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<p style="text-align: right; margin: 10px 0 5px; font-size: 10em;">See letter by <a href="/PCC/article/Pages/use-of-medications-with-weight-gain-potential-for-panic-disorder-and-covid-19.aspx" target="_top">Kow and Hasan</a> and case report by <a href="/PCC/article/Pages/covid-pandemicinduced-panic-disorder.aspx" target="_top">Bhatia et al</a></span></p>

<p class="ltrs-br-ltr-br-title"><span class="bold">Dr Bhatia and Colleagues Reply</span></p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold">To the Editor:</span> In this case,<span class="htm-cite"><a href="#ref1">1</a></span> a detailed examination of the patient was conducted. The patient had no past medical history of hypertension, diabetes mellitus, thyroid dysfunction, or other medical illness. His body mass index was also noted, which was within normal limits. With all of these factors in mind, his medication was started in addition to psychotherapy. The patient presented for regular follow-up, and no side effect with paroxetine was observed or reported by the patient.</p>
<p class="ltrs-br-ltr-br-body-text">Fluoxetine is also associated with gastrointestinal side effects and activating effects, which result in noncompliance in patients. And, many patients with coronavirus disease 2019 (COVID-19) also present with gastrointestinal disturbance, which could have increased the patient’s anxiety with regard to COVID-19. Although some selective serotonin reuptake inhibitors are associated with weight loss at first, long-term use (ie, ><span class="thinspace"> </span>6 months) is mostly linked to weight gain.<span class="htm-cite"><a href="#ref2">2</a></span> Weight gain is less likely with citalopram or sertraline compared to fluoxetine and paroxetine.<span class="htm-cite"><a href="#ref3">3</a>,<a href="#ref4">4</a></span> Nausea and sweating are more common with fluoxetine, whereas other adverse effects are not statistically significant.<span class="htm-cite"><a href="#ref5">5</a></span></p>
<p class="references_references-heading"><span class="bold">References</span></p>
<p class="references-references-text-1-9"><a name="ref1"></a><span class="htm-ref"> 1. </span>Bhatia MS, Goyal S, Singh A, et al. COVID-19 pandemic-induced panic disorder. <span class="italic">Prim Care Companion CNS Disord</span>. 2020;22(3):20l02626. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=32369687&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.4088/PCC.20l02626" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref2"></a><span class="htm-ref"> 2. </span>Everything You Need to Know About Antidepressants That Cause Weight Gain. Healthline website. <a href="https://www.healthline.com/health/antidepressants-that-cause-weight-gain" target="_blank"><span class="hyperlink">https://www.healthline.com/health/antidepressants-that-cause-weight-gain</span></a>. Accessed November 11, 2020.</p>
<p class="references-references-text-1-9"><a name="ref3"></a><span class="htm-ref"> 3. </span>Sussman N, Ginsberg D. Rethinking side effects of the selective serotonin reuptake inhibitors: sexual dysfunction and weight gain. <span class="italic">Psychiatr Ann</span>. 1998;28(2):89–97. <a href="https://doi.org/10.3928/0048-5713-19980201-10" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref4"></a><span class="htm-ref"> 4. </span>De Wilde J, Spiers R, Mertens C, et al. A double-blind, comparative, multicentre study comparing paroxetine with fluoxetine in depressed patients. <span class="italic">Acta Psychiatr Scand</span>. 1993;87(2):141–145. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8447241&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1111/j.1600-0447.1993.tb03345.x" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref5"></a><span class="htm-ref"> 5. </span>Brambilla P, Cipriani A, Hotopf M, et al. Side-effect profile of fluoxetine in comparison with other SSRIs, tricyclic and newer antidepressants: a meta-analysis of clinical trial data. <span class="italic">Pharmacopsychiatry</span>. 2005;38(2):69–77. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15744630&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1055/s-2005-837806" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Manjeet Singh Bhatia, MD</span><span class="superscript">a</span></p>
<p class="ltrs-br-ltr-br-author"><a href="mailto:manbhatia1@rediffmail.com">manbhatia1@rediffmail.com</a></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Sheenam Goyal, MD</span><span class="superscript">a</span></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Apala Singh, MD</span><span class="superscript">a</span></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Ankit Daral, MD</span><span class="superscript">a</span></p>
<p class="end-matter"><span class="superscript">a</span>Department of Psychiatry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India</p>
<p class="end-matter"><span class="bold-italic">Published online:</span> November 25, 2020.</p>
<p class="end-matter"><span class="bold-italic">Potential conflicts of interest:</span> None.</p>
<p class="end-matter"><span class="bold-italic">Funding/support:</span> None.</p>
<p class="abstract-citation"><span class="italic">Prim Care Companion CNS Disord 2020;22(6):20lr02805a</span></p>
<p class="front-matter-rule"><span class="bold-italic">To cite:</span> Bhatia MS, Goyal S, Singh A, et al. Dr Bhatia and colleagues reply. <span class="italic">Prim Care Companion CNS Disord. </span>2020;22(6):20lr02805a.</p>
<p class="doi-line"><span class="bold-italic">To share: </span>https://doi.org/<span class="doi">10.4088/PCC.20lr02805a</span></p>
<p class="end-matter">© <span class="italic">Copyright 2020 Physicians Postgraduate Press, Inc.</span></p>
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