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| |  SSRIs More Effective But Adverse Drug Interactions Still a Problem WASHINGTON, Nov. 7, 1996 -- A new group of antidepressants -- known as selective serotonin reuptake inhibitors or SSRIs -- are fast replacing the use of older tricyclic antidepressants because of their high effectiveness and decreased side effects. However, as these drugs increase in popularity (the best known is Prozac), so are the number of people being admitted to emergency departments for severe SSRI interactions or overdoses. Thomas G. Martin, MD, MPH, an emergency physician, medical toxologist, and author of the review, noted that although SSRI poisoning or overdose in patients is less dangerous than overdose with older antidepressants, the "serotonin syndrome," an adverse drug interaction, is dangerous and can be fatal if not recognized and treated in time. "These new antidepressants are helpful to many patients when used correctly," says Dr. Martin. "But even though these drugs have fewer side effects than their predecessors, they can be dangerous when combined with other drugs." Serotonin syndrome causes a variety of symptoms including hallucinations, confusion, fluctuating blood pressure, seizures, high temperatures, stiffness, and irregular heart beats. People taking SSRIs develop serotonin syndrome when they also take illegal drugs such as LSD, cocaine, or "ecstasy" (MDMA); or prescription drugs such as imipramine (Tofranil) and Demerol -- a commonly prescribed pain medication. The adverse drug interactions appears to be most severe (resulting in death) when SSRIs are combined with monoamine oxidase inhibitors (MAOIs) antidepressants such as Nardil. "Because the number of prescriptions being written for SSRIs is rising rapidly, emergency physicians are going to see the serotonin syndrome a lot more frequently," says Martin. "We want people, especially the elderly who are likely to be taking a variety of medications, to be aware that something as subtle as increased confusion, unusual behavior, or agitation may be the first sign of serotonin syndrome. So it's important that your doctor know what drugs you take." -- Emergency Physicians Identify Battered Women by Injuries to the Head, Chest, and Abdomen Areas Knowing what injuries an abused woman is more likely to have -- cuts and bruises on the head, neck, chest, and abdomen area -- can serve as warning flag to emergency physicians, say researchers in a study in the November "Annals of Emergency Medicine." However, according to Robert Muelleman, MD, an emergency physician and lead author of the study, one-fifth of the women interviewed and found to be abused had none of these injuries. "Our study showed two things. One, we were able to show that certain injuries are very likely to indicate abuse. Two, about 20 percent of the battered women don't have those injuries, so all injured women coming to emergency departments should be screened," says Dr. Muelleman. There were 12 types of injuries that were found more often in battered women, and the most common was cuts and bruises on the face. However, some injuries were quite subtle, and because the victims may be reluctant to discuss how they were injured, the physician should pursue the cause of the injury. "When someone comes in with chest pain and says it's indigestion, we don't just accept that it's indigestion, we screen for heart disease. Likewise, when an injured woman comes in, we shouldn't just accept that the injury was unintentional, we should screen for other causes of injury, including abuse, cautions Dr. Muelleman. "This (battering) can be a fatal disease." -- Cocaine and Alcohol Do Not Mix Using cocaine may send someone to the emergency department. But combining cocaine with alcohol is more likely to lead to admission to the intensive care unit for breathing problems, mental confusion, and wounds from gunshots or knives. Researchers compared patients in a university-affiliated community hospital who had either used cocaine alone or combined it with alcohol. They found the biggest difference is that patients combining alcohol with cocaine were more likely to have suffered some kind of violent injury such as a gunshot or knife wound, or to have been assaulted. "It's clear that people who combine cocaine and alcohol suffer more violent trauma, but the exact cause and effect relationship is unknown," says Vincent Vanek, MD, chief researcher and trauma surgeon. "We do know that cocaine is a stimulant and alcohol is a depressant, and their combined use may increase the chances of complications. Although both the cocaine and cocaine/alcohol groups, which were predominantly made up of single males, spent about the same time in the hospital after being admitted, the cocaine/alcohol group had a greater chance of ending up in the intensive care unit with a tube inserted down their throat because of breathing problems. The cocaine/alcohol group also had a greater degree of mental confusion and higher blood pressure and heart rates. Dr. Vanek notes, "The combination of these two drugs can result in an addiction which is more difficult to fight than for either drug alone.
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