What Are The Differences Between SSRIs (Sertraline, Escitalopram, and Citalopram)
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- Äas pĆidĂĄn 4. 06. 2024
- Discover What are the Differences Between SSRIs like Sertraline, Escitalopram, and Citalopram.
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The video delves into the differences between various SSRIs (Selective Serotonin Reuptake Inhibitors): sertraline (Zoloft), escitalopram (Lexapro), and citalopram (Celexa). It emphasizes how understanding their pharmacokinetic and pharmacodynamic properties can inform clinical practice. Sertraline blocks dopamine active transporter (DAT) and sigma one receptors, making it mildly activating and suitable for atypical depression but potentially causing overactivation in panic disorder. Escitalopram is noted for its purity, hitting only serotonin receptors, making it well-tolerated with minimal side effects and fast onset of action. Citalopram, a racemic mixture including escitalopram's less active enantiomer, carries risks of QTC prolongation, particularly with higher doses or in certain patient populations. Despite similarities between escitalopram and citalopram, escitalopram is preferred due to its superior efficacy and tolerability. The video also discusses off-label uses, FDA approvals, and unique properties of each SSRI, such as sertraline's efficacy in anxiety and escitalopram's suitability for children. It also speculates on cultural references like Kanye West's potential use of Lexapro. Overall, it highlights how understanding the nuances of SSRIs can guide antidepressant selection based on individual patient needs and characteristics.
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#psychopharmacology #psychnp #psychnp
There is an updated version of this video here: czcams.com/video/ayz4xmTk_Y8/video.html
what is lating is dumb left is better :D
Really great content. I've watched all of the videos so far and find them really helpful. I started an educational blog (Bullet Psych) and in my weekly newsletter I have been referring my readers to your videos because I think they're so great. Keep up the good work!
EscitaloprĂĄm is the best. Most relaxing and less side effects.
Better than Citalopram for beginners? Please help
Hello, I would like to suggest videos about benzodiazepines and antihistamines. Your channel is great!!
WAVY DUDE!!!!! love your channel. hope your channel is never going to fail.
we on a ultralight beam
@@PsychoFarm listen to donda? Views?
Wish he would focus more on less ideas so it felt more cohesive ala MBDTF, but that scatteredness also seems to reflect his mental state/public persona. I find everything he does interesting.
@@PsychoFarm Yeezus and graduation probably gotta be my two fav albums
Zoloft was the most commonly prescribed antidepressant in the USA in 2018 with over 38 million prescriptions.
Loved the video very informative could follow along easily and delivered alot of good information
Wow dude, this is amazing explanation. Thank you.
Thank you for this mate you did a good job⊠đđŒ
hey pyschofarm, ive had 2 seperate cases of severe panic disorder for about 3 years on and off, i used to take lexapro on the smallest dose, 2.5mg and then 5mg and it really helped me overcome my disorder completely the first time (end of 2019 into 2020) but when i got panic disorder a second time (end of 2020) from smoking weed, I noticed not much of an impact on the same dose 2.5mg but i was told multiple times to up my dose for it and i was too scared to so i quit the medication cold turkey, and got insane migraines/headaches (thinking someting in my head was gonna pop it was so bad) as a withdrawal i think and for the past year Iâve been medicine free but I still get panic attacks everyday (heart races everyday nonstop, evil bad thoughts), and Iâm ready to get back on something, my doc prescribed me celexa but Iâm very unsure about trying it Bc Iâve been so used to take lexapro and Iâm just wondering what ur opinion would be, thank u so much for the video also u rock!!
Hi, i been to Fluvoxamine but my doctor prescribed me EscitLopram, i have problem with escitLopram, can i use citalopram for initially? Please help
I would like to find an antidepressant with the fewest side effects but also treats severe panic disorder. Lexapro seems to have the fewest but Zoloft seems to be effective for panic disorder, according to the fda at least.
I hope you're right and zoloft is going to help me. Going through horrible anxiety and depression after my doctor prescribed me bupropion xl which made me feel way worse. I've tried all these other meds too. They work awhile then quit.
Helped you?
RS naming is about the priority direction. + / - is about light rotation
Good catch, it's been a minute since organic chemistry. Thanks.
5:50 what do you mean by it âflipped kanye into maniaâ lexapro made him crazy?
Please do one on trintellix and Effexor
YESSSSSS Iâd love to learn about trintellix. Iâve taken pretty much every antidepressant out there. Trintellix makes me so nauseous but at least I can orgasm (after a LOT of trying lol)
I liked this video but it seems like the audio is on 1.5 or 1.25 speed for the voice! Made it harder to follow. My suggestion if you are watching this, go to your settings and reduce it to 0.75 playback speed.
I was on Paxil 4 years, then lexapro like 16 years or so.
I have been told by my doctor ssri likely no longer do anything for me. Yet, I can never come off it.
I have tried to twice. One time ended up in month, losing 20 lbs, did not feel normal. Ended up in a facility that re medicated me at higher levels with added medication gabapentin.
Other time went off, had a water cascade sensation down my neck and back. Needed therapy for over a year on my back part of neck. Just hate that I need to be on this rest of my life. Any advice so appreciated
Which is better for insomnia
SSRIâs achieved notoriety years ago when it was discovered that frequently they seemed to help patientâs more than talking therapy. SSRIs were celebrated in Peter Kramer's contemporary classic Listening to Prozac. Kramerâs book was remarkably honest for its time. The book was a discursive memoir by a therapist who is forced to admit that many of his clients seemed rapidly to fare far better on a pill than on his industrial-strength regimen of caring talk-therapy.
Science and medicine have advanced to where we now know that pharmacological intervention is initially necessary to boost the brainâs physical strength - much like a muscle. Once the âmuscle of the brainâ is strong enough for talk therapy, then - and only then - is the patient finally ready for Jungian Psychoanalysis and Behavioral Modification. So really, patients with tired brains are unable to profit from âphysical therapy of the mindâ, (talk therapy). First, the brain needs to acquire the strength necessary to undergo & profit from talk therapy.
The SSRIs all differ in their half-lives, chemical structure, and precise specificities. Their functional effects are broadly similar, though Prozac is the most activating, longest-lasting, least selective and most likely to provoke dose-related akathisia; paroxetine has anticholinergic and sedating antihistaminergic effects; fluvoxamine most commonly induces nausea and has the shortest half-life; and, citalopram is the most serotonin-selective (see citations 2 and 3 regarding heart warnings). The mood-brightening, resilience-enhancing and anti-anxiety properties of the SSRIs really can make a (very) modest percentage of the population feel âbetterâ. Unpredictably, other users feel worse. As a class, SSRIs (mostly) don't have the physically unpleasant and cognitively debilitating anticholinergic effects of the tricyclics. SSRIs don't demand the dietary restrictions of the MAOIs. Their dependence potential and withdrawal reaction is usually milder than the powerful opioids.
Overall, SSRIâs operate by blasting more serotonin through the system than any other neurotransmitter. The result is imbalance, a flat affect (which typically diminishes motivation and causes power imbalances among the social fabric of the patientâs life), neuroleptic malignant syndrome, galactorrhea, sleep bruxism, decreased vigilance & tired brain , extremely serious extrapyramidal reactions, and the plethora of other side-effects for which SSRIâs are known (including homicide & suicide).
It is important to realize that the efficacy of SSRIâs is somewhat less than that of even the older conventional antidepressants including the tricyclic antidepressants (TCAs). Two common problems limit the usefulness of SSRIs, at least when taken on their own. The problems stem from the indirect inhibitory effect sometimes exerted by SSRI style drugs on dopamine function, a consequence of deliberate selective targeting of the serotonin system. SSRIâs have a very poor performance record in the treatment of obsessive-compulsive disorder (OCD) which is believed to be related to its inhibition of dopamine in the mesocorticolimbic system. It has been theorized that SSRIâs causing a psychiatric emergency - Restless Leg Syndrome - is precisely a result of SSRI inhibition of dopaminergic systems; a condition corrected by bupropion (Wellbutrin).
As we already elucidated in the Mechanisms of Depression section of this text, this is precisely what clinicians should not be doing: limiting dopaminergic function of the mesocorticolimbic systems. Rather we learned that effective treatment requires that we augment the mesocorticolimbic dopaminergic systems! Part of the reason for the effectiveness of Nootropic class drugs is that they stimulate all the monoamines including norepinephrine, serotonin, and dopamine. Where many Nootropics enhances inter-hemisphere communication, SSRIâs such as fluoxetine (Prozac) impair it.
First, SSRIs can compromise libido and sexual performance, often times lingering long after cessation of the drug. SSRI-induced sexual dysfunction can still be a highly distressing phenomenon for older people too embarrassed to talk about it. These side-effects exacerbate one of the major signs of depression: loss of interest in sex and reduced libido. Proper treatment strategies must not induce sexual dysfunction. SSRI's have killed at least 800,000 patients in the USA since January 2000. If it werenât for the Citizens United case (the USA Supreme Court case permitting Congressional bribery by Corporations), and the fact that heads of pharmaceutical industries sit on the board of the U.S. FDA, there is little doubt that SSRIâs would have been banned outright years ago.
Second, though a few subjects may feel mildly euphoric, in time most patients succumb to a flat affect and loss of motivation in their lives. What many treating physicians have observed is that the flattening of the patients affect by SSRIâs will more often than not, subtly change the "balance of power" in personal relationships - for good or ill. In some cases, SSRIs may even act as thymoanaesthetisers which diminish the intensity of felt emotion, both positive & negative, giving way to a âflat affectâ. By contrast, a mood-brightening serotonin reuptake-enhancer like tianeptine (Stablon) may intensify positive emotion or sense of wellness & hope. Affective flattening may be welcome to someone in the pit of unmitigated clinical depression - But there are much better options light years ahead of SSRIâs. Succumbing to a flat affect is scarcely a life-enriching property.
A recent analysis cited the specific serotoninergic mechanisms associated with SSRIâs for making patients worse. The researchers also found tianeptine to resolve depression in these patients whose symptoms were worsened by SSRIâs.
By the late 1990âs, a backlash against SSRIs finally gathered enough pace to substantiate a flurry of lawsuits. In February 2008, a Public Library of Science meta-analysis of four commonly prescribed "second generation" antidepressants - using both published and withheld drug-company data - reported that SSRIs were scarcely more effective as antidepressants than placebos. The illustrious UK psychopharmacologist Professor David Healy delivers an even more damning verdict on contemporary psychiatry: "there is probably no other branch of medicine where the outcomes for a core disease are steadily worsening." [p. 95; Shock Therapy by Edward Shorter and David Healy (2007)] Today enormous class-action lawsuits are underway against the makers of SSRIâs - Soon to be filed against physicians prescribing them too!
In summary, the old concept of a single isolated monoamine system resulting in depression is no longer tenable. This concept was frightfully over simplistic. Today science has extensively mapped out how physical (organic/histological) alterations in a CNS ecosystem lead to multi-faceted chemical alterations and neurosis. Replacing a single monoamine creates a further imbalance to this delicate ecosystem along with extensive negative side-effects. On the other hand, proper treatment of this neurosis begins with regrowth of key structures of the mesocorticolimbic dopaminergic system.
In other words, the development and rationale for SSRI deployment were based upon a disproven myth. âThe science backing selective serotonin reuptake inhibitors, or SSRIs, as an effective remedy for increasing serotonin levels in the brain and helping depression sufferers achieve mental âbalanceâ is entirely nonexistent,â warns a prominent psychiatrist in a new peer-reviewed editorial published in the esteemed British Medical Journal (BMJ)⊠ââŠthe entire premise behind SSRIs and how they supposedly work is based on a myth.â Healy warns that the drugs, which have been linked to provoking both suicidal and homicidal tendencies in some users, have never been scientifically shown to balance anything in the brain. â
My man wrote a whole novel.
I was on sertraline 50-100-150mg for a while (maybe a year) but nothing really happened except tinnitus and a bit of a chattery jaw when I yawned lol but it didn't seem to help my "S.A.D" so I spoke to my doctor and she recommended changing to citalopram as a next option... its been nearly a year on 30mg now and once again all I'm seeming to gain is an addiction with random nervous system pulses if I forget to take them lol... not really sure what to do next... but these pills don't seem to be helping đđ any advice would be appreciated
Did you change it?
Can any of these help with sleep ?
Escitalopram only hits âSERT.â In laymenâs terms how would this be beneficial compared to others that target more...receptors is it?
less potential for sideeffects
@@hayom120 okay but isn't there some benefit in involving dopamine like Sertraline does or whatever?
@@EphesianRose there is some (potential) benefit, yes, but there are cases where you might not need that benefit. For example, let's say Zoloft was the car with a sunroof, and Lexapro was slightly less expensive with almost the same features (minus the sunroof). If you needed the car without the sunroof, you'd go for Lexapro, right? You could go for Zoloft "just because", but it would cost more money.
Problem is, a lot of psychiatrists either don't know how or don't care to actually get to know the nuances of each patient and learn what their condition is. So there isn't a lot of optimization in that regard. Sorry for the late reply!
@@deadmemelol Hey. Do you think Escitalopram is better than Zoloft for anxiety and depression? Thanks.
@@marijajankovic7360 hihi, I'm not a doctor so I cannot say definitively; however, both are considered some of the most effective antidepressants available. Escitalopram also usually has fewer side effects, so that might be a factor in your decision. Good luck :)
Does this medication cause TD âïžđ
wow mybe the first ever video where I had to turn down the playback speed
đ€Łđđ€Ł
I understand that all SSRIs can cause insomnia or sleep disturbances but do some fare better than others? I woke every two hours on Escitalopram.
Same escitalopram caused me insomnia have you tried sertaline?
@@sarayasser9089 Yes, no insomnia problems but the intestinal distress for which Sertraline is famous didnât abate after three months. Thankfully, my life normalized and I am doing well without meds.
@@skieser1
DO you mean sertaline didn't give you insomnia?
Iam on lexapro suffering from insomnia do you think if I switch to sertaline the insomnia problem will be solved ?
@@sarayasser9089 Yes, no insomnia at all from Sertraline. It just gave me diarrhea and stomach pains.
@@sarayasser9089 i canât promise you will get any relief from insomnia, some do, but that was not a side effect I suffered with this drug.
Thanks
some advice
I couldn't follow as you were talking too fast and using too many medical terms which lay people won't understand
What about prozac?
czcams.com/video/3G3titTu7is/video.html
Why does vocal fry bother me so much?
Because it's sometimes due to tiredness or laziness in your speaking
Me too. Make an effort to speak normal plzzzzzz
it seems serious but it's hard to trust with no information about who you are and "why" you're putting this much effort into this
I ask myself the same questions sometimes
6:05 do he say gay album?
Ye, short for Kanye
Slow down wen ya talk plz.lol