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The most significant division of antidepressants marketed in recent years would be the selective serotonin reuptake inhibitors (SSRIs). The six SSRIs used in the united states of america are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). The leading some uses for the SSRIs include unipolar and bipolar major depression any of course your the anxiety conditions. However, controlled trials also support the use of SSRIs inside the treatment of other psychiatric disorders including dysthymia, premenstrual dysphoria, bulimia nervosa, obesity, borderline personality disorder, alcoholism, rheumatic pain, and migraine headache.

Among the SSRIs, you will find more similarities than differences. Although all SSRI drugs possess the same the [url=http://www.thehygienerevolution.com/barbour.php]barbour paris[/url] mechanism of action, each SSRI uses a slightly different pharmacological and pharmacokinetic characteristics. This leads to differences among the SSRIs with their half-lives, clinical activity, negative effects, and drug interactions. You will find differences between SSRIs which could be clinically significant.

The first drug inside the SSRI class was Prozac (Fluoxetine), which hit the u s a market in 1987. Prozac was FDA approved on December 29, 1987. Its manufactured by Eli Lilly and Company.

[url=http://www.maximoupgrade.com/hot.php]hollister[/url] Zoloft (Sertraline hydrochloride) was the second SSRI to come to market in th usa, also it [url=http://www.1855sacramento.com/woolrich.php]woolrich[/url] was approved by way of the FDA on December 30, 1991. Zoloft is manufactured by Pfizer Inc.

Paxil (Paroxetine hydrochloride) was the third SSRI ahead to market across the usa and was approved because of the FDA on December 29, 1992. Paxil is manufactured by GlaxoSmithKline.

Luvox (Fluvoxamine maleate) was the following SSRI FDA approved on December 05, 1994. However, today its marketing status is "Discontinued".

Celexa (Citalopram hydrobromide) was approved by the FDA on July 17, 1998. Celexa is manufactured by Forest Pharmaceuticals, Inc.

Lexapro (Escitalopram oxalate) would be the newest and the majority selective of a typical SSRIs approved by way of the FDA on August 14, 2002. Lexapro is manufactured by Forest [url=http://www.achbanker.com/homes.php]hollister[/url] Pharmaceuticals, Inc. Lexapro is usually a cleaner, improved variety of Celexa.

Mechanism of action

The mental performance talks to itself through the use of special chemicals called neurotransmitters, similar to serotonin and norepinephrine. Neurotransmitters carry signals to the next nerve cell to another. Low stages of serotonin and norepinephrine were never proven to cause depression but it widely considered that elevation of them chemicals is associated with improvement in mood in depressed people.

All SSRIs develop the same general mechanism of action. SSRIs appear to relieve problems of depression by blocking the reabsorption (reuptake) of serotonin by certain nerve cells within the brain. This leaves more serotonin available, which reinforces neurotransmission (sending of nerve impulses) and improves mood. After all, the degrees of natural serotonin will rise again, whereas in the some [url=http://www.maximoupgrade.com/hot.php]hollister france[/url] instances the SSRI may well be reduced and withdrawn.

Approved indications and utilizes
SSRIs have been primarily applied to managing depression and have actually been studied for several indications outside of depression.

Celexa (Citalopram) is indicated for your remedy for:

melancholy

Lexapro (Escitalopram) is indicated for the treatment of:

major a depressive disorder
generalized melancholy (GAD)

Paxil (Paroxetine) is indicated of the treatment of:

major depressive disorder
obsessive compulsive disorder (OCD)
panic disorder
social anxiety disorder
generalized sadness
posttraumatic stress disorder (PTSD)

Prozac (Fluoxetine) is indicated for treatment of:

major a depressive disorder
obsessive-compulsive disorder
moderate to severe bulimia nervosa
panic disorder
in January 2003, Prozac was approved by way of the FDA for your treatment of depression and OCD in kids and adolescents that are 7 to 17 years legal age.

Zoloft (Sertraline) is indicated for the treatment of:

major depressive disorder
obsessive-compulsive disorder
panic disorder
posttraumatic stress disorder
premenstrual dysphoric disorder (PMDD) in adults (newest indication)
social anxiety disorder (sad)

Value
Clinical trials comparing an SSRI with another SSRI signifies that drugs within this class are equally efficacious. Each SSRI produces approximately a 60% overall response rate (ie, not less than a 50% discount in symptoms as a result of treatment).

Adverse reactions & side effects

While SSRIs do not arrive at will be found overall tolerability, the reported incidences of specific adverse reactions vary. Negative effects that patients experience are normally mild to moderate and do not require dose reductions or discontinuation. SSRIs possess the following negative effects:

Nausea. Essentially the most coomon side effect accociated with utilization of SSRIs is nausea. Paroxetine and sertraline have already been connected with slightly more cases of nausea.
Impotence. Depression itself might cause sexual dysfunction and all SSRIs have already been involved with sexual dysfunction during therapy in males and females. There may be lesser detrimental effect on sexual function by fluoxetine when compared to other agents. Citalopram has long been linked to absence of libido. Paroxetine appears to cause the highest rate of erectile dysfunction.
Anticholinergic effects. Paroxetine causes a higher rate of anticholinergic effects, such as lack of saliva, constipation, and cognitive disruption, compared with other SSRIs. These effects can be particularly problematic to tolerate for elderly or concomitantly medically ill patients.
Weight. The SSRIs vary with their effect on the burden. Sertraline is generally linked to a little level of weight-loss in the acute phase of treatment, whereas paroxetine can cause body weight after long-term treatment. Fluoxetine has got the most [url=http://www.mansmanifesto.fr/category/doudoune-moncler/‎]doudoune moncler[/url] potent appetite-suppressing effects in the temporary and produces a greater degree of weight-loss than paroxetine, sertraline, citalopram, or escitalopram.
Diarrhea. Sertraline and fluoxetine are definitely more frequently involved with diarrhea, paroxetine features a lower incidence.
Anxiety, agitation, insomnia. Fluoxetine has been associated with highest rate of anxiety and agitation. Escitalopram and paroxatine are not as likely to cause insomnia than fluoxetine and sertraline.
Sandpaper throat. Citalopram and paroxetine are more likely to cause dry mouth than escitalopram and fluoxetine.
Drowsiness, fatigue. Paroxetine continues to be associated with highest rate of drowsiness, somnolence than other SSRIs.
Headache. Sertraline and fluoxetine are linked to higher level of headache.

In some cases, antidepressants may be involved with worsening symptoms of depression or thoughts of suicide or behavior, particularly at the start of treatment or once you change your dosage. Make sure to speak to your doctor about any changes in your symptoms. You would want more careful monitoring at the start of treatment or with a change in treatment, otherwise you may need to stop klonopin when your symptoms worsen.

Pharmacokinetics

Many of the key differences among SSRIs are result from differences throughout their pharmacokinetic properties. The sole pharmacokinetic parameters shared by every one of the SSRIs is the fact that they are relatively slowly, but completely, absorbed out of your gut. They differ with regard for their protein binding, metabolism, half-lives, whether they have linear or nonlinear pharmacokinetics, whether [url=http://www.davidhabchy.com]barbour outlet[/url] they have active metabolites.

Half-life

The half-life of the drug it s time forced achieve steady-state plasma concentrations (i.e., to metabolize half the dose and lower blood concentrations by 50%). Half-life may be used to estimate the length [url=http://www.hollisterhanesmorgan.co.uk]hollister uk[/url] of time all it [url=http://www.mxitcms.com/abercrombie/]abercrombie[/url] takes is clear a drug that came from the body after treatment is discontinued.

[url=http://www.vivid-host.com/barbour.htm]www.vivid-host.com/barbour.htm[/url] Fluoxetine is different due to its long half-life as well as the long half-life from the active metabolite norfluoxetine. Fluoxetine consists of a half-life of 4-6 days and also its particular active metabolite, norfluoxetine, features a half-life of 4-16 days. In comparison, citalopram, escitalopram, paroxetine, and sertraline have shorter half-lives inside the of 20-35 hours, and steady-state concentrations (and therapeutic effect) are reached a great deal more rapidly. The long half-life of fluoxetine may blunt the consequences of missed doses or treatment discontinuation and makes it easier to discontinue than any one of the other SSRIs. Then again, fluoxetine requires a far longer washout period when compared to the other SSRIs (a few weeks), particularly if switching to monoamine oxidase inhibitors (MAOIs) or TCA.

Antidepressants with relatively short half-lives are desirable if you have multiple comorbidities and complex, multiple-drug regimens since they be suitable for once-daily dosing. A brief half-life enables physicians to switch sooner and safely to another antidepressant if treatment fails or if unfavorable drug reactions occur.

Linear and nonlinear pharmacokinetic.

Among the list of important differences to see on the list of SSRIs is whether or not their pharmacokinetic properties are linear or nonlinear.

Citalopram, escitalopram and sertraline show linear and dose-proportional pharmacokinetics. Plasma concentrations of these drugs are proportional to your daily dose [url=http://www.1855sacramento.com/peuterey.php]peuterey[/url] administered and, therefore, predictable. In comparison, [url=http://www.hollisterhanesmorgan.co.uk]hollister[/url] fluvoxamine, fluoxetine and paroxetine have nonlinear pharmacokinetics. Higher doses may produce much greater increases in plasma drug concentrations than would otherwise be expected. Thus, increasing the dose of paroxetine or fluoxetine can lead to disproportionate and unpredictable increases in plasma levels, half-lives, and uncomfortable side effects. Titration of fluoxetine and paroxetine doses may therefore be a bit more difficult compared to citalopram, escitalopram and sertraline.

Drug Activities
The interaction between monoamine oxidase inhibitors (MAOIs) and SSRIs plays the main drug interaction limiting SSRI use. This mix can lead into the development of a hyperserotonergic syndrome consisting of excitement, diaphoresis, rigidity, hyperthermia, tachycardia, hypertension, and possibly death. The severity in this interaction necessitates at least 5 week washout when switching an individual from fluoxetine to an MAOI o provide for complete elimination of the fluoxetine. At the very least 14 days should be allowed after stopping citalopram, escitalopram, paroxetine or sertraline before beginning an MAOI. This difference in washout time between fluoxetine and citalopram, escitalopram, paroxetine and sertraline when switching because of an SSRI to an MAOI is among the key differences between SSRIs.
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