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SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). “You only hit a home run first at bat about one third of the time; two-thirds of the time you have failed, struck out,” said McCall, an expert on depression, insomnia, and suicide. As published in the Journal of Psychiatric Research, McCall’s study indicates that the simple wristband may help by identifying those commonly referred to as “night owls.” These individuals appear to be the best responders to SSRIs. However, McCall understands that his study sample was small -58 patients- and the findings are very preliminary. “What our findings suggest is that night owls, the group most likely to be depressed, also look like the patients who are most likely to respond. The larks are more likely to need two drugs,” McCall said. “It make sense that owls are good responders since SSRIs tend to shift rest time to a more usual, middle-of-the-night timeframe,” said McCall.Larks, on the other hand, might better respond to a different class of drugs, such as bupropion, or Wellbutrin, which unlike SSRIs, target the neurotransmitter dopamine, providing a slight stimulation that may help larks readjust their lowest activity times- which should correspond with deep sleep times- to slightly later in the day, McCall said. “We all tend to be morning people or not, and environmental factors, such as work schedules, can also push us in one direction or another,” McCall said. Excessive exposure to light, particularly in the evening hours, whether from a lamp, a television, or a touch-screen tablet, can further shift the rest cycle to later in the 24-hour day. While there is no good data on what percentage of the population is night owls versus larks, the 58 patients in the study were about half-and-half. Those who had the latest period of rest, close to 5:00 a.m., were the best responders to SSRIs. Providers have been challenged to determine which drug could be the most effective offering for a patient.Since there currently is no lab test to tell physicians which drug should work best for a patient on the first or subsequent tries, McCall typically starts with the most inexpensive, generic SSRIs, anticipating that it may take several months and attempts to get the desired relief.
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