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

ABSTRACT

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.

There 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 SSRIs.

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.

Prescription-event 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,
sexual 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.

Citalopram 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 symptoms.

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
Options
Serotonin
Sertraline
Fluoxetine
Paroxetine
Citalopram
Fluvoxamine
SSRIs and sex
SSRIs and PMT
SSRIs and safety
SSRIs and jealousy
SSRIs and microbes
SSRI pharmacology
SSRI-induced melancholy
Body dysmorphic disorder
Methylphenidate and SSRIs
Serotonin and romantic lovers

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Below report on 4 antidepressant medications including warnings for patients on heart medications. Anyone taking the newly approved drug, Citalopram?

If you want to read about these drugs (including side affects), go here;

Ciitalopram       http://www.mentalhealth.com/drug/p30-c04.html
Fluoxetine         http://www.mentalhealth.com/drug/p30-p05.html
Paroxetine        http://www.mentalhealth.com/drug/p30-p02.html
Sertraline          http://www.mentalhealth.com/drug/p30-z02.html

Other related drugs: http://www.mentalhealth.com/fr30.html

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Tricyclic Antidepressants versus SSRI's
(Selective Serotonin Reuptake Inhibitors)

Approximately 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
improved tolerability.

Although TCAs are less expensive than the SSRIs, they have deleterious
side effects, including anticholinergic and cardiovascular side effects,
and 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, and tremor.

With the exception of sexual dysfunction, these effects generally are not
severe enough to make the patient noncompliant and often subside as
treatment continues.

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.

Caution is urged when SSRIs are coadministered with drugs such as
phenothiazines, Type 1C antiarrhythmics, and other antidepressants.

Source:  Medscape
Depression in Managed Care: Costs of Selective Serotonin Reuptake Inhibitors

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Good source for description on how these drugs affect these disorders
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Novel Uses of Selective Serotonin Reuptake Inhibitors in Older Patients
http://www.mmhc.com/nhm/articles/NHM9806_a/hay.html

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.

Obsessive-Compulsive Disorder
    Clomipramine
    Fluoxetine
    Sertraline
    Paroxetine
    Fluvoxamine

Panic Disorder
    Fluoxetine
    Paroxetine

Agitation
Chronic Pain
Cognitive Impairment
Posttraumatic Stress
Social Phobia
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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!!

PLEASE 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.

Patients 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.

Serotonin 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
tricyclic antidepressants.

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

Mental status changes
-Confusion (51%)
-Agitation (34%)
-Hypomania (21%) a mild mania
-Anxiety (15%)
-Coma (29%)

Cardiovascular
-Sinus 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 blood

Gastrointestinal
-Nausea (23%)
-Diarrhea (8%)
-Abdominal pain (4%)
-Salivation (2%) excessive secretion of saliva often accompanied by  soreness of the mouth and gums

Motor Abnormalities
-Myoclonus (58%) irregular involuntary contraction of a muscle/functional disorder of controlling motoneurons
-Hyperreflexia (52%)  overactivity of physiological reflexes/ an organism's healthy or normal functioning
-Muscle rigidity (51%) abnormal stiffness of muscle
-Restlessness (48%)
-Tremor (43%) trembling or shaking
-Ataxia/incoordination (40%) inability to coordinate voluntary muscular movements
-Shivering (26%)
-Nystagmus (15%) a rapid involuntary oscillation of the eyeballs/dizziness
-Seizures (12%)

Other
-Diaphoresis (45%) profuse perspiration artificially induced
-Unreactive pupils (20%)
-Tachypnea (26%) increased rate of respiration
-Hyperpyrexia (45%) exceptionally high fever

Definitions 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 nervous system. 

Medications are:

In the U.S.-
    Nardil 2
    Parnate 3
    Marplan 1
In Canada-
    Nardil 2
    Parnate 3
----------------------------------------
Phenelzine
Pargyline
Selegiline
Rasagiline
Phenelzine
Befloxatone
Brofaromine
Moclobemide
Isocarboxazid
Tranylcypromine

some SSRI's
    Serotonin
    Sertraline
    Fluoxetine
    Paroxetine
    Citalopram
    Fluvoxamine