Anti-serotonergic

SSRIs CYPROHEPTADINE Antidepressant effect of SSRIs are possibly antagonized by cyproheptadine Cyproheptadine is an antihistamine with anti-serotonergic activity Be aware... 

Griffiths AP, Penn ND, Tindall H. A report of acute overdosage of the anti-serotonergic drug pizotifen. Postgrad Med J 1987 63(735) 59-60. 

Siuciak, JA, Clark, MS, Rind, HB, Whittemore, SR and Russo, AF (1998) BDNF induction of tryptophan hydroxylase mRNA levels in the rat brain. J. Neurosci. Res. 52 149-158. Sprague, JE, Everman, SL and Nichols, DE (1998) An integrated hypothesis for the serotonergic axonal loss induced by 3,4-methylenedioxymethamphetamine. Neuro toxicology 19 427-A42. Stock, MJ (1997) Sibutramine a review of the pharmacology of a novel anti-obesity agent. Int. J. Obesity 21 (Suppl 1) S25-S29. 

Antihistaminic Anti-alphai Adrenergic Anticholinergic Serotonergic... 

Blier P, de Montigny C (1998) Possible serotonergic mechanisms underlying the antidepressant and anti-obsessive-compulsive disorder responses. Biol Psychiatry 44 313-323 Bonasera SJ, Tecott LH (2000) Mouse models of serotonin receptor function toward agenetic dissection of serotonin systems. Pharmacol Ther 88 133-142 Bonhoeffer T (1996) Neurotrophins and activity-dependent development of the neocortex. Curr Opin Nemobiol 6 119-126... 

Mechanism of action is serotonergic (not known to be effective anti-ADHD agents)... 

Selective serotonin reuptake inhibitors. Currently available selective serotonin reuptake inhibitors (SSRIs) include fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram. At present, expert opinion does not support the usefulness of these serotonergic compounds in the treatment of core ADHD symptoms (National Institute of Mental Health, 1996). Nevertheless, because of the high rates of comorbidity in ADHD, these compounds are frequently combined with effective anti-ADHD agents (see Combined Pharmacotherapy, below). Since many psychotropics are metabolized by the cytochrome P450 system (Nemeroff et ah, 1996), which in turn can be inhibited by the SSRIs, caution should be exercised when combining agents, such as the TCAs, with SSRIs. 

It has been known since the mid-1980s that clomipramine, a potent but nonse-lective serotonin reuptake inhibitor, is effective in reducing OCD symptoms. Since then, numerous studies have confirmed the superiority of clomipramine over placebo in OCD patients, whereas other antidepressant medications with less potent inhibitory effects on serotonin reuptake (e.g., nortripytline, desipramine) seem to be ineffective in OCD. Demonstration of the anti-OCD actions of all five SSRIs, namely, fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram, also supports the hypothesis that the antiobsessional effects of these various pharmacologic agents is due to their potent serotonergic reuptake blocking activity. 

St. John s wort also exhibits anti-inflammatory and antibacterial activity. Reports of antiviral activity arc unsubstantiated. The main adverse effect with St. John s wort is severe phototoxicity. A sunbum-like condition may occur at normal dosages. St. John s wort. should never be taken with MAOIs because of the risk of potentiation of the effects. Selective serotonin reuptake inhibitors (SSRIs) likewise should not be taken with St. John s wort because of the ri.sk of serotonergic syndrome. 

Addition of anti-akathisia agents either propranoioi (usually up to 40-120 mg/day) or a postsynaptic 5-HT2a serotonergic antagonist such as cyproheptadine (8-16 mg/day). 

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