TY - CHAP M1 - Book, Section TI - Serotonin Reuptake Inhibitors and Atypical Antidepressants A1 - Stork, Christine M. A2 - Nelson, Lewis S. A2 - Howland, Mary Ann A2 - Lewin, Neal A. A2 - Smith, Silas W. A2 - Goldfrank, Lewis R. A2 - Hoffman, Robert S. PY - 2019 T2 - Goldfrank's Toxicologic Emergencies, 11e AB - In the United States, major depressive disorder is a leading cause of disability and affects 15.7 million American adults; representing 6.7% of all US adults in 2015.97 Although major depressive disorder can develop at any age, a higher percentage of 15- to 25-year-old adults are found to have depression, and women are affected nearly twice as often as men. The exact etiology of depression and the mechanism by which increased serotonergic and norepinephrine neurotransmission modulates mood remain unclear. A complex interaction of genetics and altered serotonin neurotransmission along with alterations in brain-derived neurotrophic factor, neurotrophin-3, dopamine, norepinephrine, and excitatory neuronal pathways likely have a role in depressive disorders.119 Although termed selective serotonin reuptake inhibitors (SSRIs), these antidepressants have complex pharmacologic effects and interact with a number of other receptors and neurotransmitters. The class of SSRIs includes citalopram, escitalopram (citalopram’s active enantiomer), fluoxetine, fluvoxamine, paroxetine, and sertraline (Fig. 69–1). Atypical antidepressants extend the pharmacologic principles of SSRIs to achieve beneficial effects for patients with depression. The SSRIs and atypical antidepressants comprise the current standard for the treatment of depression.70 The SSRIs also are used to treat anxiety disorders, insomnia, chronic pain, panic disorders, social phobia, fibromyalgia, migraine, obsessive–compulsive disorders, bipolar disorders, premenstrual syndrome, menopausal symptoms, nicotine dependence, attention deficit hyperactivity disorder (ADHD), posttraumatic stress disorder, sexual dysfunction, digestive system disorders, urinary system disorders, and bulimia nervosa.10,110,116,125 They have excellent safety profiles compared with previous antidepressants such as monoamine oxidase inhibitors (MAOIs) and the cyclic antidepressants (Cas) (Chaps. 68 and 71). Similar to many xenobiotics, the appropriateness of their use, their effectiveness, and the associated morbidity and mortality have made their use increasingly controversial as the patient population, especially those at the extremes of age, and the comorbidity profiles of those using the SSRIs are expanding. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1163014335 ER -