Sertraline MAOIs

Use of die MAOIs must be discontinued 2 weeks before the administration of die SSRIs. When the SSRIs are administered witii die tricyclic antidepressants, tiiere is an increased risk of toxic effects and an increased tiierapeutic effect. When sertraline is administered witii a MAOI, a potentially fatal reaction can occur. Sjymptoms of a serious reaction include hyper-tiiermia, rigidity, autonomic instability witii fluctuating vital signs and agitation, delirium, and coma Sertraline blood levels are increased when administered witii cimetidine. 

Sertraline Linezolid (MAOI effects) Serotonin syndrome... 

Newer Generation Antidepressants. All SSRIs have been shown effective in the treatment of panic disorder. Of these, flnoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), as well as the SNRI venlafaxine ER (Effexor XR), have received FDA approval for the treatment of panic disorder. Because they are safer and easier to tolerate, SSRls/SNRls have largely supplanted the MAOIs and TCAs as standard treatments (along with benzodiazepines) for panic disorder. 

Serotonin-Boosting Antidepressants. The SSRIs have also been studied in the treatment of generalized social anxiety disorder, and paroxetine, sertraline, and venlafaxine are effective. Preliminary data suggests that the serotonin-boosting atypical antidepressants (mirtazapine and nefazodone) may also be helpful. Like the MAOIs, they appear to be effective at doses comparable to those used to treat depression. They may help avoidant patients to gradually increase their social interaction and become more assertive. 

Answer Because of sertraline s favorable side effect profile and no need for dietary restrictions, it probably should be chosen over the older agents (TCAs and MAOIs). She should be warned about nausea and possibly loose stools, anorgasmia, and insomnia before she begins therapy. It also should be explained that the medication will take at least 2 weeks to begin working and that a complete trial of the medication to assess its efficacy will take 4 to 6 weeks. Since this is her first episode of depression, she should take the medication for 6 to 12 months after her symptoms have remitted before considering discontinuation of drug therapy. 

A preliminary investigation has shown that sertraline therapy can be an effective treatment for social phobia. In this study, 80% were considered responders with all measures of social anxiety and avoidance, depression, and social functioning showing a statistically significant change from baseline to endpoint ( 84). Versiani s review of the literature led to a ranking of drug efficacy for social phobia classic MAOIs > SSRIs > BZDs > RIMAs ( 84a). 

MAOIs SSRIs t risk of serotonin syndrome >- For signs and symptoms of serotonin toxicity, see Clinical Features of Some Adverse Drug Interactions, Serotonin toxicity and serotonin syndrome Additive inhibitory on serotonin reuptake Avoid co-administration. MAOIs should not be started for at least 1 week after stopping SSRIs (2 weeks after sertraline, S weeks after fluoxetine). Conversely, SSRIs should not be started for at least 2 weeks after stopping MAOIs... 

Like other SSRIs, sertraline should not be used within 2 weeks of discontinuing monoamine oxidase inhibitors (MAOIs) and MAOIs should not be started for at least 2 weeks after stopping sertraline. 

All SSRIs have common 5-HT agonistic effects and because of this, SSRIs have common interactions and side effects. SSRIs are potent inhibitors of serotonin reuptake by CNS neurons and may interact with other drugs such as monoamine oxidase inhibitors (MAOIs) or circumstances which cause serotonin release. A minimum 2 weeks wash-out period should be observed between stopping a MAOI and starting an SSRI. Conversely, a MAOI should not be started for at least 1 week after an SSRI has been stopped, 5 weeks after fluoxetine, and 2 weeks for paroxetine and sertraline. Escitalopram and citalopram are hypersensitive to each other. 

Key to Figure 4 2 9 cis-N-methyl-2-(1-pyrrolidinyl)arylacetamides 3 0 sertraline and other 1 -phenyl-4-aminotetralins 3 1 clorgyline (MAOI s) 3 2 ifenprodil 3 3 ciscyclohexanediamines 3 4 polyamines 3 5 tricyclic antidepressants 3 6 2-phenethylamines... 

Antidepressant drugs A major class of psychotropic drugs with diverse chemical configurations including the monoamine oxidase inhibitors (MAOIs), the heterocyclic drugs (composed of mono-, di-, tri-, and hetero-cyclics), the serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline, trazodone, and venlafaxine), and bupropion are more recent innovations. Antidepressants usually must be taken for several weeks to have the desired effect and they often have a low therapeutic index, so they must be closely monitored. 

DA agonists levodopa, bromocriptine, ropinirole, pramipexole, selegiline AAAD inhibitor carbidopa M-blockers benztropine, trihexiphenidyl MAOIs phenelzine, tranylcypromine TCAs amitriptyline, imipramine, clomipramine SSRIs fluoxetine, paroxetine, sertraline Others bupropion, mirtazapine, nefazodone, trazodone... 

Pharmacotherapy is also used to delay ejaculation. Initially, local anesthetic ointments were recommended, but later case reports and open trials described the beneficial effects of monoamine oxidase inhibitors (MAOIs), clomipramine, benzodiazepines, and selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, and sertraline. 

Few data are available about sertraline interactions with MAOIs, even though they are expected to be similar to those of the other SSRIs. However, serotonin syndrome has been reported with the combined tranylcypromine-sertraline (and clonazepam also) regimen. At present, only this specific combination should be avoided. 

Traditionally, dysthymic disorder has not been the focus of pharmacotherapeutic interventions, given its chronicity and the presumed non-biological personality variables associated with it. Psychotherapy and psychoanalysis were generally considered the first-choice treatment options, although these treatment modalities have not been well studied in controlled trials. However, as a result of a series of placebo-controlled medical trials, this attitude has been changed. Among the antidepressants found to be superior to placebo are the selective serotonin reuptake inhibitors (SSRIs, with results being evident so far with fluoxetine and sertraline), the tricyclic antidepressants (TCAs) amitriptyline, desipramine, and imipramine (with a 40-60% favorable response), and the reversible and irreversible monoamine oxidase inhibitors (MAOIs) moclobemide and phenelzine, respectively. 

Selective serotonin reuptake inhibitors (SSRIs) are regarded as first-line treatment in social phobia. Fluvoxamine, paroxetine, and sertraline have been shown to be effective in double-blind placebo-controlled studies. - The irreversible monoamine oxidase inhibitor (MAOI) phenelzine shows robust results in terms of efficacy and has demonstrated (at least anecdotally), its efficacy in improving some of the cognitive aspects associated with SAD. However, phenelzine is usually less well tolerated than alternative treatments due to its associated dietary restrictions and adverse side-effect profile, including sedation and postural hypotension. Results with the reversible inhibitor of monoamine oxidase type A (RiMA) mociobemide are inconsistent. 

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