Posts Tagged ‘depression’

Citalopram and the Heart

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Peace.  It’s not a bad word.  It is not a curse word.  But it has been annoying me to no end recently.  I’m not against peace in theMiddle East, or inner peace, or even Christmas carols that wish Peace on Earth.  Peace annoys me because my nine year old daughter,Emily has turned it into her universal greeting.  Emily no longer says “Hello,” when meeting people, or “Good-bye” when leaving the house.  And Emily no longer waves her hand like a normal person when she is coming or going.  No, now Emily makes a peace sign with her first two fingers and just says, “Peace” whenever she sees me.  She will often say, “Peace” when she is just coming into, or leaving a room.  I don’t think this is a throw back to the hippies of her grandparent’s era.  I think “Peace” is supposed to be an homage to the current hip hop stars.  I don’t really like hip hop either, but that is a gripe for another day.  Emily’s greeting of “Peace” is just so odd sounding to me.  I don’t want to sound like a 92 year old man but, I think “Hello” and “Good-bye” are perfectly good greetings. I don’t think kids these day should mess with these greetings by replacing everything with “Peace.”

 

When you have depression, it can be very hard to find peace.  Most of us have said, “I feel depressed” at one time or another, but that is often not what a clinically depressed person would say.  If clinically depressed person goes to see their doctor, it is often about the physical symptoms they have.  They will tell their doctor that they have stomach problems, a lack of energy, a change in their appetite, or a lot of pain like head aches or muscle pain.

 

One of the ways we treat depression is with antidepressant medications.  The most common type of antidepressants are the SSRI’s or selective serotonin reuptake inhibitors.  During a recent round of medication reviews at the Dauphin Personal Care Home (PCH), Crystal Drayson and I discussed the dose of the SSRI citalopram in one of the patients. Crystalis the Mental Health nurse at the PCH and we’d both read reports that the upper dose of citalopram should be reduced.  Citalopram used to be prescribed up to 60 mg per day, but new reports from the Food and Drug Administration (FDA) in theUSsay high doses of citalopram may prolong the QT interval and that can be hard on the heart.

 

What is the QT interval?  When a doctor hooks electrodes up to your chest to check your heart, they are looking at an ECG or electrocardiogram.  One of the parts of the ECG print-out is called the QT interval.  If the QT interval gets too long, the patient is at an increased risk of a certain type of heart problem called torsades de pointes.  Torsades de pointes can cause cardiac arrest.  Fortunately, torsades de pointes is a rare condition.  Risk factors for torsades include advanced age, being female, having heart disease already, being on a water pill and being on more than one medication that prolong the QT interval.

 

There are actually lots of medications that prolong the QT interval.  Heart medications like sotalol,  antibiotics like clarithromycin, ADHD medications like Ritalin, antifungal medications like fluconazole, antihistamines like diphenhydramine (benadryl) and decongestants like pseudoephedrine (Sudafed) can all prolong the QT interval.  So the fact that citalopram prolongs the QT interval is not a rare drug related event.  And like many other drugs, citalopram’s effect on the QT interval is dose dependent.

 

The FDA report said citalopram 20 mg per day increased the QT interval by 8.5 ms, 40 mg per day increased it by 12.6 ms and 60 mg increased it by 18.5 ms.  Because increasing the QT interval increases the chance of the rare torsades de pointes, the FDA now says citalopram should not be used at 60mg per day anymore.  The FDA says 40 mg per day of citalopram is the maximum dose for anyone.  They further said that anyone over 60 years old shouldn’t use more than 20 mg per day of citalopram. 

 

Another interesting recommendation that came out of the FDA report was to only use citalopram at 20 mg per day for patients on certain other medications like omeprazole.  Omeprazole is a stomach medication, but it happens to effect an enzyme that breaks down citalopram.  So if you take omeprazole and citalopram together that could increase the amount of citalopram in your system.  Again that could prolong your QT interval.

 

So what should you do if you are currently taking a high dose of citalopram?  Keep taking it.  Don’t stop or adjust your medication dose on your own.  You can definitely get side effects from stopping citalopram.  Remember, even at a high dose of citalopram, the chance of heart problems are low.  However, if you are on a high dose of citalopram, make an appointment with your doctor.  The two of you can assess your risk of heart problems and decide how to proceed in your case.

 

Maybe sounding like a 92 year old man and griping isn’t so bad.  Andy Rooney griped about things on 60 Minutes from 1978 until this October.  He is 92 years old and is just now retiring from the show.  Hopefully if I keep griping, I might have a career as long as Mr. Rooney’s.

 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

 

Mood Disorders Society of Canada: www.mooddisorderscanada.ca

 

Depression Hurts website: www.depressionhurts.ca

 

Citalopram and the Heart – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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Depression: Noticing the Signs & Symptoms – Audio

By Barret Procyshyn.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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Depression: Noticing the Signs & Symptoms

By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy

Trouble sleeping is often present, perhaps increased headaches or maybe a loss of appetite. Food may not be appealing and the only way to describe the feeling is “blah”. Sad may not be one of the symptoms, but it may be serious enough you may not be able to get out of bed.

Many may believe a person of this description may be stressed out. The problem could be stress related, but it could also very likely be depression. Usually we think of depression as “feeling the blues” and can miss the physical symptoms which accompany a very common illness.

Depression is quite commonly defined as feeling sad, unhappy or miserable. Most of us have felt this way at one time or another for short periods of time. True depression is a mood disorder in which these feelings of loss, frustration and sadness interfere with our everyday lives for an extended period of time. The exact cause of depression is still a mystery to researchers, although it is believed to be related to chemical imbalances in our brains. Depression is believed to be triggered by traumatic events or even heredity. Depression is found in school aged children right to the later stages of life.

The hallmark symptoms of depression, chronic sadness and a lack of interest in activities which used to bring pleasure are most common. However; we must realize some of us may have depression and not feel the sadness. Studies show up to 69% of people who meet the diagnostic criteria for depression denied having any psychological symptoms. Although people may actually be depressed, they think it is just from being overworked, fatigued or stressed out.

However; physical symptoms need to be identified so depression does not go untreated. Some physical common physical symptoms include headache, stiff neck, backache, fatigue and changes in sleep. Bowel problems and appetite loss are also primary complaints in depression. Pain tolerance can be decreased and you may find yourself getting sick more often, because it decreases the effectiveness of your immune system.

Depression treatment aims to achieve remission of depressive symptoms, restore optimal functioning and prevent reoccurrence. Treatment often consists of therapy, medication or a combination of the two.

Medications called antidepressants can be quite effective. Although traditional antidepressants had high incidences of side effects, there are many effective and safe treatment options today. They are usually started at a low dose and increased over time to reach the optimal dose with minimal side effects. It may take up to six weeks to find the optimal medication dose for some patients and sometime the medication is switched for another. However; most patients notice effectiveness and a relief in symptoms within two to four weeks once at optimal dose. Anti-depressants should be taken consistently at the same time every day. People trying herbal medications to treat depression must be extremely cautious if also starting prescription medications because drug interactions can be very serious. Antidepressant medications should always be taken, even if you are feeling better. They should also never be stopped without the advice of your doctor or pharmacist.

If depression goes untreated it can lead to many other long term health problems. Therefore it is important to identify depressed patients quickly and create a treatment plan. If you are looking for valuable information on depression and want to search online, start at www.depressionhurts.ca. If you are on a treatment for depression your pharmacist can explain your medications and provide you with other resources for information.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

Asthma and Other Diseases

 

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio?  Listen to 730 CKDM Tuesday Mornings at 8:35 am!  We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

“I’m the King of the World!”  That may be the most famous line yelled from the front of a ship.  However the real story about the discovery of the Titanic was fascinating too.  Dr. Robert Ballard had a long time interest in the Titanic and had developed some equipment and the underwater robot Argo that could look for it.  The US Navy had no interest in the Titanic, but it wanted to find two of its submarines that had sank.  So they struck a deal.  Ballard would look for the two subs, and could use the money left over to find the Titanic.  When Ballard found the subs, he found that each had a long trail of debris that led to the sub.  The debris trail was relatively easy to find, and he could follow it to the sub.  Ballard used this technique to follow the debris trail and find the Titanic on September 1, 1985.  Are diseases like asthma a debris trail to other conditions?

Asthma is usually associated with young, otherwise healthy people.  Unlike diabetes which seems to directly or indirectly cause heart disease, kidney disease, blindness, amputation and other conditions,  asthma isn’t usually associated with other conditions.  During some of my asthma training we were told that there is an asthma, eczema, allergic rhinitis triad.  That means people with asthma often also have the skin condition eczema and the runny nose that comes from allergic rhinitis.  We aren’t exactly sure why.  It may be genetics or environment, but whatever goes wrong with the immune system to cause asthma also seems to be involved with eczema and allergic rhinitis.  So I was really interested when I heard there was a study in Ontario that was looking into what other diseases people with asthma get.

The study I read was published by Gershon et al. in the July issue of Thorax.  It looked at 4 databases that covered all 12 million people in Ontario in 2005.  They found that there were about 1.7 million people in Ontario with asthma or about 13% of the population.  Of those people with asthma, they determined about 400,000 had active asthma, and the rest were determined to be less active asthma.

One of the main measures the researchers used to detetmeine how sick the patients were was how often their doctors made a claim to Ontario Health.  Over one year for every 100 active asthma patients their doctors made an average of 1616 claims for clinic visits.  For non-asthmatics, for every 100 patients their doctors billed Ontario Health an average of 942 times in one year.  So the authors estimated that there were an extra 674 claims for the asthmatics. 

Another way of looking at is for all the health claims in Ontario 6% of all clinic claims, 8% of all ER visits, and 6% of all hospitalizations were from asthmatics from diseases other than their asthma.  That would be like an asthmatic visiting their doctor for depression.

As I said before, these extra co-existing conditions in the asthmatics is interesting because we usually think of asthmatics as being young and otherwise healthy.  For example of all the identified active asthmatics in the 2005 Ontario study, the average age of an active asthmatic was 31 years old.  However this group had more than twice as many claims for non-asthma respiratory diseases, almost twice as many psychiatric conditions like depression and anxiety and more musculoskeletal claims than the non-asthmatic control group.

Now for the chicken and egg part.  Does having asthma make you more likely to get a psychiatric condition like depression?  We don’t know.  Does treating asthma with inhaled steroids make you more likely to get a musculoskeletal condition like osteoporosis?  We don’t know.  Do some of these other conditions make it more likely to get asthma?  We don’t know.  We need more studies.

If you look in the sky, it can be very hard to see a tiny jet plane.  But if you follow the contrails or smoke from the plane, you can more easily find it.  Dr. Ballard used the debris trail to find the Titanic.  Is asthma like a debris trail we can use to find more diseases in a person?  We don’t know yet, but it will be interesting to follow the trail.

 As always if you have any questions or concerns about these or other products, ask your pharmacist.

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