Which medications in the drug class Antidepressants are used in the treatment of Lewy Body Dementia?

Updated: Aug 08, 2019
  • Author: Howard A Crystal, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

Antidepressants

Depression is frequent in DLB. Antidepressants with little or no anticholinergic activity are desirable.

Venlafaxine (Effexor)

Venlafaxine may treat depression by inhibiting neuronal serotonin and norepinephrine reuptake. In addition, it causes beta-receptor down-regulation.

Paroxetine (Paxil, Pexeva)

Paroxetine selectively inhibits presynaptic serotonin reuptake, with minimal or no effect on the reuptake of norepinephrine or dopamine.

Sertraline (Zoloft)

Sertraline selectively inhibits presynaptic serotonin reuptake.

Fluoxetine (Prozac)

Fluoxetine selectively inhibits presynaptic serotonin reuptake, with minimal or no effect on the reuptake of norepinephrine or dopamine. The drug may cause more gastrointestinal adverse effects than do other currently available SSRIs, which is why it is not recommended as a first treatment choice. Fluoxetine may be given as a liquid and a capsule.

The drug may be administered in 1 dose or in divided doses. The presence of food does not appreciably alter levels of the medication. Fluoxetine may take up to 4-6 weeks to achieve steady-state levels, as it has the longest half-life (72 h).

Fluoxetine's long half-life is an advantage and a drawback. If the drug works well, an occasional missed dose is not a problem, but if problems occur, eliminating all active metabolites takes a long time. The choice depends on adverse effects and drug interactions. Adverse effects of SSRIs seem to be quite idiosyncratic; thus, relatively few reasons exist to prefer one over another at this point if dosing is started at a conservative level and advanced as tolerated.


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