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http://www.immunesupport.com/library/showarticle.cfm?ID=1297


 Jefferson scientists show several serotonin-boosting drugs
 cause changes in some brain cells

 Press Release

 (03-01-2000) -- Researchers from Jefferson Medical College
 in Philadelphia have found changes in brain cells in rats
 treated with large doses of several anti-depressant or
 anti-obesity drugs.  In some cases, the cells shriveled or
 took on abnormal corkscrew shapes.  While the clinical
 significance of the findings isn't known, the scientists say,
 they may raise new concerns about the prolonged use of such
 commonly prescribed drugs as fluoxetine (Prozac) and
 sertraline (Zoloft).  The work also highlights the need for
 similar studies on other classes of drugs that act on the
 central nervous system.

 The scientists, led by Madhu Kalia, M.D., Ph.D., M.B.A.,
 professor of biochemistry, molecular pharmacology,
 anesthesiology, and neurosurgery at Jefferson Medical College
 of Thomas Jefferson University in Philadelphia, compared the
 effects of giving high doses for four days of four drugs --
 Prozac, Zoloft, sibutramine (Meridia) and dexfenfluramine
 (Redux) -- on rat brain cells.  Each rat received only one
 drug.

 In the study, after the toxic doses of drugs were halted, and
 the animals' brains subsequently examined, the researchers
 saw marked changes in some nerve terminals, which actively
 release the brain chemical serotonin.

 These drugs, collectively known as Selective Serotonin
 Reuptake Inhibitors (SSRIs), increase the level of serotonin,
 which is vital to brain cell communication.  Low serotonin
 levels are linked to mood and eating disorders.

 Dr. Kalia and her colleagues at Jefferson and at the Centers
 for Disease Control and Prevention and the National Institute
 of Occupational Safety and Health in Morgantown, WVa., report
 their results March 6 in the journal Brain Research.

 The question remains, what do these findings mean.  "We don't
 know if results with four days of drug treatment are
 clinically significant," Dr. Kalia says.  "We don't know if
 the cells are dying.  That's the key question.  We need to do
 more studies to prove cell death.  These effects may be
 transient and reversible.  Or they may be permanent."

 Prozac and Zoloft are Food and Drug Administration-approved
 medications for the treatment of depression and other central
 nervous system disorders.  Meridia is marketed for the
 treatment of obesity.  The anti-obesity drug Redux was pulled
 from the market in 1997 after reports of heart valve damage.

 Methylenedioxymethamphetamine (MDMA), known as the street
 drug Ecstasy, is an amphetamine-derivative that is known to
 be toxic to some brain cells.  MDMA and another drug,
 5,7-dihydroxytryptamine (5,7-DHT), were used as controls
 because both drugs push serotonin out of the brain cells.
 The brain cell changes with SSRIs were similar to those
 observed with MDMA.

 Serotonin is ubiquitous in the central nervous system, making
 it a frequent target of potential drugs.  Drugs such as
 Prozac and Zoloft raise serotonin levels for depression and
 panic attacks, for example.  Another class of SSRIs --
 anti-anorectics -- includes drugs such as Meridia and its
 predecessor, Redux.

 Such drugs block the circulating serotonin, a
 neurotransmitter.  Once brain cells use serotonin, it's
 recycled in the brain.  SSRIs keep serotonin from being
 recirculated back to the brain for subsequent use, allowing
 the chemical to stay active in the brain.

 More than a decade ago, rat studies showed that high doses of
 Redux could change the shape of some brain terminals, says
 Dr. Kalia.  Some researchers attributed the effect to the
 fact that the drug was also a serotonin releaser.

 It pumps extra serotonin out of the brain cell, depleting the
 brain cell nerve terminal, rather than just blocking
 serotonin from entering back into the cell.  "It was a big
 mystery why these brain terminals looked like corkscrews with
 high doses," Dr. Kalia remembers.  But, she says, few
 scientists examined all SSRIs.  "We asked the question,
 'Would other SSRI's cause the same effects in high doses'?"

 Because patients are using some of these drugs for long
 periods -- and scientists aren't sure of what the long-term
 effects of many of these drugs might be -- she and her
 co-workers plan to do long-term studies in animals.  "We
 would lower the doses to about 10 to 30 times the therapeutic
 dose and give it to the rats for six months or a year,
 looking at them at selected periods of time to ask the
 questions, 'Can we see these changes in serotonin cells over
 the long term, or does the brain adjust?'" she says.

 The scientists would then examine the long-term effects of
 the drugs and examine the behavioral and neurological effects
 of these brain changes.  "We need to find out if these
 changes are effecting behavioral changes in the rat and in
 patients.

 "The problems with human studies is we can't do such
 experiments in controlled environment," she explains.  One
 difficulty with using such drugs, she says, is that several
 of them are given to patients who already have psychological
 problems such as depression and mood swings.  They may or may
 not develop neurological problems following drug treatment.
 Though that isn't necessarily the case with patients taking
 anti-obesity drugs, she points out, in any case, "the
 possibility of overlooking any drug-induced neurological
 changes must be considered."





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