Dr James Schaller
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A Continuing Education Lecture for Doctors

Anti-depressants are not all the same is in the area of suicides and anxiety.


  1. Examination of 168 OD deaths with SSRI's:

        Fluoxetine 60 deaths

        Sertraline 75 deaths

        Paroxetine 28 deaths

    Key point: It matters which anti-depressant is being used in an impulsive and suicidal person. The vast majority of these deaths are "due to drug interactions with individuals taking multiple medications." Since Lexapro has the lowest SSRI interactions, perhaps suicidal people should consider it. (J. Forensic Science 2000;45:633)
  2. Another study looked at which medications cause Fatal Adverse Drug Reactions with SSRI's--death is usually associated with 2 or more drugs.

    Drug combinations that included another liver CYP450 drug were esp. dangerous. Lexapro has the lowest CYP450 interactions of all SSRI's.

    Benzodiazapines, TCA's, H2 blockers, lithium and calcium channel blockers were esp. associated with cardiac adverse reactions.

    (Who develops severe or fatal adverse drug reactions to selective serotonin reuptake inhibitors? Canadian J Psychiatry 2001;46:258-63).
  3. Attempted or completed suicide is increased in patients with neurological illness. Specific examples include epilepsy, stroke, MS, migraine with aura, brain trauma and Huntington's disease. Their medications require a low interaction SSRI and one that does not increase EPS and other movement disorders. (Current Treatment Options Neurology 2002;4:457-468)

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