SSRIs about

There is only one group of research subjects in whom rapid depletion of serotonin sometimes produces clinical depression. These are depressed patients in remission who are currently taking SSRIs. About half of these patients relapse when serotonin is depleted. Note that this only happens if they are still taking antidepressant medication. If they have stopped medication, depleting... 

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

It is perhaps not surprising that, even after taking into account pharmacokinetic differences between these drugs, the therapeutic doses of the SSRIs do not parallel their Ki for inhibition of 5-HT reuptake. For instance, citalopram is about a thousand times more selective than fluoxetine for inhibition of 5-HT uptake, and yet their clinically effective doses are similar. In short, not only is their selectivity for the 5-HT transporter in vitro a poor predictor of their efficacy in vivo but it has to be questioned whether any of these compounds actually work by blocking 5-HT uptake alone. 

Each of these side effects is experienced by only a minority of patients taking the drugs. About 15 per cent of patients taking SSRIs report headaches, and the same number complain of nausea. Diarrhoea, dizziness and insomnia are reported by 10 per cent of patients on SSRIs. But while only a minority report any particular side effect, the number of patients who report suffering... 

The reason for this warning is that abrupt cessation of SSRIs produces withdrawal symptoms in about 20 per cent of patients. Symptoms of withdrawal from antidepressant medication include gastrointestinal disturbances (abdominal cramping and pain, diarrhoea, nausea and vomiting), flu-like symptoms, headaches, sleep disturbances, dizziness, blurred vision, numbness, electric-shock sensations, twitches and tremors. Abrupt withdrawal can also produce symptoms of depression and anxiety, which can occur within hours of the first missed dose of the drug.11 Withdrawal symptoms are sometimes mistaken for a relapse, leading patients to resume antidepressant medication and to conclude that they need it in order to remain free of depression. Technically, this is not considered addiction , but it does seem awfully close. 

Klopfer, B., Psychological Variables in Human Cancer , Journal of Projective Techniques 21, no. 4 (1957) 331-40 Kondro, Wayne and Barbara Sibbald, Drag Company Experts Advised Staff to Withhold Data About SSRI Use in Children , Canadian Medical Association Journal 170, no. 5 (2004) 783 Kramer, Mark S., Neal Cutler, John Feighner, Ram Shrivastava, John Carman, John J. Sramek, Scott A. Reines, Guanghan Liu, Duane Snavely, Edwina Wyatt-Knowles, Jeffrey J. Hale, Sander G. Mills,... 

These types of antidepressant were introduced around 10 years after the SSRIs. They include the serotonin noradrenaline reuptake inhibitor venlafaxine and the selective noradrenaline reuptake inhibitor reboxetine. Although there are fewer data about these drugs, clinical experience has shown they are well tolerated and, unlike the SSRIs, they are only weak inhibitors of drug metabolism (Kent, 2000). Depression is a common psychiatric disorder seen in the elderly and often remains untreated or inadequately treated (Forsell and Fastbom, 2000). Venlafaxine was shown to improve the mood in a group of 36 older patients without any effect on cognitive function, an important consideration where there is the possibility of the coexistence of mild or undiagnosed dementia (Tsolaki et al., 2000). 

The SSRIs are believed to be more effective for numbing symptoms than other drugs. About 60% of sertraline-treated patients showed improvement in arousal and avoidance/numbing symptoms, but not reexperiencing symptoms. Similar numbers of patients have been shown to improve on paroxetine. Fluoxetine was effective in a placebo-controlled trial, and fluvoxamine was effective in an open trial. 

Mania/Hypomania Activation of mania/hypomania occurred infrequently in about 0.1% to 2.2% of patients taking SSRIs. Use cautiously in patients with a history of mania. 

Trazodone has been used therapeutically, but because of low potency and marked sedative effects, its use has been mostly restricted to a sleeping aid in doses of 50-100 mg at bedtime. It has been routinely used in adults on SSRIs, who develop sleep problems. The concern about priapism even at low doses may reduce enthusiasm for its use in male children and adolescents. 

There is no empirical evidence available for clinical use in children and adolescents. Yet, Hypericum seems to be used for the treatment of mild to moderate depression in the young (Walter et ah, 2000). St. John s wort should be avoided in young patients with severe depression and bipolar disorder (given the lack of adult data about effectiveness and risk of manic induction, respectively) and in those who have significant suicide risk. Treatments of proven efficacy (e.g., SSRIs, mood stabilisers) should be preferred in these cases. However, St. John s wort may be considered in cases of unipolar depression where conventional treatments have failed and prior to the use of combinations of drugs that have an increased risk of side effects and whose efficacy has not been demonstrated. 

Also, a malfunction in the dopamine system has been shown to make it more likely for a person to have a detached personality, which is a characteristic of patients with social anxiety disorder. Serotonin systems are thought to be involved because SSRIs are effective in treating this form of the disorder. Although these systems have been implicated, little is known about how they are malfunctioning to produce the symptoms that characterize this problem. 

In most cases, SSRIs are the first choice for drugs to combat OCD. Clomipramine, fluvoxamine, fluoxetine, paroxetine, sertraline, and citalopram are all SSRIs that have been proven effective in reducing OCD symptoms. However, in about 40 to 60% of patients, these drugs do not completely alleviate all the symptoms. When this is the case, a second type of drug called a neuroleptic is often added. Neuroleptic drugs, such as haloperidol, clozapine, risperidone, and chlorpromazine... 

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