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they have much lower lethality in overdose compared to TCAs The SSRIs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram and its enantiomer escitalopram The atypical antidepressants are bupropion, which appears to exert its effect through the dopamine neurotransmitter system; venlafaxine and duloxetine, both of which inhibit the reuptake of both serotonin and norepinephrine; nefazodone,

An inter-company sale may be described with the following example The customer orders stock from the sales organization (for example 3001) The sales organization (3001) belongs to a company code, for example, 3000 The sales organization (3001) then creates the sales order and indicates the delivering plant as a plant that belongs to a different company code, for example, company code 1000 The sales organization (3001) then invoices the customer for materials purchased The system automatically creates an inter-company billing document at the same time as the customer s billing document is created This inter-company invoice is sent from the delivering plant to the selling sales organization This is defined as an inter-company sales transaction The result of an inter-company sales transaction is that the system will create two billing documents The first is the standard customer billing document that is sent from the sales organization to the customer who receives the goods The second is the inter-company billing document that is sent from the delivering plant to the sales organization

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effective antidepressant treatment in patients with acute myocardial infarction or unstable angina Withdrawal syndromes have been reported for the SSRIs and venlafaxine These include dysphoric mood, agitation, and a flu-like state These medications should be discontinued gradually over a period of weeks or months to reduce the risk of withdrawal phenomena Fluoxetine, fluvoxamine, sertraline, venlafaxine, and citalopram in customary antidepressant doses do not appear to increase the risk of major fetal malformation when used during pregnancy Recent evidence, however, has suggested that paroxetine may be associated with a twofold increased risk of cardiac abnormalities Postpartum developmental effects are thought to be minimal, but this question calls for ongoing investigation Peripartum effects may be a of concern and are documented anecdotally in the literature The risk of depression to the mother and fetus needs to be part of the discussion with the patient about treatment options The decision to use SSRIs and other psychotropic agents during pregnancy and postpartum must be based on a thorough risk-benefit analysis for each individual A recent review of the literature on antidepressants levels in breast-feeding mothers and their infants suggests that nortriptyline, paroxetine, and sertraline are least likely to lead to detectable levels in infants Venlafaxine is reported to be well-tolerated without significant anticholinergic or cardiovascular side effects Nausea, nervousness, and profuse sweating appear to be the major side effects Venlafaxine appears to have few drug-drug interactions It does require monitoring of blood pressure because dose-related hypertension may develop in some individuals Duloxetine may also result in small increases in blood pressure Common side effects include dry mouth, dizziness, and fatigue Inhibitors of 1A2 and 2D6 may increase duloxetine levels with a risk of toxicity Nefazodone appears to lack the anticholinergic effects of the TCAs and the agitation sometimes induced by SSRIs Nefazodone should not be given with terfenadine, astemizole, or cisapride (Terfenadine and astemizole are not commercially available in the United States) Because nefazodone inhibits the liver s cytochrome P450 3A4 isoenzymes, concurrent use of these medications can lead to serious QT prolongation, ventricular tachycardia, or death Through the same mechanism of enzyme inhibition, nefazodone can elevate cyclosporine levels sixfold to tenfold Nefazodone has been given an FDA warning because it has been implicated in liver failure in rare cases Pretreatment and ongoing monitoring of liver enzymes are indicated Mirtazapine is thought to enhance central noradrenergic and serotonergic activity with minimal sexual side effects compared with the SSRIs Its action as a potent antagonist of histaminergic receptors may make it a useful agent for patients with depression and insomnia Its most common adverse side effects include somnolence, increased appetite, weight gain, lipid abnormalities, and dizziness There have been reports of agranulocytosis in 2 of 2796 patients Although it is metabolized by P450 isoenzymes, it is not an inhibitor of this system It is given in a single dose at bedtime starting at 15 mg and increasing in 15-mg increments every week or every other week up to 45 mg.

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