welcome back in today’s article we’re going to be talking about searcherline and fluoxetine and trying to figure out which one is the best for you and this is in response to a viewer who asked us to compare both of these medications if you would like us to make a article for you drop that article idea down in the comment section below and that article will be coming your way so when we’re comparing two medications especially two that are in the same family we have to go through their similarities and their differences so first when

we’re looking at fluoxetine and sertulene we’re going to look at what are they used for so they are both ssri antidepressants that are fda approved for the treatment of major depressive disorder premenstrual dysphoric disorder panic disorder and ocd however you know that fluoxetine is approved for major depressive disorder in ages eight and older and obsessive-compulsive disorder in ages seven and older sertraline is fda approved for major depressive disorder in adults only and obsessive-compulsive disorder in ages six and older now

fluoxetine is approved for the treatment of bulimia and when it’s combined with olanzapine it is approved for the treatment of bipolar depression and treatment resistant depression sertaline is approved for ptsd and social anxiety disorder however either of these medications can be used off label to treat those different disorders that they are not fda approved for and though they are both ssris or selective serotonin reuptake inhibitors they each have unique actions on those serotonergic receptors for instance

fluoxetine also has 5ht 2c antagonism this antagonism enhances the release of norepinephrine and dopamine which is generally activating which is why fluoxetine helps to improve attention concentration and even boost energy this action also contributes to its anti-bulimic effects which is often seen in higher dosages so that makes fluoxetine very useful in treating depression in someone who has a flat effect low energy they may be sleeping too much and even overeating if that’s the type of depression you have

fluoxetine may just be right for you and when it’s combined with olanzapine that 5ht2c antagonism is enhanced which makes it a superior choice in the treatment of treatment resistant depression and also bipolar depression so i will also use this for patients that i suspect have a mood disorder maybe there’s a family history of bipolar disorder and they just haven’t had a manic episode yet i may start fluoxetine with the idea that we could always add olanzapine to treat any mood disorder symptoms that may arise however the downside of this

is that it may be too activating for some patients so those with anxiety you really have to start low the lowest dose you can get is 10 milligrams so it’s best to start really low and titrate slowly to a therapeutic dose which is anywhere from 20 to 60 milligrams so sertraline is an ssri but it is also a weak dopamine transport inhibitor which means that it can increase the amount of dopamine that’s in your system by decreasing the release or the transport out of dopamine in your body and it also has some sigma 1

receptor binding now the dopamine transport inhibition helps to improve energy motivation and concentration when sertraline is combined with bupropion this action is exaggerated and that’s why that’s a popular combination to combine sertraline and bupropion the sigma-1 receptor binding isn’t completely understood but it’s understood that this unique feature of sertraline may contribute to its anti-anxiety effects and is also effective for helping to treat those psychotic symptoms of depression sertraline can also target that atypical

depression that we were talking about that fluoxetine targets because it helps to boost your energy attention and concentration so it’s also useful in treating depression with those symptoms it’s also very useful for treating depression with mixed anxiety and is preferred in my opinion for the treatment of ptsd or for those patients who have a lot of trauma but don’t necessarily have the symptomology for ptsd i find surgery to be very helpful for those patients another thing you want to consider when you’re comparing

these medications are the side effects now because they’re both ssris they have side effects that are due to increasing serotonin which we have a lot of serotonin in our gut and so the very common side effects for both of them are going to be related gut symptoms they also both have the same rare and dangerous side effects and black box warnings as all the other ssris which i cover in this video that reviews the many first-line treatments for major depressive disorder and though they both have some common side effects serturlina

zoloft tends to have more reports of sexual dysfunction than fluoxetine and fluoxetine tends to have more reports of headaches and nervousness then when we’re talking about drug interactions both of these medications inhibit the cyp2d6 and cyp3a4 however sertraline is a weak inhibitor of these substrates and so therefore sertraline doesn’t have as many drug interactions as fluoxetine does because fluoxetine is a stronger inhibitor of these substrates and so if you’re taking a lot of medications you have to be careful with fluoxetine

because most likely you’re going to run into some sort of drug interactions that are going to require dosing adjustments of those medications fluoxetine also has a very long half-life which is something else you need to consider when stop taking fluoxetine it can stay in your system for up to five weeks and so therefore when you switch to another medication you’ll have to keep that in mind as the metabolites of fluoxetine may still be in your system and can make you more vulnerable to some side effects when combined with certain medications

so definitely review that with your provider however and a big advantage of this long half-life is the fact that fluoxetine can actually taper itself because of the long half-life those metabolites will taper itself off and so a lot of patients can actually stop fluoxetine with very minimal abstinence syndrome or withdrawal so that is a huge advantage but obviously all of this should be reviewed with your provider if you’re considering stopping your medication the one last thing we’re going to review and consider when taking

fluoxetine or sertraline is how are they taken well both are taken orally and both have liquid formulation so you can do micro dosing if you’re titrating up slowly or want to taper down very slowly they both have that option sertraline comes in tablet forms and therapeutic doses of anywhere from 50 to 200 milligrams and the advantage of tablets is you can break that in half and do half doses as well fluoxetine comes in capsule form so you can’t break those in half and dosages from 10 to 60 milligrams however therapeutic dosages

are typically found between 20 and 60 milligrams with max dosing up to 80 milligrams in some circumstances so which one is the best for you sertraline or fluoxetine well whichever one you can tolerate that is improving your symptoms that would be the best one for you i hope enjoyed this video on fluoxetine and surgerling and i wish you well on your mental health care journey i thank you for reading and i’ll look forward to seeing you next week, Good bye