Antidepressants - Escitalopram, Fluoxetine, Sertraline

The antidepressant drug is a source indicated in the treatment of psychiatric disorders in the state of mind and mood. Despite its name, the depression is not its only indication.

Antidepressants can also be used in other psychiatric disorders such as bipolar disorder, anxiety disorders, obsessive-compulsive disorder, post traumatic stress, and even organic diseases such as fibromyalgia and premenstrual syndrome.



The first antidepressants were discovered in the middle of the 20th century. Over time, new classes of antidepressants were being developed, as well as side effects reduced and its use spread. In European countries about 3-7% of the population routinely use some type of antidepressant drugs.

No one knows the exact causes of depression, but the concentration of certain brain chemicals, called neurotransmitters, are involved in this process. The main ones are serotonin, norepinephrine and dopamine. The action of different antidepressants passes through the regulation of these substances.

My goal is to write a textbook of pharmacology, specifically about antidepressants. I will mention the main classes and make some comments about the side effects and interactions of the most prescribed antidepressants in the world. A lot of confusion can appear when the leaflet is read by medical laymen, and fear of developing some of side effects described is often the cause of patient's abandonment of treatment. People should understand how antidepressants work and pay attention to the most common adverse consequences.

To avoid a very long text, I will divide it into parts. In the first part the selective reuptake inhibitors (SSRIs) are discussed. Later I will expand on the tricyclic and tetracyclic antidepressants, the serotonin reuptake inhibitors / norepinephrine, MAO inhibitors and atypical antidepressants.

Selective reuptake inhibitors (SSRI)

  • Fluoxetine (Prozac, Daforin, Prozen, Psipax)
  • Sertraline (Zoloft, Assert, Serpax)
  • Paroxetine (Seroxat, Dropax, Paxil, Benepax, Pondera, Parox)
  • Citalopram (Celexa, Cipramil, CittaCipram, Procimax)
  • Escitalopram (Cipralex, Lexapro)

SSRIs are the most prescribed class of antidepressants in the world. They are relatively new drugs - the first drug of this class, fluoxetine, Prozac famous, began to be marketed in 1987 - safe even at high doses, well tolerated and has amild side effect profile.

Do inhibitors act as selective serotonin reuptake inhibitors (SSRIs)?

Serotonin is a neurotransmitter, a substance involved in neurons connection, associated with regulation of mood, emotion, sleep and appetite. The selective serotonin reuptake prevents the removal of serotonin from the synaptic cleft, where this neurotransmitter exerts its actions. Thus serotonin remains available for a longer time, leading to improvement in patients' mood.

Like any antidepressant drug, it takes at least two weeks to begin taking effect of selective reuptake inhibitors and up to 8 weeks to reach their full potential.

The main adverse effect of this class is sexual dysfunction, including decreased libido and difficulty in achieving orgasm, which is why these drugs can be used in the treatment of premature ejaculation. Other common side effects include nausea and insomnia.

This class of antidepressants should be used with care by young people under 24 years due to a higher incidence of suicidal thoughts in the first weeks of treatment. There is also an increased risk of bleedings, which makes undesirable the combination of anticoagulants such as warfarin, and antiplatelet agents such as aspirin or clopidogrel.

You should never use any antidepressant SSRI with MAO inhibitors. It must always be an area of at least 14 days between the use of each of them. This combination can be fatal.

Fluoxetine (Prozac, Daforin, Prozen, Psipax)

Its easy dosage of one tablet per day and the profile of mild adverse effects, especially when compared to existing drug at the time, made it quickly the 2nd most common drug sold in the U.S. during the early 90th and leading antidepressant in the world.

The effective dose of Fuoxetine is 20 mg per day, enough to keep up to 80% of cerebral serotonin acting longer. It is important to remember that clinical effect only starts to be relevant from the 3rd week of use. For patients who do not respond till the sixth week the dose may be progressively increased to a maximum of 80 mg per day. When suspended, Fluoxetine remains viable in the circulation for over 4-6 days, the drug in this class with higher half-life.

Since there is a new formulation of Fluoxetine can be taken 1X per week.

The most frequent side effects of Fuoxetine are nausea, insomnia, decreased libido, delayed ejaculation, tremors, decreased appetite, fatigue and anxiety. In general symptoms that arise at the start of treatment disappear with time. If the changes do not improve sex, buspropiona or buspironein combination with it usually solve the problem.

Medicines should not be used in combination with Fluoxetine (SSRIs and others) without medical authorization including: alcohol, opioid analgesics, warfarin, carbamazepine, anti-inflammatory drugs, sibutramine, tamoxifen, tramadol, phenytoin, antidepressants.

Sertraline (Zoloft, Assert, Serpax)

Sertraline is an antidepressant, which has been in the market since 1992. Its effective dose is 50mg/day, may be increased to 200mg/day. The profile of Sertraline is very similar to Fluoxetine, so I will highlight only the significant differences.

Side effects are similar, however, complaints of nausea tend to be more common with Sertraline than with other SSRI antidepressants. However, Sertraline (Zoloft) appears to have a rate of success in treating depression upto 40% greater than fluoxetine.

Paroxetine (Seroxat, Dropax, Paxil, Benepax, Pondera, Parox)

Paroxetine was released after Sertraline, in 1993. The dosage ranges from 20mg/day to 50mg/day.

Unlike Fluoxetine and Sertraline that can cause anxiety and agitation Paroxetine often cause drowsiness. Sexual dysfunction appears to be more frequent with Paroxetine when compared with other SSRIs. Symptoms of dry mouth and weight gain are also common with this drug.

Despite the worst adverse event profile, Paroxetine appears to be the most effective antidepressant in this class.

Citalopram (Celexa, Cipramil, Citta Cipram, Procimax)

Its main characteristic is that have fewer side effects of a sexual nature. It also seems to be the best antidepressant for patients with this class to anxiety associated. The dose of citalopram is 20mg/day, can reach up to 60mg/day.

Escitalopram (Cipralex, Lexapro)

Launched in 2001, is a derivative of Escitalopram and Citalopram with increased power of action. 10 mg of Escitalopram have the same effects 40 mg Citalopram. Its recommended dose varies between 10mg/day and 20mg/day.

However, when taken in doses equivalent, Escitalopram has the same efficacy and side effect profile as Citalopram.
Depression drugs
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User discussion

25 March 2012
Hello! Can a child be born healthy if the mother in the first month of pregnancy was taking "Cipralex"? The instruction says that pregnant women should avoid this drug, but I learned of the pregnancy only after 5 weeks of pregnancy. How will this affect the baby if the pregnancy is saved? I'd like to give birth to a healthy baby! Thank you in advance for your reply!
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06 April 2012
I am 13 years old and I am suffering from fears: when I go out of the apartment, shut it, go to the elevator and then suddenly I get stricken with panic - have I locked the door or not?Also when I come to school, I sometimes do not feel my clothes and get the feeling that I am completely naked. Should I consult a doctor?
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