Using Secondary Binding Properties to Select a Not So Selective Serotonin Reuptake Inhibitor/Brainstorms December 1998

Using Secondary Binding Properties to Select
a Not So Selective Serotonin Reuptake Inhibitor

Stephen M. Stahl, M.D., Ph.D.

Issue: Secondary binding characteristics of SSRIs (selective serotonin reuptake inhibitors) can be helpful in selecting which 1 of the 5 agents to prescribe for an individual patient.

In an earlier Brainstorms,¹ the secondary binding characteristics of the SSRIs were examined. Here we show these graphically for all 5 agents (fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram). We also propose how such properties can create potential advantages and disadvantages for various patient profiles.² Understanding not only the primary action of the SSRIs (namely, serotonin reuptake inhibition) but also how each of the 5 SSRIs differs from one another in the dozen or so secondary pharmacologic actions may assist the prescriber in selecting a specific SSRI to match the clinical profile of an individual patient. At best, these are rules for which there are many exceptions when applied to an individual patient.

References

1. Stahl SM. Not so selective serotonin reuptake inhibitors. J Clin Psychiatry 1998;59:343-344

2. Stahl SM. Essential Psychopharmacology. 2nd ed. New York, NY: Cambridge University Press. In press

Brainstorms aims to provide updates of novel concepts emerging from the neurosciences that have relevance to practitioners.

From the Clinical Neuroscience Research Center in San Diego and the Department of Psychiatry at the University of California San Diego.