Escitalopram

Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline... 

Escitalopram Lexapro No Tablet, solution 10 10-20 Once daily... 

The efficacy of paroxetine, sertraline, and escitalopram was established in large controlled trials.58-60 SSRIs improve social anxiety and phobic avoidance and reduce overall disability. 

Si, T. M., Yang, Q., Liu, Y. et al. (2006). The relationship between the genetic polymorphism ofCYP P450 2C19 and the pharmacokinetics of escitalopram in Chinese volunteers. Chinese Journal of New Drugs, 15(15), 1296-9. 

Robinson, Robert G., Ricardo E. Jorge, David J. Moser, Laura Acion, Ana Solodkin, Steven L. Small, Pasquale Fonzetti, Mark Hegel and Stephan Arndt, Escitalopram and Problem-Solving Therapy for Prevention of Poststroke Depression A Randomized Controlled T rial , Journal of the American Medical Association 299, no. 20 (2008) 2391-400 Rogers, Carl, On Becoming a Person A Therapist s View of Psychotherapy, London Constable, 1961... 

Generalized anxiety Duloxetine Escitalopram Paroxetine Venlafaxine XR Benzodiazepines Buspirone Imipramine Sertraline Hydroxyzine Pregabalin... 

Social anxiety disorder Escitalopram Fluvoxamine Paroxetine Sertraline Venlafaxine XR Citalopram Clonazepam Buspirone Gabapentin Miitazapine Phenelzine Pregabalin... 

Venlafaxine extended release, duloxetine, paroxetine, and escitalopram are FDA approved for treatment of GAD. Sertraline is also effective. Acute response and remission rates are approximately 65% and 30%, respectively. Imipramine may be used when patients fail to respond to selective serotonin reuptake inhibitors (SSRIs). In one trial, diazepam, trazodone, and imipramine had greater anxiolytic activity than placebo. 

Since the introduction of the first approved SSRI, fluoxetine (1) in 1987 [9], a number of SSRIs have been developed for the treatment of depression [2], Currently, the five most commonly prescribed SSRIs are fluoxetine, escitalopram (2, S-enantiomer of citalopram), sertraline (3), paroxetine (4) and fluvoxamine (5). Recent effort in the clinical development of new SSRIs has focused on the treatment of premature ejaculation (PE) by taking advantage of the ejaculation-delaying side effects of SSRIs [10]. Although SSRIs have been prescribed off-label to treat this condition, an SSRI with rapid onset of action and rapid clearance could be preferred for on-demand treatment of PE [11,12]. Dapoxetine (LY210448, 6), an... 

After more than a decade of use, bupropion (24) is considered a safe and effective antidepressant, suitable for use as first-line treatment. In addition, it is approved for smoking cessation and seasonal affective disorder. It is also prescribed off-label to treat the sexual dysfunction induced by SSRIs. Bupropion is often referred to as an atypical antidepressant and has much lower affinity for the monoamine transporters compared with other monoamine reuptake inhibitors. The mechanism of action of bupropion is still uncertain but may be related to inhibition of dopamine and norepinephrine reuptake transporters as a result of active metabolites [71,72]. In a recently reported clinical trial, bupropion extended release (XL) had a sexual tolerability profile significantly better than that of escitalopram with similar re-... 

Other examples of efficient enzymatic resolutions by reaction at a remote position from stereocentres have been reported, such as the lipase-catalysed resolution of a synthetic intermediate of escitalopram." This property of enzymes has also been effectively used to resolve sterically hindered compounds by the introduction of a tether so that the enzyme-catalysed reaction can be performed at an artificially created, but less hindered, remote location. An example is the resolution of tertiary alcohols by the introduction of a glyoxylate ester. 

SSRls Citalopram Escitalopram Flnoxetine Flnvoxamine Paroxetine Sertraline... 

The current SSRIs in the United States inclnde fluoxetine, fluvoxamine, sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). All effectively treat major depression. In addition, one or more of the SSRIs has been shown effective in the treatment of dysthymic disorder, the depressive phase of bipolar disorder, premenstrual dysphoric disorder, panic disorder, social phobia, obsessive-compnlsive disorder, bnlimia nervosa, and binge-eating disorder. 

Citalopram (Ceiexa), Esdtalopram (Lexapro). Escitalopram is the enantiomer S-citalopram. Citalopram is a 50 50 mixtnre of s- and r-citalopram of which the former is the active component. Both are very selective SSRIs. The side effects of citalopram and escitalopram appear to be comparable to other SSRIs. 

SSRls and SNRIs. The SSRl antidepressants, together with venlafaxine, have replaced the benzodiazepines as treatments of choice for GAD. Paroxetine and escitalopram are FDA approved for GAD, though it is generally believed that all SSRls and SNRIs are effective for GAD. Similar to the TCAs, SSRIs/SNRIs appear to be most effective for the intrapsychic symptoms of GAD but less effective than benzodiazepines for the somatic manifestations of the disorder. 

SSRls. SSRI antidepressants have also received considerable scrutiny in the treatment of OCD. Fluoxetine, fluvoxamine, paroxetine, and sertraline are all approved by the FDA for the treatment of OCD. Current studies suggest that each of these medications is more effective for OCD when administered at the higher end of the therapeutic dose range, that is, fluoxetine 60-80 mg/day, fluvoxamine 200-300 mg/ day, paroxetine 40-60 mg/day, and sertraline 150-200 mg/day. No controlled studies are yet available regarding the use of citalopram or escitalopram for OCD. Refer to Chapter 3 for more information regarding SSRl antidepressants. 

Beta agonists (terbutaline, albuterol) Theophylline Antidepressants Bupropion Citalopram Escitalopram Duloxetine Fluoxetine Fluvoxamine... 

The S-enantiomer of citalopram (escitalopram) is over 100 times more potent in inhibiting the reuptake of 5-HT into brain slices than the R-form and is devoid of any activity at the neurotransmitter of other receptor types (racemic citalopram has an affinity for histamine receptors and causes sedation). In in vivo studies, escitalopram is more potent than the R-form or the racemate in releasing 5-HT in the cortex of conscious rats it has been... 

In addition to the five SSRIs currently available, many more compounds are in development which will no doubt be marketed in the near future. Of the new arrivals, escitalopram, the S-enantiomer of citalopram, has already become available in many European countries. A brief discussion of the properties of this drug has been presented on p. 98. 

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