November 29, 2023 • 12 mins
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Join Dr. Amayo and Dr. Handratta as they dive into the dark yet enlightening side effects of conventional antidepressants. From weight gain to sexual side effects and hyponatremia, this lively conversation unpacks the mechanisms, challenges, and potential solutions. Get ready for a dose of medical insight with a dash of humor in this must-listen episode.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Thanh (00:00):
Very.
(00:01):
That's true.
That's so true.
Yeah.
Like in Vietnam, there'sliterally a word is now where if
you say it, it literally means.
Um, this is an event that you'regoing to go to where you're
going to drink and eat a lot oflike little aperitifs with like
a bunch of people around gettingrowdy.
And there's a word for that?
(00:21):
Yes.
Welcome to the Y in Psychiatry!
Dr. Amayo (00:26):
Hi, this is Dr.
Amayo C/L fellow.
Thanh (00:29):
Where we delve into the intricate nuances of psychiatric
topics.
Dr. Handratta (00:33):
My name is Dr.
Handratta attendingpsychiatrist.
I did my residency fromUniversity of Connecticut and
then I did my fellowship fromGeorgetown University in
consultation and liaison.
Thanh (00:43):
Each episode features interview style discussions that
explore the intersection of themind medicine and the human
experience.
Together we'll uncover thehidden why and the
groundbreaking discovery shapingthe psychiatric landscape.
So grab a seat, warm beverage,tune in, and let's embark on
this journey to unlock themysteries of the human psyche.
(01:06):
Only on The Y in Psychiatry.
Dr. Amayo (01:10):
Okay, welcome to the Y in psychiatry.
Today will be our second episodeon side effects with
conventional antidepressants.
And today we'll be focusing onthe weight gain, the sexual side
effects hyponatremia andwithdrawal side effects.
As usual, I'm your host, Dr.
Amayo.
And with me, we have the guru,Dr.
(01:31):
Handratta.
Say, hi, sir.
Dr. Handratta (01:33):
Hi.
How are you guys doing?
Dr. Amayo (01:35):
Okay so one, especially for my patients that
identifies as female, one of thebiggest question they ask me is
if they're gonna gain weightwith the medication I sometimes
use styles and try to see whichSSRI is more likely to cause
weight gain And so I guess myquestion is why does
antidepressants in general causeweight gain?
Dr. Handratta (01:55):
That's a good question, Because this is a
question that people usuallyask.
So the mechanism behind weightgain with antidepressants is
that antidepressants that blockthe serotonin 5HT-2C receptors.
Are more likely to gain weightbecause this particular receptor
is present in your hypothalamus,the area of the brain that
(02:18):
controls your feeding andmetabolism.
There's an area called arcuatenucleus.
So when you block the 5HT-2Creceptor, you can increase the
appetite.
Second is when you block thehistamine receptors can also
increase the appetite.
So any medication that blocksthe 5HT-2C and histamine
receptors are more likely tocause weight gain.
For example, your mirtazapine.
And if you look atantipsychotics, your olanzapine
(02:39):
that does that.
Clozapine does that.
Quetiapine does that.
So that's why these medicationsare more likely associated with
weight gain.
Dr. Amayo (02:47):
And is it just the 5HT-2C or it has to be a combo
5HT-2C and histamine?
Dr. Handratta (02:53):
Either one.
Dr. Amayo (02:54):
And doing both would make it even worse, like Razin
does Both.
Dr. Handratta (02:57):
Yes.
Dr. Amayo (02:58):
And with the histamine, the blocking of the
histamine receptors, is thatalso associated with the
hypothalamus arcuate nucleus, oris that a different mechanism?
Dr. Handratta (03:05):
So it's, it is actually, everything actually
basically ends up there.
Dr. Amayo (03:08):
Okay.
Dr. Handratta (03:09):
Because hypothalamus Exactly.
Which is something that controlsyour feeding as well as your
metabolism.
Dr. Amayo (03:14):
And just one more question.
So in depression, there's a lossof appetite and there's a weight
loss associated with depression.
Is it the same mechanism withthe hypothalamus, arcuate
nucleus that's affected?
Dr. Handratta (03:28):
So in patients with depression, so there are
different reasons actually whypatients can lose weight.
So sometimes actually thedepression is because of an
inflammatory condition andthere's an increase in the
cytokines.
So increase in the inflammatorycytokines itself can cause
decrease in the appetite.
So patients who haveinflammatory reaction like
cancer, rheumatoid arthritis,you have too much cytokines.
(03:50):
So cytokines can cause somethingcalled sickness behavior.
And the way you differentiatesickness behavior from
depression is that the twothings that are very typical of
sickness behavior is anorexiaand psychomotor retardation.
Another reason, what I think,which may or may not be true, is
that serotonin actually works onreceptors depending upon the
concentration.
(04:10):
So when you have a low amount ofserotonin binds to the 5HT-1 A
receptors.
When you have a little bit high,it binds to 5HT2A.
When you have too much serotoninbinds to 5HT2C receptors So when
serotonin So when serotonin istoo low, it might be the five HT
one receptor that gets affected.
Dr. Amayo (04:25):
And that's the other receptors that's the one we
want?
Dr. Handratta (04:27):
Which is an auto receptor but these receptors are
also present in arcuate nucleus.
Dr. Amayo (04:30):
Oh, okay.
Yeah.
Dr. Handratta (04:31):
But the thing that actually makes more sense
in my head is actually thecytokines.
Dr. Amayo (04:35):
That's interesting.
Dr. Handratta (04:36):
Anhedonia too, right?
Like patients usually havedecreased reward, so they have
little satisfaction actuallywith eating.
So that might be another reasonactually that yeah, food is not
palatable.
Dr. Amayo (04:46):
And it could just be lack of motivation
Dr. Handratta (04:48):
Lack of motivation.
Exactly.
Dr. Amayo (04:49):
To even do those life sustaining like activities
Dr. Handratta (04:53):
Exactly.
Because you are actually, as weknow from our previous lectures,
that you get stuck in thedefault mode.
Default mode just, and you don'tuse a central executive network,
which is actually tells you,which is close to the sensory
motor area, which tells you,Hey, let's go to the kitchen and
make food and go to therestaurant and cook get some
food or order it online.
Yeah.
Dr. Amayo (05:09):
Okay, so just I wanna summarize for the weight gain
the main culprit is the 5HT-2Creceptors and the histamine uh
receptors and those will affectyour hypothalamus arcuate
nucleus, which controlsappetite.
That's that and any SSRI thatblock those receptors might
increase your chance of gainingweight.
Do we know any do you know whichones are particularly notorious
(05:31):
mirtazapine.
Dr. Handratta (05:31):
It blocks the 5HT-2C receptor.
You've got citalopram andescitalopram that has an
antihistamine property to it.
So these are some of themedication which are more likely
to cause weight gain.
Paroxetine too, actually hitsthese receptors.
But the weight gain, if you lookat it with paroxetine, once
patient gains weight, it doesn'treach a plateau.
They keep on gaining weight.
Whereas with citalopram andescitalopram, they gain weight
(05:53):
and then they reach a plateau.
Dr. Amayo (05:55):
And I'm guessing, so Prozac and Sertraline are less
Dr. Handratta (05:59):
They're less likely.
Fluoxetine and Sertaline areless likely cause weight gain?
Dr. Amayo (06:03):
Okay.
So sexual side effects.
That's another one that I findwith specific population.
And this way are usually myyoung males that are concerned
about that.
Yeah.
Dr. Handratta (06:11):
So sexual side effects is another thing that we
worry about.
Do depression itself canactually cause decrease in the
sexual function.
Yes.
So that's actually the major,cause I always educate them, my
patients saying that, Hey,depression itself can cause
this.
Let's start an antidepressantand see how you do.
With the psychotherapy, I alwayscombine antidepressants,
psychotherapy together Right nowthere are some antidepressants
(06:33):
which are more likely to causesexual side effects than other
majority of the antidepressantswill cause it.
If they hit the serotonergicsystem, stimulation of the
5HT-1A receptor is more likelyassociated with premature
ejaculation
Dr. Amayo (06:46):
And, from just our recent talk, the 5HT-1A, it
seems like it leads, it doesn'tneed as much serotonin coverage
to be hit.
So almost any, anything you givethat's hits serotonin would hit
the 5HT1A.
Dr. Handratta (06:59):
And then when you stimulate the 5HT-2C receptor,
you cause delayed ejaculation.
Dr. Amayo (07:05):
And this is the same 5HT-2C that is the culprit for
weight gain.
Dr. Handratta (07:08):
Yes.
So when you block those 5HT-2C,you cause weight gain.
When you stimulate, you actuallycause delayed ejaculate
Dr. Amayo (07:14):
So when you block it, weight gain, stimulated.
Okay.
And SSRIs can do both.
Dr. Handratta (07:19):
SSRIs can actually stimulate 5HT-2C
because if you increase theamount of serotonin, if you
flood the system with serotoninwe know that 5HT-2 C receptor is
a low affinity receptor.
So when there's too muchserotonin, it goes in, binds to
5HT-2 C, right?
So when you have serotonin, thefirst receptor to be saturated
is 5HT-1 A, followed by 5HT-2 A,and then 5HT-2 C.
Dr. Amayo (07:38):
And um, how can I help with that?
So with my patients, if theyhave the sexual side effects I
know from.
Sometimes I had Bupropion or Ihad sildenafil.
Is there anything I can dowithout giving them more meds?
Is there anything I can do withthe medication itself besides
stopping it?
Dr. Handratta (07:53):
So antidepressants, which are more
likely to be associated sexualside effects is fluoxetine
sertraline, and venlafaxine, arethe highest incidence of sexual
side effects, the one that isassociated with very low risk of
sexual side effects isvortioxetine and vilazodone.
So those are the two whichbasically I switch to.
Actually the patient iscomplaining of sexual side
effects with most of those youcan add, you can switch to
(08:14):
buproprion if the patient hasdepression, right?
Bupropion is more effective.
The patient has anorgasmia likedecreased desire for sexual
activity, right?
You can add buspirone, which isa partial agonist at 5HT-1 A
receptor.
You can actually use somethingthat blocks the 5HT-2 C receptor
that delay ejaculation like il,right?
Some literature will also saythat skip a dose of
antidepressant, the day you areplanning actually a sexual
(08:36):
activity.
Dr. Amayo (08:37):
So I wonder how skipping a day would work then.
Dr. Handratta (08:39):
So the skipping a day basically with a very short
half-life.
You basically deplete theserotonin system, so you can
actually look, paroxetine andfluvoxamine are more notorious
actually for withdrawal as wellas venlafaxine.
So I basically stay away fromthat.
Skipping a dose.
Yes.
Yeah.
I guess
Dr. Amayo (08:54):
the next one would be the hyponatremia.
I think that's an interestingone, how SSRIs can, increase
your chances of hyponatremia.
Dr. Handratta (09:01):
So hyponatremia is another side effects.
But hyponatremia is more likelyto happen in patients who are
elderly.
The elderly patients have adecrease in the global
filtration rate.
So that is a reason why they'reat more risk for hyponatremia.
Hyponatremia is also a risk,especially in post-surgical
patients because of the stressthat they go through.
Because stress nausea, vomiting,pain can increase your a ADH
(09:24):
production.
But antidepressants actually,the way it causes hypo natia is
a little bit different.
So SIADH is a syndrome ofinappropriate, ADH production.
So in SIADH, there will be analteration in the ADH, but
according to the data, whatantidepressant does is that it
directly stimulates thevasopressin receptor.
Your collecting ducts where ADHworks.
Which is called as a V2receptors.
(09:45):
V2.
Yes because ADH is also calledvasopressin.
So antidepressants by attachingto these V2 receptors, they
usually stimulate the secondmessenger system and they
increase the attachment ofaquaporin channels, and that
actually leads to thereabsorption of water from the
collecting duct and dilutingyour system and that's causing
(10:08):
hyponatremia.
So it's also called as asyndrome of inappropriate anti
diuresis instead of SIADH.
Because your ADH is not involvedhere, the antidepressants will
directly go and stimulate thoseV2 receptors in your collecting
duct.
Dr. Amayo (10:22):
And is that what ADH does?
Stimulate the V2 receptors tocause more increase in
aquaporin.
And so the serotonin or theSSRIs goes and basically
pretends to be ADH.
Dr. Handratta (10:34):
Exactly
Dr. Amayo (10:35):
And so there's not an increase in ADH it's just the
SSRIs are pretending to be it.
Dr. Handratta (10:39):
Yeah, exactly right.
Instead of increasing the ADH,the ADH level will be low
actually, these patients, so youcan't test.
Dr. Amayo (10:46):
I just wanna summarize the two we just did.
So for the sexual side effects,the reason is because of 5HT-1 A
and 5HT-2 C.
And it's interesting to notethat it's a simulation of the
5HT-2 C, that will lead to
Dr. Handratta (11:00):
delayed ejaculation.
Dr. Amayo (11:01):
Delayed ejaculation.
Yes.
And the 5HT-1 A will lead toanorgasmia.
Dr. Handratta (11:05):
So 1A will lead to premature ejaculation.
Dr. Amayo (11:07):
Premature ejaculation.
Yes.
5HT-2 C will lead to delayedejaculation.
Yes.
And that's important to notebecause blocking a 5HT-2 C will
lead to weight gain
Dr. Handratta (11:14):
And I think you are also right actually, Dr.
Amayo, like stimulating a 5HT2-Ccan also lead to anorgasmia.
Because when you stimulate the5HT-2 C, you decrease the amount
of dopamine in your rewardcenter of the brain.
Dr. Amayo (11:25):
So stimulator 5HT-2 C will give you both delayed
ejaculation and anorgasmia.
And so that's why we get thosesexual side effects.
And then for hyponatremia theissue is the SSRI pretends to be
ADH stimulates stimulates theV2, increase aquaporin channel,
and now we are taking in morewater, and elderly patients and
people that, that going a lotstress are at risk for this.
(11:45):
So it's.
I think we have time, eventhough we have one more draw
side effects.
I think we can touch thatanother time.
And that's it for today'ssession.
Thank you.
Joining us.
Katrina Wachter (11:57):
Thank you for joining us on today's episode.
Our tireless team is alreadyhard at work, cobbling together
another potpourri of fascinatingdiscussion for next week, so be
sure to tune in, visit ourwebsite and our podcast feed and
let us know your thoughts on theepisode.
Subscribe so you don't miss ourreleases every Wednesday.
Until next time, keep smiling,keep shining, and stay curious.
Very.
(00:01):
That's true.
That's so true.
Yeah.
Like in Vietnam, there'sliterally a word is now where if
you say it, it literally means.
Um, this is an event that you'regoing to go to where you're
going to drink and eat a lot oflike little aperitifs with like
a bunch of people around gettingrowdy.
And there's a word for that?
(00:21):
Yes.
Welcome to the Y in Psychiatry!
Dr. Amayo (00:26):
Hi, this is Dr.
Amayo C/L fellow.
Thanh (00:29):
Where we delve into the intricate nuances of psychiatric
topics.
Dr. Handratta (00:33):
My name is Dr.
Handratta attendingpsychiatrist.
I did my residency fromUniversity of Connecticut and
then I did my fellowship fromGeorgetown University in
consultation and liaison.
Thanh (00:43):
Each episode features interview style discussions that
explore the intersection of themind medicine and the human
experience.
Together we'll uncover thehidden why and the
groundbreaking discovery shapingthe psychiatric landscape.
So grab a seat, warm beverage,tune in, and let's embark on
this journey to unlock themysteries of the human psyche.
(01:06):
Only on The Y in Psychiatry.
Dr. Amayo (01:10):
Okay, welcome to the Y in psychiatry.
Today will be our second episodeon side effects with
conventional antidepressants.
And today we'll be focusing onthe weight gain, the sexual side
effects hyponatremia andwithdrawal side effects.
As usual, I'm your host, Dr.
Amayo.
And with me, we have the guru,Dr.
(01:31):
Handratta.
Say, hi, sir.
Dr. Handratta (01:33):
Hi.
How are you guys doing?
Dr. Amayo (01:35):
Okay so one, especially for my patients that
identifies as female, one of thebiggest question they ask me is
if they're gonna gain weightwith the medication I sometimes
use styles and try to see whichSSRI is more likely to cause
weight gain And so I guess myquestion is why does
antidepressants in general causeweight gain?
Dr. Handratta (01:55):
That's a good question, Because this is a
question that people usuallyask.
So the mechanism behind weightgain with antidepressants is
that antidepressants that blockthe serotonin 5HT-2C receptors.
Are more likely to gain weightbecause this particular receptor
is present in your hypothalamus,the area of the brain that
(02:18):
controls your feeding andmetabolism.
There's an area called arcuatenucleus.
So when you block the 5HT-2Creceptor, you can increase the
appetite.
Second is when you block thehistamine receptors can also
increase the appetite.
So any medication that blocksthe 5HT-2C and histamine
receptors are more likely tocause weight gain.
For example, your mirtazapine.
And if you look atantipsychotics, your olanzapine
(02:39):
that does that.
Clozapine does that.
Quetiapine does that.
So that's why these medicationsare more likely associated with
weight gain.
Dr. Amayo (02:47):
And is it just the 5HT-2C or it has to be a combo
5HT-2C and histamine?
Dr. Handratta (02:53):
Either one.
Dr. Amayo (02:54):
And doing both would make it even worse, like Razin
does Both.
Dr. Handratta (02:57):
Yes.
Dr. Amayo (02:58):
And with the histamine, the blocking of the
histamine receptors, is thatalso associated with the
hypothalamus arcuate nucleus, oris that a different mechanism?
Dr. Handratta (03:05):
So it's, it is actually, everything actually
basically ends up there.
Dr. Amayo (03:08):
Okay.
Dr. Handratta (03:09):
Because hypothalamus Exactly.
Which is something that controlsyour feeding as well as your
metabolism.
Dr. Amayo (03:14):
And just one more question.
So in depression, there's a lossof appetite and there's a weight
loss associated with depression.
Is it the same mechanism withthe hypothalamus, arcuate
nucleus that's affected?
Dr. Handratta (03:28):
So in patients with depression, so there are
different reasons actually whypatients can lose weight.
So sometimes actually thedepression is because of an
inflammatory condition andthere's an increase in the
cytokines.
So increase in the inflammatorycytokines itself can cause
decrease in the appetite.
So patients who haveinflammatory reaction like
cancer, rheumatoid arthritis,you have too much cytokines.
(03:50):
So cytokines can cause somethingcalled sickness behavior.
And the way you differentiatesickness behavior from
depression is that the twothings that are very typical of
sickness behavior is anorexiaand psychomotor retardation.
Another reason, what I think,which may or may not be true, is
that serotonin actually works onreceptors depending upon the
concentration.
(04:10):
So when you have a low amount ofserotonin binds to the 5HT-1 A
receptors.
When you have a little bit high,it binds to 5HT2A.
When you have too much serotoninbinds to 5HT2C receptors So when
serotonin So when serotonin istoo low, it might be the five HT
one receptor that gets affected.
Dr. Amayo (04:25):
And that's the other receptors that's the one we
want?
Dr. Handratta (04:27):
Which is an auto receptor but these receptors are
also present in arcuate nucleus.
Dr. Amayo (04:30):
Oh, okay.
Yeah.
Dr. Handratta (04:31):
But the thing that actually makes more sense
in my head is actually thecytokines.
Dr. Amayo (04:35):
That's interesting.
Dr. Handratta (04:36):
Anhedonia too, right?
Like patients usually havedecreased reward, so they have
little satisfaction actuallywith eating.
So that might be another reasonactually that yeah, food is not
palatable.
Dr. Amayo (04:46):
And it could just be lack of motivation
Dr. Handratta (04:48):
Lack of motivation.
Exactly.
Dr. Amayo (04:49):
To even do those life sustaining like activities
Dr. Handratta (04:53):
Exactly.
Because you are actually, as weknow from our previous lectures,
that you get stuck in thedefault mode.
Default mode just, and you don'tuse a central executive network,
which is actually tells you,which is close to the sensory
motor area, which tells you,Hey, let's go to the kitchen and
make food and go to therestaurant and cook get some
food or order it online.
Yeah.
Dr. Amayo (05:09):
Okay, so just I wanna summarize for the weight gain
the main culprit is the 5HT-2Creceptors and the histamine uh
receptors and those will affectyour hypothalamus arcuate
nucleus, which controlsappetite.
That's that and any SSRI thatblock those receptors might
increase your chance of gainingweight.
Do we know any do you know whichones are particularly notorious
(05:31):
mirtazapine.
Dr. Handratta (05:31):
It blocks the 5HT-2C receptor.
You've got citalopram andescitalopram that has an
antihistamine property to it.
So these are some of themedication which are more likely
to cause weight gain.
Paroxetine too, actually hitsthese receptors.
But the weight gain, if you lookat it with paroxetine, once
patient gains weight, it doesn'treach a plateau.
They keep on gaining weight.
Whereas with citalopram andescitalopram, they gain weight
(05:53):
and then they reach a plateau.
Dr. Amayo (05:55):
And I'm guessing, so Prozac and Sertraline are less
Dr. Handratta (05:59):
They're less likely.
Fluoxetine and Sertaline areless likely cause weight gain?
Dr. Amayo (06:03):
Okay.
So sexual side effects.
That's another one that I findwith specific population.
And this way are usually myyoung males that are concerned
about that.
Yeah.
Dr. Handratta (06:11):
So sexual side effects is another thing that we
worry about.
Do depression itself canactually cause decrease in the
sexual function.
Yes.
So that's actually the major,cause I always educate them, my
patients saying that, Hey,depression itself can cause
this.
Let's start an antidepressantand see how you do.
With the psychotherapy, I alwayscombine antidepressants,
psychotherapy together Right nowthere are some antidepressants
(06:33):
which are more likely to causesexual side effects than other
majority of the antidepressantswill cause it.
If they hit the serotonergicsystem, stimulation of the
5HT-1A receptor is more likelyassociated with premature
ejaculation
Dr. Amayo (06:46):
And, from just our recent talk, the 5HT-1A, it
seems like it leads, it doesn'tneed as much serotonin coverage
to be hit.
So almost any, anything you givethat's hits serotonin would hit
the 5HT1A.
Dr. Handratta (06:59):
And then when you stimulate the 5HT-2C receptor,
you cause delayed ejaculation.
Dr. Amayo (07:05):
And this is the same 5HT-2C that is the culprit for
weight gain.
Dr. Handratta (07:08):
Yes.
So when you block those 5HT-2C,you cause weight gain.
When you stimulate, you actuallycause delayed ejaculate
Dr. Amayo (07:14):
So when you block it, weight gain, stimulated.
Okay.
And SSRIs can do both.
Dr. Handratta (07:19):
SSRIs can actually stimulate 5HT-2C
because if you increase theamount of serotonin, if you
flood the system with serotoninwe know that 5HT-2 C receptor is
a low affinity receptor.
So when there's too muchserotonin, it goes in, binds to
5HT-2 C, right?
So when you have serotonin, thefirst receptor to be saturated
is 5HT-1 A, followed by 5HT-2 A,and then 5HT-2 C.
Dr. Amayo (07:38):
And um, how can I help with that?
So with my patients, if theyhave the sexual side effects I
know from.
Sometimes I had Bupropion or Ihad sildenafil.
Is there anything I can dowithout giving them more meds?
Is there anything I can do withthe medication itself besides
stopping it?
Dr. Handratta (07:53):
So antidepressants, which are more
likely to be associated sexualside effects is fluoxetine
sertraline, and venlafaxine, arethe highest incidence of sexual
side effects, the one that isassociated with very low risk of
sexual side effects isvortioxetine and vilazodone.
So those are the two whichbasically I switch to.
Actually the patient iscomplaining of sexual side
effects with most of those youcan add, you can switch to
(08:14):
buproprion if the patient hasdepression, right?
Bupropion is more effective.
The patient has anorgasmia likedecreased desire for sexual
activity, right?
You can add buspirone, which isa partial agonist at 5HT-1 A
receptor.
You can actually use somethingthat blocks the 5HT-2 C receptor
that delay ejaculation like il,right?
Some literature will also saythat skip a dose of
antidepressant, the day you areplanning actually a sexual
(08:36):
activity.
Dr. Amayo (08:37):
So I wonder how skipping a day would work then.
Dr. Handratta (08:39):
So the skipping a day basically with a very short
half-life.
You basically deplete theserotonin system, so you can
actually look, paroxetine andfluvoxamine are more notorious
actually for withdrawal as wellas venlafaxine.
So I basically stay away fromthat.
Skipping a dose.
Yes.
Yeah.
I guess
Dr. Amayo (08:54):
the next one would be the hyponatremia.
I think that's an interestingone, how SSRIs can, increase
your chances of hyponatremia.
Dr. Handratta (09:01):
So hyponatremia is another side effects.
But hyponatremia is more likelyto happen in patients who are
elderly.
The elderly patients have adecrease in the global
filtration rate.
So that is a reason why they'reat more risk for hyponatremia.
Hyponatremia is also a risk,especially in post-surgical
patients because of the stressthat they go through.
Because stress nausea, vomiting,pain can increase your a ADH
(09:24):
production.
But antidepressants actually,the way it causes hypo natia is
a little bit different.
So SIADH is a syndrome ofinappropriate, ADH production.
So in SIADH, there will be analteration in the ADH, but
according to the data, whatantidepressant does is that it
directly stimulates thevasopressin receptor.
Your collecting ducts where ADHworks.
Which is called as a V2receptors.
(09:45):
V2.
Yes because ADH is also calledvasopressin.
So antidepressants by attachingto these V2 receptors, they
usually stimulate the secondmessenger system and they
increase the attachment ofaquaporin channels, and that
actually leads to thereabsorption of water from the
collecting duct and dilutingyour system and that's causing
(10:08):
hyponatremia.
So it's also called as asyndrome of inappropriate anti
diuresis instead of SIADH.
Because your ADH is not involvedhere, the antidepressants will
directly go and stimulate thoseV2 receptors in your collecting
duct.
Dr. Amayo (10:22):
And is that what ADH does?
Stimulate the V2 receptors tocause more increase in
aquaporin.
And so the serotonin or theSSRIs goes and basically
pretends to be ADH.
Dr. Handratta (10:34):
Exactly
Dr. Amayo (10:35):
And so there's not an increase in ADH it's just the
SSRIs are pretending to be it.
Dr. Handratta (10:39):
Yeah, exactly right.
Instead of increasing the ADH,the ADH level will be low
actually, these patients, so youcan't test.
Dr. Amayo (10:46):
I just wanna summarize the two we just did.
So for the sexual side effects,the reason is because of 5HT-1 A
and 5HT-2 C.
And it's interesting to notethat it's a simulation of the
5HT-2 C, that will lead to
Dr. Handratta (11:00):
delayed ejaculation.
Dr. Amayo (11:01):
Delayed ejaculation.
Yes.
And the 5HT-1 A will lead toanorgasmia.
Dr. Handratta (11:05):
So 1A will lead to premature ejaculation.
Dr. Amayo (11:07):
Premature ejaculation.
Yes.
5HT-2 C will lead to delayedejaculation.
Yes.
And that's important to notebecause blocking a 5HT-2 C will
lead to weight gain
Dr. Handratta (11:14):
And I think you are also right actually, Dr.
Amayo, like stimulating a 5HT2-Ccan also lead to anorgasmia.
Because when you stimulate the5HT-2 C, you decrease the amount
of dopamine in your rewardcenter of the brain.
Dr. Amayo (11:25):
So stimulator 5HT-2 C will give you both delayed
ejaculation and anorgasmia.
And so that's why we get thosesexual side effects.
And then for hyponatremia theissue is the SSRI pretends to be
ADH stimulates stimulates theV2, increase aquaporin channel,
and now we are taking in morewater, and elderly patients and
people that, that going a lotstress are at risk for this.
(11:45):
So it's.
I think we have time, eventhough we have one more draw
side effects.
I think we can touch thatanother time.
And that's it for today'ssession.
Thank you.
Joining us.
Katrina Wachter (11:57):
Thank you for joining us on today's episode.
Our tireless team is alreadyhard at work, cobbling together
another potpourri of fascinatingdiscussion for next week, so be
sure to tune in, visit ourwebsite and our podcast feed and
let us know your thoughts on theepisode.
Subscribe so you don't miss ourreleases every Wednesday.
Until next time, keep smiling,keep shining, and stay curious.
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