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Selective Serotonin Reuptake InhibitorAka: SSRI

Indications: First Line
1. Major Depression
2. Generalized Anxiety Disorder
  1. Fluvoxamine (Luvox)
  2. Paroxetine (Paxil)
3. Premature Ejaculation
  1. Paroxetine (Paxil)
  2. Sertraline (Zoloft)
  3. Fluoxetine (Prozac)
Indications: Adjunctive
1. Migraine Headache Prophylaxis
  1. Fluoxetine (Prozac)
2. Diabetic Neuropathy
  1. Paroxetine (Paxil)
3. Fibromyalgia
  1. Fluoxetine (Prozac)
4. Neurocardiogenic Syncope
  1. Paroxetine (Paxil)
  2. Sertraline (Zoloft)
  3. Fluoxetine (Prozac)
Adverse Effects of all SSRI
1. Appetite suppression
2. Sleep disturbance
3. Galactorrhea
  1. Lowering Dopamine disinhibits Prolactin
4. Sexual Dysfunction
  1. See Antidepressant Induced Sexual Dysfunction
5. Hyponatremia
  1. Consider monitoring Serum Sodium
6. Upper Gastrointestinal Bleeding in over age 65 years
  1. Average rate: 7.3 per 1000 person years (6.6 - 7.9)
    1. Bleeding risk increased with SSRI potency
  2. Other Risk Factors
    1. Very old patients (where young is age 65 years)
    2. Prior history of Gastrointestinal Bleeding
    3. Diabetes Mellitus
    4. Medications (Coumadin, ASA, NSAIDs, Corticosteroid)
  3. References
    1. Van Walraven (2001) BMJ 323:655
Precautions
1. Avoid concurrent use with MAO inhibitor
  1. Risk of Serotonin Syndrome
Overdose Symptoms and Signs
1. Usually mild and non-life threatening
2. Cardiovascular effects unlikely
3. Nausea or Vomiting
4. Diarrhea
5. Dizziness or somnolence
6. Seizures
7. Serotonin Syndrome
Classes: Selective Serotonin Reuptake Inhibitors (SSRI)
1. Monocyclic
  1. Fluvoxamine (Luvox)
2. Bicyclic
  1. Fluoxetine HCl (Prozac)
3. Tricyclic
  1. Sertraline HCl (Zoloft)
4. Tetracyclic
  1. Paroxetine HCl (Paxil)
Classes: Other new Antidepressants (non-SSRI)
1. See Antidepressant
2. Serotonin Norepinephrine Reuptake Inhibitors (SNRI)
  1. Venlafaxine (Effexor)
  2. Same class as Tricyclic Antidepressants
3. Norepinephrine Dopamine Reuptake Inhibitor (NDRI)
  1. Bupropion (Wellbutrin, Zyban)
4. Serotonin Antagonist and Reuptake Inhibitor (SARI)
  1. Nefazodone (Serzone)
  2. Same class as Trazodone (Desyrel)
5. Norepinephrine Antagonist Serotonin Antagonist (NASA)
  1. Mirtazapine (Remeron)
References
1. Bhatia (1997) Am Fam Physician 55(5):1683
2. Stone (2003) Am Fam Physician 68(3):498

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.