SSRIs, SNRIs and SSNRIs: clinical guideline by the ACP

The American College of Physicians has issued a Clinical Practice Guideline about the use of Second-Generation Antidepressants in the treatment of Depressive Disorders. The recommendations that arise from it are the following:

Recommendation 1: The American College of Physicians recommends that when clinicians choose pharmacologic therapy to treat patients with acute major depression, they select second-generation antidepressants on the basis of adverse effect profiles, cost, and patient preferences (Grade: strong recommendation; moderate-quality evidence).

Recommendation 2: The American College of Physicians recommends that clinicians assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy (Grade: strong recommendation; moderate-quality evidence).

Recommendation 3: The American College of Physicians recommends that clinicians modify treatment if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder (Grade: strong recommendation; moderate-quality evidence).

Recommendation 4: The American College of Physicians recommends that clinicians continue treatment for 4 to 9 months after a satisfactory response in patients with a first episode of major depressive disorder. For patients who have had 2 or more episodes of depression, an even longer duration of therapy may be beneficial (Grade: strong recommendation; moderate-quality evidence).

Second generation antidepressants include: selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], also named selective serotonin norepinephrine reuptake inhibitors [SSNRIs].

SSRIs:

citalopram (Celexa, Cipramil, Dalsan, Recital, Emocal, Sepram, Seropram), escitalopram (Lexapro, Cipralex, Esertia), fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin (EUR), Fluox (NZ), Depress (UZB), Lovan (AUS)), fluvoxamine (Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox), paroxetine (Paxil, Seroxat, Sereupin, Aropax, Deroxat, Rexetin, Xetanor, Paroxat), sertraline (Zoloft, Lustral, Serlain), zimelidine (Zelmid, Normud),

SNRIs and SSNRIs:

venlafaxine (Effexor XR, Effexor), desvenlafaxine (Pristiq), nefazodone (Serzone), milnacipran (Dalcipran/ Portugal; Ixel/ France), duloxetin (Cymbalta), bicifadine

Source: Using Second-Generation Antidepressants to Treat Depressive Disorders: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine

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