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Selective serotonin reuptake inhibitors

admin — Wed, 30 Nov 2011 21:58:56 +0000

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

Tags: Aropax, Celexa, Cipralex, Cipramil, Citalopram, Coumadin, Dextromethorphan, Dilantin, Escitalopram, fluoxetine, fluvoxamine), Lexamil, Lexapro, Luvox, Paroxetine, Paxil, phenytoin, Prozac, Sarafem, selective serotonin reuptake inhibitors, Seroplex, Sertraline, SSRI, Symbyax, Tramal, Ultram, Viibryd, Vilazodone, warfarin, zoloft

Psychiatric Drugs’ Use Drops for Children

admin — Thu, 09 Oct 2008 17:57:55 +0000

Suicide Warnings Raise Bigger Fears On Testing Process
Warnings that drugs such as Prozac, Paxil and Effexor can increase suicidal behavior in some children have resulted in a nearly 20 percent drop in U.S. pediatric prescriptions of the widely used antidepressants and have triggered deep concerns about the quality of current data on psychiatric drugs, doctors and regulators said.
The unprecedented fall of what were once considered wonder drugs comes as a series of taxpayer-funded analyses have systematically undermined the claims of industry-funded drug trials, raising thorny questions about the ways in which psychiatric drugs are being tested, marketed and used.
No one knows the consequences of such a steep decline in children’s drug prescriptions: Critics of the drugs say regulators ought to crack down further, as British health authorities did last month, but many American psychiatrists are worried that reduced access to medications could cause an increase in suicide as a result of untreated depression.
As with many disputes over these and other psychiatric drugs, opinions are more readily available than definitive data. The fundamental problem, many experts said, is that there are not enough systematic long-term studies about psychiatric drugs.
“The problem is we don’t have enough good data,” said Thomas Laughren, director of the division of psychiatry products at the Food and Drug Administration. “All of our data are focused on the short term.”
As a result, he and others said, a consensus is growing that the system of approving psychiatric drugs based on industry-run trials that sometimes last just 12 weeks is not providing doctors with the information they need — many physicians place patients on the drugs for years. Senior FDA officials say they are weighing whether companies should be required to conduct longer trials to reveal the true risks and benefits of the drugs.
Pharmaceutical makers say that profound change would increase the time and expense of bringing new medications to market.
Although the agency does ask that companies pursue long-term trials after drugs are approved, few do. At a meeting this month, Laughren said, regulators will debate whether long-term trials “should be asked for at initial approval.”
Alan Goldhammer, associate vice president for regulatory affairs at the Pharmaceutical Research and Manufacturers of America, said long-term studies should be conducted by public health agencies at taxpayer expense.
“I don’t think they fall within the province of the pharmaceutical industry because they are so costly and time-consuming that it would probably bring drug development to a halt,” he said. “There would not be the funds to develop new drugs if one focused on one drug and tried to know everything about it.”
In the absence of long-term data, however, doctors, parents and patients have been confused by a steady stream of concerns that have recently emerged:
• An FDA review last year found that newer antidepressants increase suicidal behavior among some children, and the agency ordered that a “black box” warning be placed on them.
• British authorities last month went even further, telling doctors there never to prescribe medications to depressed children without first trying multiple alternatives, and never to prescribe drugs without also providing psychotherapy. Doctors were also warned not to prescribe the antidepressants Paxil and Effexor to depressed children under any circumstances.
• On Sept. 28, the FDA announced that the drug Strattera, prescribed widely to children with attention deficit disorder, had also been found to increase the risk of suicidal behavior in some, and told manufacturer Eli Lilly and Co. to add a black-box warning.
• Also last month, a major government analysis of antipsychotic medications found newer, expensive drugs were neither safer nor more effective than an older generic medication that doctors rarely use. The drugs had never been systematically compared in a long-term trial. Another study in older patients, paid for by Canadian health authorities, found the newer drugs “are not necessarily safer” when it came to causing uncontrolled movements; for years, doctors have believed the newer drugs were significantly less likely to cause that side effect.
Reflecting the confusion caused by the lack of good data, FDA regulators have drawn the ire both of critics who say the agency has not gone far enough to protect patients who take the drugs and of many psychiatrists who say the agency is going too far.
Antidepressant prescriptions for children fell nearly 20 percent in the last year, according to a recent report by the American Psychiatric Association and data from NDCHealth, a health care information company. Experts at the association worry that patients have been scared into thinking the drugs are dangerous, when the bigger danger of suicide lies in untreated depression.
Again, the FDA’s Laughren said there is little data on whether the drop in prescriptions is a good thing or a bad thing.
“It could mean that physicians are prescribing more rationally and that explains the drop, or it could mean there is a decreased access of medications,” he said. “Ultimately, systematic controlled trials are the best way to figure out the risks and benefits.”
Many experts said without long-term studies, doctors are left to rely on trial and error — and drug company marketing. Millions of dollars have been spent to boost the profile of newer antipsychotic drugs, for example. Although some patients clearly benefit, the study paid for by the federal government suggests doctors have embraced the new products without clear evidence that they are superior.
Many psychiatrists, in fact, were so certain the new drugs were better that they questioned the need to pit the new medications against an older drug, said Yale psychiatrist Robert Rosenheck, who helped conduct the study that found all of them did about as well.
Such misjudgments cannot be corrected when doctors are so dependent on short industry-sponsored trials, said Columbia University psychiatrist Jeffrey Lieberman, who led the antipsychotics study. Short-term studies do not tell clinicians which drug to try first or which is more cost-effective.
Many industry trials also carefully select the patients being studied in order not to muddy the results, whereas doctors routinely deal with patients with multiple conditions and complex problems. And companies have been legally allowed to keep short-term trials with inconvenient results out of public view. Studies that showed antidepressants were ineffective in children, for example, were systematically excluded from the medical literature. The result was that the data available to doctors painted a rosy picture of the drugs.
“If we only had the public evidence, we would have recommended the use of all the [drugs],” said Tim Kendall, a British psychiatrist who led a two-year analysis of both the public and secret data.
When the unpublished trials were taken into account, the evidence, he said, led them to rule out the use of Paxil and Effexor for children and to severely curtail the use of the other antidepressants.
Children with milder forms of major depression — who are persistently teary, emotionally flat, or uninterested in activities for several weeks — ought not to be candidates for the drugs at all, he said. Instead, the new British guidelines call for watchful waiting.
Children with severe forms of major depression — losing weight, not sleeping, and showing suicidal behavior — should get talk therapy for at least three months, Kendall said, before doctors consider adding a medication.
But Thomas Insel, director of the National Institute of Mental Health in Bethesda, said requiring three months of talk therapy before giving medication is unrealistic, because talk therapy is not widely available.
“It is not clear to me that most 16-year-olds would get any treatments at all,” he said. “It is hard to imagine that is an improvement.”
Depriving doctors of antidepressants could also prompt clinicians to venture into uncharted territory with even less data, Insel said. He is concerned that physicians are already switching children from antidepressants to antipsychotic drugs, none of which have been approved for children. The federal government’s top mental health researcher said it “was amazing” that nearly a quarter of all antipsychotic prescriptions for children are going to those younger than 9, the vast majority of them boys.
“I am concerned we are going to see an increase in . . . antipsychotics in this population,” said Insel. “Have we gone from one set of medications of known benefit and of questionable risks to a group of medications with unknown benefits and well-known risks?”

By Shankar Vedantam
Washington Post Staff Writer
Saturday, October 8, 2005; A01

washingtonpost.com

Source: j.b5z.net/i/u/2043019/i/washingtonpost.doc

Tags: Children, drug prescriptions, Effexor, Paxil, Prozac, Psychiatric Drugs' Use, Suicide Warnings

Antidepressants Hardly Help

admin — Thu, 18 Sep 2008 08:39:35 +0000

Popular antidepressants including Prozac and Paxil have little impact on most patients, according to a comprehensive review of newly released data from trials that were conducted before the drugs were approved in the U.S.
Researchers from the U.K., U.S. and Canada analyzed results for fluoxetine (better known by the brand name Prozac), venlafaxine (Effexor), nefazodone (Serzone) and paroxetine (Paxil or Seroxat) — all members of a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). The researchers’ paper, published this week in the journal PLoS Medicine, claims that only patients who are diagnosed “at the upper end of the very severely depressed category” get any meaningful benefit from the widely prescribed drugs. For the others, the paper says, antidepressants are barely more effective than a placebo (although patients suffering from depression, like those suffering from chronic pain, generally do see a substantial placebo benefit).
There are plenty of studies about antidepressants. What makes this one so important — the results were front-page news across the U.K. on Tuesday — is that the researchers were able to track down comprehensive unpublished trial results from the drug makers themselves before the drugs were authorized for sale in the U.S., and include them in their review of the literature. The U.S. Food and Drug Administration (FDA) must receive records of all relevant pharmaceutical-company trials, both published and unpublished, before it will approve a drug. Under the Freedom of Information Act, the researchers writing in PLoS Medicine were recently able to obtain those FDA records of industry-sponsored clinical trials. They yield data, they believe, that lets them avoid a bias that often plagues reviews of previous research: the tendency for conclusive positive results to be published, sometimes more than once, and thus over-represented, while mediocre results can be ignored or even swept under the rug.
Drug companies claim the review is still flawed, however. One massive problem: there are many more recent studies than those surveyed in the article, which looked only at pre-approval trials conducted before 1999. Nicholas Francis, a U.K. spokesman for Eli Lilly and Company, which produces Prozac, says that the new study “does not take into account that today more than 12,000 patients have participated in Prozac clinical trials and thousands of scientific papers have referenced Prozac, supporting its use in the treatment of depression.” Some 50 million people worldwide have taken Prozac, and in a company statement Lilly said it “is proud of the difference Prozac has made to millions of people living with depression.” Similarly, paroxetine producer GlaxoSmithKline warns, “This analysis has only examined a small subset of the total data available … and this one study should not be used to cause unnecessary alarm and concern for patients.” As a spokeswoman for Wyeth, Effexor’s maker, points out, these were, after all, the same data the FDA reviewed before approving the drugs for public use.
There are really two issues at the heart of the controversy. One is the difference between “statistical significance” — a measure of whether the drug’s effects are reliable, and that patient improvement is not just due to chance — and “clinical significance,” whether those effects actually are big enough to make a difference in the life of a patient. The researchers behind this new paper did find that SSRI drugs have a statistically significant impact for most groups of patients: that is, there was some measurable impact on depression compared to the placebo effect. “But a very tiny effect may not have a meaningful difference in a person’s life,” says Irving Kirsch, lead author on the paper and a professor of psychology at the University of Hull in England. As it happens, only for the most severely depressed patients did that measurable difference meet a U.K. standard for clinical relevance — and that was mostly because the very depressed did not respond as much to placebos. The drug trials showed SSRI patients improved, on average, by 1.8 points on the Hamilton Depression Rating Scale, a common tool to rate symptoms such as low mood, insomnia, and lack of appetite. The U.K. authorities use a drug-placebo difference of three points to determine clinical significance.
The more troubling question concerns what kind of data is appropriate for analyzing a drug’s efficacy. The companies are correct in claiming there is far more data available on SSRI drugs now than there was 10 or 20 years ago. But Kirsch maintains that the results he and colleagues reviewed make up “the only data set we have that is not biased.” He points out that currently, researchers are not compelled to produce all results to an independent body once the drugs have been approved; but until they are, they must hand over all data. For that reason, while the PLoS Medicine paper data may not be perfect, it may still be among the best we’ve got.

By LAURA BLUE/LONDON Tuesday, Feb. 26, 2008
Source: http://www.time.com/time/health/article/0,8599,1717306,00.html?iid=sphere-inline-bottom

Tags: Antidepressants, Food and Drug Administration, Hardly Help, Paxil, pharmaceutical, Popular antidepressants, Prozac, SSRI drugs

Paxil

admin — Sun, 14 Sep 2008 10:16:44 +0000

Paroxetine – Brand Name: Paxil

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

Tags: Compulsive, depression, Disorder, Obsessive, panic disorder, Paroxetine, Paxil, phenylpiperidine derivative, Selective Serotonin Reuptake Inhibitor, social anxiety disorder, SSRI

Psychiatric Drugs »» Antidepressants | Antipsychotics | Antianxiety | Antimanic Agents | Stimulants | Prescription Drugs » Tag: Paxil

Selective serotonin reuptake inhibitors

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