Mhe0204_040-42_dco

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 company MANAG 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

Source: http://www.spectroscopyonline.com/spectroscopy/data/articlestandard//mhe/082004/85799/article.pdf