Selective serotonin reuptake inhibitors selectivity differences

Meyer, J., Wilson, A., Sagrati, S., Hussey, D., Carella, A., Potter, W., et al. (2004). Serotonin transporter occupancy of five selective serotonin reuptake inhibitors at different doses An [11CJDASB positron emission tomography study. American Journal of Psychiatry, 161, 826-835. 

Different types of antidepressants are supposed to work by different means. SSRIs (selective serotonin reuptake inhibitors) are supposed to increase serotonin levels. NDRIs (norepinephrine dopamine reuptake inhibitors) are supposed to increase norepinephrine and dopamine, rather than serotonin. These two types of antidepressants are supposed to be selective , affecting the... 

Pacher, P., Ungvari, Z., Nanasi, P.P., Furst, S. and Kecskemeti, V. (1999) Speculations on difference between tricyclic and selective serotonin reuptake inhibitor antidepressants on their... 

Selective serotonin reuptake Inhibitors (SSRIs) and other newer antidepressants Due to their widely differing structures in comparison to TCAs, several methods for their determination in biological matrices have been developed for each compound individually. Presented here are examples of HPLC determinations for several of these drugs. 

Serendipity has played a major role in the discovery of most classes of psychotropic drugs. For example, the observation that the first antidepressants, the tricyclic antidepressants and the monoamine oxidase inhibitors, impeded the reuptake of biogenic amines into brain slices, or inhibited their metabolism, following their acute administration to rats, provided the experimenter with a mechanism that could be easily investigated in vitro. Such methods led to the development of numerous antidepressants that differed in their potency, and to some extent in their side effects (for example, the selective serotonin reuptake inhibitors) but did little to further the development of novel antidepressants showing greater therapeutic efficacy. The accidental discovery of atypical antidepressants such as mianserin led to the broadening of the basis of the animal models... 

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. 

This case report (Figures 6-4Ato 6-4C) (McDermut et al. 1995) of selective response to dihydropyridine CCBs but not a phenylalkylamine CCB is of considerable interest in relationship to the patient s history of nonre-sponsivity to multiple tricyclic antidepressants, the selective serotonin reuptake inhibitors, lithium, carbamazepine (the patient developed drug-induced hepatitis on carbamazepine and was unable to be evaluated), alprazolam, trazodone, and phenelzine. This suggests that patients with refractory mood disorders may have differential responses to various CCBs and that nonresponse to one CCB does not preclude response to another CCB, particularly if the other CCB is from a different category (Table 6-3). 

In contrast, a less extensive but still convincing database has identified important clinical differences in efficacy for antidepressants used to treat patients with atypical or comorbid depression. Individuals with atypical depression (distinct quality of mood, hyperphagia, hypersomnia, psychomotor retardation, rejection sensitivity, and such unusual atypical features as chocolate craving] have superior responses to monoamine oxidase inhibitors (MAOIs], selective serotonin reuptake inhibitors (SSRIs), and perhaps venlafaxine, and most do not respond well to tricyclic antidepressants (TCAs] (Davidson et al. 1982 Liebowitz et al. 1988 Quitkin et al. 1988, 1991). Despite these data, TCAs unfortunately have been the first choice for most atypical patients until SSRIs were introduced. 

Treatment of cerebral stroke patients with selective serotonin reuptake inhibitor antidepressant showed difference in improvement with respect to laterality. The post-stroke major depressive disorder improved much more in right stroke subjects in comparison with the left stroke ones (Spalletta el al., 2003). In case of unilateral brain injury due to stroke or parkinsonism, the intact hemisphere plays an important role in recovery and compensation for the lost motor function (Schallert el al., 2003). A well-selected homeopathic potency may facilitate recovery by acting on the intact hemisphere. It has been demonstrated that the brain can asymmetrically... 

Selective serotonin reuptake inhibitors (SSRI s) like Prozac are used to treat many psychiatric disorders ranging from intermittent explosive disorder, to obsessive-compulsive disorder, to major depression and panic disorder (1), even though these disorders differ in their behavioral expression. How does one drug class treat these disparate disorders ... 

Psychodynamic supportive psychotherapy (n = 107) has been compared with psychotherapy plus medication (n = 101) in patients with major depressive disorder (93). The medications included venlafaxine, selective serotonin reuptake inhibitors, nortriptyline, and nortriptyline plus lithium. Lithium was used as an augmentation strategy in the patients who took lithium and nortriptyline (number not given). There were no differences in outcomes between the two treatment groups. No adverse effects specific to lithium were reported. 

At least several weeks administration of virtually all antidepressant drugs, be they the classical tricyclic compounds or the newer selective serotonin reuptake inhibitors (SSRI), is required before patients see relief from their symptoms. A recently developed SSRI whose structure departs markedly from existing agents appears to differ from other agents, in that it appears to act in a much shorter time. The final step in the synthesis of this agent elzasonan (182) comprises aldol condensation of the benz-aldehyde (180) with the thiamorpholine (181). ... 

SSRb are the most recent class, named after the drugs mechanisms of action (Selective Serotonin Reuptake Inhibitors), of which fluoxetine is the archytype. Other examples include danopramine, dtalopram, fluvoxamine, mirtazapine and paroxetine. Later members, such as venlafaxine, differ in being serotonin (re) UPTAKE INHIBITORS that also inhibit noradrenaline reuptake (but are weaker against dopamine uptake). The SSRIs show less side-effects, particularly less sedative actions, than the other classes. 

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