Treatments  > Biological > Medication > SSRIs

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

  • 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.

 

  • 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.