Sunday 20 October 2013

Side Effects of Antidepressants

Antidepressants do have side effects and if you are prescribed these medications, make sure your doctor discuss them with you. I will discuss the side effects of some of the usual classes of antidepressants used. It is also interesting to note that even sugar pills can cause side effects, read more about it here.

1. Selective Serotonin Reuptake Inhibitors (SSRI)

These include Escitalopram, Setraline and Fluoxetine.

SSRIs are probably the most commonly prescribed class of antidepressants. SSRIs are safe and used in various age groups from children to elderlies. They are not only given in clinical depression (description of clinical depression click here) but also in other disorders such as anxiety disorders and even in anger management.

Common side effects of SSRIs include:

- Tummy discomfort
- Nausea
- Headaches
- Drowsiness
- Anxiety

These side effects are usually transient and are worst in the first 4-5 days. In the long term, some people may experience gaining weight or sexual dysfunction with SSRIs. However these are reversible once the medication is stopped.

2. Selective Serotonin Norepinephrine Reuptake Inhibitor (SNRI)

These include Duloxetine and Venlafaxine.

SNRIs are newer antidepressants. They have the advantage of also working on the norepinephric neurotransmitters in the brain as well. Their side effects profile are similar to SSRIs but they are more likely to cause nausea, dry mouth and excessive perspiration. Venlafaxine may increase blood pressure and your blood pressure should be monitored if you are given this medication by your doctor.

3. Tricyclics Antidepressants (TCAs)

This is an older class of medication and include Amitriptylline and Clomipramine.

They are more likely to cause side effects like:

- somnolence
- drowsiness
- dry mouth
- constipation
- difficulty passing urine
- blurred vision
-weight gain

TCAs can be dangerous in overdose as they can cause heart irregularities. For this reason, they are seldom used these days.

REMEMBER: In any medical treatment, your doctor will consider and discuss with you the benefits and risks of the treatment as well as any alternatives available. Whilst antidepressants can cause side effects, they have been shown irrevocably to save lives and prevent suicide. During the initial phase of treatment, your doctor will monitor you closely for any side effects and to make any necessary adjustments to the dosage or to change the medication altogether.

Studies have also shown that only 40% of patients with side effects will tell their doctors. So if you have side effects with medication bothering you, do let your doctor know so that he can better tailor his treatment for you!

Monday 14 October 2013

Happy Hari Raya Haji

To all my Muslim friends and colleagues, a very happy Hair Raya Haji!

Sunday 13 October 2013

Eating Disorders In Singapore

1. What are the types of Eating Disorder?

Eating Disorders are a group of psychological conditions where sufferers have severe difficulties in their eating habits and behaviour. They include Anorexia Nervosa, Bulimia Nervosa, Binge-eating disorder and other types of eating disorder. About 1 in 15 females may be at risk of a ED but only a small proportion of these sufferers sought help with a psychiatric clinic in Singapore. Some patients seek help for other problems like depression but have ED as a coexisting problem which was picked up during our assessment.

2. Who suffers from certain EDs more? What is the demographic like and why?

In Singapore, young teenage school-going females are most likely to suffer from EDs like Anorexia. ED especially Anorexia can be perceived as a cultural phenomenon. In the past, we do not value thinness as much in our society. In fact, obesity was seen as a sign of wealth. However, as we become rapidly westernised and bombarded by the influence of western media, thinness and the emaciated look in females became idealised. Young girls are particularly vulnerable to these influences and they face more peer pressure from their friends in school and their social circles where everyone is trying to achieve the thin look. 

3. Is the demographic changing? Any reasons for this change?

Although there are no recent local data to support this, from my clinical experience, more males are starting to suffer from ED. This is due to the fixation on masculinity in males these days, again influenced by western media. In male ED, the fixation is often on muscle definition and exercising instead of the obsession on thinness.

There are also an increase in the cases of orthorexia nervosa, a less common type of eating disorder where the individual is obsessed about eating "healthy" food and about exercising. This is again in contrast to Anorexia where the individual is pursuing thinness. Orthorexia can nevertheless lead to the same consequences as Anorexia if the individual eliminates too many types of food from his or her diet and ends up not eating and emaciated.

4. What are the main causes of ED in Singapore and do the causes differ across gender, cultural or racial lines?

The exact causes of ED is unknown and is likely to be multifactorial. There is likely to be a genetic link as it can run in the family. Neurotransmitters (brain chemicals) like serotonin have been implicated. Many ED patients also have psychological problems such as low self esteem, impulsive or perfectionistic personalities and troubled relationship. Social issues such as media influences and peer pressure to look thin also play a part in tipping a person over into ED.

5. What do you think of the rise in ED cases? How representative do you think the numbers of treated patients are of the actual group?

I believe many cases are not still not identified and treated. We are also not catching them early enough and they surface only when the youth is in a serious stage. In fact, even for anorexia which is the most well recognised ED, patients are often already in a very bad physical state when they first see a doctor. Patients with other ED like binge eating disorder may not even seek help at all as their family and friends may often just see their behaviour as gluttony. There is also a stigma to seeking treatment for psychiatric conditions which prevents people from seek help.

6. What are the most obvious signs that someone needs help - and how can loved ones intervene?

Early signs of ED are often hard to pick up for parents. If a parent noticed that their teenager is always preoccupied with being fat when they are not, are secretly vomiting their food out or having menstrual irregularities they should raise the red flag. Other symptoms that may be obvious are overexercising and using laxatives to control weight. As ED particularly Anorexia has high mortality (death) rate, if parents are concerned, it is best that they seek a consultation with a psychiatrist to check so that treatments can be started early.

7. How should one seek help?

Help is readily available. One can just call up our psychiatric clinics 64796456 to make an appointment for an assessment. 

Those wishing to seek help from our restructured hospital, can call the SGH Eating Disorder Unit at 6326 6697.