The law does not permit testing of drugs on children so none of these types of drugs are tested on children. Drug companies therefor can not recomend a dosage for a child and doctors are taking a bit of a risk in prescribing such a drug. They take a risk knowing they are trying to do their very best for that child and explain to parents the risk and the fact the drug is not tested or licenced for use in child medicine. With all the good will in the world, things do go wrong from time to time, just as they do in adult medicine.

RayB , Newcastle upon Tyne, UK

My experience of Citalopram, an SSRI

I took citalopram for 7 weeks and during that time I experienced considerable anxiety, many panic attacks and very severe insomnia, with only limited relief of my low mood.

Whilst taking citalopram I was given zopiclone to relieve my insomnia. As zopiclone is addictive I was advised to take it infrequently, so I took it every third night. On those occasions when I did not take zopiclone I experienced many nights when I did not sleep at all, remaining awake for the whole of the night and only falling asleep for a couple of hours around 6-7 am in the morning.

Some medical practitioners prescribe propranolol, a beta blocker, 3x 40 mg daily, for their patients when they start taking citalopram, to slow the heart rate during a panic attack.

After taking citalopram for a period of 7 weeks, reaching a dose of 30 mg daily, my insomnia was so severe that I did not sleep for a period of 36 hours and I was having panic attacks every few hours. I became anorexic and I also did not want to drink. As I was feeling suicidal I sought medical help and was advised to stop taking citalopram.

As my experience of taking citalopram had been life-threatening, I decided to research the mode of action of SSRIs.

Citalopram, initially, intensifies the anxiety and insomnia of a depressed patient because it stimulates the hypothalamic-pituitary-adrenal (HPA) axis in the brain. A person suffering from clinical depression already has an overactive HPA axis; citalopram makes it even more overactive:
‘Depression is characterised by an over activity of the hypothalamic-pituitary-adrenal (HPA) axis.’
http://www.neuroendo.org.uk/content/view/31/11/

‘Acute citalopram activated the HPA-axis at the hypothalamic level and long-term citalopram treatment desentised the HPA-axis at the pituitary level’

Ref: Journal of Neuroendocrinology Volume 11 Issue 6 Page 465-471, June 1999

Citalopram, by initially stimulating the HPA axis at the pituitary level, as well as at the hypothalamic level, causes the release of ACTH (Adrenocorticotrophic hormone). This, in turn, stimulates the adrenal cortex, causing the release of cortisol into the bloodstream:

‘…Intravenous administration of the selective serotonin (5-HT) re-uptake inhibitor, citalopram, increases plasma cortisol.’

Ref: Journal of Psychopharmacology Volume 163 Number 1 August 2002
http://www.springerlink.com/content/6x9tne5ml1nlad33/

Consequently, clinically depressed patients, who are already experiencing insomnia and anxiety, will sleep even less, feel more anxiety and may begin to have panic attacks as they are placed in an even more intense ‘fight or flight’ state by ingesting citalopram:

‘Although stress isn’t the only reason that cortisol is secreted into the bloodstream, it has been termed “the stress hormone” because it’s also secreted in higher levels during the body’s ‘fight or flight’ response to stress, and is responsible for several stress-related changes in the body.’

http://stress.about.com/od/stresshealth/a/cortisol.htm

48 hours after ceasing to take citalopram my panic attacks had stopped and I was eating and drinking more normally. I was sleeping about 6 or 7 hours at night with the aid of 75 mg amitriptyline, a tricyclic antidepressant.

Unfortunately, about 5 days after stopping citalopram my anxiety and insomnia returned. This state reached a peak 11 days after I stopped taking citalopram. I sought medical help and was prescribed 2 mg diazepam 4x a day for 7 days, to relieve my intense anxiety and agitation:

‘SSRI Withdrawal Syndrome’
The following criteria define the SSRI (or SNRI) withdrawal syndrome:
Criterion A: A course of treatment in which an SSRI (or vanlafaxine) is stopped or interrupted or the dose is reduced after a period of 4 weeks or more.
Criterion B: Two or more of the following symptoms develop within 1 to 10 days of criterion A (except for fluoxetine in which case the symptoms must develop within 28 days):
(a) dizziness or light headedness
(b) nausea and/or vomiting
(c) headaches
(d) lethargy
(e) anxiety and/or agitation
(f) tingling (paresthesias), numbness or "electric" shock-like sensations in the head or limbs
(g) tremors
(h) sweating
(i)insomnia
(j) irritability
(k) vertigo (dizziness)
(l) diarrhea
http://www.psycom.net/depression.central.withdrawal.html


‘Withdrawal symptoms when treatment is discontinued are common, particularly if discontinuation is abrupt (see section 4.8 Undesirable effects). In clinical trials adverse events seen on treatment discontinuation occurred in approximately 40% of patients treated with citalopram.’

http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=1070

I am 61 years of age.

X, Nottingham,

having been on seroxat, on and off for 8 years. I relised what it was doing to me. From age 32-40. I got off it. While I was on it I tried to kill myself three times and thought about it daily.

This stuff is killing us.

Steve, London, UK

Seroxat is also a highly addictive substance for adults. It is not active as an antidepressant in a large number of patients, why do these products remain on the market? What sort of regulation is this, "we are disappointed" tell that to the parents of the children who are no longer here.

bob taylor, castelnau, France

Although it may not be possible to prosecute the company surely there is a way to punish them. Why doesn't the NHS remove GSK from its list of suppliers?

Chris Horne, Ilkley,

How utterly disgraceful that this drug company should not be proscuted. The MHRA have failed in not protecting these young children. All they have done is told GSK to go and sit on 'The Naughty Chair' for a while till it all calms down. What kind of drug regulator system do we have in this country? Surely it is about time this goverment held an enquiry into how GSK. were allowed to get away with this. We are talking about young children lives . My heart goes out to all the families who have suffered , they have to live with it everyday.

Anna, Mancester, UK