These data suggest that escitalopram in standard clinical doses does not alter driving performance in healthy volunteers. Escitalopram did not alter driving performance at any time, whereas mirtazapine impaired driving after 2 days but not after 9 and 16 days. They were randomly assigned to escitalopram (increasing to 20 mg/day over 15 days), mirtazapine (increasing to 45 mg/day over 15 days), and placebo in a double-blind crossover design. The effects of both acute and subchronic mirtazapine and escitalopram on driving performance in a specially adapted vehicle have been studied in 18 healthy participants (nine men and nine women) mean age 31.4 years. Also we do not know how SSRI treatment might alter psychological performance in depressed patients, many of whom have pre-existing cognitive deficits due to the depressive disorder. However, it is not clear how far the reduction in vigilance that the authors detected would lead to deficits in performance of real-world tasks such as driving (see below). This study has a certain ecological validity because it investigated the effects of subchronic treatment with SSRIs rather than the more common approach of using single doses. The authors speculated that this might be due to its concomitant dopamine re-uptake blocking properties. In contrast to other SSRIs, sertraline did not apparently impair vigilance in the Mackworth clock task. The same authors have previously reported similar deficits after fluoxetine, paroxetine, and venlafaxine, suggesting that impairment of vigilance might be a general consequence of drugs that potently block serotonin re-uptake. In 24 healthy men and women aged 30–50 years who were randomized to receive citalopram (40 mg/day), sertraline (100 mg/day), and placebo for 14 days in a crossover, within-subject design, citalopram (but not sertraline) caused impaired vigilance on the Mackworth clock task. SSRIs are generally thought to have relatively little effect on tasks of psychological performance in comparison to tricyclic antidepressants and agents such as mirtazapine. Mania has been reported in six patients, five of whom were taking citalopram and one paroxetine. Aronson MA, DPhil, MBChB, FRCP, HonFBPhS, HonFFPM, in Meyler's Side Effects of Drugs, 2016 Psychological, psychiatric Common adverse events included somnolence (25%), insomnia (20%), flu symptoms (15%), increased appetite (15%), and decreased appetite (15%). Sixty-five percent of the remaining subjects met the response criteria with a mean final dose of 13 ± 4.1 mg/24 hr. Two subjects did not complete the trial due to lack of efficacy and tolerability. If needed and tolerated, increase by 5 mg/24 hr at weekly intervals up to a maximum of 20 mg/24 hr. Seven of the 17 (41%) responders and 25% of all treated subjects could not tolerate the 10-mg/24 hr dose.ġ0–17 yr: A 12-wk open-label trial in which 20 subjects were given an initial PO dosage of 5 mg once daily × 7 days followed by 10 mg once daily. 25% of subjects responded at doses <10 mg/24 hr and 36% responded at doses ≥ 10 mg/24 hr. Mean dosage of responders with significant improvement at 11.1 ± 6.5 mg/24 hr.
If needed after 1 wk, dose may be increased to 20 mg once daily.Īutism and Pervasive Developmental Disorders (PDD limited data)Ħ–17 yr: A 10-wk open-label trial in which 28 subjects were given a weekly PRN increasing PO dosage regimen of 2.5, 5, 10, 15, and 20 mg/24 hr. If needed after 3 wk, dose may be increased to 20 mg once daily.Īdult: Start with 10 mg PO once daily. ≥ 12 yr and adolescent: Start with 10 mg PO once daily. <12 yr: Limited data, only one placebo-controlled RCT did not demonstrate efficacy.
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