Selective Serotonin Reuptake Inhibitors

Citalopram (Celexa)escitalopram oxalate (Lexapro)fluoxetine (Prozac)paroxetine (Paxil)setraline (Zoloft)

Depression, anxiety disorders, some personality disorders

Neurotransmitter in the CNS

Found in high concetnrations in certain neurons in the hypothalamus, limbic system, medulla and spinal cord.

SSRIs block the reuptake of serotonin into the prensynaptic nerve terminals, thereby increasing the extracellular levels of serotonin available to bind to the postsynaptic receptor.

Headache, urinary retention, weight changes, sleep changes (insomnia, somnolence, and/or vivid dreams), diminished libido and erectile dysfunction, suicidal ideation/increased risk of suicide (particularly in children and adolescents)

Cannot be used concomitantly with MAOIs, TCAs.Liver impairment (SSRIs are metabolized in the liver)

*Obtain baseline liver function tests and body weight.*Assess for risk of suicide, disorders of sexual function, use of other CNS suppressants.*Antidepressant therapy works best when use in conjunction with behavioral therapy.*If discontinued abruptly, can cause withdrawal symptoms, including, nausea, sweating, dizziness, tremors, vertigo, confusion, and nightmares.

*Maintain follow up appointments with health care providers.*Monitor weight *Educate pt on potential side effects, and encourage pt to report problematic side effects to physician.*Educate parents and younger patients in particular on the increase risk of suicide during the first few weeks of therapy.*Do not discontinue abruptly.*Do not drive or engage in hazardous activites until sedative effect is know. Take at bedtime to avoid negative side effects of sedation.*Can take up to 6 weeks to reach full potential.

*Occurs when taking other meds that affect the metabolism, synthesis, or reuptake of serotonin, causing serotonin to accumulate in the body.*Symptoms include confusion, anxiety, restlessness, hypertension, tremors, sweating, hyperpyrexia, and ataxia.*Conservative tx is to discontinue SSRI use and provide supportive are.*In severe cases, mechanical ventilation and muscle relaxants may be necessary.

50-200mg/day

20-80mg/day

*Can decrease elimination of beta blockers, leading to hypotension and bradycardia.*Concurrent use with warfarin increases risk for bleeding, due to competitive protein binding.*Concurrent use with benzos may increase adverse CNS effects.