health field — just that we are seeing it so publicly," Caine said.

Sheen’s long track record of offenses — from drugs and violence to rumors of trouble on set — might have hinted at mental health problems in the past. Yet he has consistently avoided major repercussions that could have "tempered his grandiosity," according to Alesandra Rain, co-founder of Point of Return, a nonprofit organization in Westlake Village, Calif., that helps people escape pill addiction.

"Now the consequences are beginning to hit him, but he is still working from the perspective that he is untouchable," Rain said. "His media blitz is being misinterpreted as public support and he is not in the frame of mind to realize the damage he is doing."

Supporting Sheen
To repair the damage to his health, his career and his relationships, Sheen will need a dedicated network of support; one that will likely include many of the people he has publicly offended.

"This may require ex-spouses, family members, friends and colleagues who don’t always work together or even get along, to present a uniformed front and work together," said Joshua Klapow, a clinical psychologist at the University of Alabama, Birmingham School of Public Health.

Having everyone on board is critical, Klapow said.

"This is a huge undertaking in a situation like Charlie’s," he added. "He has huge social networks."

The long-term effects of what might be a public decline for Sheen are uncertain.

"The world can be very forgiving, especially if his behaviors are viewed by others as victimless," Caine said. "Having a powerful negative impact on the people around him would tip the balance. Short of that, many are allowed to recover from being fools or buffoons."

Sheen reportedly threatened to cut off ex-wife Brooke Mueller’s head and send it to her mom. He also called "Two and a Half Men" creator Chuck Lorre a "clown," a "stupid, stupid little man" and a "p***y punk that I never want to be like."

But acknowledging past mistakes is part of the recovery process, said Martin Binks, clinical psychologist and CEO of Binks Behavioral Health PLLC, citing the 12-step program from Alcoholics Anonymous. Sheen’s media frenzy might therefore aid in his recovery, said Binks, such that "he will have lots of data to look back on and remind himself of his bottom."

Sheen called Alcoholics Anonymous a "bootleg cult" with a 5 percent success rate in a Feb. 24 interview on "The Alex Jones Show."

As for Sheen’s future, learning to live with the consequences of the past is part of recovery, said Mark Williamson, a psychiatrist at Memorial Hermann Prevention and Recovery Center in Houston.

"It is often quoted in treatment circles, ‘You cannot save your behind and your face at the same time,’" Williamson said. "With appropriate treatment, people will be informed by their past behavior as it relates to their everyday lives moving forward."

Sad Reality or Reality TV?
Although Sheen’s behavior on TV and online might appear to be his last act, they could be his best performance ever, according to Randy Roberts, author and distinguished professor of history at Purdue University in West Lafayette, Ind.

"Beyond rehab, jail or death, I think there’s a fourth option here," Roberts said. "A realty-TV show."

Roberts said Sheen "pressed the limits of what can be done on TV and now he’ll press the limits of realty TV.

"Everybody’s playing their part in this made-for-TV drama," Roberts said, adding that the tape of the police taking his kids away should have tipped everyone off.

George Santo Pietro, another friend of Sheen’s, said Sheen is still in control.

"There’s a method to his madness," Pietro said. "There’s a bigger story to Charlie than everyone has seen."

The University of Alabama’s Klapow said it is possible that Sheen’s behavior is calculated.

"We don’t know what is orchestrated, we don’t know what is drug induced, and we don’t know what are his demons coming to the surface," Klapow said. "All we can do is sit, watch and hope and pray that we are seeing a performance and not the real Charlie Sheen."

BY KATIE MOISSE, ABC NEWS MEDICAL UNIT – view article

Reducing your reliance on antidepressants requires patience and a doctor’s involvement.

When the weight of her husband’s cancer and the stress of her corporate job became too heavy to bear, Karen Huber did as many of her friends had done and started taking an antidepressant.

What she didn’t realize was how difficult it would be to stop.

After a year of taking 10 milligrams of Lexapro daily, on top of 50 mg of Trazodone that she had been taking for a decade to help her sleep, Huber tried to quit cold turkey. The withdrawal symptoms were insufferable: anger and frustration so overwhelming she "could have chewed through a brick."

When Huber tried quitting again in March, she attacked it with a three-pronged strategy: She split her pills in half every couple of weeks, took nutritional supplements to mitigate her irritability, and ultimately checked into a detox center for three weeks. It took more than two months, but it worked.

"If I had known how hard antidepressants are to get off of, I would have tried to avoid them," said Huber, 54, of Little Rock, Ark.

Antidepressant usage doubled between 1996 and 2005, to 10 percent of the U.S. population, according to a study published last year in the Archives of General Psychiatry. That boom means masses of patients who face the challenges of stopping.

Though antidepressants are the most commonly prescribed medications in the U.S., there are no official published guidelines for when and how to come off them, said Dr. Michael Banov, a psychiatrist and author of the new book "Taking Antidepressants" (Sunrise River Press, $16.95).

Generally, patients should stay on antidepressants for at least nine to 12 months to reduce the likelihood of a depression relapse, Banov said. But beyond that, it’s up to patients to work with their doctors on whether and how to wean themselves off the drugs. Sometimes the process is unpleasant.

About 20 percent of people who try to quit suffer what the drug companies coined "antidepressant discontinuation syndrome," which can cause symptoms including depression, anxiety, irritability, dizziness, nausea, light-headedness and electric shocks known as "brain zaps."

Symptoms can be more severe the longer you have taken antidepressants, the higher the dosage and the more sensitive your body happens to be, Banov said. They also depend on the drug. Paxil and Effexor are associated with some of the worst withdrawal symptoms because they clear out of your system quickly, leaving little time for your body to adjust to the sudden drop in the neurotransmitter serotonin. Prozac, meanwhile, takes a long time to leave your body, diffusing the withdrawal effects.

Though drug companies warn of potential withdrawal symptoms in their literature, physicians don’t always alert their patients when they prescribe the meds, and many people start taking antidepressants not knowing it’s so hard to stop.

"It made me angry. I felt like I hadn’t been told," said Katherine Perry, 40, an English professor in Cumming, Ga., who became uncomfortably irritable and anxious when she tried to wean herself off Paxil and Wellbutrin on separate occasions.

A cruel catch to discontinuing antidepressants is that it can be hard to tell if the symptoms are from withdrawal or a return of depression, so you have to wait it out, Banov said. If it’s withdrawal, the symptoms should begin to clear up in one to two weeks, though sometimes it takes six to eight. If it’s depression, they’ll get worse.

The key to managing withdrawal is to taper the dosage gradually. But some people need more help, especially when they’re trying to come off several prescription drugs.

Wendy Honeycutt was put on antidepressants after the suicides of her mother and brother. It proved a "doorway to disaster," she said, as the side effects later prompted her to take sleeping pills and anti-anxiety medication. At the peak, she was taking seven prescription drugs.

When she decided to clear her body because she felt like "a toxic mess," the Texas woman went into a debilitating withdrawal that left her sleepless, anxious, shaking, sweating and emotionally numb, with electrical zaps feeling like "red-hot pokers in my head." She was incapacitated for two months and sick for three years.

It wasn’t until Honeycutt found Point of Return, a nonprofit based in Malibu, Calif., that helps people come off their prescription meds, that she began to improve. In addition to offering tapering schedules, information on how drugs interact with each other and emotional support, the organization swears by a schedule of nutritional supplements to temper withdrawal, including omega-3 fatty acids to support brain function and glutathione to enhance the immune system.

Honeycutt, 44, a pastor who now volunteers at Point of Return, said she has been medication-free for three years.

Of course, some people need to be on antidepressants and shouldn’t quit. Long-term untreated depression is bad for your brain and body, causing parts of the hippocampus to shrink and hurting the immune system, Banov said. The goal is to be depression-free, not medication-free, he said.

But for Huber, who used the Point of Return program for the six weeks she tapered her dosage, life is better without them — though not necessarily easier. The Lexapro had protected her like a "hard shell," keeping her from being weepy all the time, especially after her husband died last summer.

"Since I’ve been off them, I cry much easier, I’m much more tender," Huber said. "But that’s OK. That’s part of the grief process." More…

Article by Alexia Elejalde-Ruiz, Chicago Tribune, August, 29, 2010- view article