SSRIs/SNRIs

Long-acting Opioids (e.g., MS Contin, Oxycontin) SSRI/SNRI Pregabalin... 

The clinician should bear in mind the toxic potential for the various antidepressant medications when patients already have or develop suicidality. The TCAs and MAOIs have narrow therapeutic indices, whereas the SSRIs, SNRIs, nefa-zodone, and mirtazapine have wide therapeutic indices.22... 

PD may be treated successfully with TCAs, SSRIs, SNRIs, or MAO Is, as well as benzodiazepines51,52 (Table 37-6). While all these agents are similarly effective, SSRIs have become the treatment of choice in PD. Benzodiazepines often are used concomitantly with antidepressants, especially early in treatment,... 

SSRIs/SNRI SSRIs (in general) SSRIs (in general)... 

Lee etal. (2005) 5-HT6 (C267T) SSRIs, SNRIs, mirtazapine nefazodone, TCAs... 

Fluvoxamine SSRIs, SNRIs, mirtazapine, nefazodone, TCAs Milnacipran... 

Triple reuptake inhibitors (TRIs), which inhibit reuptake at all three transporters, have attracted considerable interest in recent years [77]. The involvement of dopamine reuptake in the etiology of depression and other CNS disorders has been recognized [29,30]. As a result, TRIs have been proposed to offer a faster onset of action and improved efficacy for depression over currently prescribed single or dual action monoamine reuptake inhibitors. Historically, the mesocorticolimbic dopamine pathway is thought to mediate the anhedonia and lack of motivation observed in depressed patients [78,79]. In addition, methylphenidate, both immediate release and extended release formula, has been found to be effective as an augmenting agent in treatment-resistant depression [4]. Furthermore, clinical studies using the combination of bupropion and an SSRI or SNRI have showed improved efficacy for the treatment of MDD in patients refractory to the treatment with SSRIs, SNRIs, or bupropion alone [5,80,81]. 

As noted earlier, SSRIs/SNRIs can produce transient nervousness during the start-np phase of treatment. A start low and go slow approach is therefore advisable when treating patients with panic disorder. Nevertheless, panic disorder is often best controlled only after attaining daily doses at the upper end of the dose range. Please refer to Chapter 3 for additional discussion of the SSRIs/SNRIs. 

SSRls and SNRIs. The SSRl antidepressants, together with venlafaxine, have replaced the benzodiazepines as treatments of choice for GAD. Paroxetine and escitalopram are FDA approved for GAD, though it is generally believed that all SSRls and SNRIs are effective for GAD. Similar to the TCAs, SSRIs/SNRIs appear to be most effective for the intrapsychic symptoms of GAD but less effective than benzodiazepines for the somatic manifestations of the disorder. 

Buspirone does not share any of the problematic benzodiazepine properties such as sedation, motor impairment, addiction, physical dependence, or withdrawal. The most common side effects of buspirone include dizziness, nausea, headache, fatigue, and dry mouth. Despite its activity in the serotonin system, buspirone is not associated with the sexual side effects that plague the SSRIs, SNRIs, MAOIs, and TCAs. 

Depression SSRIs SNRIs Mirtazapine Bupropion Nortriptyline Desipramine ... 

Histrionic Personaiity Disorder (HPD). HPD has also received remarkably little study, but we can perhaps extrapolate from our experiences with BPD. HPD shares with BPD the target symptom of mood instability. Although medications seldom play a significant role in the treatment of HPD, SSRIs/SNRIs may provide some benefit in alleviating depression as well as in reducing affective lability. 

SSRI/SNRI GAD OCD Panic disorder PTSD Social anxiety disorder Onset worsening side-effects on initiation few long-term effects Relatively safe in overdose (venlafaxine possibly less safe) Well-described more common with paroxetine uncommon with fiuoxetine... 

Table 1.7 The most common side effects of SSRIs, SNRIs and other newer antidepressants (Sadock and Sadock, 2001)...

SSRIs, SNRIs, or mirtazapine for treatment-resistant depression (use combinations ot antidepressants with atomoxetine with caution as this may theoretically activate bipolar disorder and suicidal ideation)... 

For anxiety, gabapentin is a second-line treatment to augment SSRIs, SNRIs, or benzodiazepines... 

Can cause a fatal serotonin syndrome when combined with drugs that block serotonin reuptake (e.g., SSRIs, SNRIs, sibutramine, tramadol, etc.), so do not use with a serotonin reuptake inhibitor or for up to 5 weeks after stopping the serotonin reuptake inhibitor... 

MAOIs are generally reserved for second-line use after SSRIs, SNRIs, and combinations of newer anfidepressanfs have failed... 

Antidepressants (with caution because antidepressants can destabilize mood in some patients, including induction of rapid cycling or suicidal ideation in particular consider bupropion also SSRIs, SNRIs, others generally avoid TCAs, MAOIs)... 

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