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Re: Info on Celexa/citalopram

Posted by Elizabeth on March 28, 1999, at 4:38:44

In reply to Re: Info on Celexa/citalopram, posted by Mark on March 25, 1999, at 6:21:57

> It's probably not more effective than other
> antidepressants. It is thought to be the
> most Serotonin selective of the SSRI's
> (Prozac, Paxil, Luvox, Zoloft, Celexa) which
> means only that it is likely to have less side
> effects. So, in general, it is good, likely
> to be no better than other antidepressants
> (though likely to not be worse), and thought to
> have SLIGHTLY less side effects and better
> tolerability than the other SSRI's.

Well, the side effect thing has always been the main selling point of the SSRIs (that and their safety). It does seem that they work for some kinds of depression for which tricyclics are not very useful (like atypical depression and dysthymia), without the food-drug and drug-drug interactions of the MAO inhibitors, which is pretty nice. (Social phobia and bulimia nervosa are two other disorders for which SSRIs may prove something of a substitute for MAOIs.) And they're the first antidepressants to help much with OCD.

I'm not so convinced that more selective = fewer side effects, though. Paxil (which used to hold the "most selective" title in the U.S. until we got Celexa) seems to cause just as many side effects as Prozac, Zoloft, or Luvox, and I hear more stories of people gaining a lot of weight on Paxil than any of the other SSRIs. (Yeah, I know the official story is that they cause weight loss.) It does seem that Paxil is more likely to be sedating than Prozac or Zoloft, but it's not clear if that has anything to do with its greater "selectivity." I'm pretty amazed at the amount of hype that Celexa has managed to generate. I'd be much more excited if some of the novel European antidepressants (brofaromine, minaprine, tianeptine, etc.) started getting approved here.
It seems to me that the best thing about the SSRIs, side effects-wise, is not so much that they target serotonin, as that they don't bind to alpha-1, histaminergic, and muscarinic cholinergic receptors - that seems to be the source of most of the tricyclics' side effects.

Mirtazapine is certainly the most interesting of the new antidepressants (IMHO), but it carries the curse of a reputation for causing weight gain, which people (women especially - that's two-thirds of diagnosed depressives) just hate.

Having concluded that the available antidepressants were just not working for me (my last antidepressant trial involved Parnate combined with amoxapine), I ended up looking elsewhere even though what I have is clearly depression (well, and panic disorder, but that's been much easier to fix). Anticonvulsants, antipsychotics, and stimulants were a bust too, but opioids seem to have some promise. (Now if only I could sleep properly....)

So, what do people think that the next big advance in drug therapy for depression will be?




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