RevisePsych

SSRIs

• Examples: 

- fluoxetine​

- paroxetine

- citalopram

- escitalopram

- sertraline

- fluvoxamine

 

• Increase available levels of the neurotransmitter serotonin

- The nerve cells normally recycle serotonin by soaking it back up again. The SSRIs work by stopping (inhibiting) this re-uptake of serotonin. As the serotonin is not soaked up again, more will be present to pass on messages to nerve cells nearby.

 

• Delay in onset: takes 2-4 weeks to be effective.

 

• Not addictive but can get discontinuation syndromes.

 

• No more effective than TCAs but less toxic in overdose.

 

 

Side-effects

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• Common

- Nausea and vomiting, sexual dysfunction, insomnia.

 

• Less common

- Drowsiness, headache, loss of appetite, diarrhoea.



• Uncommon

- Restlessness/anxiety.

 

• Rare

- Suicidal ideas/rash/dry mouth/tremors and dystonias.

 

• SSRIs are associated with an increased risk of bleeding.

- Consider prescribing a gastroprotective drug in older people who are taking non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin.

 

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• Fluoxetine, fluvoxamine and paroxetine have a higher propensity for drug interactions.

 

• For people who also have a chronic physical health problem, consider using citalopram or sertraline as these have a lower propensity for interactions.

 

• Paroxetine is associated with a higher incidence of discontinuation symptoms (shorter half-life).

 

• Fluoxetine/sertraline in children and young people due to possible increase in suicidal thoughts.