Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are widely used medications for the treatment of a variety of mental health disorders.  Several weeks are generally required until maximum benefit is achieved.  SSRIs are generally safer than other antidepressants when taken as an overdose with seizures being the main concern with overdose. Serotonin syndrome can occur when SSRIs are used in conjunction with other medications that increase serotonin activity. Serotonin syndrome is characterized by hyperthermia, rigidity, tremor, and cardiovascular collapse.  

Class Drugs

• Citalopram

• Escitalopram

• Fluoxetine

• Fluvoxamine

• Paroxetine

• Sertraline

Class Mechanism of Action

• Blocks reuptake of serotonin in central nervous system.

Class Application

Depression

• Increases serotonin levels in the synaptic cleft.

• 2-12 weeks needed to reach maximum benefit.

• Individuals respond differently to each medication.

Obsessive-compulsive disorder (OCD)

Panic disorder

Generalized anxiety disorder

Post-traumatic stress disorder (PTSD)

Premenstrual dysphoric disorder

Bulimia (fluoxetine)

Class Adverse Effects

Sleep disturbance

• Fluoxetine and sertraline are more activating.

Useful in patients who feel fatigued.

• Paroxetine and fluvoxamine are more sedating.

Useful in patients who have trouble sleeping.

Sexual dysfunction

• Anorgasmia

• Delayed ejaculation

• Decreased libido

Suicidal thoughts

• Children and teenagers can develop suicidal thoughts when taking this medication.

Discontinuation syndrome

• Occurs when SSRI is stopped suddenly.

• Headache, malaise, agitation, irritability, sleep change

Considerations in overdose

• Prolonged QT interval

• Seizures

• Serotonin syndrome, especially in combination with other drugs such as MAOi

Drug Table

Drug Name	Application	Comments	Image
Citalopram		Seizure risk in overdose	"Cintas Truck"
Escitalopram		Seizure risk in overdose	"S" and "Cintas Truck"
Fluoxetine			"Flu Shot" "Eating"
Fluvoxamine			"Flu Shot" is "Mine"
Paroxetine			"Parrot" "Eating"
Sertraline			"Serta Mattress" and "Line"