Posted by PaulM78704 on January 17, 2014, at 15:07:47
In reply to Antidepressant Liver Injury Common Certain Ad's, posted by Phillipa on January 2, 2014, at 20:47:49
They are not saying severe and irreversible liver damage is "common". "They calculate that 0.5% to 3% of patients treated with antidepressants may develop asymptomatic mild elevation of serum alanine aminotransferase (ALT) levels."
Oddly, According to the American Gastroenterological Association (AGA), 1 to 4 percent of the asymptomatic population have elevated serum liver chemistries! See http://www.aafp.org/afp/2005/0315/p1105.html
So I am not clear how many cases of elevated ALT or AST are related to medications. However just search for Wellbutrin and liver damage and you will see it is a known risk.
Asymptomatic mild elevation of ALT, suggesting that the liver is under stress, would not be surprising as the liver has to metabolize drugs, as well as alcohol etc. But that does not mean severe irreversible liver damage: in December 2009, 3 months after I stopped drinking, my ALT level was 69 (0 to 44 is normal) but by September 2011 it was back to 21. I am 63 and taking multiple medications for comorbid ADD, major depression, and Generalized Anxiety Disorder with a past history of severe alcohol abuse, so I imagine I am at higher risk than normal.
My psychiatrist orders blood tests at least once a year, and this is stated in the prescribing instructions for drugs like Wellbutrin and Cymbalta (see http://www.webmd.com/mental-health/news/20051017/fda-broadens-liver-warning-for-cymbalta)
ALT, AST and other liver enzyme levels need to be checked for patients at higher risk (elderly, multiple medications, and those taking the higher risk drugs).
The antidepressants associated with highest risk for hepatotoxicity are monoamine oxidase (MAO) inhibitors, tricyclic/tetracyclic antidepressants, nefazodone (Serzone), bupropion (Welbutrin), duloxetine (Cymbalta), and agomelatine (Valdoxan).
The investigators admit that the evidence is scanty, but they say nothing that suggests severe liver damage is common. I would suggest it is rare, except for those with prior liver damage, often caused by past alcohol or drug abuse. Very few cases are irreversible. You are more likely to get liver damage from Tylenol or even taking excessive vitamins (such as Vitamin A or Niacin).
poster:PaulM78704
thread:1057543
URL: http://www.dr-bob.org/babble/20140104/msgs/1058803.html