The new antidepressants: Selective serotonin reuptake inhibitors

摘要: Since fluoxetine's (Prozac, Eli Lilly and Company, Indianapolis, IN) launch in 1988, similar new SSRIs have entered the United States market. The available now include sertraline (Zoloft, Pfizer Inc., New York, NY, released 1991), paroxetine (Paxil, Smith-Kline Beecham Pharmaceuticals, Philadelphia, PA, 1992), fluvoxamine (Luvox, 1994, addition to fluoxetine). Citalopram, an SSRI used extensively Europe since 1989, is expected be 1998. In clinical practice, many physicians use off-label children adolescents based on extrapolation from adult data lore suggesting benefit tolerability pediatric population. After more than a decade, safety efficacy are finally being generated. Currently, only two Food Drug Administration (FDA) indication for children, both indications were given 1997, years after each medication market: (1) indicated ages 8 17 old with obsessive–compulsive disorder (OCD), (2) 6 OCD. Fluoxetine major depressive (MDD), that may eventually apply FDA indications. Each of currently has at least one approved indication, likely reflecting marketing strategy rather treatment specificity among agents class. MDD, OCD, bulimia nervosa; panic disorder; initial citalopram MDD. gained approval population without definitive adolescents. For patients all ages, revolutionary offering greater easier monitoring older such as tricyclic antidepressants (TCAs) monoamine oxidase inhibitors (MAOIs). Venipuncture serial EKGs not required safe SSRIs. do cardiac risk potential widely discussed child adolescent psychiatry literature TCAs. also lack dangerous dietary interactions require unrealistic restriction taking MAOIs. Until appearance SSRIs, stimulants psychotropic most pediatricians frequently relative comfort. quickly became welcome formulary, expanding options number psychiatric disorders: anxiety disorders, nervosa. Pediatricians psychiatrists prescribing frequency because obvious advantages over agents. fact, fluoxetine (along methylphenidate) 10 medications commonly However, caveats should govern pediatrician adolescents: thorough assessment essential prior starting any agent, complications demand caution. This article describes strategies choosing several criteria, including: 1treatment data, 2untoward effects profile, 3pharmacokinetic characteristics, 4potential drug–drug interactions, 5cost. concludes suggestions dosing pretreatment work-up.