Selective serotonin reuptake inhibitors in affective disorders -II. Efficacy and quality of life

Abstract

Since their introduction, the selective serotonin reuptake inhibitors (SSRIs) have become one of the most widely used classes of medication in psychiatry. Their popularity is based on apparent efficacy over a wide range of disorders and a favorable side-effect profile. However, as with any psychotropic medication, considerable data are required to define where a drug works and where it does not. There is now a wealth of evidence demonstrating that SSRIs may differ in their efficacy profiles in certain depressive symptoms, in different subtypes of depression, with respect to their ability to maintain efficacy over time, on broader outcomes such as quality of life, and in the consistency of the usually effective minimum therapeutic dose across the age spectrum and across indications. Although this review includes data on all SSRIs, it focuses on fluoxetine and sertraline, which in addition to being the most widely used SSRIs are also the most widely studied. The relative quantity and quality of data on these two SSRIs means that it is possible to make relatively firm inferences regarding their differential effects on affective symptoms and quality of life.

SSRIs and cognitive performance in a working sample

“…Both beneficial (Levkovitz et al, 2002;Harmer et al, 2004;Zobel et al, 2004) and detrimental (Masand and Gupta, 1999;Schmitt et al, 2001;Joss et al, 2003) effects have been reported. In part, this may be due to the differing pharmacological, and hence specific cognitive effects, or individual SSRIs Goodnick and Goldstein, 1998). It was not possible to pursue this in the current study because of the small numbers involved.…”

Activation of septal 5‐HT1A receptors alters spatial memory encoding, interferes with consolidation, but does not affect retrieval in rats subjected to a water‐maze task

“…Our findings might have some relevance to approaches relying upon the modification of serotonergic functions in the brain for treating disorders such as e.g., depression, anxiety, or post-traumatic stress. Concerning depression, for instance, selective serotonin reuptake inhibitors (SSRI) have the best safety record among the different therapeutic options (van Laar et al, 2002), but there is a literature reporting on possible SSRI-related memory problems (Goodnick and Goldstein, 1998;Joss et al, 2003;Wadsworth et al, 2005). Although these memory problems could be related to various confounding factors (subject's history, age, existence of age-related cognitive dysfunctions.…”

Psychotropic medication use and accidents, injuries and cognitive failures

“…However, most studies have concluded that SSRIs have fewer adverse effects (Nutt, 2003;Hindmarch, 1995), both in the short-and long-term (Cassano and Fava, 2004), are relatively free from cognitive and psychomotor effects (Hindmarch 1995) and do not impair driving performance (Hale, 1994). The side-effect profiles of individual SSRIs do, of course, vary Goodnick and Goldstein, 1998), as do their specific effects on cognitive function (Oxman et al, 1996). In this study fluoxetine and paroxetine were most commonly used, but individual analyses were not possible because of small numbers.…”