Proximity Switch

The most important group of antidepressants on the market in recent years is the selective serotonin reuptake inhibitors (SSRIs). The six SSRIs available in the United States are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft). The primary use of so-called SSRIs include unipolar depression and bipolar and all anxiety disorders. However, controlled studies support the use of SSRIs in the treatmentother psychiatric disorders, including dysthymia, premenstrual dysphoria, bulimia and obesity, borderline personality disorder, alcoholism, rheumatic pain, headaches and migraines.

Among known as SSRIs, there are more similarities than differences. Although all SSRIs have a similar mechanism, each SSRI has a slightly different pharmacological and pharmacokinetic properties. This leads to differences between the so-called SSRIs in their half-life, clinical activity, sideeffects and interactions with other drugs. There are differences between SSRIs, which may be clinically relevant.

The first drug class was the SSRI Prozac (fluoxetine), which is pressing the U.S. market in 1987. Prozac is FDA approved December 29, 1987. E 'produced by Eli Lilly and Company.

Zoloft (sertraline hydrochloride) was the second SSRI to reach the American market, and was approved by the FDA December 30, 1991. Zoloft, manufactured by PfizerInc.

Paxil (paroxetine hydrochloride) was the third SSRI to reach the American market and is approved by the FDA December 29, 1992. Paxil manufactured by GlaxoSmithKline.

Luvox (Fluvoxamine maleate) was followed SSRI FDA has approved the 05 Maggio, 1994, but now his status as a marketing "and not".

Celexa (citalopram hydrobromide) was approved by the FDA July 17, 1998. Celexa is manufactured by Forest Pharmaceuticals Inc.

Lexapro (escitalopramoxalate) is the newest and most selective of the so-called SSRIs have been approved by the FDA August 14, 2002. Lexapro is manufactured by Forest Pharmaceuticals, Inc. Lexapro is a cleaner, improved version of Celexa.

Mechanism

The brain communicates with itself by means of special chemicals called neurotransmitters such as serotonin and norepinephrine. Neurotransmitters carry signals from one nerve cell to another. Low levels of serotonin and norepinephrine did notshown to cause depression, but the general perception that the revolt of these substances is associated with improved mood in depressed people.

All SSRIs have the same general mechanism. SSRIs seem to relieve the symptoms of depression by blocking the reabsorption (reuptake) of serotonin in certain nerve cells in the brain. This leaves more serotonin available, which increases the transmission (transmission of nerve impulses) and improves the mood. Over time, the volume of natural resourcesserotonin will rise again, and in some cases, SSRIs reduced or withdrawn.

Approved indications and uses

SSRIs have been used primarily to treat depression and had studied in several indications outside of depression.

Celexa (Citalopram) is indicated for the treatment of:
depression

Lexapro (escitalopram) is indicated for the treatment of:
severe depression
generalized anxiety(GAD)

Paxil (paroxetine) is indicated for the treatment of:
severe depression
obsessive-compulsive disorder (OCD)
Panic Disorder
social anxiety
generalized anxiety
post-traumatic stress disorder (PTSD)

Prozac (fluoxetine) is indicated for the treatment of:
severe depression
Obsessive-Compulsive Disorder
moderate to severe bulimia
Panic Disorder
In January 2003, Prozacwas approved by the FDA for the treatment of depression and OCD in children and adolescents aged 7 to 17 years.

Zoloft (sertraline) is indicated for the treatment of:
severe depression
Obsessive-Compulsive Disorder
Panic Disorder
posttraumatic stress
Menstrual Dysphoric Disorder (PMDD) in adults diagnosis (latest data available)
social anxiety

Efficiency

Clinical trials comparing an SSRI with a secondSSRIs suggest that drugs in this class are equally effective. Each SSRI produces about 60% of an overall response rate (ie a reduction of at least 50% of symptoms after treatment).

Adverse Reactions

Although SSRIs appear to be no difference in the treaties generally, reported cases of specific adverse effects vary. Adverse effects that patients experience is usually mild or moderate and no dose reduction of fracture is required. SSRIhave the following negative effects:
Effects Nausea. Coomon side-accociated of SSRIs is nausea. Paroxetine, sertraline, and have been associated with a little 'more cases of nausea.
Sexual dysfunction. Depression can cause sexual dysfunction and other SSRIs have been associated with sexual dysfunction during treatment in men and women. Perhaps there is less adverse effects on sexual function of fluoxetine in comparison with other drugs. Citalopram isassociated with loss of libido. Paroxetine appears to cause the highest rate of sexual dysfunction.
Anticholinergic effects. Paroxetine caused a greater effect anticholinergics, such as dry mouth, constipation, cognitive disorders and, in comparison with other SSRIs. This effect can be extremely difficult to accept for the elderly or medically ill patients simultaneously.
Weight. Difference SSRIs in their effects on weight. Sertraline is generally associated withsmall degree of weight loss in the acute phase of treatment, while paroxetine may lead to weight gain after prolonged treatment. Fluoxetine was the most powerful effects suppress appetite in the short term and provide a greater degree of weight loss paroxetine, sertraline, citalopram, escitalopram o.
Diarrhea. Sertraline and fluoxetine are more frequently associated with diarrhea, paroxetine has a lower incidence.
Anxiety, agitation, insomnia. Fluoxetineassociated with the highest rate of anxiety and confusion. Escitalopram and paroxatine are less likely to cause insomnia, such as fluoxetine and sertraline.
Dry mouth. Citalopram and paroxetine are more likely to cause dry mouth, such as escitalopram and fluoxetine.
Drowsiness and fatigue. Paroxetine is associated with the highest percentage of drowsiness, somnolence and other SSRIs.
Headache. Sertraline and fluoxetine is associated with a higher degree of headache.

Insome cases, antidepressants may worsen the symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when changing the dose related. Be sure to talk to your doctor about any changes in your symptoms. You may need a more careful in the beginning of treatment or a change in treatment, or it may be necessary to discontinue the medication if your symptoms worsen.

Pharmacokinetics

Some of the main differences result from SSRIdifferences in their pharmacokinetic properties. The only pharmacokinetic parameters are common to all known as SSRIs is that they are relatively slow, but completely absorbed from the intestine. Differ in their proteins, metabolism, half life, be they linear or nonlinear pharmacokinetics, or active metabolites.

Half Life

The half-life of a substance is the time needed to achieve plasma concentrations at steady state (ie the conversionhalf dose, and blood levels below 50%). Half-life may be used to estimate how long it will take a drug by the body to cope with the treatment is stopped.

Fluoxetine is unique because of its long half-life and long half-life of its active metabolite norfluoxetine. Fluoxetine has a half-life of 4-6 days and its active metabolite norfluoxetine has a half-life of 4-16 days. For comparison, citalopram, escitalopram, paroxetine and sertraline have shorter half-life ininterval of 20-35 hours and the concentrations at steady state (and the therapeutic effect) is achieved much faster. The long half-life of fluoxetine, the effects of missed doses or stop treatment stomp and make it easier to find than all other SSRIs. On the other hand, fluoxetine is a much longer period of washout of other SSRIs (few weeks), especially when it comes to inhibitors of monoamine oxidase (MAO), or TCA.

Antidepressants relativelyshort half-life is desirable that people with multiple comorbidities and complex, multi-drug regimens, because they provide a daily dose. A short half life allows doctors to move more quickly and safely to an alternative antidepressant treatment fails, or if the medication if you experience adverse reactions.

Linear and nonlinear pharmacokinetics.

One of the important differences between particular called SSRIs or their pharmacokinetics are linear ornonlinear.

Citalopram, escitalopram and sertraline shows linear pharmacokinetics and dose proportional. The plasma concentrations of these drugs is proportional to the dose, and therefore predictable. In contrast, fluvoxamine, fluoxetine and paroxetine are not linear pharmacokinetics. Higher doses may be much larger increases in drug concentration in plasma for the production of what would otherwise be expected. So you can increase the dose of paroxetine and fluoxetine afterdisproportionate and unpredictable increase plasma half-life and side effects. Titration of doses of fluoxetine and paroxetine may be more difficult than with citalopram, escitalopram, and sertraline.

Drug Interactions

The interaction between monoamine oxidase inhibitors (MAOIs) and SSRIs are the most important interaction studies limited the use of SSRIs. This combination can lead to the development of a syndrome consisting hyperserotonergic voltagesweating, rigidity, hyperthermia, tachycardia, hypertension, and possibly death. The severity of this interaction requires at least 5 weeks of washout, when a patient from fluoxetine to an MAOI allow the complete elimination of fluoxetine. At least 14 days after discontinuation of citalopram, escitalopram, paroxetine or SERTRALINE before starting treatment with an MAOI be allowed. This difference in time between washout fluoxetine and citalopram, escitalopram, paroxetine, and when SERTRALINEswitching from one SSRI to an MAOI is one of the main differences between SSRIs.

Citalopram, escitalopram, and sertraline have the lowest risk of drug interactions between known as SSRIs. Citalopram should be avoided in patients who are expected to take doses. Sertraline was better for patients taking beta-blockers or heart-type IC antiarrhythmic agents.

Billing thioridazine with fluoxetine or paroxetine may cause serious cardiac problems.

The addition of a new member for your family cat is usually more exciting for you that your current cat. Even if they are sequestered by nature, most cats learn to accept any, or at least tolerate newcomers. Because they are very territorial, the way you going to introduce the new cat to your existing cat can mean the difference between success or "cat-astrophe.

The procedure can be launched from a minimum of 10-12 days for kittens and young cats up to 12 weeks ofolder cats. This depends entirely on the personality of the individual cat. Make sure that the "first" cat care. This will help you feel confident that he is not competing for your love.

Define your cat to a "safe" room until the introduction process is complete. Should be a small room like a bathroom or small bedroom that your current cat rarely visits. Furnish with a bed, scratching post, food, water and litter.

In principle, the first cat and hisshowl at the cat on the opposite side of the door. Just ignore him and walk away. Never punish him for vocalizing aggressively, it will only cause problems between the two cats. Be sure to praise and pet the cat first when he acts calmly when near the new cat in the room.

After a few days, take a rag or wash cloth and rub with your cat as a pet and play with her. Try another lap to do the same with your first cat. During feeding, smelling rag for each cat, cat under the secondbak. This will help them to perfuming the other cat with something positive to associate with food. Very little force feeding each day will help you get used to the smell quickly. Ensure that the recovery of odor on clothes every day.

Then you can feed them more closely. Keep the cat in her "safe" room with the door closed completely, and place each cat's dish on their side of the door. Be sure to educate them at the same time. Once both eat with no growling or hissing, you can moveto the next level of the market.

Close your first cat in a room, he likes to regularly and make sure you have water, food options and a litter box. Let your cat explore the house. After a few hours, return to her room and let your cat in the first place. He probably noise and confusion, when it was still the smell of a cat in his territory odor. Again, be patient and praise him when he decided calmly. Repeat this activity at least once a day until both cats outcasual.

Before letting the cats have full access to all the others, let them come face to face in a security situation. Make use of two hard plastic door pressure to destroy the new cat's room door open only 2-3 centimeters. Make sure that the door can not be pushed even further and that neither cat can look up through the opening. The goal is to give them a chance to swat paws at one another and even nose to nose, with no possibility of contact with the full body. Feed each cat on their respectiveside of the door. When you no longer hiss or growl at each other, try to play with them, both in the same room.

Directly translated from French, Mardi Gras means "Fat Tuesday" and celebrate the day before Ash Wednesday, a Christian observer marked the first day of Lent. Mardi Gras, or Carnival, is a holiday recognized for its original roots in a pagan celebration quite like Mardi Gras, we know and love today. During the Roman occupation of Europe, it is often easier to spread Christianity, and the adoption of some of the indigenous traditions of religion. InIn fact the date of Christmas and the use of Christmas trees and Easter eggs presumably descended from pagan traditions as well. As a result, Mardi Gras, a strong emphasis on pampering and luxury, a sharp contrast with the weeks of Lent as a time of penitence and self-denial, which occurs during the forty days before the Eastern Sunday. Because both events were celebrated in old-fashioned way so close, it is difficult to believe that the transition from the adoption of aFrivolity period immediately preceding the one abstained.

Treatment of the roots of this festival, it is therefore appropriate to host a Mardi Gras celebration in your company? Feast surrounded by more religious connotations avoided like the plague in a modern world and politically correct. Similarly, all events that appear to be serious in the eyes of the corporate world. Yes, it seems a bit 'ironic that a trend home Mardi Gras celebration for enterprises willrise. Opinions seem to be in some parts of the media in terms of Mardi Gras. On one side is a quick way to the inadequacy of a celebration that turns to excess, especially for small businesses that their business model is built around the savings to combat the recent collapse of the economy.

But there are more and more companies choose to entertain Mardi Gras, but instead of the traditional holiday feast. This is an interesting approach toattitudes affect work, as companies seek to improve employees' work ethic by using a concept similar to the sequence of events from the home before Lent Mardi Gras. There is a good way to encourage a moment of joy and liberation, followed by a renewed effort and focus on the job front. It also contributes to the well-known traditional benefits of a society, the party to strengthen the team and promote the hard work of staff and a good business that customers who have already been given.Maybe it's a bad switch to change the tradition away from a vacation of a party not early next winter, which seems grace and renewal of spring. However, even critics would agree that the events which are calculated to four employees and customers have a significant impact on corporate profitability and productivity. Adding a fun and exciting carnival theme was also the most attended and successful After Effects. Laissez les bons temps rouler!