Selective serotonin reuptake inhibitors general

Taylor, Matthew J., Nick Freemantle, John R. Geddes and Zubin Bhagwagar, Early Onset of Selective Serotonin Reuptake Inhibitor Antidepressant Action Systematic Review and Meta-Analysis , Archives of General Psychiatry 63 (2006) 1217-23... 

The selective serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of 5-HT into the presynaptic neuron. They are generally chosen as first-line antidepressants because of their safety in overdose and improved tolerability compared to earlier agents. 

Selective Serotonin Reuptake Inhibitors (SSRIs). Some doctors report that the SSRI antidepressants are also effective treatments for cataplexy. This has not been well studied, but because the SSRIs are generally safer and more tolerable than the TCAs, they may be a welcome alternative. 

In trials of hospitalized patients tricyclic antidepressants have generally been more efficacious than selective serotonin reuptake inhibitors (SSRIs). Otherwise there are no overall differences between the drugs in terms of tolerability or efficacy in primary care settings. After reviewing 15 trials it was concluded that drags are effective in the treatment of dysthymia with no differences between and within class of drugs. Tricyclic antidepressants are more likely to cause adverse events and dropouts. As dysthymia is a chronic condition, there remains little information on quality of life and medium or longterm outcome. 

Antidepressant drugs, such as the tricyclic antidepressants and the selective serotonin reuptake inhibitors (SSRIs), are very important for the treatment of psychotic depression (see Chapter 34). They have been shown to be effective when used in the treatment of several anxiety disorders, including general anxiety, obsessive-compulsive disorder, and several phobias, including agoraphobia. Because the SSRIs are less toxic than the tricyclic antidepressants, their use in the treatment of anxiety is safer and less likely to produce serious side effects. 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

FDA, Food and Drug Administration GAD, general anxiety disorder OCD, obsessive-compulsive disorder PMDD, Premenstrual dysphoric disorder PTSD, post-traumatic stress disorder SRI, serotonin reuptake inhibitor SSRI, selective serotonin reuptake inhibitor. 

It is of note that Hypericum, often described as the natural Prozac, has the opposite effect of fluoxetine— and selective serotonin reuptake inhibitors (SSRIs) in general—on the CYP system. Fluoxetine inhibits several CYP isoenzymes, potentially resulting in increased blood levels of drugs metabolized through this pathway (See Chapter 22). 

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) begin to be used as antidepressants. These medications are generally effective and have fewer side effects than earlier drugs. 

It is thus understandable why some earlier authors previously doubted the efficacy of antidepressants in general (Weiner et al.. 1980) or the advantages of newer antidepressants compared with classical products (Song et al., 1993). However, the great majority of doctors and scientific authors consider that the efficacy of first-generation antidepressants (imipramine, amitriptyline, nortriptyline) has been proved beyond any reasonable doubt, and that efficacy also has been demonstrated for newer products such as trazodone, the selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake... 

Disadvantages of the benzodiazepines include the risk of dependence, depression of central nervous system functions, and amnestic effects. In addition, the benzodiazepines exert additive central nervous system depression when administered with other drugs, including ethanol. The patient should be warned of this possibility to avoid impairment of performance of any task requiring mental alertness and motor coordination. In the treatment of generalized anxiety disorders and certain phobias, newer antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are now considered by many authorities to be drugs of first choice (see Chapter 30). 

After a almost 30-year dominance of TCAs in the treatment of depression, selective serotonin reuptake inhibitors (SSRIs) were introduced in the 1980s. Since then, these drugs have also been used in the treatment of chronic pain (Ansari, 2000). SSRIs appear to be less effective in most patients than TCAs. Meta-analyses have shown that, in general, TCAs seem to be more effective... 

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. 

Antidepressants generally fall into one of three categories (1) tricyclic antidepressants (TCAs), which are so named because of their three-ring chemical structure (2) selective serotonin reuptake inhibitors (SSRIs), which block only the reabsorption of serotonin and not of norepinephrine and (3) monoamine oxidase (MAO) inhibitors, which inhibit the metabolic breakdown of norepinephrine and/or serotonin. 

Wongpakaran, N., van Reekum, R., Wongpakaran, T., Clarke, D. (2007). Selective serotonin reuptake inhibitor use associates with apathy among depressed elderly A case-control study. Annals of General Psychiatry, 6(7), 1-6. 

Bipolar depression affects 1% of the general population, and treatment resistance is a significant problem. The addition of pindolol can lead to significant improvement in depressed patients who are resistant to antidepressant drugs, such as selective serotonin reuptake inhibitors or phenelzine. Of 17 patients with refractory bipolar depression, in whom pindolol was added to augment the effect of antidepressant drugs, eight responded favorably (95). However, two developed transient hypo-mania, and one of these became psychotic after the resolution of hypomanic symptoms. In both cases transient hypomanic symptoms resolved without any other intervention, while psychosis required pindolol withdrawal. 

---