SSRIs

=Selective Serotonin Reuptake Inhibitors=

How it works
//SSRIs selectively inhibit the presynaptic reuptake of serotonin (5-hydroxytryptamine, 5HT).//

Questions to Ask
What medications? //other antidepressants, opioids, stimulants (due to increased serotonin syndrome)// - medical conditions? //epilepsy (increases seizures), bipolar disorder (may provoke mania), high bleeding risk, severe hepatic impairment (halve dose)// - allergies?

Take note: Treatment with, or within 14 days of stopping, a MAOI Treatment with, or within 2 days of stopping, moclobemide

__Breastfeeding:__ - low levels have been detected in the breast milk - amounts ingested by the infant are small (usually not detected in the serum, often only the weak metabolite) - sertraline is the one of the preferred antidepressants during breastfeeding

How to take
//Depression//—all SSRIs are equally effective in treating depression. //OCD//—SSRIs appear to be effective. //Eating disorders//—in treatment of eating disorders (especially bulimia) there is more evidence to support the use of fluoxetine than for other SSRIs. //Post-traumatic stress disorder//—SSRIs are used as drugs of choice, but quality of evidence is poor. Paroxetine is currently the only SSRI marketed for this indication in Australia. //Generalised anxiety disorder, social phobia//—SSRIs are used to treat these, although not all are marketed for these indications. //Premenstrual dysphoric disorder (PMDD)//—fluoxetine and sertraline are marketed for use in PMDD although some published trial data indicate efficacy is similar to placebo after 3 months
 * Which SSRI?**

SSRIs are usually taken in the morning to minimise insomnia, but fluvoxamine and paroxetine can cause somnolence, and may need to be given in the evening.
 * Dosing:**

Side effects
nausea, agitation, insomnia, drowsiness, tremor, dry mouth, diarrhoea, dizziness, headache, sweating, weakness, anxiety, weight gain or loss, sexual dysfunction, rhinitis, myalgia,
 * Common:**

Other advice?
- Fluoxetine has an active metabolite, norfluoxetine, that contributes significantly to its effects, and has a long half-life (up to 16 days). Other SSRIs have much shorter half-lives (around 24 hours). Adverse effects and interactions with fluoxetine may persist after treatment is stopped. The incidence of withdrawal symptoms is lowest with fluoxetine. - Do not drive or operate machinery until you know how this medicine affects you. - Do not stop taking this medicine suddenly unless your doctor tells you to. - Tell all doctors, dentists or pharmacists that you are taking this medicine, as there may be significant interactions with other medicines. - Do not use non-prescription medicines or herbal products without discussing these with a pharmacist.

CMI
Citalopram: [|Citalopram] AMH Escitalopram: [|Esipram] AMH Fluvoxamine: [|Movox] AMH Paroxetine: [|Paroxetine] AMH Sertraline: [|Sertraline] AMH