May 29, 2023

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

Transcribed from video
What Are The Differences Between SSRIs (Sertraline, Escitalopram, and Citalopram) By Psychofarm