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Letter to the Editor

Dr Bhatia and Colleagues Reply

Manjeet Singh Bhatia, MD; Sheenam Goyal, MD; Apala Singh, MD; and Ankit Daral, MD

Published: November 25, 2020

See letter by Kow and Hasan and case report by Bhatia et al

Dr Bhatia and Colleagues Reply

To the Editor: In this case,1 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.

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, > 6 months) is mostly linked to weight gain.2 Weight gain is less likely with citalopram or sertraline compared to fluoxetine and paroxetine.3,4 Nausea and sweating are more common with fluoxetine, whereas other adverse effects are not statistically significant.5


1.Bhatia MS, Goyal S, Singh A, et al. COVID-19 pandemic-induced panic disorder. Prim Care Companion CNS Disord. 2020;22(3):20l02626. PubMed CrossRef

2.Everything You Need to Know About Antidepressants That Cause Weight Gain. Healthline website. Accessed November 11, 2020.

3.Sussman N, Ginsberg D. Rethinking side effects of the selective serotonin reuptake inhibitors: sexual dysfunction and weight gain. Psychiatr Ann. 1998;28(2):89-97. CrossRef

4.De Wilde J, Spiers R, Mertens C, et al. A double-blind, comparative, multicentre study comparing paroxetine with fluoxetine in depressed patients. Acta Psychiatr Scand. 1993;87(2):141-145. PubMed CrossRef

5.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. Pharmacopsychiatry. 2005;38(2):69-77. PubMed CrossRef

Manjeet Singh Bhatia, MDa

Sheenam Goyal, MDa

Apala Singh, MDa

Ankit Daral, MDa

aDepartment of Psychiatry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

Published online: November 25, 2020.

Potential conflicts of interest: None.

Funding/support: None.

Prim Care Companion CNS Disord 2020;22(6):20lr02805a

To cite: Bhatia MS, Goyal S, Singh A, et al. Dr Bhatia and colleagues reply. Prim Care Companion CNS Disord. 2020;22(6):20lr02805a.

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Volume: 22

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