scholarly journals Strategies for Managing Depression Refractory to Selective Serotonin Reuptake Inhibitor Treatment: A Survey of Clinicians

2000 ◽  
Vol 45 (5) ◽  
pp. 476-481 ◽  
Author(s):  
David Mischoulon ◽  
Andrew A Nierenberg ◽  
Leena Kizilbash ◽  
Jerrold F Rosenbaum ◽  
Maurizio Fava
Keyword(s):  
Reuptake Inhibitor ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Monoamine Oxidase Inhibitor ◽  
Oxidase Inhibitor ◽  
Tricyclic Antidepressant ◽  
Selective Serotonin ◽  
Treatment Practices ◽  
Group Settings ◽  
First Choice

Objective: To examine treatment practices in cases where selective serotonin reuptake inhibitors (SSRIs) are ineffective. Methods: We surveyed 801 clinicians (including 630 psychiatrists) attending the Massachusetts General Hospital's annual psychopharmacology review course. Clinicians were presented with a vignette about a patient with depression who had responded partially to an SSRI and were asked to choose among various strategies available to manage this patient. Results: Of those surveyed, 466 clinicians had been in practice a mean of 16.6 years (SD 10.7). Not all clinicians chose to answer every question. Among 455 respondents, 84% (n = 382) chose to increase the dose of the SSRI, 10% (n = 47) chose augmentation or combination, and 7%(n = 31) opted for switching agents. When asked to switch to another agent, 448 responded, of whom 52% (n = 235) chose a newer antidepressant, 34% (n = 152) chose another SSRI, 10%(n = 44) chose a tricyclic antidepressant (TCA), 2%(n = 8) chose a serotonin norepinephrine reuptake inhibitor (SNRI), 1% (n = 5) chose a monoamine oxidase inhibitor (MAOI), and 1% (n = 4) chose an undefined “other” agent. Among 445 respondents, bupropion was the most widely chosen augmenting agent (30%, n = 134), followed by lithium (22%, n = 98). West coast and Canadian clinicians preferred to switch to another SSRI rather than to a newer antidepressant. Canadian clinicians preferred lithium to bupropion as their first-choice augmenting agent, as did clinicians from academic settings. Clinicians from community, individual practice, or group settings favoured bupropion. More experienced clinicians preferred bupropion as a first-choice augmenter, whereas less experienced ones showed a slight preference for lithium. Canadian clinicians were more likely to use MAOIs as second-line agents. Conclusions: Clinicians in this sample often followed strategies different from those recommended in the literature. Bupropion may have an important role in augmentating treatment with SSRIs.

scholarly journals Trends and Advances in Separation and Detection of SSRIs and SNRIs in Biological Matrices

2013 ◽  
Vol 2013 ◽  
pp. 1-15 ◽  
Author(s):  
Ruchita Das ◽  
Y. K. Agrawal
Keyword(s):  
Reuptake Inhibitor ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Date Rape ◽  
Antidepressant Drugs ◽  
Selective Serotonin ◽  
Biological Matrices ◽  
First Choice ◽  
Analytical Approaches ◽  
Norepinephrine Reuptake

Nowadays antidepressant drugs like selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) represent the first choice in the treatment of moderate to severe depressive illness, various phobias, and personality disorders. In spite of the therapeutic aspects, they often produce very severe and toxic effects in deliberate and accidental cases of poisoning. These are also considered as date-rape drugs used for drugged victims for raping or robbing. Therefore, in recent years, their analyses in different biological matrices for clinical and toxicological analysis purposes has been a target worthy of interest. Thus, the review focuses on recent advancements of various separation techniques like chromatography and electrophoresis that are concernd with the determination of selective serotonin reuptake inhibitor and selective norepinephrine reuptake inhibitor drugs and their metabolites in various biological matrices. In addition to this, a critical discussion on analytical approaches has also been incorporated, suggesting their applicability and limitations for further implementations. Thus, this paper will definitely help in the selection and development of proper analytical methodologies to achieve satisfactory results, better scientific understanding, and test interpretation.

scholarly journals Perioperative adolescent serotonin syndrome secondary to methadone and fentanyl administration: A case report

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Emily Anne Smith Bergbower ◽  
◽  
Enoch Cheung ◽  
Caron Hong ◽  
◽  
...  
Keyword(s):  
Selective Serotonin Reuptake Inhibitor ◽  
Reuptake Inhibitor ◽  
Serotonin Reuptake ◽  
Serotonin Syndrome ◽  
Monoamine Oxidase Inhibitor ◽  
Opioid Analgesic ◽  
Oxidase Inhibitor ◽  
Selective Serotonin ◽  
Adolescent Male ◽  
Serotonin Reuptake Inhibitor

Serotonin Syndrome (SS) is a serious toxidrome associated with significant morbidity when undiagnosed or improperly managed. We report a perioperative case of serotonin syndrome in an adolescent male on fluoxetine (selective serotonin reuptake inhibitor-SSRI) therapy secondary to an intraoperative combined opioid analgesic regiment. He received low dose methadone and fentanyl for induction for a LeFort osteotomy, the presumed trigger for his perioperative SS. This study demonstrates the essential need for anesthesiologists’ vigilance regarding identifying SS, risk factors of SS and implementation of immediate and effective management. Abbreviations: GAD: Generalized Anxiety Disorder; GPCR: G-protein Coupled Receptor; IV: Intravenous; MAOI: Monoamine Oxidase Inhibitor; MDD: Major Depressive Disorder; OR: Operating Room; PACU: Post-Anesthesia Care Unit; RAE: Right Angle Endotracheal; SERT: Serotonin Transporter; SNRI: Serotonin-Norepinephrine Reuptake Inhibitor; SS: Serotonin Syndrome; SSRI: Selective Serotonin Reuptake Inhibitor.

Sertraline-Phenelzine Drug Interaction: A Serotonin Syndrome Reaction

1994 ◽  
Vol 28 (6) ◽  
pp. 732-735 ◽  
Author(s):  
Mark A. Graber ◽  
T. Brent Hoehns ◽  
Paul J. Perry
Keyword(s):  
Blood Pressure ◽  
Drug Interaction ◽  
Monoamine Oxidase ◽  
Selective Serotonin Reuptake Inhibitor ◽  
Reuptake Inhibitor ◽  
Serotonin Reuptake ◽  
Serotonin Syndrome ◽  
Monoamine Oxidase Inhibitor ◽  
Oxidase Inhibitor ◽  
Selective Serotonin

OBJECTIVE: To report a serious drug interaction possibly occurring with the monoamine oxidase inhibitor phenelzine and the selective serotonin reuptake inhibitor sertraline. CASE SUMMARY: A 61-year-old woman with treatment-refractory major depressive disorder was being treated unsuccessfully with lithium, phenelzine, thioridazine, and doxepin. Sertraline 100 mg/d was added to the patient's therapy. Within three hours of ingesting the first dose, the patient experienced a dramatic increase in her temperature, pulse, and respirations along with labile blood pressure, and symptoms of rigidity, diaphoresis, shivering, and decreased sensorium. The patient was transported to the emergency room and treated with diazepam 10 mg iv, followed by midazolam 10 mg iv for control of rigidity. She was also intubated. The patient then experienced precipitous falls in her blood pressure and respiratory rate. Ice packs combined with a cooling blanket and dantrolene 80 mg iv were administered to control fever and rigidity, respectively. She had an initial working diagnosis of neuroleptic malignant syndrome, which was later changed to serotonin syndrome. Dantrolene was continued for 72 hours at which time the patient was extubated and transferred to a psychiatric unit. CONCLUSIONS: Selective serotonin reuptake inhibitor antidepressants should not be combined with monoamine oxidase inhibitor antidepressants because of the risk of serotonin syndrome.

scholarly journals A comparative study to assess the effect of escitalopram and amitriptyline on psychomotor functions in patients of depression

2020 ◽  
Vol 9 (11) ◽  
pp. 1701
Author(s):  
Amit V. Mohite ◽  
Baliram V. Ghodke ◽  
Patil Arun W.
Keyword(s):  
Reaction Time ◽  
Reuptake Inhibitor ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressant ◽  
Significant Rise ◽  
Selective Serotonin ◽  
Psychomotor Function ◽  
Flicker Fusion Frequency ◽  
Visual Reaction

Background: Depression is a most common and widespread of all psychiatric disorders. Treatment of depression includes the use of antidepressants commonly used clinically such as tricyclic antidepressants, selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitor, and monoamine oxidase inhibitors. Certain antidepressants apart from improvement in the symptoms found to have detrimental effect on cognitive and psychomotor function. Objective of this study was to assess and to compare the effect of escitalopram and amitriptyline on cognitive and psychomotor functionsMethods: Effect of escitalopram and amitriptyline on psychomotor function was assessed by using Critical flicker fusion frequency (CFF) and Reaction time (RT) in patients of mild to moderate depression at the end of 2nd and 4th week of monotherapy.Results: Patients in both the group have their RT remained significantly higher (p<0.001) in comparison with control and CFF remained significantly lower at the end of both the week. There was a significant rise in CFF in escitalopram group as compared to amitriptyline (p<0.001). Escitalopram showed a significant improvement in Visual reaction time (VRT), Auditory reaction time (ART) and Choice reaction time (CRT) (p<0.001) compared to amitriptyline at both the follow ups.Conclusions: Findings of this study support the use of Selective serotonin reuptake inhibitor (SSRI) i.e. escitalopram which had shown less impairment of psychomotor function in patients of Depression as compared to amitriptyline (Tricyclic antidepressant), in special subgroups of population who operate machinery, drive vehicle or require alertness for the work.

Clinical comparison of selective serotonin reuptake inhibitors in the treatment of geriatric depression: a review of literature

2000 ◽  
Vol 10 (4) ◽  
pp. 349-373 ◽  
Author(s):  
Richard Marc Patel
Keyword(s):  
Side Effect ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Relevant Literature ◽  
The Elderly ◽  
The United States ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Geriatric Depression ◽  
First Choice

IntroductionWith their ease of administration, relatively benign side-effect profile and safety in overdose, in the United States the selective serotonin reuptake inhibitors (SSRIs) have become de facto first choice in the treatment of geriatric depression, displacing tricyclic antidepressants (TCAs). In this paper, the relevant literature regarding neurochemistry, kinetics, dosing, efficacy and differential side-effect profiles of citalopram, fluvoxamine, fluoxetine, sertraline, and paroxetine, the five currently available SSRIs in the USA, will be reviewed with special emphasis on geriatric data. Of late, considerable controversy has been generated regarding whether SSRIs are as effective as TCAs in severe and melancholic depressive subtypes. This important issue will be explored and the relative utility of all the SSRIs in the elderly patient compared and contrasted. Finally, reasons for difficulties in comparing results across studies will be elucidated.

scholarly journals Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine

2006 ◽  
Vol 188 (4) ◽  
pp. 337-345 ◽  
Author(s):  
Tony Kendrick ◽  
Robert Peveler ◽  
Louise Longworth ◽  
David Baldwin ◽  
Michael Moore ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Randomised Trial ◽  
Depression Scale ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
First Choice

BackgroundThe cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care.AimsTo determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UK primary care.MethodAn open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression.ResultsNo significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3–29.0) for TCAs, 28.3 (95% CI 24.3–32.2) for SSRIs and 24.6 (95% CI 20.6–28.9) for lofepramine. Mean health service costs per patient were $762 (95% CI 553–1059) for TCAs, $875 (95% CI 675–1355) for SSRIs and $867 (95% CI 634–1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective (with a probability of up to 0.6).ConclusionsThe findings support a policy of recommending SSRIs as first-choice antidepressants in primary care.

scholarly journals Paroxetine and bupropion have no in vitro effects on lynphocyte proliferation and viability

2007 ◽  
Vol 56 (2) ◽  
pp. 116-119 ◽  
Author(s):  
Ramiro Ronchetti ◽  
Mariana Dal Pizzol ◽  
Rodrigo Pestana Lopes ◽  
Rachel Rubin da Silva ◽  
Gabriel José Chittó Gauer ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cell Viability ◽  
Reuptake Inhibitor ◽  
Peripheral Blood ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Favorable Effect ◽  
Immunological Effects

OBJECTIVE: Initial studies with tricyclic antidepressants demonstrated that they jeopardize the immune system activity. Recent studies suggested that selective serotonin reuptake inhibitors would have stimulating immunological effects. Here, we explored the in vitro immunological effects of two antidepressants used in clinical practice, paroxetine (selective serotonin reuptake inhibitor) and bupropion (norepinephrine and dopamine reuptake inhibitor). METHOD: Peripheral blood samples were obtained from 16 healthy volunteers and the peripheral blood mononuclear cells were isolated and cultured in vitro. We evaluated the effects of bupropion and paroxetine on cell viability as well as the ability to suppress phytohemagglutinin-induced lymphocyte proliferation. RESULTS: Both antidepressants produced neither significant effect on cell viability nor on T-cell proliferation. CONCLUSIONS: This could be of valuable information for the clinical practice when these drugs are administered. These results indicate a more favorable effect of such psychopharmacological drugs when compared to reported immunological effects associated with tryciclic antidepressants.

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