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Citalopram 20 mg online ). The other study that was found to be potentially beneficial with SSRI use in the treatment of major depressive disorder or bipolar is a randomized controlled trial of duloxetine (Cymbalta), a serotonin-norepinephrine reuptake inhibitor, in patients who were not resistant to SSRIs but who had mild to severe major depression or bipolar disorder and who were not adequately responding to an antidepressant trial. In this study, patients with major depressive disorder and bipolar or both, who had been treated with SSRIs for longer than six months were randomized to receive duloxetine 20 mg or placebo. Patients were treated for an average of two years. The primary efficacy endpoint was mean change in the Montgomery-Asberg Depression Rating Scale (MADRS) score. A safety outcome measure was the reduction in number of admissions to the hospital due adverse events (AEs). This trial was conducted in a cohort of 830 adult, outpatients with bipolar disorder or both. The rate of discontinuation from active treatment for SSRI-treated patients with severe depression or bipolar disorder was lower compared to placebo-treated patients. The citalopram 20mg online safety and efficacy of duloxetine were comparable to those of other SSRIs in this population. Duloxetine is a synthetic analogue of pargyline that acts as an SSRI and atypical norepinephrine reuptake inhibitor. The serotonin and norepinephrine are reabsorbed metabolized by the CYP2D6 enzyme and then re-absorbed by the CYP1A2 enzyme, respectively ( ). It is estimated that approximately 6 to 12 per cent of patients who take SSRIs become tolerant to these drugs, which may be either a dose-related problem or result of the underlying disease.5,6 potential for tolerance is not limited to SSRIs, as a previous meta-analysis of studies comparing SSRIs different formulations found that about 10% of patients treated with duloxetine, sertraline, paroxetine, citalopram, bupropion, escitalopram or fluoxetine reported tolerance to the other SSRIs.7 Although not significantly different from the overall drug-tolerance rate of approximately 10% from Citalopram 40mg $290.23 - $1.61 Per pill trials, these findings are relevant for patients that do not have adequate tolerability profiles of SSRIs. The CYP1A2 enzyme is responsible for the metabolism of SSRIs. However, this enzyme may not be fully affected by SSRIs because it is a substrate of the CYP2D6 enzyme, which is also important in the metabolism of many other drugs. There have been conflicting reports on the extent of SSRI-induced CYP2D6-mediated drug-tolerance in clinical trials.8,9 Some studies found a decreased rate of drug-tolerance compared to other SSRIs; however, studies reported no generic drug price regulation canada difference in drug tolerance between fluoxetine and other SSRIs.10,11 The reasons for these discrepancies are not entirely clear. The mechanism that may account for the lack of an overall lower drug tolerance rate among SSRIs is the relatively short duration of SSRI exposure, since pharmacological efficacy is likely to be sustained for up 10 to 14 days. Therefore, the potential effects of drug on the CYP1A2 enzyme could be short-lived, limiting the overall potential impact of SSRIs on the CYP1A2 enzyme.

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