Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants considered the current standard of drug treatment. A possible cause of depression is an inadequate amount of serotonin, a chemical used in the brain to transmit signals between neurons. SSRIs are said to work by preventing the reuptake of serotonin (also known as 5-hydroxytryptamine, or 5-HT) by the presynaptic neuron, thus maintaining higher levels of 5-HT in the synapse. Chemists Klaus Schmiegel and Bryan Molloy of Eli Lilly discovered the first SSRI, fluoxetine. This class of drugs includes:
Citalopram (Celexa, Cipramil)
Escitalopram (Lexapro, Cipralex, Seroplex, Lexamil)
Fluoxetine (Prozac, Sarafem, Symbyax)
Fluvoxamine (Luvox)
Paroxetine (Paxil, Aropax)
Sertraline (Zoloft)
Vilazodone (Viibryd)

These antidepressants typically have fewer adverse effects than the tricyclics or the MAOIs, although such effects as drowsiness, dry mouth, nervousness, anxiety, insomnia, decreased appetite, long-term weight gain and decreased ability to function sexually may occur. Some side effects may decrease as a person adjusts to the drug, but other side effects may be persistent.

Work by two researchers has called into question the link between serotonin deficiency and symptoms of depression, noting that the efficacy of SSRIs as treatment does not in itself prove the link. Research indicates that these drugs may interact with transcription factors known as “clock genes”, which may play a role in the addictive properties of drugs (drug abuse), and possibly in obesity.

A systematic review of randomized controlled trials published in the Archives of General Psychiatry showed that up to one-third of the 6-week effect of SSRI Treatment can be seen in the first week. The same study also found that patients treated with SSRIs were 64% more likely to achieve a 50% absolute reduction in HRSD than patients given a placebo.[1]

Citalopram (Celexa): usual dosing is 20 mg initially; maintenance 40 mg per day; maximum dose 60 mg per day.
Escitalopram (Lexapro, Cipralex): usual dosing is 10 mg and shown to be as effective as 20 mg in most cases. Maximum dose 20 mg. Also helps with anxiety.
Paroxetine (Paxil, Seroxat): Also used to treat panic disorder, OCD, social anxiety disorder, generalized anxiety disorder and PTSD. Usual dose 25 mg per day; may be increased to 40 mg per day. Available in controlled release 12.5 to 37.5 mg per day; controlled release dose maximum 50 mg per day. Less cycling in patients who are bipolar.
Fluoxetine (Prozac): Also used to treat OCD, bulimia, and panic disorder. Long half-life; less withdrawal when medication is stopped. Dosing is 20 mg to a maximum of 80 mg.
Fluvoxamine (Luvox): Although primarily used in the treatment of OCD, a doctor may prescribe it for depression. Initial dose is 50 mg, increasing by 50 mg every 4-7 days. If daily dose is greater than 100 mg give in equally divided doses or give larger dose at bedtime not to exceed 300 mg per day.
Sertraline (Zoloft, Lustral): Also used to treat panic disorder, OCD, PTSD, social anxiety disorder, premenstrual dysphoric disorder. Dosing is 50-200 mg per day and should be titrated upward.

Be aware of drug interactions. Dextromethorphan (found in many brands of over-the-counter cough syrup) as well as the opioids tramadol (Tramal, Ultram), and pethidine/meperidine are contraindicated with all SSRIs as they are serotonin reuptake inhibitors (SRIs) themselves and the combination could cause the potentially fatal serotonin syndrome. Many SSRIs inhibit the metabolism of dextromethorphan as well, further adding to the risk.

Drug interactions may also occur when concurrently taking phenytoin (Dilantin) and warfarin (Coumadin) (phenytoin and warfarin levels are increased).

Always check with pharmacy regarding potential drug interactions.[2]

Source:

[1]http://en.wikipedia.org/wiki/Antidepressant

[2]http://en.wikipedia.org/wiki/List_of_antidepressants

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Are antidepressants addictive?

Antidepressants do not cause an addiction as with opioid drugs (such as heroin), barbiturates, amphetamines (speed), alcohol and nicotine. This means that taking your medicine regularly should not cause tolerance or craving.

• Tolerance: This occurs when the body gets used to the drug or medicine when it is taken regularly, so that you need to take higher doses to have the same effect.

• Craving: This is a physical urge, where the body needs the drug or medicine to maintain a desired state or feeling such as euphoria (feeling high), or to avoid an unwanted one such as delirium tremens (the shakes). It can also have a psychological element to it.

What are discontinuation symptoms?

Antidepressants can sometimes cause symptoms called ‘discontinuation’ symptoms. These may happen if the dose is reduced, if you miss a dose or if you suddenly stop taking the medicine. At least one in every three people may get these symptoms.

Symptoms are usually mild and should go away after a few days, but occasionally can be more severe. Symptoms may take up to five days to occur and may last for up to two weeks. Be careful not to confuse discontinuation/withdrawal symptoms with the side effects of any new antidepressants prescribed. The following table lists some of the main discontinuation/withdrawal symptoms:

How do I avoid discontinuation symptoms?

Your antidepressant should be taken as prescribed, and should only be discontinued after discussing with your doctor. Antidepressants should not be stopped suddenly. They should be discontinued gradually, generally by reducing the dose over a four-week period until they have stopped completely. Your doctor or pharmacist will advise you on how to do this for the medicine that you are taking.

Some people still experience discontinuation symptoms despite stopping the antidepressant slowly. If you think that you are experiencing troubling symptoms, discuss this with your doctor, as you may need to decrease more slowly, or in smaller steps.

Please refer to the manufacturer’s patient information leaflet that comes with your medicine for more information and the full list of side effects and precautions. If you have any questions or concerns about your medicines, or if you are worried about anything you think might be a side effect, ask your doctor, pharmacist or nurse.

This leaflet gives you some information about this medicine. It does not replace the expertise or judgement of a doctor, pharmacist or other healthcare professional. It is not a manufacturer’s patient information leaflet and is not to be taken as a substitute for, or an endorsement of, the manufacturer’s information or advice in respect of any medicine referred to in this leaflet. You might find more information in other leaflets or books, or on the internet but remember, the internet is not always accurate.

Whilst every care has been taken in the compilation of this leaflet, CNWL is not responsible for any loss or damage howsoever caused as a result of any inaccuracy or error contained in this leaflet, including (for the avoidance of doubt) in relation to breach of contract, misrepresentation or negligence whether of CNWL or any other person; but nothing in this leaflet shall exclude or restrict liability for death or personal injury resulting from negligence.

The information given in this leaflet is current as at the publication date.

This leaflet has been written by Central and North West London Mental Health NHS Trust Pharmacy Department, 30 Eastbourne Terrace, London W2 6LA www.cnwl.org – Publication Date: May 2007

Source: http://beh.zedcore.com

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Overview
Paxil is the brand name for Paroxetine, a phenylpiperidine derivative. Paxil is an SSRI – Selective Serotonin Reuptake Inhibitor, which is a type of antidepressant. SSRIs work by increasing levels of serotonin (a neurotransmitter) to normal.

Paxil’s effects can usually be felt within one to four weeks.

Why is this drug prescribed?
Paxil is used primarily to treat Obsessive-Compulsive Disorder (OCD.)

Paxil is also used to treat:
depression
panic disorder / panic attacks
diabetic nerve pain (neuropathy)
chronic tension headaches
social anxiety disorder (social phobia)
premature ejaculation
premenstrual syndrome (PMS)

Warnings
The safety and effectiveness of Paxil in children under 18 years old have not been established.

Paxil is not addictive. Suddenly discontinuing Paxil may lead to withdrawal symptoms such as confusion, dizziness, sweating, or tremors. Dosage should be gradually tapered when Paxil is discontinued.

Paxil does not usually cause sedation, but patients should not drive or operate heavy machinery until it is known that Paxil does not affect the ability to safely engage in these activities.

For Pregnant or Nursing Mothers: One study showed no adverse effects due to Paxil during pregnancy, but further study is required and pregnant women are not advised to take Paxil. Paxil passes into human breast milk, and nursing mothers should not take Paxil.

Contraindications
Paxil should Not be used for people with an allergy or hypersensitivity to this drug or any SSRI.

Precautions
Paxil may be used with caution in people with the following conditions:
liver or kidney disease – lower dosage may be needed
seizures (epilepsy or convulsions) – risk of seizures is increased
a history of mania – Paxil may activate mania
elderly – lower dosage may be needed
brain disease or damage
mental retardation

Adverse Reactions
Paxil may cause the following reactions:
lowered blood pressure and fainting upon standing (postural hypotension)
sweating
dry mouth
nausea
headache
drowsiness
sedation
nervousness
insomnia
constipation
weakness
loss of appetite
taste disorders
tingling in hands
upset stomach
dizziness
blurred vision
itching
chills
abnormal ejaculation
impotence
sexual dysfunction
diarrhea
hypomania
seizures

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Paxil are:
MAO Inhibitors (within 14 days) – serious or even fatal interactions can occur when taken with Paxil
benzodiazepines, desipramine, Haldol (haloperidol), and Normodyne (labetalol) – Paxil may increase the effects of these drugs
Dilantin (phenytoin) – can decrease blood levels of Paxil and reduce its effects
Quinaglute (quinidine) and Tagamet(cimetidine) – can increase Paxil levels and lead to drug toxicity
Astemizole (Hismanal) – can lead to a serious change in heart rhythm when taken with Paxil
Ultram (tramadol) – can increase the risk of seizures when taken with Paxil
Tryptophan – can increase side effects such as sweating, nausea, and dizziness when taken with Paxil
Coumadin (warfarin) – can cause bleeding when taken with Paxil
Moclobemide (Manerex) within 3 to 7 days
Buspirone (BuSpar), Bromocriptine (Parlodel), Dextromethorphan (cough medicine), Levodopa (Sinemet), Lithium, Meperidine (Demerol), Nefazodone (Serzone), Pentazocine (Talwin), other SSRIs (such as: Citalopram [Celexa], fluoxetine [Prozac], fluvoxamine [Luvox], sertraline [Zoloft]), LSD, MDMA (ecstasy), marijuana, Sumatriptan (Imitrex), Tramadol (Ultram), Trazodone (Desyrel), Tryptophan, Venlafaxine (Effexor) – taking these medicines with Paxil can increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome, whose symptoms include confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching.

Source: http://whatmeds.stanford.edu/medications/paroxetine.html

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