SSRI' Abstract selective serotonin reuptake inhibitors http://www.biopsychiatry.com/ssris.htm
Systematic review and guide to selection of selective serotonin reuptake
inhibitors by Edwards JG, Anderson I, University of Southampton, Faculty of Medicine, Health and Biological Sciences, Department
of Psychiatry, Royal South Hants Hospital, England.
Drugs 1999 Apr; 57(4): 507-33
A meta-analysis of 20 short term
comparative studies of 5 selective serotonin reuptake inhibitors (SSRIs; citalopram, fluoxetine, fluvoxamine, paroxetine and
sertraline) has shown no difference in efficacy between individual compounds but a slower onset of action of fluoxetine.
were suggestions that fluoxetine caused more agitation, weight loss and dermatological reactions than the other SSRIs.
More patients discontinued fluvoxamine and fewer patients stopped sertraline because of adverse effects than their comparator
The most common adverse reactions to the SSRIs were gastrointestinal
(especially nausea) and neuropsychiatric (particularly headache and tremor).
Data from the Committee on Safety
of Medicines showed more reports of suspected reactions (including discontinuation reactions) to paroxetine, and of gastrointestinal
reactions to fluvoxamine and paroxetine, than the other SSRIs during their first 2 years of marketing.
monitoring revealed a higher incidence of adverse events related to fluvoxamine than its comparators. There were higher incidences
of gastrointestinal symptoms, malaise, sedation and tremor during treatment with fluvoxamine and of sedation, tremor, sweating,
dysfunction and discontinuation reactions with paroxetine.
Fluoxetine was not associated with a higher incidence of
suicidal, aggressive and related events than the other SSRIs. Patients have survived large overdoses of each of the compounds,
but concern has been expressed over 6 fatalities following overdoses of citalopram.
Drug interactions mediated
by cytochrome P450 enzymes are theoretically less likely to occur during treatment with citalopram and sertraline, but there
is a sparsity of clinical data to support this.
Methodological difficulties and price changes do not allow choice for
recommendations on the choice of SSRI based on pharmacoeconomic data. Taking into account the strengths and weaknesses of
the methods used to compare drugs, guidelines to the selection of individual SSRIs in clinical practice are proposed.
should be avoided in patients likely to take overdoses.
Fluoxetine may not be the drug of first choice for
patients in whom a rapid antidepressant effect is important or for those who are agitated, but it may have advantages over
other SSRIs in patients who are poorly compliant with treatment and those who have previously had troublesome discontinuation
Fluvoxamine, and possibly paroxetine, should not be used as first choice
in patients especially prone to SSRI-related adverse reactions, while paroxetine should be avoided if previous discontinuation
of treatment was troublesome.
When in doubt about the risks of drug interactions, citalopram or sertraline should be
considered given the lower theoretical risk of interactions.
Go to above site for information the following information:
SSRIs and PMT
SSRIs and safety
SSRIs and jealousy
SSRIs and microbes
Body dysmorphic disorder
Methylphenidate and SSRIs
Serotonin and romantic lovers
Below report on 4 antidepressant
medications including warnings for patients on heart medications. Anyone taking the newly approved drug, Citalopram?
you want to read about these drugs (including side affects), go here;
Other related drugs: http://www.mentalhealth.com/fr30.html
Tricyclic Antidepressants versus SSRI's
(Selective Serotonin Reuptake Inhibitors)
two-thirds of patients with major depression will respond to antidepressant therapy. The most commonly prescribed antidepressants
are the tricyclic antidepressants (TCAs) and the newer-generation selective serotonin reuptake inhibitors (SSRIs), which include
fluoxetine, paroxetine, and sertraline.
Recently, citalopram became the fourth SSRI
approved in the United States for the treatment of depression.
Drugs in these two classes are widely regarded as effective
in the treatment of depression; however, the SSRIs are associated with
Although TCAs are
less expensive than the SSRIs, they have deleterious
side effects, including anticholinergic and cardiovascular side effects,
poorer long-term tolerability, which may ultimately result in higher
overall treatment costs.
The most common
adverse effects of SSRIs include sexual dysfunction,
nervousness, insomnia, drowsiness, fatigue, sweating, headache,
With the exception of sexual dysfunction, these effects generally are not
severe enough to make the
patient noncompliant and often subside as
A major concern of therapy with the SSRIs is the
potential for drug-drug
interactions because of their effect on the cytochrome P450 system.
This possibility is especially
important in patients with cardiac disease,
who often are taking multiple medications.
is urged when SSRIs are coadministered with drugs such as
phenothiazines, Type 1C antiarrhythmics, and other antidepressants.
Depression in Managed Care: Costs of Selective Serotonin Reuptake Inhibitors
Good source for description on how these drugs affect these disorders
Uses of Selective Serotonin Reuptake Inhibitors in Older Patients
The use of selective
serotonin reuptake inhibtors (SSRIs) has become popular because of the drugs' potency, selectivity, and safe side-effect profiles
for the treatment of depression in older adults.
SSRIs approved in this country for treatment of depression in adult
populations include fluoxetine, sertraline, and paroxetine. Fluvoxamine is approved for obsessive-compulsive
disorder (OCD) only; fluoxetine, paroxetine, and sertraline are approved for OCD; and paroxetine and sertraline have been
approved for panic disorder.
This article reviews the novel uses of SSRIs in elderly populations, including the treatment
of OCD, panic disorder, agitation, chronic pain, cognition problems, posttraumatic stress disorder, and social phobia.
WARNING ON Serotonin Syndrome: SSRI's/Tricyclics & MAOIs
I just read a 10/15/01
warning on Medscape about Venoflaxine/Effexor and MOIA's causing Serotonin Syndrome. In looking up this syndrome it
is possible with any SSRI or Tricyclic anti-depressants and even some over the counter stuff like St. John's Wort!!
read the symptoms of syndrome (below). I've added the definition next to technical descriptions. This syndrome
has been around for awhile and on a rise since the 60's when we began using more and more drugs which directly affect serotonin.
Maybe I didn't pay too much attention to it since Kelly was never on any of these meds.
Hopefully anyone on an SSRI,
Tricyclic or MOAI antidepressant has been
warned about Serotonin Syndrome and were told report any subtle changes
such as increasing confusion, unusual behavior, or agitation, which may be early signs of serotonin syndrome.
should have been told to stop using an MAO inhibitor 14 days before starting SSRI therapy too.
Serotonin Syndrome: Serotonin syndrome is described in the literature as a potentially serious drug-related
condition characterized by a number of mental, autonomic and neuromuscular changes. Although serotonin syndrome can cause
death, the condition is mild in most persons, and with supportive care alone they tend to recover completely.
syndrome is most often reported in patients taking two or more medications that increase CNS serotonin levels by different
mechanisms. The most common drug combinations associated with serotonin syndrome involve the MAOIs, selective serotonin reuptake
inhibitors (SSRIs), and the
Because of the dramatic rise in the use of SSRIs, it is predicted
that emergency room physicians are going to encounter the serotonin syndrome more frequently than in the past
Symptoms Associated with Serotonin Syndrome http://www.uspharmacist.com/NewLook/DisplayArticle.cfm?item_num=94
-Hypomania (21%) a mild mania
tachycardia (36%) sinus rhythm at a rate greater than 100 beats per minute
-Hypertension (35%) abnormally high arterial
blood pressure accompanied by nervousness, dizziness, or headache
-Hypotension (15%) abnormally low pressure of the
-Abdominal pain (4%)
excessive secretion of saliva often accompanied by soreness of the mouth and gums
(58%) irregular involuntary contraction of a muscle/functional disorder of controlling motoneurons
overactivity of physiological reflexes/ an organism's healthy or normal functioning
-Muscle rigidity (51%) abnormal stiffness
-Tremor (43%) trembling or shaking
-Ataxia/incoordination (40%) inability to coordinate
voluntary muscular movements
-Nystagmus (15%) a rapid involuntary oscillation of the eyeballs/dizziness
-Diaphoresis (45%) profuse perspiration artificially induced
-Tachypnea (26%) increased rate of respiration
-Hyperpyrexia (45%) exceptionally high fever
from InteliHealth Medical Dictionary
MAOI's Monoamine oxidase (MAO) inhibitors are used to relieve certain
types of mental depression. They work by blocking the action of a chemical substance known as monoamine oxidase (MAO) in the
In the U.S.-