Handbook Of Psychiatric Drugs, 2004 Edition (current Clinical Strategies)

Current Clinical Strategies Handbook Drugs of Psychiatric 2004 Edition Lawrence J. Albers, MD Assistant Clinical Professor Department of Psychiatry and Human Behavior University of California, Irvine, College of Medicine Rhoda K Hahn, MD Clinical Professor Department of Psychiatry and Human Behavior University of California, Irvine, College of Medicine Christopher Reist, MD Associate Professor and Vice Chair Department of Psychiatry and Human Behavior University of California, Irvine, College of Medicine Current Clinical Strategies Publishing www.ccspublishing.com/ccs Digital Book and Updates Purchasers of this text may download the digital book and updates at the Current Clinical Strategies Publishing Web site: www.ccspublishing.com/ccs. Copyright © 2004 by Current Clinical Strategies Publishing. All rights reserved. This book, or any parts thereof, may not be reproduced or stored in an information retrieval network without the permission of the publisher. The reader is advised to consult the drug package insert and other references before using any therapeutic agent. No warranty exists, expressed or implied, for errors and omissions in this text. Current Clinical Strategies is a registered trademark of Current Clinical Strategies Publishing Inc. Current Clinical Strategies Publishing 27071 Cabot Road Laguna Hills, California 92653-7011 Phone: 800-331-8227 Fax: 800-965-9420 Internet: www.ccspublishing.com/ccs Indications for medications contained in this book sometimes may not be approved by the FDA. Varying degrees of empirical evidence exist for the effectiveness of medications for non- FDA approved uses. The authors have included those off-label indications where sufficient research has been completed to warrant the consideration of these agents as treatment alternatives. Printed in USA ISBN 1929622-39-2 Antidepressants Serotonin-Specific Inhibitors Reuptake I. Indications A. Serotonin-Specific Reuptake Inhibitors (SSRIs) are the most widely prescribed class of antidepressants. SSRIs have proven efficacy in the treatment of major depression, dysthymia, obsessive-compulsive disorder (OCD), panic disorder, bulimia nervosa, post-traumatic stress disorder, generalized anxiety disorder and social phobia (social anxiety disorder). B. SSRIs are also effective in the treatment of bipolar depression and premenstrual dysphoric disorder. They may have some efficacy in the treatment of pain syndromes, such as migraine headaches and chronic pain. There is some evidence that they be effective in impulse control disorders. These agents have also been used to treat behavioral components of borderline personality disorder. II. Pharmacology A. SSRIs block serotonin reuptake into presynaptic nerve terminals, leading to enhanced serotonergic neurotransmission. B. The half-life for these agents is approximately 24 hours for the parent compound. Fluoxetine, however, has a half-life of 2-4 days, and its active metabolite, norfluoxetine, has a 7-10 day half-life. Thus it takes fluoxetine over a month to reach steady-state plasma concentrations while the other SSRIs take approximately 5 days. C. With the exception of fluvoxamine, the SSRIs are highly bound to plasma proteins. SSRIs have significantly less effect on muscarinic, histaminic, and adrenergic receptors, compared to tricyclic antidepressants (TCAs), and the SSRIs are generally better tolerated. III.Clinical Guidelines A. Dosage: SSRIs have the advantage of once-daily dosing. The dosage of fluoxetine, citalopram, and paroxetine is 20 mg per day; the dosage should be decreased to 10 mg per day in the elderl