No formulary should restrict itself to one SSRI for the treatment of depression Experts say SSRIs tend to have similar efficacy but different side-effect profiles, and patients who don’t respond to one might respond to another BY ELAINE ZABLOCKI
(SSRIs) are the treatment of choice formajor depression (and may also be used
Major depression is a serious medical illness
which can significantly interfere with a person’s thoughts, physical health,
for conditions such as anxiety, obsessive-
behavior, mood and activity. Lifetime risk for major
depression ranges from 7% to 12% among men,
and from 20% to 25% among women. In most ■ Prozac (fluoxetine)patients, it is a relapsing, remitting illness; after the
first episode there is a greater than 40% chance ■ Paxil (paroxetine)of a second episode within a two-year period.
Patients with chronic illnesses such as diabetes ■ Lexapro (escitalopram)
and heart disease tend to have higher rates of major
Today, selective serotonin reuptake inhibitors
serotonin, a chemical that transmits electrical signals between brain cells. Itmay take as long as four to eight weeks
SSRIs - Total Prescriptions Written 2002 vs. 2003*
of treatment before the patient feels the
full effect of SSRIs. This class of drugstends to have fewer and different side
effects than earlier antidepressants (suchas tricyclics and monoamine oxidase in-
nervousness, insomnia, diarrhea, rash,agitation, or low sex drive and lack of
orgasm may occur in response to SSRIs. These side effects can often be treated
by changing the dose or switching to adifferent SSRI. Citalopram Escitalopram** Fluoxetine Paroxetine Sertraline (Celexa) (Lexapro) (Prozac) (Zoloft)
* 12/01 through 11/02; 12/02 through 11/03 ** Escitalopram not approved until August 2002.
all SSRIs appear to be equally effective. MHEGRAPHIC MHE Source: NDCHealth, a healthcare information companyMANAG ED H EALTHCARE EXECUTIVE
drug-drug interactions,” he says. “Zoloft,
Drug Administration (FDA) planned to well. According to The Pink Sheet,
discuss the issue at a joint meeting Celexa’s manufacturer, Forest Laborato-
ries, has stepped up efforts to shift users
cause patients who don’t respond to one
just as effective as Lexapro, if appropriate
dosages are used,” Abramowicz says.
fall of 2001 and dramatically transformed
(venlafaxine), increases levels of norepi-
nephrine as well as serotonin (and is there-
to switch patients to the generic, resulting
treatment of clinical depression. Novasoy
have beneficial effects on brain function
Forest Laboratories, which blocks the re-
likely to be on the market by the brand-name antidepressant in 2002,
proved in the United States for treatment
of Alzheimer’s disease. According to the
en and adolescents with . All Rights Reser
studies, the British regulators concluded
suits are under way concer ning nausea and vomiting because of cancer
there was a significant risk of hostility,
Paxil, but generic versions from two chemotherapy, but it recently failed tests
“substance P,” and it had been touted as
“There are no convincing data duced Paxil Controlled Release (CR)
showing that SSRIs are less safe in in April 2002, and it now represents ap-
pression. MHE
children than in adults,”Abramowicz says.
“The benefit of SSRIs in preventing tions in the United States. Both imme-
This article is based on information supplied by The
Medical Letter (www.medicalletter.org) a nonprofit or-
ganization that publishes newsletters offering critical
appraisals of new drugs and comparative reviews ofolder drugs. The Medical Letter is completely inde-
pendent of the pharmaceutical industry. It is sup-
ported entirely by subscription sales and accepts no
whether they are taking Gener ic Celexa should become advertising, grants or donations. Financial informa-
tion provided by NDCHealth, a healthcare information
MANAG ED H EALTHCARE EXECUTIVE
REGLAMENTO DE INFRACCIONES Y SANCIONES CAPITULO I DISPOSICIONES GENERALES ARTÍCULO 1.- (DEFINICIONES).- Para efectos de aplicación del presente reglamento se establecen, además de las definiciones contenidas en el artículo 2 de la Ley de Electricidad, las siguientes: Infracción. Es el acto u omisión que constituye transgresión o incumplimiento a las disposiciones de l
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