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SSRIs and SNRIs for Depression Treatment
- 1. SSRIs and SNRIs:In adults PRESENTED BY NOMAN RAJPUT
- 6. Neurotransmitter Receptor Hypothesis of Antidepressant Action Decreased state due to up-regulation of receptors Stahl S M, Essential Psychopharmacology (2000)
- 7. Neurotransmitter Receptor Hypothesis of Antidepressant Action Antidepressant blocks the reuptake pump, causing more NT to be in the synapse Increase in NT causes receptors to down-regulate Stahl S M, Essential Psychopharmacology (2000)
- 23. Plasma half life Fluvoxamine Paroxetine Sertraline Fluoxetine Escitalopram Citalopram 17-22h 24h 26h 4-6 days 30h 33h
- 25. Adverse Effects (A/Es) of SSRIs Nausea+ Fluvoxamine Discontinuation sym++ Paroxetine A/E Sertraline Insomnia++ Agitation++ Rash+ Fluoxetine A/E Escitalopram Agitation, Insomnia Citalopram
- 26. Major interactions (CP 450 inhibitor) Fluoxetine Sertraline Fluvoxamine Paroxetine Citalopram Escitalopram Avoid - MAOi, St. John’s wort. Plasma level of some antipsychotics/some benzos/carbamazepine/TCAs plasma level of theophylline (Fluvo) Avoid - MAOi, St. John’s wort. Caution with alcohol, NSAID’s, Warferin
- 48. Thank you all….
Hinweis der Redaktion
- Difference f c nd s??Paroxetine== most A/Es…Fluvoxamine- nausea
- antidepressants, which affect other monoamine neurotransmitters as well.
- 5-hydroxytryptamine 5-HT.. 14 distinct downstream serotonin receptors (5-HT receptors).
- Hypo nd midbrain e beshi
- They act upon two neurotransmitters in the brain that are known to play an important part in mood, namely, serotonin and norepinephrine. This can be contrasted with the more widely-used selective serotonin reuptake inhibitors (SSRIs), which act only on serotonin.
- Sertraline- 200max. Though >100mg no help. TCA- 75-100
- Life threatning
- CP450 inhibitors
- When SS occurs?
- Receptor rebound…..Onset within 5 dayz f stopping treatment. Or during tapper or in missed dose….treatment??– mild- no rx others- reintroduce or another f same class with longer half life..
- SIADH… 5Ht regulation f ADH…So SSRI n SNRI more…..
- citalopram
- Vascular injury------ platelet---- release f 5HT---- Vaso constricton. 5HT s a weak platelet aggregator. SSRI inhibit the 5HT transporter responsible fr uptake f 5HT n platelet
- Fluoxetine--- insulin req reduced, HBA1c improved, wt loss…. Limited data n venla
- Citalopram- QT prolong…. Dnt go fr SNRI. Tolerance…bp
- 10 mg start n hepatic
- – active monitoring, individual guided self-help, CBT or exercise are preferred in these cases