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Ssri n snri
1. SSRIs and SNRIs:In adults Dr. Syed Faheem Shams Student of MD (Part-II) Psychiatry, BSMMU
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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)
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23. Plasma half life Fluvoxamine Paroxetine Sertraline Fluoxetine Escitalopram Citalopram 17-22h 24h 26h 4-6 days 30h 33h
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
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