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According to a recent survey1 of the most common reasons for patient visits to family physicians in the United States, depression and anxiety ranked 11th and 17th, respectively.

Ten to 20 percent of adults in the United States experience depression at some point in their lifetime.2 Many antidepressants have been released in the United States over the past two decades.

Selective serotonin reuptake inhibitors have become the drugs of choice in the treatment of depression, and they are also effective in the treatment of obsessive-compulsive disorder, panic disorder, and social phobia.

Mirtazapine, which is unrelated to the selective serotonin reuptake inhibitors, is unique in its action—stimulating the release of norepinephrine and serotonin.

This article is an update of information about the newer agents for depression and new indications for older antidepressants.

Selective serotonin reuptake inhibitors (SSRIs) have replaced tricyclic antidepressants as the drugs of choice in the treatment of depressive disorders, mainly because of their improved tolerability and safety if taken in overdose.

The newest indication for sertraline is the treatment of PMDD.

Sertraline has been shown to improve quality-of-life scores and psychologic and behavior symptoms in patients with PMDD.1516 [Reference 15—Evidence level A, RCT] Its effectiveness has been demonstrated with both continuous dosing throughout the month and luteal-phase dosing.

New indications for selective serotonin reuptake inhibitors include post-traumatic stress disorder, premenstrual dysphoric disorder, and generalized anxiety disorder.It is the only SSRI that is FDA-approved specifically for the treatment of depression in patients who are 65 years of age or older.6 A starting dose of 10 mg per day is preferred in elderly patients, with subsequent titration to 20 mg per day or more.Dosages of 20 to 40 mg per day are commonly required for the treatment of depression; 60 to 80 mg per day may be necessary for the treatment of bulimia and OCD7 .SSRIs block the reuptake of serotonin (5-HT) into the presynaptic nerve terminal, thereby enhancing serotonin neurotransmission, which presumably results in their antidepressant effects.Although this is the predominant mechanism of action of this class of drugs, each SSRI has a slightly different pharmacologic profile that leads to its distinct clinical activity, side effects, and drug interactions.3 Six SSRIs are currently marketed in the United States; five of them have been approved by the U. Food and Drug Administration (FDA) for the treatment of depression Costs are average wholesale prices for 30 days of the lowest-dose therapy from Red Book. J.: Medical Economics Data, 2002, rounded to the nearest dollar.

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