Citalopram is a highly selective and potent SSRI with minimal effects on the neuronal reuptake of norepinephrine (NE) and dopamine (DA). Citalopram is a dicyclic phthalide derivative and its effect is due to a specific inhibition of the re-uptake of serotonin in the brain ( Stahl 1994). Inhibition of the neuronal transporter for serotonin has long been established as one of the mechanisms of action of numerous antidepressants ( Barker 1995). However, head-to-head comparisons have provided contrasting findings ( Cipriani 2006). SSRIs are generally more acceptable than TCAs, and there is evidence of similar efficacy ( NICE 2010). During the last 20 years, ADs prescription has dramatically risen in western countries, mainly because of the increasing prescription of SSRIs which have progressively become the most commonly prescribed ADs ( Ciuna 2004). Amongst ADs many different agents are available, including tricyclics (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs, such as venlafaxine, duloxetine and milnacipran), and other agents (mirtazapine, reboxetine, bupropion). Although pharmacological and psychological interventions are both effective for major depression, in primary and secondary care settings antidepressant (AD) drugs remain the mainstay of treatment in moderate to severe major depression ( APA 2006 NICE 2010). This condition is associated with marked personal, social and economic morbidity, loss of functioning and productivity, and creates significant demands on service providers in terms of workload ( APA 2000 NICE 2010). It was the third leading cause of burden among all diseases in the year 2004 and it is expected to be the greatest cause in 2030 ( WHO 2006). Major depression is generally diagnosed when a persistent and unreactive low mood and/or loss of interest and pleasure are accompanied by a range of symptoms including appetite loss, insomnia, fatigue, loss of energy, poor concentration, psychomotor symptoms, inappropriate guilt and morbid thoughts of death ( APA 1994).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |