Magazine Articles (from What's Happening in Brighton Magazine)

Dr. M J VandenBurg
Private Specialist in General Medicine with an interest in Sexual Health.
Pharmaceutical & Medico-Legal Expert.


The Boss has told me off! By this, I don't mean Bruce Springsteen who goes by the name of the "Boss", but the erstwhile editor of What's Happening Magazine. He has decided that this should really be a medical column and not an introduction to the Malcolm VandenBurg life story.


For this month, the medical issue I was going to talk about was the treatment of bad backs; which I myself suffer from, but "Upstairs", thought that this was too much like my life story again. He suggested I write about the side effects of Viagra, not sure if the same comments apply to him, me, or us both.


I happen to know a lot about Viagra. I have registered two Medicines for Erectile Dysfunction, done research on Premature Ejaculation, and indeed, reviewed 30,000 ECG's, which are electrical recordings from the heart; to ascertain the true risk of Viagra to patients with cardiac disease. We did so much work on Sexual Health Medicines, that my company had a special department that we called the "Below the Belt" division. We also registered antibiotics for Gonorrhoea and Chlamydia as well as NSU (Non Specific Urethritis) and many other "down below" infections.


Indeed, such conditions make up three-quarters of my practice. Perhaps, more of this; another time.


One of the other things that the Below the Belt Department worked on was the class of anti-depressants known as SSRI's, (Selective Serotonin Re-uptake Inhibitors) such as Prozac and Seroxat (whose real names are Fluoxetine and Paroxetine); there are many others. The reason why they fell within this category were, because they prevent orgasms in many people, delay orgasms in almost all men and women and are used by Specialists as a cure for Premature Ejaculation.


I also meet these medicines a lot in my Forensic Medical Practice and in my Court work as they alter behaviour, cause aggression, and may precipitate suicidal behaviour or/and have been linked to homicides. They have to be used with special caution in those aged under 25, as there is even a net increase in suicides in this group given SSRI's, whereas above the above 25 age-group, there is a net decrease although it may precipitate suicidal thoughts in a lot of older patients. I have done research on many of these compounds.


The last e-mail that sent me, detailed four questions on anti-depressants.


I've only answered one this month. More next month and here goes my real Medical column:


My wife and I are thinking of having a baby. She has been on the anti-depressant Seroxat for 5 years and I have heard that it is dangerous to take this medicine during pregnancy. Could you put her and my mind at ease and tell us if it is dangerous to take Seroxat during pregnancy? B.D


Dear B.D,


I'm afraid I cannot re-assure you. No treatment for anything is safe. There is a risk-benefit ratio to everything. This is a contentious area. There is no doubt that some anti-depressants present a health risk to your baby, however, stopping them may also have a risk. Seroxat is not acceptable to my mind in Pregnancy.


You and your wife need an in-depth discussion with your Doctor, be that GP or Obstetrician (that is the doctor in charge of your wife and her pregnancy). I am not sure whether all midwives will know the answer, however, because the substances have been in the news because of their safety or otherwise during pregnancy, they maybe most informed. Doctors believe that the overall risk of birth defects and other problems for you and the baby inside you are rare and the risk low. However, some anti-depressants have been associated with health problems in babies.


In general, the risk-benefit ratio of Citalopram (trade name: Celexa/Cipramil), Fluoxetine (trade name: Prozac) and Sertraline (trade name: Zoloft/Lustral) are thought to be acceptable. There was some thought that they may cause problems with rare lung diseases in babies if taken in the first four to five months of Pregnancy, as well as some very rare heart defects, although this has neither been confirmed nor disproved. This is the case for other very rare birth defects.


Unluckily, the drug your wife is on, Paroxetine (Seroxat) is to my mind, not to be used during pregnancy. There is a much larger risk of proven association with foetal heart diseases.


Additionally, if any anti-depressant is taken throughout pregnancy, especially including and up to the three months before birth, the baby may get a discontinuation or withdrawal reaction and some people used to think it was advisable to slowly reduce the dose before birth, however, this is now not recommended as it puts the mother at risk of a recurrence of her depression without decreasing the risk to the baby.


You really need a long consultation with a Health Care Professional. I would certainly recommend you coming off the Seroxat before getting pregnant, and if your Doctor thinks your mental health issues are bad enough to need an anti-depressant, consider the other ones I have mentioned; Citalopram, Fluoxetine, Sertraline and most importantly, balancing the risk to yourself of precipitating recurrence of mood disturbances, depression and anxiety disorders and the potential low risk of very rare birth defects in your baby. The answer is not as simple or 100% reassuring like you would have wanted.


Next month, I will be answering other questions on anti-depressants, without any personal pre-rambles. This is a transition piece, to get where the editor wants me to be. Please keep your questions coming in.




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