Selective serotonin reuptake inhibitor

SSRIs can help people who are depressed, like this "sorrowing old man" painted by Vincent van Gogh

Selective serotonin reuptake inhibitors (SSRIs) are a class of pharmacological agents primarily used in the treatment of depression, anxiety disorders, and several other psychological conditions.

SSRIs are among the most frequently prescribed antidepressants across the globe due to their efficacy and tolerability. Widely used SSRIs include fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro).

Therapeutic Indications

SSRIs are utilized in the management of a variety of mental health disorders, including:

• Major depressive disorder
• Various anxiety disorders such as obsessive-compulsive disorder (OCD), panic disorder, and generalized anxiety disorder (GAD)
• Post-traumatic stress disorder (PTSD)
• Eating disorders
• Certain types of chronic pain

Depression

In the treatment of severe depression, SSRIs are often the first-line pharmacological intervention. For patients with moderate depression that is unresponsive to psychotherapy, SSRIs can provide symptom relief. The effectiveness of SSRIs in the treatment of mild, transient depression remains a topic of ongoing research and debate.

Anxiety Disorders

For individuals diagnosed with GAD, SSRIs have demonstrated effectiveness in reducing anxiety, thereby facilitating participation in therapeutic interventions such as cognitive behavioral therapy. SSRIs are also considered a first-line treatment for severe OCD. While not curative, the use of SSRIs in conjunction with psychotherapy improves treatment outcomes.

PTSD

The United States Food and Drug Administration has granted approval for the use of fluoxetine (Prozac) and paroxetine (Paxil) in the treatment of PTSD. However, SSRIs are not considered a standalone cure for PTSD and are typically used in combination with psychotherapeutic interventions. Notably, apart from Prozac and Paxil, most other SSRIs do not appear to significantly improve PTSD symptoms.

Side Effects and Precautions

Like all medications, SSRIs can have side effects. These may include, but are not limited to:

• Nausea
• Diarrhea
• Dry mouth
• Insomnia
• Drowsiness
• Dizziness
• Sweating

These side effects often improve over time or with a dosage adjustment. However, it's important for patients to report any side effects to their healthcare provider.

Discontinuation Syndrome

Abrupt discontinuation of SSRIs can lead to a withdrawal-like condition known as SSRI discontinuation syndrome. Symptoms can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Gradual dose reduction is typically recommended to minimize these effects.

Interactions

SSRIs can interact with a variety of other medications, including other antidepressants, certain pain or headache medications, and the herbal supplement St. John's Wort. These interactions can increase the risk of Serotonin syndrome, a potentially life-threatening condition. Always discuss any other medications you are taking with your healthcare provider.

• Some other medicines for depression and anxiety:
  • Monoamine oxidase inhibitors (MAOIs)
  • Tricyclic antidepressants
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Lithium
  • Buspirone (Buspar)
  • Mirtazapine (Remeron)
• Some pain medications
  • Pethidine/meperidine (Demerol)
  • Tramadol (Ultram)
• Other things
  • Dextromethorphan, an over-the-counter cough medicine
  • St. John's Wort, an herb that some people use to treat depression
  • MDMA (Ecstasy), an illegal drug

Related pages

• Serotonin
• Depression
• Anxiety disorders

References

Selective serotonin reuptake inhibitor Resources
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The following are antidepressant subclasses and drugs

MAO Inhibitors Isocarboxazid, Phenelzine, Tranylcypromine

SNRIs Duloxetine, Levomilnacipran, Venlafaxine

SSRIs Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

Tricyclics Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine

Miscellaneous Bupropion, Flibanserin, Mirtazapine, Nefazodone, Trazodone