What is the difference between these? I understand they are forms of SSRI but is the difference mainly chemical.
The sites all say the help rebalance seratonin (sp?) but that is about it.
Is it a difference like Asprin vs Ibuprofen vs Naproxen, where as they are all NSAIDS or a difference like Ibuprofen (or asprin) vs Acetomenephen, where as they both relieve pain but do it differently.
That sentence makes no sense to me. Aspirin (acetysalycylic acid) is a different chemical than ibuprofen (Advil, Motrin, etc.) But they are all NSAIDs. Whereas, acetominophen (Tylenol, etc.) is not an NSAID, but only an antalgesic. They all relieve pain but different chemicals do it differently. Acetominophen does not relieve inflammation, or if does, only slightly.
Anyway, to answer your question, Wellbutrin is not a SSRI. It is a weak blocker of the neuronal uptake of serotonin and norepinephrine. It inhibits the neuronal reuptake of dopamine to some extent.
Prozac, Zoloft, and Paxil are SSRI. As such, they all work the same way. However, IANAMD.
The only difference I can see between the SSRI’s you listed is that they all have different side-effects. They all do the same thing, but a person taking this type of anti-depressant might try all of them until they find one that doesn’t do more harm than good with the side-effects.
And barbitu8 is correct, Wellbutrin works with the dopamine system and is used sometimes with an SSRI. It’s also commonly prescribed to women who are, for lack of a better word, frigid. It’s supposed to boost libido in women.
Hope I’ve helped. 
BTW - You missed one in the main SSRI family. Celexa is also prescribed often for depression.
Some cost more than others. Some need a pill to be taken twice a day. Some cause drowsiness while others cause anxiety, Comprende?
Each of the medicines have subtle differences that might compell a doctor to choose one over the other to better meet the specific needs of each individual patient.
IANAMDE 
I suggest you stand in front of a mirror in the dark and say “Quadgop the Mercotan” three times.
“… and I can’t even say Ticonderoga.”
SSRIs have a range of possible documented side effects, including:
Delayed ejaculation
Loss of libido
Nausea
Hypertension
Weight gain
Lest you feel that the SSRIs are too dangerous, remember that these side effects are rather less intrusive that those presented by, say, certain MAO-Inhibitors, or by depression itself. These effects are by no means experienced by all users of SSRIs. One SSRI will have one group of side effects, while others have will have different effects. Understanding the drugs and judging which will be efficacious without unacceptable side effects is a job for a physician.
This article is kinda creepy. Rewiring your brain with over proscribed drugs that lose efficacy over time? I think I’ll take a pass. Not to mention the side effects.
Barbitu8 summed it up pretty well (as usual!) as did the other respondants, so I’ve nothing really useful to add other than it’s a complex area of medicine. As a Family doc, a generalist, I’m comfortable prescribing about 3 different anti-depressants, and then only if the patient agrees to work with a therapist or psychiatrist. There are getting to be so many choices out there, each with its own variable advantages and disadvantages that I frankly can’t keep up.
I agree. This is not candy, and not for normal reactions to life’s stresses. It’s serious medicine for people with serious depression, and here, the benefits can really outweigh the risks.
They’re not candy, but once you find one that works, it can make an extraordinary difference.
The process of finding the correct drug can take a while, and ideally you should work with a psychiatrist for this. If you’re seeing another kind of therapist (social worker, psychologist, etc., none of whom can give prescriptions), he or she will usually have the names of several psychiatrists just so you can deal with the drug issue.
My regular shrink’s a social worker, and when we determined that a drug might help she gave me the name of a psychiatrist. At first, we tried Wellbutrin because it has the fewest sexual side effects. I found it made me too hyper, and worsened rather than lessened my anxiety. So then we tried Paxil, which is particularly indicated for panic. A low dose worked for me, so the much-feared sexual side effects are minimal.
I only had to see the psychiatrist three times, which was a Good Thing since those visits were out of pocket. My GP is perfectly happy to issue my renewals, although like Qagdop I don’t think he’d have been comfortable prescribing in the first instance.
I have prescription coverage through my health plan, so it’s not costing me too much. Prozac is coming off patent soon, so will be available in generic version (which is why its manufacturer is busy pushing a seven-day version, for which it will retain the patent).
Good luck - Oxy.
Even the side effects can be of mixed benefit … If I can just get in better shape, I can rock and roll all night, baby! Can be a bit frustrating, though, I have to admit.
As a final year resident, I prescribe these drugs often.
Zoloft, Prozac and Paxil are all SSRIs and probably more similar than drug literature would have us believe. Paxil is the only one currently approved for treatment of social anxiety and is useful for depression with an element of anxiety. It also tends to make patients drowsy and can be useful if sleep is impaired. It causes lots of side effects, though, especially for the first couple weeks; mainly gastrointestinal and a drugged-drowsy sensation. Zoloft has fewer side effects and I tend to use it in more elderly patients. In this population, depression is often subtle and it is important to ask specifically about hobbies and activities. Prozac is cheap (generic), dependable and a good choice too. Wellbutrin is meant for “atypical” depressions, if other alternatives fail, if there is hypersomnolence (too much sleep) or I suppose if smoking is an issue, not that I use it personally for the last one.
If they are so similar why is Paxil the only one for anxiety,
I ask as we just got out new fomulary meds for our HMO and they have replaced Prozac with Paxil. In other words they won’t pay for Prozac but only Paxil.
This has a few people I work with upset. It isn’t so bad I just got my Azmacort replaced with Flovent but I don’t use a steriod often so maybe twice a year and if this Flovent is bad I’ll pay the extra for the Azmacort.
But at $100.00 a prescription it seems that isn’t an option for many. I know there is an appeals process but it usually fails.
But it seems maybe even dangerous to arbitraily take someone off one antidepressent to another unless they are the same.
Flovent is pretty good, I prescribe it a lot. But both flovent and azmacort are meant to be maintenance medications, used regularly, whether the asthma is acting up or not. Anyone who needs a rescue inhaler (like albuterol) more than once a week should be on a maintenance medication, to reduce lung inflammation. It’s the lung inflammation, not the bronchospasm, that causes long-term lung damage.
You raise legitimate issues with the formulary comments, but I can’t open that can of worms right now. It’s late. I don’t need to get angry, I want to sleep tonight.
Dr Pap has given a good description of the “fantastic four” of antidepressants, much more concisely than I could have.
I have a related question…how about Celexa? It is described as “a highly selective” SSRI. Can someone explain this?
Zoloft alone doesn’t do much for me; combined with Celexa it works…also I take lithium. Wellbutrin made me manic, Prozac had no effect. Imipramine was the only single med I took that was fairly effective, but it has significant side effects. It seems there is a lot of trial & error in finding the correct combination & dosage.
Carina, who truly wishes she didn’t have to spend so much of her life on meds but it’s better than the alternative!
Wellbutrin is that quit smoking pill? What if I were to use it to quit smoking, is there a chance that I could develop depression once the drug is stopped and my brain has to readjust to lower levels of serotonin?
[QUOTE]
*Originally posted by adam yax *
**
Not to be a big hijacker, but I have a question about withdrawal from these medications as well. The last time I tried to stop taking Prozac, I nearly ended up in the psych ward. Mind you, I started out with pretty bad depression, but nothing that came even CLOSE to what occurred when I stopped taking Prozac. I gradually lowered the dosage as my physician prescribed, but still had major problems getting off of it.
Yet, I frequently hear it’s not “habit forming.” Okay, maybe it’s not habit forming in the sense that I need more and more to get an affect. But doesn’t this kind of withdrawal mean…well, isn’t it WITHDRAWAL? Or is it all in my head?
-L
It’s definitely not in your head. I ran out of Paxil at one point and after a couple of days I was not doing well. I had physical symptoms like a weird dizziness when I moved around, and heightened anxiety. I went on these drugs (now on Celexa) because they said they aren’t habit-forming but now I feel stuck on them. They are worth the side effects to me but I dread having to get off them some day.
My brother was on Wellbutrin and the difference with those MAOIs is you can’t take a lot of other things with them (OTC cold medicine, etc.) Drinking a lot of alcohol isn’t a good idea with any of these.
[QUOTE]
*Originally posted by gigi *
**
A friend of mine caused an auto accident on his way to my house while trying to get off of Zoloft. The dizziness and “foggy” feeling when trying to get off of Prozac is horrible as well. I know now that if I want to stop taking this medication I have to take a week or so off of work and make sure I don’t need to do anything besides drool.
What really bugs me about this is that it ends up making me feel truly CRAZY. Because the doc generally assures me, “no side affects, no addiction, no problem.” Then when I show up at his office door crying, hysterical, unable to work, too dizzy to drive, he acts as if it can’t possibly be the medication he prescribed because he’s never seen such a thing before. I end up assuming that I’m either completly bonkers, or I’m the one unlucky person in eleventy million who has this problem.
-L
All antidepressants can cause rebound depression if stopped too suddenly. It usually takes a few days to a few weeks, just like the medications take a while to start working in the first place. That’s why it’s important to taper off the medication rather than stop cold turkey.
IMO, the differences between the SSRIs are minimal. I don’t know how much better Paxil is for anxiety symptoms than the others, but I always suspected the SAD indication to be more the result of aggressive marketing and FDA lobbying than hard science. Celexa was late to the marketing party; it claims to be more selective and thus have fewer side effects, but again, I doubt that has been objectively backed up.
I can’t really add much to what the other docs have said. I think these are great drugs, and they’ve helped bring psychiatric treatment to primary care; I plan to take some psych electives in my Internal Medicine residency for just that reason.
Dr. J