Posted by SLS on August 10, 2008, at 15:44:11
In reply to Re: What is the best SSRI in our opnion?, posted by dcruik518 on August 10, 2008, at 11:48:26
> Regarding Prozac: it is one of the worst SSRI's in terms of metabolism because they're are a significant number of caucasians who lack the ability to properly metabolize the cyp450 enzyme. Paxil is the other SSRI susceptible to this problem. OFten people who esperience extreme anxiety on low dose Prozac actually have liver problems and are suffering from Serotonin syndrome. In my opinion Zoloft is the most effective SSRI, mainly because it is good for so many different things, but also because also it has has a little known but significant dopamine reuptake inhibition effect, thus preventing the flattening of affect so common with the other SSRI's.
Also: Prozac is a more potent 5-HT2c antagonist than it is a reuptake inhibitor. At lower dosages, the 5-HT2c receptor antagonism prevails, and produces activation and agitation. This often disappears at higher dosages. Steven Stahl describes this in a Medscape article, but doesn't specify what he considers to be a low dosage. This same phenomenon is seen with Geodon. For both drugs, it is recommended to begin at the therapeutic target dose, i.e. 20mg for Prozac and 40mg for Geodon.