At the risk of beating a dead horse, here I go.

Cocaine and SSRIs are NOT similar drugs! They both have an effect on
seratonin and the word "norepineprhine" appears in the description of the
mechanisms of both however, I believe that to equate the two is either
misled or the result of an imcomplete understanding of biochemistry.

To quote the USPDI:

Cocaine, "interferes with the uptake of norepinephrine by ADRENERGIC nerve
terminals.....Norepinephrine acts on alpha-ADRENERGIC RECEPTORS in blood
vessels to produce vasoconstriction" and "cocaine's indirect sypathetic
nervous system-stimulating activity results in potentition of the effects
of endogenous catechholamines ie epinephrine and dopamine as well as
norepinephreine."

an SSRI (sertraline), "SELECTIVE inhibitor of neuronal serotonin (5-HT) IT
HAS ONLY WEAK EFFECTS ON NEURONAL UPTAKE OF NOREPINEPHREINE AND DOPAMINE,
serotonin uptake enhances serotonergic transmission which results in
subsequent inhibition of adrenergic activity in the locus ceruleus.
Specifically, sertraline depresses the firing of the raphe serotonin
neurons, this in turn, increases activity of the locus ceruleus, with
consequent desentization of the postsynaptic beta-receptors and presynaptic
alpha2-recpeptors. SERTRALINE HAS NO SPECIFIC AFFINITY FOR ADRENERGIC
RECEPTORS,....DOPAMINERGIC RECEPTORS.  Sertaline does not inhibit monoamine
oxadise."

Some of the same words,yes, NOT the identical action OR meaning. In fact
adrenergic and dopaminergic receptors are the main receptors that cocaine
effects, SSRIs have no specific affinity for these receptors.

I cannot imagine the response of a young, depressed, breastfeeding mother
who is told that the drug that just may save her life or at least make her
life worth living is "similar" to a dangerous, addictive, street drug.

Sorry to beat that horse, but I believe the beating was needed. As HCPs we
have an obligation to relate information to our clients and patients, not
to twist and misread that data to scare patients or to serve our own,
sometimes idealist, platforms.

Facts are facts. And the facts "are" coke isn't Zoloft, or Paxil, or Prozac.

Again, only meant to enlighten.

Mary Jozwiak IBCLC
Private Practice

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