How Prozac "Fluoxetine" has changed the handling of depression
Prozac®, the flagship drug of the 1990s, was nicknamed the "happy pill".
It is truthful that this antidepressant therapy is directly i of the most widely prescribed in the world. As the leader of a novel course of antidepressants, Prozac® has been a keen success amongst full full general practitioners.
However, it directly off faces contest from other more recent molecules.
Until the early on 1990s, effective antidepressants were available to people amongst low, just they were relatively hard to traveling bag likewise sometimes caused side effects.
As a upshot, total full general practitioners were reluctant to process the depressed in improver to readily turned to psychiatrists. This all changed with the advent of Prozac®.
Well tolerated, supported by a real active marketing policy, this drug was rapidly widely prescribed, a success which explains why its consumption was considered excessive past sure experts such as Prof. Edouard Zarifian.
Prozac: the arrival of a rubber antidepressant
Like other antidepressants, Prozac® tin cutting downwards the feelings of sadness besides equally low that characterize depressed people, provided that the treatment is delayed for a few weeks in add-on to continued for a sufficient catamenia of fourth dimension, unremarkably half-dozen months.But more than its efficacy, which actually seems somewhat less than that of previous generations of antidepressants, it is its condom of function that is of interest.
Because Prozac® has niggling or no result on other encephalon mediators such every fleck acetylcholine, it does not movement dry out oral fissure, prostate problems or lower blood pressure.
Prozac® is composed of fluoxetine, a heart that well-nigh entirely inhibits the reuptake of serotonin, a encephalon neurotransmitter.
It thence increases the concentration of serotonin inward the neurons. It has been shown that depressed patients have a lower concentration of serotonin degradation products inwards the cerebrospinal fluid (surrounding the encephalon).
Numerous medical studies have shown that fluoxetine reduces depressive symptoms also likewise reduces the severity of other mental disorders, obsessive-compulsive disorder, together alongside bulimia.
In improver, it has depression toxicity, particularly to the centre, making it suitable for cardiac patients, the elderly or those taking any medications. In the depressed, inward whom the take a chance of suicide is ever acquaint, this is also a reassuring chemical element.
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Nevertheless, apart from its effectiveness, which is sometimes insufficient in severe depressions, Prozac® has a few drawbacks.For example, its direction may crusade nervousness or insomnia in patients or fifty-fifty an episode of overexcitement.
Conversely, it may cause drowsiness, an result that should live warned to motor vehicle drivers. Minor digestive disturbances (nausea, constipation) as well every bit skin rashes have also been reported.
Finally, Prozac® requires merely nigh precautions for office inwards people amidst epilepsy, diabetes, liver affliction, or those receiving oral anticoagulants.
Serotoninogens are the start antidepressants prescribed in the metropolis
The success of Prozac® could non get unnoticed past other pharmaceutical companies likewise as many other fluoxetine-similar molecules acting past the same machinery before long appeared on the market place.
Within a few years, serotoninergic, ane.e. substances that increase the center of serotonin inwards the fundamental nervous system, became the beginning form of antidepressants delivered past doctors practicing inwards cities, in addition to the prescription of antidepressants doubled inward 5 years (from 1992 to 1997) in France.
Other serotonergic drugs available include sertraline (Zoloft®), paroxetine (Deroxat®), fluvoxamine (Floxyfral®) inwards add-on to citalopram (Seropram®).
These antidepressants differ inward their pharmacological characteristics together alongside almost accept other indications such equally anorexia, social phobia...
The advent of dual-action antidepressants
More recently, other antidepressants take been developed that deed on ii neurotransmitters: serotonin, such every bit Prozac, in addition to norepinephrine.This is the case amidst milnacipran (Ixel®) as well equally venlafaxine (Effexor®).
This dual-activeness could let these drugs to live more than effective than Prozac® inward add-on to comparable to tricyclics (which are considered the reference antidepressants) spell maintaining the good tolerance of serotonergic antidepressants. However, their side effects are likewise greater.
Prozac is currently available inward capsule form or every flake a potable solution besides as about depressants answer to the twenty mg daily dose, which is one capsule alone, to live taken amidst or without meals.
Others call for two or even iii capsules depending on the indication. Reimbursed at 65% by Social Security, the price of Prozac is 9.17 euros for fourteen capsules.
Which antidepressants should I accept?
In the absence of a demonstrated divergence in efficacy betwixt the different types of antidepressants, the pick is made according to the patient'sec efficacy, tolerance, together with preferences. The French National Authority for Health (HAS) recommends In 1st intention, because of their ameliorate tolerance:
- Selective serotonin reuptake inhibitors (SSRIs);
- Serotonin too norepinephrine reuptake inhibitors (SNRIs);
- Three "other antidepressants" (of dissimilar pharmacological mechanism): mianserin, mirtazapine, as well as vortioxetine;
The second line of work, because of their take chances of cardiovascular toxicity, the imipramine (tricyclic) antidepressants;
In the tertiary task, agomelatine because of its hepatic toxicity in improver to tianeptine which carries a take chances of abuse in improver to dependence.
As a concluding resort, because of their numerous adverse effects together amongst drug interactions, monoamine oxidase inhibitors (MAOIs), only later on on failure of other alternatives.
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