Antidepressants and Liver Failure

Last month (December 2013) the American Journal of Psychiatry published Antidepressant-Induced Liver Injury: A Review for Clinicians, by Voican C.S. et al.  The study was a literature search from 1965 onwards.

Here are the authors’ results:

  • All antidepressants can induce hepatotoxicity, especially in elderly patients and those taking more than one drug
  • Liver damage is generally unpredictable and unrelated to dose
  • Liver damage can occur within a few days of initiation
  • Antidepressant-induced liver failure can be life threatening
  • Antidepressants with higher risk for liver failure include: iproniazid, nefazodone, phenelzine, imipramine, amitriptyline, duloxetine, bupropion, trazodone, tianeptine, and agomelatine
  • Antidepressants with lower risk: citalopram, escitalopram, paroxetine, and fluvoxamine
  • Although an infrequent event, antidepressant-induced liver injury may be irreversible

 

 

  • Dustin Salzedo

    My DILI (drug induced liver injury) happened a full week after I stopped taking sublingual agomelatine in a clinical trial. I’m pretty sure Novartis wasn’t told- a for profit CRA with a $$ incentive not to report drop outs and response failures – and in a trial, there isn’t a mechanism to report to the FDA. Lovely.

  • Phil_Hickey

    Dustin,

    As you say, lovely!

    I was talking to an elderly psychiatrist in the early 90’s,and he mentioned that one of his clients, whom he’d had on lithium carbonate for many years, had developed kidney impairment. I asked him how common this was. He replied to the effect that pretty much all clients develop liver or kidney problems or both if they’re kept on the drugs long enough.

    I asked him what he planned to do. He replied that he would switch the client to another drug, but he added, with a fatalistic shrug, “The damage is done.”

    Best wishes.

  • Sweet63

    In the early 1990s it was routine to prescribe Zoloft for nursing homes residents, even though the PDR clearly said it was contraindicated for the elderly.

  • cannotsay

    I got both liver and kidney impairment from sertraline (Zoloft), olazapine (Zyprexa), risperidone (Risperdal) , clomipramine and lorazepam. My kidney/liver readings were back to normal 1.5 months after stopping everything. I am happy that I could have them reversed. I stayed on several drugs (not all at the same time) for around a year before stopping everything cold turkey. It was a heck of a withdrawal, but I am happy I did it cold turkey. I admit though that it might not be for everybody :D.

  • Phil_Hickey

    Sweet63,

    Gwen Olsen wrote Confessions of a Rx Drug Pusher. She describes very clearly how pharma targeted nursing homes precisely because the residents were “captive” and the nurses would get them to take their pills. No more problems with that old bugaboo: non-compliance.

    I suspect that similar things have happened in group homes for people with
    developmental disabilities. Next big push is to have a mental health worker in every GP’s office.

  • Phil_Hickey

    cannotsay,

    That’s quite a cocktail! I’m glad things returned to normal.

  • cannotsay

    Yeah… And I forgot, I was also prescribed at some point dextroamphetamine to combat the effects of clomipramine. It made me sleepy. At that point, I was taking 4 drugs at the same time: olanzapine (to so call “augment” the effect of the SSRI/SRI), sertraline (Zoloft), lorazepam and dextroamphetamine. The thing about olanzapine is that I was given it as a replacement of risperidone because the latter caused me akathisia. Since I had done some research about the matter and I read some papers about SSRI/SRI and OCD I kept asking what was the purpose of having a neurleptic. They kept repeating “to augment the effect of the SSRI/SRI” which was not very convincing. I even remember a graphic movement of the hands of one of the psychiatrists describing what “augment” meant. The guy reminded me to the wizard Merlin when he was doing that!

    I don’t remember much of the day to day of the one year or so that I was taking the drugs. I remember a lot of before and after, but not of the year. I do not know if it is because of the drugs or because the whole experience was so traumatic that it is a defense mechanism of my mind to forget about it as much as possible. What the SSRIs left me, apparently permanently, is short term memory losses. It’s been several years that I stopped the drugs and I still have this problem. It is not significant, but I find myself forgetting things of the immediate past from time to time. Not dramatic though, but it is one of the well known side problems of SSRIs.

  • cannotsay

    Hi Phil,

    For some reason your other comment shows as deleted. It was a matter of survival. It cost me my marriage and the relationship with my parents but if I had not stopped the drugs, I might be dead by now because the deterioration of my kidneys and liver was unstoppable.

    What I had going for me was the legal framework of my state (that framework that the Murphy bill seeks to change). So, I stopped the drugs, became an anti-psychiatry activist and I have never looked back :.

  • Phil_Hickey

    cannotsay,

    What’s remarkable is that you managed to get out of the system at all!

  • Phil_Hickey

    guest,

    Sorry about the deletion muddle – it’s now fixed. The liver and kidney damage issue doesn’t get enough airtime.

    In that regard, here’s a nice irony. In 2001, I lost my kidneys to a rare autoimmune disease. Prior to that, I had been extremely healthy. I lost my career, my health, my quality of life, and about half of my remaining life expectancy all at the same time. I was very despondent. The nephrologist wanted to put me on an antidepressant. I refused. He brought a lot of pressure to bear, including trying to sway my wife to the idea. A few months later, I mentioned this to one of the staff. She told me she thought that I was the only patient in that dialysis unit who was not taking an antidepressant! There were about a hundred patients in the unit.

  • cannotsay

    Sorry to hear about your kidney issues and that you are on dialysis.

    Indeed, it is unconscionable that these things are not mentioned more often. I have the data with me that the antidepressants caused me both kidney and liver failure. The liver recovered completely, but the kidneys never fully recovered even though most of the damage got reversed. I am considered a Chronic kidney disease stage 2 patient even though there has not been deterioration over the years of my kidney function after it significantly recovered from the damage inflicted by the SSRIs.

  • Phil_Hickey

    cannotsay,

    I dialyzed from 2001 to 2012, at which point I got a kidney
    transplant, and that has improved things for me.

  • cannotsay

    I am happy to hear you got the transplant. Make sure to keep those psychotropics as far as possible from your new kidney!

  • Zoe

    This I did not know. Thank you for posting this. Not that I take medication, nor would ever take antidepresants. But it’s interesting, as I can pass this information on to others.

  • Zoe

    This I did not know. Thank you for posting this. Not that I take medication, nor would ever take antidepresants. But it’s interesting, as I can pass this information on to others.

  • S Parlati

    I still have on going issues with my liver after taking Prozac and then Paxil over a ten year period. When I was on them my liver function tests were always abnormal and I had difficult time after eating anything. Developed gallstones and had to have gallbladder removed. After surgery, surgeon said that my gallbladder and liver were completely encased in scar tissue!!! I have been off all ssri poisons and lost weight and liver tests are normal but I still have fatty liver and trouble after eating anything. For anyone reading this. …please do not take psychotropic meds!!! There are natural ways to improve mental health like exercise, diet low in sugar and low grains, omega 3, and supplementation of methylfolate that all work better than any psych medication.

  • all too easy

    What happened to the scar tissue that completely encased your liver?

  • all too easy

    When you were on them, your liver tests were always abnormal.

    Why did you keep taking them?

    Would you provide the evidence from the literature that proves your prescription works better than any psych medication? Thank you

  • Rob Bishop

    Also, there’s several powerful methods for changing the maladaptive cognitive habits that create anxiety and depression. How we think creates how we feel. We can radically improve how we feel by challenging the cognitive distortions make us miserable. We can tame our negative self-defeating thoughts and irrational fears by discovering what creates them.

  • all too easy

    You see, that’s one of the many problems Phil has created. Any anti can say anything she’d like knowing Phil will give her his blessing, his stamp of approval. It has been left for me to expose these lies over and over and over again. If not for me, how many naive guests visiting this place will buy the garbage that could actually destroy them? Phil has an ethical obligation to weed out those who could do real harm. And that raises another serious problem.

    Phil, dear kindly old Phil, he himself, with all his might seeks to steer people away from getting the kind of medical help that could in fact save their lives. An educated, articulate, intelligent man, who has devoted his entire life to try to help the suffering, is in reality, doing great harm–to those very folks he has longed to reach.

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  • Jen

    So, I’ve been taking Paxil for over 15 yrs. with signs of Cirrohossis of the liver. So your trying to tell me it’s not the Paxil. Not do to alcohol.