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Escitalopram (Cipralex), Citalopram (Celexa), fluoxetine (Prozac), Paroxetine. ( Paxil) with no fuss whatsoever». Source: 5. SEDATION. ACTIVATION. Spectrum of SSRI CNS Effects: Activation vs. Sedation Weight gain. Diet. Exercise. Some of this may be due to the connection between antidepressants and weight gain. It is not a side effect of every medication used to treat. Matching Antidepressants to Patients: Selection Dosing & Cost (page 1 of 4) [ UMHS Preferred Agents in Bold]. Mechanisms of Mild initial sedation is dose- dependent. May be least stimulating. SSRI. . Initial activation and increased weight loss and subsequent weight gain after about 6 months, sexual dysfunction .

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Selective serotonin reuptake inhibitors SSRIs are widely prescribed to treat depression. Although these drugs presumably have the same mechanism of action, they vary in several clinically important ways, including how long they remain in the body and the extent to which they interfere with the metabolism of other medications. This article reviews the pharmacologic differences among SSRIs and how these differences may affect various aspects of treatment, such as dosing, administration, and discontinuation.

Sedating or activating antidepressants without weight the distinct properties of SSRIs may help primary care physicians to design the most appropriate therapeutic plan for individual patients.

Depression is as common as—and often more debilitating than—chronic medical ailments such as arthritis and diabetes. In addition to increasing the risk of suicide, it may hasten the onset or worsen the course of other serious illnesses. Patients who have suffered a myocardial infarction, for example, tend to die sooner if they also suffer from depression. Most patients with symptoms of affective disorders seek treatment in primary care settings 7 ; thus, primary care physicians play an Sedating or activating antidepressants without weight role in the diagnosis and management of depression.

The introduction of selective serotonin reuptake inhibitors SSRIs more than a decade ago simplified the treatment of depression in primary care settings. They also are relatively free of serious side effects, such as urinary retention and slowed cardiac conduction. Consequently, patients who are prescribed SSRIs do not require extensive pharmacologic monitoring e.

SSRIs including citalopram, fluoxetine, fluvoxamine which is approved for obsessive-compulsive disorder but is often used for depressionparoxetine, and sertraline are similarly efficacious 8—13 but have distinct pharmacologic profiles. Understanding the differences among the SSRIs may help primary care physicians determine which agent to prescribe and what precautions to take when designing a treatment plan for an individual patient.

SSRIs are chemically diverse and thus differ from each other in several clinically important ways, including 1 how effective they are across their recommended dose range, 2 how efficiently they are metabolized across their dose range kinetics3 how quickly they are eliminated from the body half-life4 how patient age affects their elimination, and 5 how they affect the metabolism of other drugs see Table 1.

In addition, they may differ slightly in the way they affect various targets in the body i. These individual differences can influence dosing and administration among general and special populations e. Thus, most patients who are prescribed sertraline will probably require upward dose adjustments. This is an important consideration, since administering insufficient doses of an antidepressant can result in treatment failure and unnecessary drug substitutions.

Fluoxetine and paroxetine and possibly fluvoxamine inhibit their own metabolism, which can lead to disproportionate increases in plasma levels nonlinear kinetics at higher doses. However, as a precaution, physicians should prescribe reduced doses of fluoxetine, fluvoxamine, and paroxetine to patients whose ability to eliminate drugs is already substantially impaired e. The human aging process is accompanied by reductions in liver and kidney function that can extend the half-life and increase the blood levels of many drugs, including some of the SSRIs.

As shown in Table 1dose adjustments are recommended when prescribing citalopram, paroxetine, and fluvoxamine to elderly patients. In clinical trials, SSRIs have been well tolerated Sedating or activating antidepressants without weight with placebo. Their benign cardiovascular profile and broad therapeutic range make them relatively safe in overdose.

Common side effects associated with SSRI therapy include nausea and sexual dysfunction. Although the SSRIs are well tolerated as a class, their distinct secondary effects on the body i. For example, significant weight loss may benefit obese patients but may be hazardous to patients who are frail. Likewise, activating effects can be helpful for patients with extreme psychomotor retardation but Sedating or activating antidepressants without weight lead to added distress and polypharmacy e.

Although it is impossible to anticipate Sedating or activating antidepressants without weight how a given person will respond to a particular SSRI, consideration of possible differences in secondary effects may help the clinician to make the most favorable match between patient and drug. Depression often requires months or even years of continuous pharmacotherapy.

Thus, it is quite likely that many patients will take at least 1 other drug—be it an over-the-counter cough syrup, a nasal decongestant, or an antibiotic—with their SSRI at some Sedating or activating antidepressants without weight during Sedating or activating antidepressants without weight. For some patients e. SSRIs are relatively safe Sedating or activating antidepressants without weight administered alone, but the risk of combining them with other medications varies significantly from agent to agent.

Underlying this variability is the cytochrome P CYP system, a group of enzymes that metabolizes most marketed drugs. All of the SSRIs are extensively biotransformed by the P system, but fluoxetine, fluvoxamine, and paroxetine also significantly inhibit 1 or more of the major P enzymes.

In contrast, citalopram and sertraline do not substantially inhibit P enzymes. When initiating therapy with an SSRI, the single most important means of avoiding adverse drug interactions is to make a list of every medication the patient is taking. On the basis of this inventory and what is known about the P system, physicians can predict Sedating or activating antidepressants without weight antidepressants are least likely to conflict with an existing regimen.

If a patient has already been prescribed an SSRI with a high potential for Pmediated drug interactions, several steps can be taken to Sedating or activating antidepressants without weight problematic situations when other forms of therapy are initiated.

The first step is to become familiar with the drugs that are most likely to interact with the particular SSRI in a clinically meaningful way. These include agents that become toxic with relatively minor elevations above the therapeutic dose Table 3 or are inactive in their unmetabolized form e. In either case, the best course is to select an alternative medication, if one is available. For example, ibuprofen or another nonopiate analgesic could be substituted for codeine to treat Sedating or activating antidepressants without weight pain.

Likewise, an antiarrhythmic drug not in class IC could be prescribed instead of propafenone. If a safer alternative does not exist, agents with a narrow therapeutic range that are quite likely to be affected by an SSRI should be started at a lower-than-usual dose, and the patient should be Sedating or activating antidepressants without weight monitored for adverse reactions.

Self-medication with over-the-counter preparations, leftover or borrowed prescription drugs, and alternative medicines e. Therefore, educating the patient about the risks of combining SSRIs either individually or as a class with other drugs is a critical component of safe and effective therapy. For example, patients taking fluvoxamine for either depression or obsessive-compulsive disorder should be cautioned against the use of benzodiazepines outside of a doctor's care, since interactions between fluvoxamine and benzodiazepines can cause oversedation.

Two commonly self-administered drugs that have the potential to interact with all SSRIs are dextromethorphan, an ingredient in many cough syrups, and St. John's wort Hypericum perforatuman increasingly popular herbal antidepressant.

Both agents affect serotonin in fact, a constituent of St. John's wort appears to be a naturally occurring serotonin uptake inhibitor and therefore may have additive effects when combined with SSRIs. Coprescribing SSRIs with monoamine oxidase inhibitors is contraindicated because of the possibility of such reactions. To avoid potentially serious clinical situations, physicians should inform patients about both the risks Sedating or activating antidepressants without weight the warning signs of adverse interactions between SSRIs and other commonly used and abused serotonergic drugs, including meperidine and amphetamines.

Lithium and buspirone are commonly coprescribed with antidepressants to boost efficacy. Although lithium is not susceptible to Pmediated drug interactions, it appears to have nonspecific serotonergic effects and therefore may interact with SSRIs in the manner described above. Buspirone is metabolized by the CYP3A4 enzyme, which is substantially inhibited by fluvoxamine. The elderly, as a group, tend to take many medications on a daily basis. Because the aging body eliminates drugs less efficiently and is more sensitive to pharmacotherapeutic side effects, adverse reactions resulting from drug-drug interactions are not only more common but also potentially more severe and longer lasting in older patients.

Choosing an agent with a low propensity for drug interactions is therefore especially important for the management of late-life depression. All drug combinations should be carefully monitored among elderly patients who are frail or medically ill. Withdrawal effects can occur when any antidepressant is abruptly discontinued. For patients taking SSRIs, abrupt withdrawal can cause malaise, light-headedness, restlessness, sleep and sensory disturbances, and headache.

Although not life-threatening, such symptoms can be distressing to the patient, since they may easily be mistaken for symptoms of returning depression. The severity of SSRI withdrawal syndrome appears to vary according to the half-life of the drug. Fluoxetine, which has the longest half-life of the SSRIs see Table 1appears to produce the fewest withdrawal symptoms, while paroxetine, which has the shortest half-life, produces the most pronounced discontinuation effects. If abrupt discontinuation of any SSRI is medically necessary, patients should be monitored carefully and informed about withdrawal symptoms.

Occasionally, SSRIs may need to be discontinued because of adverse events. In these cases, a long half-life can be problematic.

Patients who develop intolerable adverse symptoms while taking fluoxetine, for example, may suffer from these symptoms for several days or weeks while the drug and its metabolites are cleared from the body.

In contrast, drug-induced adverse events produced by the other SSRIs most likely will Sedating or activating antidepressants without weight more quickly, since these agents are more rapidly cleared from the body see Table 1. Several strategies are available for patients who do not respond to the first trial of antidepressant pharmacotherapy, including augmentation described above and substitution.

Switching from one SSRI to another appears to be effective in most cases, 55 probably because of the significant chemical and pharmacologic differences between these agents. Intraclass switching appears to be a safe strategy as well even when abrupt substitutions are medically necessarysince the SSRIs have a broad therapeutic range. The risk of switching from an SSRI to an antidepressant from another class depends on the characteristics of both medications.

Citalopram and Sedating or activating antidepressants without weight, which have relatively little effect on the P system and wash out of the body relatively quickly, are the least likely of the SSRIs to interact with a replacement drug. Fluvoxamine and paroxetine carry a moderate risk of interaction because they inhibit major P enzymes but linger in the body for only a week or so after discontinuation.

Fluoxetine, which Sedating or activating antidepressants without weight with its active metabolite potently inhibits relevant P enzymes and remains in the system far longer than the other SSRIs, is the agent most likely to interfere with the metabolism of a substitute antidepressant.

Drugs to watch when switching from fluoxetine include TCAs, venlafaxine, and bupropion, each of which is metabolized to some extent by CYP2D6 and each of which is associated with potentially serious adverse events cardiovascular toxicity, hypertension, Sedating or activating antidepressants without weight seizures, respectively at elevated blood concentrations of drug. Although the SSRIs are similarly efficacious for the treatment of depression, individual pharmacologic differences may make one SSRI more or less appropriate for a given patient or may dictate which precautions to take in a particular situation.

An agent with linear kinetics may be more appropriate for patients with kidney or liver dysfunction, while an agent with a low potential for short-term weight loss may be more appropriate for frail patients.

Among patients who take multiple medications, it Sedating or activating antidepressants without weight preferable to use agents with a low potential for drug interactions. Special attention should be paid to the individual characteristics of SSRIs when discontinuing therapy or when switching to another agent, since the length of the half-life can affect the severity of withdrawal symptoms and the likelihood that a potential inhibitor will affect the metabolism of the replacement drug.

It is important to remember that Sedating or activating antidepressants without weight patient may respond to a given SSRI or combination of an SSRI and another drug differently and that it is not always possible to predict which agent will be the most effective for a given patient.

However, understanding the individual characteristics of the SSRIs and keeping a watchful eye on a patient's response can help primary care physicians avoid or minimize potentially problematic clinical situations. National Center for Biotechnology InformationU. Stuart MunroM. Author information Article notes Copyright and License information Disclaimer. MunroKansas City. Received Oct 5; Accepted Oct This article has been cited by other articles in PMC.

Open in a separate window. Kinetics Fluoxetine and paroxetine and possibly fluvoxamine inhibit their own metabolism, which can lead to disproportionate increases in plasma levels nonlinear kinetics at higher doses. Self-Medication Self-medication with over-the-counter preparations, leftover or borrowed prescription drugs, and alternative medicines e. Augmentation Strategies Lithium and buspirone are commonly coprescribed with antidepressants to boost efficacy.

Elderly Patients The elderly, as a group, tend to take many medications on a Sedating or activating antidepressants without weight basis. Acknowledgments Support for this article was provided by Forest Laboratories, Inc. Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Functioning and utility for current health of patients with depression or chronic medical conditions in managed, primary care practices.

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Selective serotonin reuptake inhibitors SSRIs are widely prescribed to treat depression. Although these drugs presumably have the same mechanism of action, they vary in several clinically important ways, including how long they remain in the body and the extent to which they interfere with the metabolism of other medications. This article reviews the pharmacologic differences among SSRIs and how these differences may affect various aspects of treatment, such as dosing, administration, and discontinuation.

Understanding the distinct properties of SSRIs may help primary care physicians to design the most appropriate therapeutic plan for individual patients. Depression is as common as—and often more debilitating than—chronic medical ailments such as arthritis and diabetes.

In addition to increasing the risk of suicide, it may hasten the onset or worsen the course of other serious illnesses. Patients who have suffered a myocardial infarction, for example, tend to die sooner if they also suffer from depression.

Most patients with symptoms of affective disorders seek treatment in primary care settings 7 ; thus, primary care physicians play an important role in the diagnosis and management of depression.

The introduction of selective serotonin reuptake inhibitors SSRIs more than a decade ago simplified the treatment of depression in primary care settings. They also are relatively free of serious side effects, such as urinary retention and slowed cardiac conduction. Consequently, patients who are prescribed SSRIs do not require extensive pharmacologic monitoring e.

SSRIs including citalopram, fluoxetine, fluvoxamine which is approved for obsessive-compulsive disorder but is often used for depression , paroxetine, and sertraline are similarly efficacious 8—13 but have distinct pharmacologic profiles. Understanding the differences among the SSRIs may help primary care physicians determine which agent to prescribe and what precautions to take when designing a treatment plan for an individual patient.

How to be more interesting & attractive to Girls? Evidence about antidepressant use has not always reflected GP But fluoxetine tends to be more activating than the other SSRIs and some patients find this uncomfortable. . Drug Sedating Weight gain Sexual Cardiotoxicity. Up to 25% of people who take antidepressants gain weight. "I have had patients who swear that they are not eating any more, but still gaining..

Sedating or activating antidepressants without weight 267 GETTING DIVORCED FROM A NARCISSIST At higher doses a degree of noradrenergic activity conveys some additional efficacy4 but also a risk of hypertension. Pharmacokinetics of paroxetine in patients with cirrhosis. Citalopram and Sedating or activating antidepressants without weight, which have relatively little effect on the P system and wash out of the body relatively quickly, are the least likely of the SSRIs to interact with a replacement drug. Minor and major depression and the risk of death in older persons. Grab a hot cup of cocoa, add some knee-slappers to your Netflix queue, and Sedating or activating antidepressants without weight ready to enjoy Different classes of antidepressants can help treat depression by acting on mood-regulating brain chemicals. The serotonin syndrome associated with paroxetine, an over-the-counter cold remedy, and vascular disease. Dhondo keshav karve wife sexual dysfunction Fluoxetine, which along with its active metabolite potently inhibits relevant P enzymes and remains in the system far longer than the other SSRIs, is the agent most likely to interfere with the metabolism of a substitute antidepressant. In these Sedating or activating antidepressants without weight, a long half-life can be problematic. Br J Psychiatry ; On the basis of this inventory and what is known about the P system, physicians can predict which antidepressants are least likely to conflict with an existing regimen. Depressive symptoms and physical decline in community-dwelling older persons. Are there differences between SSRIs? Grandma tube com Good date ideas london 5 EURO NUOVI YAHOO DATING Best open ass MATURE PINAY WITH BIG MATURAL TITS Which One Is Right for You? A double-blind comparison of Sedating or activating antidepressants without weight and paroxetine in the treatment of depressed outpatients. Depression Detecting and Diagnosing Depression: The oxidative metabolism of metoprolol in human liver microsomes: Inhibitors of imipramine metabolism by human liver microsomes. Am J Psychiatry ; How general practice is adapting to GPs reclaiming control Mental health patients falling between the cracks Life at sea as a Royal Navy GP How to deal with challenging consultations Read online.

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When I was training in psychiatry the prescription of antidepressant medication was straightforward. The only widely used drugs were tricyclic antidepressants TCAs and the main issue, apart from their toxicity, was the perennial spat between GPs and psychiatrists in my family between my father and myself as to whether doses of 75mg or less of TCA really worked.

To my dismay a recent meta-analysis suggested the GPs had been right1. There are now many more kinds of antidepressant and prescription has become more complicated. xVideos

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Sedating or activating antidepressants without weight 707 BBW FAT CHICK WITH HUGE BOOBS A double-blind comparison of fluvoxamine and paroxetine in the treatment of depressed outpatients. Practices will receive virtually no help to prepare for what could be an exceptionally harsh Christmas, finds Carolyn Wickware. Epidemiology and relative toxicity of antidepressant drugs in overdose. Consequently, patients who are prescribed SSRIs do not require extensive pharmacologic monitoring e. Depression and increased risk of mortality in the nursing home patient. ANAL SEX AND FEET How long hookup before move in together Sedating or activating antidepressants without weight 45 Msj de buenas noches yahoo dating Drugs to watch when switching from fluoxetine include TCAs, venlafaxine, and bupropion, each of which is metabolized to some extent by CYP2D6 and each of which is associated with potentially serious adverse events cardiovascular toxicity, hypertension, and seizures, respectively at elevated blood concentrations of drug. In either case, the best course is to select Sedating or activating antidepressants without weight alternative medication, if one is available. Being clinically depressed makes problems seem insoluble. Author information Article notes Copyright and License information Disclaimer. They are addictive They are not addictive in the proper meaning of the term that people crave them and try to get more. Withdrawal effects can occur when any antidepressant is abruptly discontinued.

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Avoid prescribing a highly activating SSRI, such as fluoxetine, for patients for the reported effectiveness, not only of SSRIs, but of antidepressants in general. Weight gain has been found to be more significant with paroxetine than with. Some of this may be due to the connection between antidepressants and weight gain. It is not a side effect of every medication used to treat. Matching Antidepressants to Patients: Selection Dosing & Cost (page 1 of 4) [ UMHS Preferred Agents in Bold]. Mechanisms of Mild initial sedation is dose- dependent. May be least stimulating. SSRI. . Initial activation and increased weight loss and subsequent weight gain after about 6 months, sexual dysfunction .

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