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SSRIs vs Triclycic antidepressants

Feb 19, 2005

I read a recent study and the investigators found that SSRIs may be effective and better tolerated than tricyclic antidepressants in HIV-positive adults. SSRIs did not appear to affect CD4+ cell counts. They said that if drug-drug interactions are a concern, sertraline (Zoloft), citalopram (Celexa), and possibly escitalopram (Lexapro) may be considered.

Is this really new? Were these drugs not used in HIV positive people before. What's the big deal about this study?

Reference J Caballero and M C Nahata. Use of selective serotonin-reuptake inhibitors in the treatment of depression in adults with HIV. Annals of Pharmacotherapy 39(1): 141-145. January 2005.

Response from Dr. Horwath

No, this is not new. But this article sounds like a review, and probably isn't intended to present new findings.

Both SSRI's and tricyclic antidepressants have been used and studied for depression in people with HIV infection. Both are effective, and when used properly, both are safe. Tricyclics are associated with the risk of cardiac arhythmias if the blood levels are too high. Drug interactions can elevate blood levels. Some HIV drugs, like ritonavir, can cause to such interactions. All things considered, the SSRI's are considered somewhat safer and better tolerated than tricyclics. However, when used with attention to the potential adverse effects, tricyclics are quite safe and effective. Among the SSRI's, sertraline, citalopram and escitalopram are less associated with drug interactions than paroxetine (Paxil) and fluoxetine (Prozac).

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