Selective serotonin reuptake inhibitors and

Opioids, benzodiazepines, barbiturates, corticosteroids, dopamine agonists (e.g., amantadine, bromocriptine, levodopa, pergolide, pramipexole, ropinirole), H2-receptor antagonists, anticholinergics (e.g., diphenhydramine, trihexylphenidyl), P-adrenergic blockers, clonidine, methyldopa, carbamazepine, phenytoin, baclofen, cyclobenzaprine, lithium, antidepressants (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors), and interleukin-2... 

Alternatives to estrogen for hot flushes are shown in Table 31-6. Progesterone alone may be an option in women with a history of breast cancer or venous thrombosis, but side effects limit their use. For women with contraindications to hormone therapy, selective serotonin reuptake inhibitors and venlafaxine are considered by some to be first-line therapy, but efficacy of venlafaxine beyond 12 weeks has not been shown. 

Some failures will be due to the presence of variants in drug handling. Patients who are rapid acetylators of isoniazid have a slower antituberculous response than slow acetylators (Evans and Clarke, 1961). Asthmatics who do not respond well to (32-agonist bronchodilators may have fewer functioning p2-adrenergic receptors (Drysdale et al., 2000). Variations in the synthesis or structure of the serotonin transporter protein, which is involved in selective reuptake of serotonin by presynaptic neurons, may explain why some patients with depressive disorders respond to selective serotonin reuptake inhibitors and others do not (Steimer et al., 2001). 

Serotonin syndrome (sibutramine) The rare, but serious, constellation of symptoms also has been reported with the concomitant use of selective serotonin reuptake inhibitors and agents for migraine therapy (eg, sumatriptan, dihydroergotamine), certain opioids (eg, dextromethorphan, meperidine, pentazocine, fentanyl), lithium, or tryptophan. Because sibutramine inhibits serotonin reuptake, it should not be administered with other serotonergic agents. 

Drugs that may be affected by dexmethylphenidate or racemic methylphenidate include antihypertensive agents, pressor agents, coumarin anticoagulants, anticonvulsants, tricyclic antidepressants, selective serotonin reuptake inhibitors, and clonidine. 

Is Effexor more effective for depression than an SSRI Med Lett Drugs Ther 2004 46 15-16. Kirby D, Harrigan S, Ames D. Hyponatraemia in elderly psych iatric patients treated with selective serotonin reuptake inhibitors and venlafaxine a retrospective controlled study in an inpatient unit. Int 1 Geriatr Psychiatry 2002,17 231-237. 

Smith D, Dempster C, Glanville I, et al. Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants a meta-analysis. Br 1 Psych iatry 2002,180 396-404. 

Roose SP, Glassman AH, Walsh BT, et al Tricyclic nonresponders phenomenology and treatment. Am J Psychiatry 143 345-348, 1986 Roose SP, Glassman AH, Attia E, et al Comparative efficacy of selective serotonin reuptake inhibitors and tricyclics in the treatment of melancholia. Am J Psychiatry 151 1735-1739, 1994... 

Dalton SO, Johansen C, Mellemkjaer L, et al Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding a population-based cohort study. Arch Intern Med 163 59-64, 2003... 

Lane, R., O Hanlon, J.F. Cognitive and psychomotor effects of antidepressants with emphasis on selective serotonin reuptake inhibitors and the depressed elderly patient. Germ. J. Psychiatry 2, 1-28, 1999. 

The similar pharmacological profile of selective serotonin reuptake inhibitors and St. John s wort would suggest the potential of a pharmacodynamic interaction due to an additive effect. A case of concurrent use of sertraline and St. John s wort, resulting in mania, was reported for a patient with a history of depression who was prescribed sertraline and who also took St. John s wort against medical advice (58). A similar potentiation of serotonergic effect was reported by Gordon (49). 

SERT Serotonin reuptake from synapse Target of selective serotonin reuptake inhibitors and some tricyclic antidepressants... 

Giner L et al Selective serotonin reuptake inhibitors and the risk for suicidality in adolescents An update. Int J Adolesc Med Health 2005 17(3) 211. [PMID 16231472]... 

Newer antidepressants (eg, fluoxetine, paroxetine, citalopram, venlafaxine) are mostly selective serotonin reuptake inhibitors and are generally safer than the tricyclic antidepressants and monoamine oxidase inhibitors, although they can can cause seizures. Bupropion (not an SSRI) has caused seizures even in therapeutic doses. Some antidepressants have been associated with QT prolongation and torsade de pointes arrhythmia. The SSRIs may interact with each other or especially with monoamine oxidase inhibitors to cause the serotonin syndrome, characterized by agitation, muscle hyperactivity, and hyperthermia. 

Kelly CM, Juurlink DN, Gomes T, Duong-Hua M, Pritchard KI, Austin PC, Faszat LF (2010) Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen a population based cohort study. BMJ 340x693... 

Cronin-Fenton D et al (2010) Selective serotonin reuptake inhibitors and adjuvant tamoxifen therapy risk of breast cancer recurrence and mortality. Future Oncol 6 877-880... 

Kobayashi K, Yamamoto T, Chiba K, et al. The effects of selective serotonin reuptake inhibitors and their metabolites on S-mephenytoin 4 -hydroxylase activity in human liver-microsomes. Br J Cbn Pharmacol 1995 40 481 -85. 

Sproule BA, Naranjo CA, Bremner KE, et al. Selective serotonin reuptake inhibitors and CNS drug interactions-a critical review of the evidence. Clin Pharmacokinet 1997 33 454-471. 

Hemeryck A, Belpaire FM. Selective serotonin reuptake inhibitors and cytochrome P-450 mediated drug-drug interactions an update. Curr Drug Metab 2002 3 13-37. 

The discovery of the antidepressant effect of medications was coincidental to their use for other disorders. Initial work published in 1952 reported that iproniazid (originally used for the treatment of tuberculosis) could elevate mood. Although the use of iproniazid was discontinued due to toxicity, many other additional medications have been tested and approved for the treatment of depression. These include monoamine oxidase inhibitors, tricyclics, selective serotonin reuptake inhibitors, and a heterogeneous class of atypical drugs. 

Phenylazepan derivatives, (V), prepared by Wu (5) were effective as both NK antagonists and selective serotonin reuptake inhibitors and used in treating major depression disorders. 

Aspirin produces an antipyretic and anti-inflammatory effect primarily by irreversibly inhibiting cyclooxygenase (thus having similar effects to NSAIDs). It possesses an antiplatelet effect that may have additive effect with other drugs with a similar effect (e.g, selective serotonin reuptake inhibitors) and those which affect other aspects of blood clotting. The risk of interactions and adverse effects are reduced by using a lower dose (e.g. 75 mg) fortunately, a full antiplatelet effect is seen at this dose. This is considered in Part 1, Cardiovascular Drugs. 

Sussman, N., D. L. Ginsberg and J. Bikoff (2001). Effects of nefazodone on body weight a pooled analysis of selective serotonin reuptake inhibitor- and imipramine-controlled trials. J Clin Psychiatry 62(4) 256-60. 

The uses, drug interactions, and adverse effects of the monoamine oxidase inhibitor tricyclic, selective serotonin reuptake inhibitor, and heterocyclic antidepressants are discussed. 

Rothschild A, Phillips K Selective serotonin reuptake inhibitors and delusional depression. Am J... 

A. Classification and Pharmacokinetics The major classes of antidepressant drugs are shown in Figure 30-1 tricyclic antidepressants, heterocyclic antidepressants, selective serotonin reuptake inhibitors, and monoamine oxidase inhibitors. 

Sedation Sedation is a common CNS effect of tricyclic drugs (although less so with protriptyline and desipramine) and of most heterocyclic agents (Table 30-2). MAO inhibitors, selective serotonin reuptake inhibitors, and bupropion are more likely to cause CNS-stimulating effects. 

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