SSRI – Selective Serotonin Reuptake Inhibitor.
SSRI or selective serotonin reuptake inhibitor is the depression medication that most doctors use to start antidepressive therapy. SSRIs are effective, safer to use and side effects are few as compared to other types of antidepressants. Previously we discussed treatments of depression and antidepressants and here we discuss SSRI which is the most common first line of antidepressants used for depression.
Uses of SSRIs in Psychiartry.
- Clinical depression forms the main indication for selective serotonin reuptake inhibitors.
- Anxiety disorders.
- Panic disorders.
- Eating disorders such as anorexia and bilumia
- Chronic pain.
- Irritable bowel syndrome.
- Premature ejaculation.
How Selective Serotonin Reuptake Inhibitors or SSRIs Work.
Inadequate amount of neurotransmitters, which are naturally occurring brain chemicals, is a possible cause of depression. Neurotransmitters, as the name suggests, are responsible for transmission of nerve or brain signals. Serotonin also called 5-HT, is one such neurotransmitter. SSRIs raise the levels of serotonin in the brain which brings about a “good mood” effect. Fall of serotonin levels in the brain due to serotonin uptake results in a depressive state of mind.
Serotonin Reuptake.
Adequate levels of these neurotransmitters like serotonin, help the brain cells to receive and send chemical signals which helps to boost the mood of the person. This is brought about by the SSRIs by preventing the reuptake or reabsorption of serotonin by the nerve cells thereby maintaining adequate levels. Since they act selectively on serotonin and inhibit its uptake , they are called selective serotonin reuptake inhibitors or SSRIs.
List of Selective Serotonin Reuptake Inhibitors or SSRIs.
The following is the list of SSRIs or SSRIs examples with generic names and brand names in brackets, which are approved by the FDA to treat depression.
- Fluoxetine (Prozac),
- Paroxetine (Paxil),
- Sertraline (Zoloft),
- Citalopram (Celexa) and
- Escitalopram (Lexapro).
- Vibryd – recently approved in early 2011.
Some of these SSRIs are available as time release form and are designated as XR or CR. They are given in single dose and provide controlled release of the medication throughout the day or week. Their advantage is that less nausea is experienced with these time release SSRIs.
Common Side Effects of SSRIs.
Following are the adverse effects or side effects of SSRIs.
- Decreased libido,
- Difficulty to reach an orgasm,
- Headache and nausea,
- Fatigue and dizziness,
- Dryness of the mouth,
- Nervousness and restlessness,
- Drowsiness.
- Insomnia (difficulty in falling asleep)
- Indigestion and diarrhea.
- Change in weight. This could manifest as weight gain or weight loss. Weight gain, however is more common with SSRIs.
- Heart problems with SSRIs are extremely rare. Overdose of Fluxetine is known to cause cardiac arrythmias and myocardial infarction. Cardiovascular patients on SSRIs should be carefully monitored with ECG monitoring.
However some of these side effects do go away with time. Sexual problems mentioned above, which are also caused by other antidepressants occur in about 50% of the patients who take SSRIs.
Precautions and Safety Concerns to be taken with Selective Serotonin Reuptake Inhibitors. (SSRIs).
SSRIs and Pregnancy.
Antidepressants can cause harm to the unborn or nursing child. Using antidepressants in late pregnancy can lead to withdrawal symptoms in the newborn. These withdrawal symptoms are of short duration. Such symptoms include mild respiratory problems, a weak cry, restlessness and tremors. If you are pregnant or planning to become pregnant or nursing your child, do talk to your doctor. Paxil in particular which is a SSRI can cause congenital defects including defects in the lungs and heart of the developing fetus.
Drug reactions with SSRIs.
Drug interactions with SSRIs are known and no drug should be included for use without talking to your treating doctor when on SSRI. Some drugs which interact with SSRIs are blood thinners (warfarin), NSAIDs (ibuprofen), drugs given for cardiac arrhythmias (propafenone) and tricyclic antidepressants (imipramine).
SSRIs and anticoagulants.
If you are on any SSRI do not take aspirin or non steroidal anti-inflammatory drugs (NSAIDs) or any anti coagulants because such a combination will increase risk of bleeding.
Serotonin syndrome.
Rarely SSRIs can cause serotonin syndrome which occurs due to high levels of serotonin. This can occur usually when two drugs which increase serotonin in the brain are given in combination for depression. These could be antidepressants for depression or some other drug given for some other illness. Even giving the herbal supplement, St John’s wart with a SSRI can cause such a complication. Serotonin csyndrome can cause side effects such as confusion, fever, dilated pupils, increased and irregular heart beat and can even cause unconsciousness. Appearance of such symptoms should immediately require medical attention.
SSRIs and suicide risk.
All antidepressants carry risk of suicide attempt especially in young children, teens and young adults and it is mandatory that such a warning be displayed on the label of the medication. The first few weeks of treatment with antidepressants should be watched carefully for signs of worsening depression and should be reported immediately to the treating doctor if anything untoward is noticed.
Withdrawal Symptoms with SSRIs.
Taking SSRIs does not cause addiction but on discontinuation, withdrawal signs and symptoms are seen. They include headache, nausea, dizziness, lethargy, fever and bodyache.
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