Posted by manowar on January 9, 2002, at 17:18:23
In reply to Re: SSRIs could cause strokes?, posted by OldSchool on January 9, 2002, at 14:05:26
Hi Old School,
Yeah, of course you’re right. Everyone is different, and responds to meds differently. AND-this is not from a study at all, really. It seems that it is just based on observations from a few Neurologists that-- based on some clinical cases, are concerned that serotonergic drugs COULD cause strokes.
Here is part of the article from “Neurology”:
--Note: I’ve inserted the numbers as references.
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Cerebral vasoconstriction and stroke after use of serotonergic drugs
A. B. Singhal, MD, V. S. Caviness, MD, A. F. Begleiter, MD, E. J. Mark, MD, G. Rordorf, MD and W. J. Koroshetz, MD
From the Departments of Neurology (Drs. Singhal, Caviness, Begleiter, Rordorf, and Koroshetz) and Pathology (Dr. Mark), Massachusetts General Hospital, Boston, MA.
Address correspondence and reprint requests to Dr. A.B. Singhal, Stroke Service, VBK-802, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; e-mail: asinghal@partners.org
1) Serotonin (5-hydroxytryptamine) is a potent vasoconstrictor amine. The authors report three patients who developed thunderclap headache, reversible cerebral arterial vasoconstriction, and ischemic strokes (i.e., the Call–Fleming syndrome). 2) The only cause for vasoconstriction was recent exposure to serotonergic drugs in all patients, and to 3) pseudoephedrine in one patient. 4) These cases, and the literature, suggest that the use of serotonin-enhancing drugs can precipitate a cerebrovascular syndrome due to reversible, multifocal arterial narrowing.
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Again, above is a copy of part of the article from “Neurology”. I’ve used the numbers, to be able to refer to the sentences from the above article.Some points of concern and a few questions:
1) “Serotonin (5-hydroxytryptamine) is a potent vasoconstrictor amine”
--This seems to be more a statement of fact than an opinion or an assumption. That concerns me. Why haven’t we --as patients been informed this in the past? Or, is that something that has slipped me, which everyone else knows?2) “The only cause for vasoconstriction was recent exposure to serotonergic drugs in all patients, and to pseudoephedrine in one patient.”
--This seems to be another statement of fact. I wouldn’t know how the writer of the article came to his conclusion, but he seems to be very sure of himself.
(Of course, what doctor IS NOT sure of himself-even if he is WRONG? I've yet to meet him/her. hehehe)3) What is pseudoephedrine?
4)”These cases, and the literature, suggest that the use of serotonin-enhancing drugs can precipitate a cerebrovascular syndrome due to reversible, multifocal arterial narrowing.”
--Pretty strong statement- huh?AND-- what do they mean "and the literature"--is there literature out there that suggest that the use of serotonin-enhancing drugs can precipitate a cerebrovascular syndrome due to reversible, multifocal arterial narrowing?
Question: what is cerebrovascular syndrome? Is that just a fancy name for a stroke?
Question 2: What is multifocal arterial narrowing? Does that just mean that in many areas of the brain, the blood vessels constrict?
Of course, these journal articles are not for public consumption. I happen to get the journals because I like to be ‘in the know’ as much as possible. I don’t think this article from “Neurology” or the article from “PsychiatryMatters.MD” was intended to startle anyone. They are just published to raise awareness to other physicians, that there COULD be a problem based on un-controlled studies.I would doubt very seriously, though, that there would be a bias against serotonergic agents by a group of Neurologists.
Just a thought: I don't know anything about 'vasodilators', but maybe could they be considered while taking SSRIs?
--Tim
poster:manowar
thread:89439
URL: http://www.dr-bob.org/babble/20020103/msgs/89476.html