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INTRODUCTION:Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that selectively increase the levels of serotonin in the synaptic cleft by blocking its uptake by serotoninergic neurons. They are now extensively used to treat various psychiatric disorders like depression, panic disorders, obsessive compulsive disorders and are now being evaluated in the treatment of a number of other psychiatric disorders like bulimia nervosa and social phobia. In this scenario we try to elucidate the serum electrolyte level, serum serotonin level, renal function test and platelet count to check out the changes as in different papers demonstrated that there are variations in different parameters of renal function occurred with chronic administration of SSRI. Objectives: To evaluate serum electrolyte level, serum serotonin level, renal function tests and platelet count of patients with major depressive disorder on chronic SSRI therapy and screen for any adverse drug reactions (if any) Materials and Methods: A cross-sectional observational study conducted in the Department of Psychiatry, Department of Biochemistry and Department of Pharmacology of Medical College and Hospital, Kolkata . The study protocol was approved by the Institutional Ethics Committee. Written consent was obtained from the subjects included in the study. Results and Discussion: After evaluating the biochemical parameters, it was observed that long term (more than 6 months) SSRI therapy can cause decline Platelet count (29.76%) and Serum Sodium Levels i.e. Hyponatremia (29.76%); whereas the serum serotonin levels (17.86%) were found to be elevated. Further, a negative correlation of -0.605 was observed between the serum sodium levels (in subjects with hyponatremia) and the duration for which the subjects were taking SSRI whereas a positive correlation of +0.407 was observed between the serum serotonin levels (in subjects with above normal serum serotonin levels) and the duration for which the subjects were taking SSRI. A number of adverse drug effects were reported. 28 subjects (33.33%) reported at least any one of the following symptoms like Headache, Sedation, Dizziness, Anxiety, Agitation. 12 subjects (14.28%) reported having recurring suicidal thoughts. 21 subjects (25.00%) reported GIT Problems like nausea/ vomiting/ constipation/ dyspepsia. 13 subjects (15.48%) reported reduction in sleep time while 20 subjects (23.81%) reported reduction in appetite. Sexual Problems like decreased libido, ejaculation difculty or impotence was reported by 19 subjects (22.62%). 25 subjects (29.76%) reported that they had gained weight after the therapy. Discontinuation Symptoms were reported by 59 subjects (70.24%). Conclusion: The hemogram of patients on SSRI therapy should be monitored from time to time and their biochemical parameters should be evaluated to prevent any untoward adverse effects in the subjects. The patients on SSRI therapy should be closely monitored for adverse effects like sexual problems, GITproblems, CNS manifestations, suicidal thoughts, discontinuation symptoms among others.

Background: There is an increased use of antidepressant and anti-anxiety medications as an aftermath of unfavorable conditions such as the COVID-19 pandemic. There is a need to estimate its use during this period. Aims and Objectives: This study will help to find out the changing trend in the pattern of the use of antidepressant and anti-anxiety medications in outpatients over a 4-year period including the COVID-19 pandemic period in Kolkata. Materials and Methods: This descriptive, observational, record-based study was conducted in Medical College and Hospital, Kolkata. The data of consumption daily defined doses (in DDDs) of antidepressant and antipsychotic drugs and data of total patient load in all the outpatient departments were obtained. The antidepressant and anti-anxiety drugs use was calculated in DDD/1000/patients/day for the years 2018–2021. Results: There was sharp decrease in the aggregate use of antidepressants and anti-anxiety medications in the year 2020, which coincided with the COVID-19 pandemic, followed by sharp increase in their aggregate use in the year 2021. Conclusion: The change in the trend of use of antidepressants and anti-anxiety medications was observed from the years 2018 to 2021. There was decreased use in 2020 due to less outpatient attendance, because of lockdown and transport unavailability, during COVID-19, followed by increased use in the year 2021, due to rise in mental problems as because of pandemic and lifting of lockdown.

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are recommended as first-line anti-depressants in Major Depressive Disorder (MDD) because of their relatively benign safety profile. Hyponatremia is under reported and notorious adverse effect of SSRIs shown by few Randomised Clinical Trials (RCTs). There are only few published studies of SSRIs on serum sodium level in human and animal model. Aim: To determine SSRI induced hyponatremia in human and its correlation with age. Materials and Methods: The clinical part is a prospective cohort study whereas second part is experimental study involving animals. In clinical part-Patients of either sex, aged above 18 years, attending the Out-Patient Department (OPD) of Psychiatry of a tertiary hospital and diagnosed as MDD Diagnostic and Statistical Manual (DSM) V with the help of a senior psychiatrist, were screened and recruited in the study after satisfying the inclusion and exclusion criteria by consecutive sampling. Patients were prescribed fluoxetine (n=90), sertraline (n=55), paroxetine (n=30) and escitalopram (n=25). Parameters recorded (serum sodium) at baseline, 4th week, 8th week and 12th week. Symptoms due to hyponatremia and Adverse Drug Reactions (ADR) were also checked. Multiple group comparison at different visits for sodium level was done using one-way ANOVA and repeated measures ANOVA test and relationship of blood sodium level with age were estimated with bivariate correlation. Animal experiment was done in Pharmacology Department, animals were randomised into 5 groups control, fluoxetine, sertraline, paroxetine and escitalopram (n=6). Blood sodium checked at baseline, 2nd week and 4th week. Kruskal Wallis test and Friedman’s test done to detect changes in sodium level in follow-up period. Results: Mean age ranged between 40-50 years with equal gender distribution. Both within group and between group analysis revealed significant difference in blood sodium level (p-value< 0.0001). Hyponatremia was strongly correlated with age (correlation coefficient >-0.783). Most participants (184 out of 200) developed asymptomatic hyponatremia. Two among sertraline developed seizure leading to discontinuation to therapy. About 72 (38.09%) ADRs belonged to probable, mostly belonging to fluoxetine and sertraline group, developement of hyponatremia was 9 days (median) from starting SSRI. In animal part within group analysis revealed significant change of sodium from baseline in all drug treated animals (p-value