Newer Antidepressants And Serotonin Syndrome

Kirk C. Mills

General., Principles.of NewerAntidepressanlS Trazodone

AcuteOverdose, Toxicity


Nefazodone Treatment

Bupropion Toxicity Treatment


Selective Seroton}n..Reupta.kenlnh.i.bitors

AcuJisoverdose Toxicity Treatment


AcuteOverdose Toxicity


Serotonin.., Syndrome Chapter, References

The newer antidepressants are commonly referred to as atypical, heterocyclic, or second-generation antidepressants to distinguish them from monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). This distinction is important because newer antidepressants are more selective in their pharmacologic activity and have drastically different toxicologic behavior than MAOIs and TCAs. As a group, the newer antidepressants are the most popular form of psychopharmacologic therapy for the treatment of major depression. In addition, they are also commonly prescribed in the treatment of many other psychiatric disorders such obsessive-compulsive disorder, panic disorders, and eating disorders. Although none of the newer antidepressants have been labeled by the Food and Drug Administration for use in children, their use in adolescents and older children is not uncommon.

Emergency physicians are increasingly challenged to evaluate patients who have taken these newer antidepressants. Questions commonly arise as to the extent of management needed to treat these patients appropriately. Therefore, the newer antidepressants are discussed individually in this chapter, highlighting specific treatment recommendations. Importantly, all antidepressants, especially the MAOIs and selective serotonin reuptake inhibitors (SSRIs), have the potential to produce the serotonin syndrome, a recently recognized drug-induced disorder, which is discussed at the end of this chapter. The newer antidepressants that are discussed in this chapter include trazodone (Desyrel), nefazodone (Serzone), bupropion (Wellbutrin), mirtazapine (Remeron), venlafaxine (Effexor), and the SSRIs: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram (Celexa).

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