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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by BRC on May 28, 2004, at 13:45:19
Hi, everyone I have another quick question. This has been bothering me for a while and I can't seem to find the answer. I have been taking anti-depressants (mostly SSRI's) and anti-anxiety meds daily for abut five years now. I know that medication is metabolized in the liver and was wondering if these meds can cause liver damage (especially as long as I have been on them). My family physician also started me on a cholesterol lowering medication several months ago and I know this affects the liver. I just don't want to end up harming myself if these meds can cause damage to organs. Thanks to anyone who has any knowledge or suggestions.
Posted by zeugma on May 28, 2004, at 13:57:20
In reply to Can Antidepressants damage the liver?, posted by BRC on May 28, 2004, at 13:45:19
Serzone is being withdrawn because of hepatotoxicity. The other AD that I know of which is (relatively- we are not talking about ALCOHOL here) hepatotoxic is nardil. Also, Cylert, a stimulant used in ADD treatment, and which I have taken in the past, can damage the liver.
I think the issue with Serzone, as opposed to the other two meds, is that the liver toxicity is so unpredictable. Even so, many would argue that the risk is too minimal to warant being withdrawn. Personally, I have completely avoided alcohol for the last year because alcohol puts a lot more strain on my liver than anything else I have ever ingested (including Cylert).
Posted by BRC on May 28, 2004, at 19:53:29
In reply to Re: Can Antidepressants damage the liver?, posted by zeugma on May 28, 2004, at 13:57:20
Thanks for the response to my post. I had heard about the Serozone scare and even people filling lawsuits against the manufacturer. I am just weary of beeing on so many meds. I'm not used to taking so much at one time and it just seems like so much medicine could be dangerous. My doc's currently have me on 5. I try to eat healthy, exercise, and take alot of vitamin supplements to kind of make up for all the meds I have to take. Thanks again for your response.
Posted by King Vultan on May 29, 2004, at 11:16:23
In reply to Can Antidepressants damage the liver?, posted by BRC on May 28, 2004, at 13:45:19
To add to the good information provided by zeugma, Marplan (isocarboxazid), which I guess is still available in the US to people willing to go through the hassle of dealing directly with the manufacturer, has hepatotoxicity similar to that of Nardil. Both of these are hydrazine derivatives, which is apparently the source of this (relatively rare) problem.
One of the early hydrazine MAO inhibitors had a disasterously high rate of associated liver failure and was withdrawn decades ago. If one takes a look at the prototypical hydrazine derivative and anti-tuberculosis agent isoniazid, this drug has a small but significant ability to cause hepatitis that doctors and patients must be aware of. According to "Mosby's 2004 Drug Guide",the incidence appears to be age related, with approximately 0 cases per 1000 patients under 20 years of age to to a maximum of 23 cases per 1000 for people in the 50-64 age group.
The incidence of liver problems for Nardil and Marplan are in the "rare" category and are much less than this, but from what I've read, the hepatotoxicity for these two drugs appears to also be age related. The Mosby book referenced above indicates the incidence of liver failure with Cylert (pemoline) to also be relatively rare, with 15 cases of acute liver failure reported to the FDA since marketing of the drug began in 1975, with 12 of them resulting in death or liver transplantation.
Todd
Posted by BRC on May 29, 2004, at 20:59:03
In reply to Re: Can Antidepressants damage the liver?, posted by King Vultan on May 29, 2004, at 11:16:23
Wow!! thanks for all the info and time you spent answering my post (everyone else inculded:). I have been taking an SSRI in some form or fashion for about five years now and I also take the benzo Klonopin and the SSNRI Remeron. So, I was wondering if these particular meds can cause harm to the liver. My concern is because my family doc. put me on a cholesterol lowering med and I know it has an effect on the liver. So, I was wondering if the liver will be overloaded with the combined meds? Thanks in advance if you answer the post.
Posted by BRC on May 29, 2004, at 21:08:05
In reply to Re: So, are SSRI's and benzo's safe? King Vultan, posted by BRC on May 29, 2004, at 20:59:03
Sorry, my message is in the above post (post right above this one).
Posted by BRC on May 29, 2004, at 21:20:09
In reply to Re: So, are SSRI's and benzo's safe? King Vultan, posted by BRC on May 29, 2004, at 21:08:05
Sorry, just trying to get this thing to work where you can click on post specifically for you.
Posted by zeugma on May 30, 2004, at 10:20:34
In reply to Re: So, are SSRI's and benzo's safe? King Vultan, posted by BRC on May 29, 2004, at 20:59:03
SSRI's are not liver-damaging, what many of them do is block the liver 's capacity to process other drugs. For example, if you are taking the SSRI Paxil, you need to be closely monitored if you add nortriptyline ( a tricyclic antidepressant) because the Paxil slows down the body's ability to eliminate the nortriptyline and toxic levels can accumulate. That is why polypharmacy can be dangerous.
Benzos are quite safe except when combined with alcohol. That has nothing to do with the liver, but is a CNS depressant interaction.
Remeron can raise cholesterol levels. I assume you are getting your cholesterol levels monitored and the Remeron has not elevated them? Then the Remeron is probably safe. What I would do is notify the family doc about the other meds, and if the raised cholesterol is a new condition, then you should tell your pdoc about the Remeron's possible effect.
Posted by BRC on May 30, 2004, at 13:36:40
In reply to Re: So, are SSRI's and benzo's safe? King Vultan » BRC, posted by zeugma on May 30, 2004, at 10:20:34
Thanks for the info. My family doc. knows what I am taking Remeron as well as my p-doc knows I am on cholesterol lowering med. My cholesterol is elevated but it was the triglycerides (the fat that was in the blood that was high) and my doc said I needed meds to control this.
I had researched where Remeron can raise cholesterol levels, and at first I thought that was probably the cause. Because I am only 28 (male) and weigh about 160lbs. and I eat pretty healthy, exercise, and use vitamin supplements. But my family doc. says that the condition is probably inherited. But I know he probably doesn't know that Remeron can raise cholesterol level. I go back in 2 months to get my cholesterol checked again and if it and my triglycerides remain high I will confront him about the Remeron.
One quick question is the raising of cholesterol a common or not so common side effect of Remeron.
Thanks soooooooo much for your time and effort in answering my post. If you have any more info or questions feel free to ask. Thanks again
Posted by flmm on May 30, 2004, at 16:12:37
In reply to Re: So, are SSRI's and benzo's safe? King Vultan, posted by BRC on May 30, 2004, at 13:36:40
So is this why alcohol and ssri meds have a wierd mix? Whenever I drink I get a wierd hangover that lasts a long time! Is there a problem eliminating alcohol?
Posted by TJB on May 31, 2004, at 8:51:13
In reply to Re: So, are SSRI's and benzo's safe? King Vultan, posted by flmm on May 30, 2004, at 16:12:37
Anytime you take a drug while taking another they will be in competition with each other. Some more than others. I ended up with acute hepatitis (liver enzymes over 900) from being on Prozac and being given a hefty dose of antibiotics for a blood infection. Now I have my liver enzymes checked every 6 months or so. Drinking alcohol with meds compromises your ability to break down either the meds or the alcohol. That is why some people get super drunk from one drink while on some AD's etc. Liver metabolism is very selective from person to person so some people seem like they can handle alot of different medication while others can't. Its trial and error but not the type of trial and error you want to mess with.
Posted by flmm on May 31, 2004, at 11:47:47
In reply to Re: So, are SSRI's and benzo's safe? King Vultan, posted by TJB on May 31, 2004, at 8:51:13
I think what I mean is, would the problem be more complicated with Prozac versus something else because of the long half life of Prozac? thanx!
Posted by TJB on June 1, 2004, at 16:10:12
In reply to Re: So, are SSRI's and benzo's safe? King Vultan, posted by flmm on May 31, 2004, at 11:47:47
This is really total speculation but I would think it would be worse as far as the length of the hangover because of Prozacs long half life. The longer your liver is tied up metabolizing one drug the longer it could take to finish up with the other one. Some ADs use different enzymes to be broken down though and some aren't even a problem with alcohol. Unfortunetly Prozac happens to effect the common enzymes that are used to break down alcohol as well as other frequently used meds. Some people can have liver failure from drinking alcohol and taking too much tylenol. Ya just never know.
Posted by shadowmon on June 2, 2004, at 3:15:58
In reply to Re: So, are SSRI's and benzo's safe? King Vultan, posted by TJB on June 1, 2004, at 16:10:12
I was curious about how liver enzymes are affected by the use of SSRI's as well, My enzymes werent as high as 900, but the thought of something wrong with my liver made me reconsider my using paxil. I am not using lexapro. While on the paxil, I gained an enormous amount of weight (due to the slowing of the metabolism) and got diagnosed with the fatty liver that sometimes comes with elevated liver enzyme levels. anyojne experience this as well?
This is the end of the thread.
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