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<ref name="PRESCORN2004">,

 Antidepressants: Past, Present and Future, 
  
 Berlin:Springer, 
 2004, 
  
  
 ISBN 978-3-540-43054-4, 
  
  
  
 Pages: 241–62,</ref>. 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<ref name="PRESCORN2004"/>:

• 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<ref name=nicedpsn/>. The effectiveness of SSRIs in the treatment of mild, transient depression remains a topic of ongoing research and debate<ref name=nicedpsn>

Depression in Adults: Recognition and Management(link). National Institute for Health and Care Excellence. RCPsych Publications.

</ref>.

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<ref name = Kapczinski>Kapczinski F; Lima MS; et al. 2003,

 Antidepressants for generalized anxiety disorder, 
 The Cochrane Database of Systematic Reviews, 
 
 
 pp. CD003592,
 DOI: 10.1002/14651858.CD003592,
 PMID: 12804478,</ref>. 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<ref>Arroll B; Elley CR; et al. 2009, 
 Antidepressants versus placebo for depression in primary care, 
 The Cochrane Database of Systematic Reviews, 
 
 
 pp. CD007954,
 DOI: 10.1002/14651858.CD007954,
 PMID: 19588448,</ref><ref name=ocd>

Review Finds SSRIs Modestly Effective in Short-Term Treatment of OCD(link). Medscape.

February 28, 2008.

</ref>.

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<ref name=ptsd>Hetrick SE; Purcell R et al. 2010,

 Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD), 
 The Cochrane Database of Systematic Reviews, 
 
 
 pp. CD007316,
 DOI: 10.1002/14651858.CD007316.pub2,
 PMID: 20614457,</ref><ref name=":3">Berger W; Mendlowicz MV et al. 2009, 
 Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: A systematic review, 
 Progress in Neuro-Psychopharmacology & Biological Psychiatry, 
 
 Vol. 33(Issue: 2),
 pp. 169–180,
 DOI: 10.1016/j.pnpbp.2008.12.004,
 PMID: 19141307,
 PMC: 2720612,
 
 Full text,</ref><ref name=":4">, 
 World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision, 
 The World Journal of Biological Psychiatry: The Official Journal of the World Federation of Societies of Biological Psychiatry, 
 
 Vol. 9(Issue: 4),
 pp. 248–312,
 DOI: 10.1080/15622970802465807,
 PMID: 18949648,
 
 
 Full text,</ref>. Notably, apart from Prozac and Paxil, most other SSRIs do not appear to significantly improve PTSD symptoms<ref name=Hos2015>Hoskins M; Pearce J et al. 2015, 
 Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis., 
 British Journal of Psychiatry, 
 
 Vol. 206(Issue: 2),
 pp. 93–100,
 DOI: 10.1192/bjp.bp.114.148551,</ref>.

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<ref>Warner CH; Bobo W; Warner C; Reid S; Rachal J,

 Antidepressant discontinuation syndrome, 
 American Family Physician, 
 2006,
 Vol. 74(Issue: 3),
 pp. 449–56,
 
 PMID: 16913164,</ref>.

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<ref>Boyer EW; Shannon M,

 The serotonin syndrome, 
 The New England Journal of Medicine, 
 2005,
 Vol. 352(Issue: 11),
 pp. 1112–20,
 DOI: 10.1056/NEJMra041867,
 PMID: 15784664,</ref>. 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

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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