As the clinical practice of using more than one drug at a time increase, the clinician
is faced with ever-increasing number of potential drug interactions. Although many
interactions have little clinical significances, some may interfere with treatment or even
be life-threatening. This review provides a better understanding of drug-drug
interactions often encountered in pharmacotherapy of depression. Drug interactions can
be grouped into two principal subdivisions : pharmackinectic and pharmacodynamic.
These subgroups serve to focus attention on possible sites of interaction as a drug
move from the site of administration and absorption to its site of action.
Pharmacokinetic processes are those that include transport to and from the receptor site
and consist of absorption, distribution on body tissue, plasma protein binding,
metabolism, and excretion. Pharmacodynamic interactions occur at biologically active
sites. In this review, emphasis is placed on antidepressant medications, how they are
metabolized by the P450 system, and how they alter the metabolism of other drugs.
When prescribing antidepressant medications, the clinician must consider the drug-drug
interactions that are potentially problematic.
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