Adverse effects including sexual problems associated with the use of selective serotonin reuptake inhibitors in a tertiary care center of Eastern Nepal.

Background: Selective serotonin reuptake inhibitors (SSRIs) use has been associated with various adverse drug events, including sexual problems in recent literature. Methods: After written informed consent, remitted psychiatric patients were enrolled if they were taking an SSRI. The remitted state was ascertained by clinical assessment of a psychiatrist and reassessed with the use of self-response screening questionnaires (Beck Anxiety Inventory for anxiety, Beck Depression Inventory for depression). The self-response questionnaire “adverse drug effect (ADE) tool” was used to assess ADEs and the Arizona Sexual Experience Scale to assess sexual problems. Results: The total of 200 subjects was enrolled with 63% females. Commonly used SSRIs were escitalopram, fluoxetine, and sertraline for the common diagnosis of depression, recurrent depressive disorder, and panic disorder in this institute. The average duration of remission during the enrollment was 11.99 months (standard deviation: 12.269). The overall prevalence of adverse effects was 91.5%. The incidence of adverse effect and sexual problem were: weight gain (57%), dryness of mouth (32.5%), headache (30%), dizziness (28.5%), paresthesia (24.5%), confusion (23.5%), tremors (21.5%), irritation (20.5%) sexual dysfunction (SD) (17.2%), increase in anxiety (17%), akathisia (16%), nausea (14.5%), itchiness (14.5%), excessive sweating, (14.5%), difficulty in sleeping (10%), weight loss (6%), rash (6%), diarrhea (4%), vomiting (3%), and others (3%). Conclusion: Adverse effect (irrespective of severity) was commonly seen with SSRI use. Common adverse effects seen among remitted subjects were weight gain, dryness of mouth, headache, dizziness, paresthesia, etc. SD was other important side effect.

Psychiatric Comorbidity in Cases Admitted for Alcohol Dependence.

Background – Alcohol dependence syndrome (ADS) is a medical disorder with some particular features resulting from a prolonged and heavy use of alcohol. When people with ADS present to a psychiatric service, they usually have developed other health problems. Objective – Since eastern Nepal has a heavy load of alcohol related problems, this hospital based descriptive study was carried out to observe psychiatric co-morbidity among inpatient-ADS cases. Method – In this cross sectional study of 60 consecutive inpatients, psychiatric co-morbidities were diagnosed according to the diagnostic criteria of ICD-10. Results – Mean age of the cases was 39.19 years, 75% were male and 90% were married. Three fourths used other substances besides alcohol; main being nicotine, opioid and cannabis. Eighty percent cases had one or other or more than one diagnosable psychiatric illness, including ICD-10 mental and behavioral disorders in 63% and personality problems severe enough to affect the course of substance use disorder in 48% of the total cases. The most common psychiatric disorder in ADS cases was anxiety disorders, followed by mood affective disorders, and psychotic illness. Among the personality problems, dissocial plus narcissistic, and anxious group were common. Conclusion – Psychiatric co-morbidity is common in people with alcohol dependence.