Antidepressants SSRI-type

Drug withdrawal reactions are liable to occur in neonates whose mothers are ingesting drugs of abuse or antidepressants of the SSRI type (p. 228). 

Although certain illnesses contribute to falls, medications have been shown to cause falls independent of other factors. The most commonly offending drugs are benzodiazepines because they have been shown to increase falls and hip fractures. An association between the dose (the higher the dose, the more likely the fall), duration of use, and type of benzodiazepine (e.g., long-acting medications) has also been reported. Other classes of medications that increase the risk of falls include tricyclic antidepressants, SSRIs, and opioid analgesics. 

For patients with moderately severe BED, treatment with cognitive behaviour therapy combined with an antidepressant of the SSRI type is the treatment of choice, If this proves ineffective, preliminary results suggest that possible alternative drugs, including venlafaxine, sibutramine and topiramate are potentially useful. Their definitive place in the treatment of BED awaits the outcome of further research. 

Switching non-responsive patients from an SSRI to an SNRI led 25 per cent of them to get better. Change from an SSRI to bupropion produced virtually the same remission rate (26 per cent). But what of the patients who were not switched to a different class of antidepressant, but instead were simply given another SSRI Twenty-seven per cent of these patients also got better - a remission rate that is virtually identical to that produced by changing to a different type of medication. In other words, the rate of improvement did not depend on the kind of drug to which the patient had been switched. Simply changing from one SSRI to another was as effective as changing to a completely... 

Different types of antidepressants are supposed to work by different means. SSRIs (selective serotonin reuptake inhibitors) are supposed to increase serotonin levels. NDRIs (norepinephrine dopamine reuptake inhibitors) are supposed to increase norepinephrine and dopamine, rather than serotonin. These two types of antidepressants are supposed to be selective , affecting the... 

These types of antidepressant were introduced around 10 years after the SSRIs. They include the serotonin noradrenaline reuptake inhibitor venlafaxine and the selective noradrenaline reuptake inhibitor reboxetine. Although there are fewer data about these drugs, clinical experience has shown they are well tolerated and, unlike the SSRIs, they are only weak inhibitors of drug metabolism (Kent, 2000). Depression is a common psychiatric disorder seen in the elderly and often remains untreated or inadequately treated (Forsell and Fastbom, 2000). Venlafaxine was shown to improve the mood in a group of 36 older patients without any effect on cognitive function, an important consideration where there is the possibility of the coexistence of mild or undiagnosed dementia (Tsolaki et al., 2000). 

Neuroanatomically both the locus coeruleus and the raphe nuclei project to the spinal cord where they gate sensory pathways from the skeletomuscular areas. As there is evidence that both noradrenaline and 5-HT are dysfunctional in depression, it is perhaps not surprising to find that the pain threshold is often reduced in patients with depression. Conversely, different types of antidepressants have been shown to have an antinociceptive effect in both rodent models of neuropathic pain, and clinically in fibromyalgia, chronic fatigue syndrome, postherpetic neuralgia and diabetic neuropathy. In general, it would appear that the dual action antidepressants (such as the TCAs and SNRIs) are more effective than the SSRIs. 

Dmg-induced serotonin syndrome is generally mild and resolves when the offending drugs are stopped. However, it can be severe and deaths have occurred. A large number of drugs have been implicated including tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), selective serotonin re-uptake inhibitors (SSRIs), pethidine, lithium, and dextromethorphan. The most severe type of reaction has occurred with the combination of selective serotonin re-uptake inhibitors and monoamine oxidase inhibitors. Both non-selective MAOIs such as phenelzine and selective MAOIs such as moclobemide and selegiline have been implicated. 

Tone, Andrea. The Age of Anxiety A History of America s Turbulent Affair with Tranquilizers. New York Basic Books, 2009. This book traces the history of drugs to treat anxiety from the first tranquilizer sold in 1955 to the billions of antianxiety drugs sold today. Although tranquilizers like Valium fell out of favor because of their addictiveness, the use of selective serotonin reuptake inhibitor (SSRI) antidepressants have become widely popular treatments for anxiety. The book places the popularity of these types of drugs within the larger context of what Tone calls the tranquilizer culture. 

Hence, there is little doubt that antidepressants may be useful as an adjunct in the treatment of patients with chronic pain. Traditional tricyclic medications such as amitriptyline and nortriptyline are often considered the drugs of choice for chronic pain.52 Newer drugs such as the SSRIs (e.g., paroxetine) and SNRIs (e.g., venlafaxine) might also be considered for some patients with fibromyalgia, neuropathies, and other forms of chronic pain.29 Future research should help clarify how specific antidepressants can be used most effectively as part of a comprehensive regimen for treating various types of chronic pain. 

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that stimulates the pineal gland s ability to produce melatonin. Antipsychotic drugs also have this effect. Other medicines have the opposite effect. Certain types of medicines used to treat cardiovascular disease called beta blockers reduce the production of melatonin by the pineal gland. Nonsteroidal antiinflammatories, which are used to treat pain and/or fever,... 

Regarding the drug treatment of depression in children, there is so far a paucity of good clinical trials to show that antidepressants are effective. Several small studies suggest that daily doses of up to 5mg/kg of imipramine may be beneficial, but there is no data to show whether other types of antidepressant medication are effective. The side effects and toxicity of tricyclic antidepressants are legion and have been discussed in detail elsewhere. Undoubtedly the SSRIs should now be the drugs of first choice in the treatment of depression in children. 

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