Newer antidepressants are gradually replacing old tricyclic antidepressants because of comparable efficacy with fewer side effects and a much lower risk of death from overdose. Newer-generation antidepressants include trazodone hydrochloride, bupropion hydrochloride, and the selective serotonin reuptake inhibitors fluoxetine hydrochloride, sertraline hydrochloride, and paroxetine.
Trazodone and bupropion, unlike tricyclic antidepressants, are ineffective for panic. Anticholinergic effects-dry mouth, blurred vision, constipation, and urinary retention — and cardiovascular effects are less with the newer drugs than with tricyclic antidepressants. Weight loss can occur with bupropion and fluoxetine. Overdose lethality is rare with these newer drugs.
Newer antidepressants, like tricyclic antidepressants, show efficacy at two to six weeks, and about 50% to 70% of depressed patients obtain benefit. Patients who partially respond or do not respond may benefit from lithium or triiodothyronine augmentation or by changing to a different class of drug, such as from trazodone to serotonin reuptake inhibitors and serotonin reuptake inhibitors to bupropion.
Trazodone is highly sedating, and dose titration to the maximum tolerated dose is required in the 100-mg to 600-mg at bedtime range based on daytime sedation. Trazodone, 50 mg to 100 mg, is widely used as a hypnotic in lieu of potentially addicting medications. It may worsen preexisting ventricular arrhythmias. It causes priapism in about 1 in 7,000 men.
Bupropion is highly activating, may benefit adults with attention deficit disorder, and has the advantage among antidepressants of causing no sexual dysfunction. It has the disadvantage, however, of a higher seizure risk than tricyclic antidepressants. Patients with eating disorders, head trauma, seizure history, or who are taking other drugs that lower the seizure threshold (such as theophylline) should not receive this drug. The dosage is 300 to 450 mg daily and must be divided.
Fluoxetine, the first marketed serotonin reuptake inhibitor, has now been shown to be beneficial in many conditions including depression, mixed anxiety-depression, anorexia, bulimia, panic, and obsessive-compulsive disorder. The other serotonin reuptake inhibitors, sertraline and paroxetine, will probably show a similar spectrum of action and have the advantage of a shorter half-life to allow for more rapid dose adjustment and washout in case of intolerance. Selective serotonin reuptake inhibitor antidepressants may be lethal in combination with monoamine oxidase-inhibitor antidepressants.
Both bupropion and paroxetine carry less risk of precipitating mania in patients with bipolar depression than do tricyclic antidepressants.
1994
Related posts:
- Management of treatment-resistant depression: Switching antidepressants If lithium augmentation is ineffective, it should be discontinued and the antidepressant changed (Table 5). A lack of response to one of the newer agents in a class, such as the selective serotonin reuptake inhibitors (SSRIs), does not predict lack of response to...
- Antidepressants: Drug Interactions The most common drug interaction with antidepressants is their influence on the metabolism of other drugs. Antidepressants are metabolized through catabolic enzymes located in a variety of places, but primarily in the smooth endoplasmic reticulum of hepatocytes: the cytochrome P450 (CYP) enzymes. Many other...
- Indications for Use of Antidepressants All antidepressants are indicated for the treatment of acute major depressive episodes; there is also evidence for their use in the prevention and relapse and recurrence. In addition, a number of more minor forms of depression may also respond to antidepressant medication, including dysthymic...
- Paroxetine (Paxil) for Depression The Food and Drug Administration has approved the marketing of the selective serotonin reuptake inhibitor paroxetine hydrochloride (Paxil / SmithKline Beecham) for the treatment of depression. It is the third of a new group of antidepressants that are supplanting older drugs. The other two...
- Antidepressants: Pharmacology The use of antidepressants in the treatment of depression remains the best-understood use of these medications; however, there is a growing list of other indications for antidepressants, including panic disorder (PD), obsessive-compulsive disorder (OCD), bulimia and posttraumatic stress disorder (PTSD). Many of these illnesses...
Hello, everybody, who is interested to be healthy. My name is Kelly. I learnt about depression by my own experience. Now I am ok. Here I want to share my thoughts and ideas how to treat depression symptoms.