What Are The Differences Between SSRIs (Sertraline, Escitalopram, and Citalopram). This is the first video in the Understand SSRIs Better Series.
All right so this is the understand ssris better series and this particular video will be on the differences between the ssris and i wanted to have a focus on how the pharmacokinetic and the i’ll just list out the ssris so this video will be going over prozac fluvoxamine which is luvox paroxetine and the common
Denominator between all these drugs is that they block the receptor cert although in this video we’ll learn that the the first drug i want to go over is sertraline which is the brand name zoloft and for each of these drugs i’m going to go into the other receptors they hit the fda approval and the off label
Used for these drugs and the thing i really want to focus on is how you could use the other receptors that the drugs hit to kind of remember the differences that exist between these drugs so the other receptors that zoloft hits are dat and sigma one it’s fda approved for depression ocd and kids over six panic disorder
Ptsd pmdd social anxiety and it’s used off label for generalized anxiety disorder and other anxiety disorders so zoloft blocks that and that is the dopamine active transporter which is responsible for the reuptake of dopamine so if you block that and it’s unclear if zoloft has enough that blockade for clinical
Relevance but it’s still really useful to remember the unique clinical about what an increase of dopamine would cause so zoloft is mildly activating so it works best with patients with atypical depression and just a quick reminder atypical depression is depression that has weight gain hypersomnia interpersonal
Rejection sensitivity and mood reactivity um so zoloft is the ssri that’s known to work best for patients with hypersomnia low energy and mood reactivity um the downside of that is it can cause some over activation in patients with panic disease zoloft is also an antagonist that’s sigma one um we don’t really exactly
Know what sigma is involved with it’s called the sigma enigma so it’s unclear but it might help with the anxiety effects and psychotic depression where zoloft seems to have an advantage and i can’t help but notice that all the ssris that are particularly good for ocd also block sigma one in terms of side effects
Zoloft is particularly known for diarrhea this by memory being called scorcher lean are probably the two best antidepressants anxiety and that’s because they have the best balance of benefits side effects and costs um zoloft if you use it less than 150 milligrams it has significantly less sip interactions than
If you use it above zoloft also has the best safety record in cardiovascular disease and it’s proven safe for depressed patients with recent mi so if i just summarize zoloft in one line i’d say that it’s an ssri that works well with atypical depression given it’s that blockade it’s got an excellent safety profile
Minimal interactions that doses less than 150 and the one downside the next antidepressant i’m going to talk and the other receptors it hits is basically none um it’s the purest ssri so it basically just hits cert it’s fda approved for depression in children over 12 and for generalized anxiety so escitalopram
Gets its name from and just as a quick review enantiomers are molecules that are mirror images of one another very similar to your left hand and right hand and the rs is the naming convention and left is the word sinister in latin so that’s where it gets the s and r is rectus or right as in morally right i’m
Left-handed so obviously this this naming convention is very upsetting to me so um when drugs exist as an enantiomers usually only one physiological effects and the other is less active or it’s inactive or it produces adverse effects so that’s kind of the situation for uh citalopram where the s enantiomer is the
One that has the effects that we want so other drugs a quick review eszopiclone which is lunesta is also there’s also a drug called zopiclone so that’s the s enantiomer ketamine which is the s for ketamine amphetamine and dextroamphetamine which is the counterclockwise version of ketamine methylphenidate and
Dexmethylphenidate which is focalin um versus ritalin and modafinil which is provigil versus art modafinil so that’s just new vigil so escitalopram is modestly superior and i’ll go into that into the next slide so lexapro is known for being the most selective ssri so it’s basically just purely hitting cert
Tolerated it has the fewest side effects probably has the least amount of insomnia it’s got a linear and dose proportional pharmacokinetics for any antidepressant so all things considered i think that lexapro and zoloft are probably the first line antidepressants other important things for lexapro is it’s improved
In kids uh 12 and older so only lexapro and prozac are approved for children and for prozac it’s approved for kids eight and older and also it’s known to mildly raise qtc generally we prefer the prams which is citalopram and escitalopram for the medically amount of drug interactions but it also has the
Worst record in terms of the qtc interval so you know with all these drugs there’s pros and cons one other thing about lexapro is that i have this theory that lexapro is what flipped kanye into mania um from his 2016 album the life of pablo you can hear this line you ain’t never seen nothing crazy then this when he
Offers lexapro and then in 2018 he drops his “ye” album which the cover says i hate being bipolar it’s awesome so that’s why that i have this theory so if i had to use a one-liner for lexapro i’d say it’s the purest ssri it’s got the fewest side effects the least interactions it’s approved in kids 12 and older
And the downside is that it has mild qtc increase so now the next ssri i’m going onto is citalopram or celexa the other receptor it hits is histamine it’s fda approved for depression and it’s used off label for ocd social anxiety gad panic disorder and pmdd so as i was saying before citalopram is the racemic mixture
Of escitalopram r citalopram enantiomer in this mix so that’s why i kind of think of it as similar to escitalopram with just a few additional problems so the additional problems fda said you can’t exceed 40 milligrams per day of citalopram because it’s not effective and it’s just a higher risk and they say don’t
Exceed 20 so those patients are patients older than 60 who are poor cyp2c19 metabolizers and the other problematic thing that the r-enantiomer causes is it has mild antihistaminergic properties um the r-enantiomer also can interfere with the s enantiomers that kind of means that it alters the dose effect curve
So as you get higher it’s not um because the r-enantiomer interacts with the s enantiomer and makes it so it kind of has a that still brings known for it has some favorable findings in the elderly so if i did give a one-liner celexa is basically escitalopram plus the problematic enantiomer that’s got a little
Bit of antihistamine and causes more qtc problems
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What Are The Differences Between SSRIs (Sertraline, Escitalopram, and Citalopram) By Psychofarm
