Which medications in the drug class Selective Serotonin Reuptake Inhibitors are used in the treatment of Narcissistic Personality Disorder?

Updated: May 16, 2018
  • Author: Sheenie Ambardar, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

Selective Serotonin Reuptake Inhibitors

SSRIs such as citalopram may be used to treat depressive symptoms in adult patients with NPD. They are the antidepressants of choice because of their minimal anticholinergic effects. All are equally efficacious; selection depends on adverse effects and drug interactions. Determining whether the patient with NPD has a formal axis I diagnosis of major depression or depressive symptoms related to narcissistic pathology is important; this determination will influence the length and course of treatment.

Citalopram (Celexa)

Citalopram enhances serotonin activity through selective reuptake inhibition at the neuronal membrane. No head-to-head comparisons of SSRIs exist, though on the basis of metabolism and adverse effects, citalopram is considered the SSRI of choice for patients with head injury.

Escitalopram (Lexapro)

This agent is an SSRI and an S-enantiomer of citalopram that is used for the treatment of depression. Escitalopram enhances serotonin activity because of selective reuptake inhibition at the neuronal membrane. Its mechanism of action is thought to be the potentiation of serotonergic activity in the central nervous system (CNS) through the inhibition of CNS neuronal reuptake of serotonin. The onset of depression relief may occur after 1-2 weeks, which is faster than the relief obtained from other antidepressants.

Fluoxetine (Prozac)

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

Fluoxetine may cause more gastrointestinal adverse effects than other SSRIs now currently available. 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 fluoxetine works well, an occasional missed dose is not a problem; 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.

Fluvoxamine (Luvox CR)

Fluvoxamine enhances serotonin activity due to selective reuptake inhibition at the neuronal membrane. It does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer adverse effects than do tricyclic antidepressants.

Fluvoxamine has been shown to reduce repetitive thoughts, maladaptive behaviors, and aggression and to increase social relatedness and language use.

Sertraline (Zoloft)

Zoloft selectively inhibits presynaptic serotonin reuptake. It is indicated for obsessive-compulsive disorder in children aged 6-17 years.

Paroxetine (Paxil, Pexeva)

This would be unlabeled use. Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake. It also has a weak effect on norepinephrine and dopamine neuronal reuptake.

For maintenance dosing, make dosage adjustments to maintain patient on lowest effective dosage, and reassess the patient periodically to determine the need for continued treatment.


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