Fluoxetine disadvantages

The approval of mirtazapine in the United States was based on six double-blind, placebo- and amitriptyline-controlled studies in which it was found to be superior to placebo and comparable with amitriptyline in terms of antidepressant efficacy (173,174). In a double-blind, crossover study, 63% of patients who failed to respond to 6 weeks of double-blind treatment with amitriptyline responded to mirtazapine (175). In two studies, mirtazapine was found to be efficacious in the treatment of patients hospitalized for major depression. In the first study, the antidepressant efficacy of mirtazapine was comparable with that of amitriptyline and superior to placebo (176). In the other study, the antidepressant efficacy was superior to that of fluoxetine (118). There are advantages and disadvantages to mirtazapine, including the following ... 

Another alternative technique, solid-phase microextraction (SPME), was used for the determination of fluoxetine [79] and several TCAs [80], SPME is a miniaturized and solvent-free technique, where analytes are extracted from the sample by adsorption on a thin polymer coating fixed to the solid surface of a fiber, located inside an injection needle or a capillary. Its main disadvantage is that special strategies are needed to couple SPME to the LC-MS analysis. 

Gastrointestinal adverse effects are one of the major disadvantages of SSRIs. The most common is nausea, and the incidence is said to be 20% or more for paroxetine (45,46), sertraline (47), fluvoxamine (5), fluoxetine (48), and citalopram (10,49). Although nausea can lead to drug withdrawal, it usually disappears after a few weeks. Other gastrointestinal symptoms that occur commonly with fluoxetine and sertraline are loose stools and diarrhea (47,48,50), while constipation has been more often reported with fluvoxamine (5) and paroxetine (45,46). 

Gastrointestinal adverse effects are one of the major disadvantages of SSRIs (see General section). Two women developed stomatitis while taking fluoxetine in one it recurred on rechallenge (25). 

Another difference between the SSRI antidepressants is their half-lives. Paroxetine has a half-life of approximately one day, sertraline one to two days, and fluoxetine seven to ten days. A long half-life is an advantage in maintaining a stable blood level but a disadvantage when starting or stopping the mediciaton. It takes six weeks to reach a steady state with fluoxetine. 

---