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Selective Serotonin Reuptake Inhibitor
Aka: Selective Serotonin Reuptake Inhibitor, SSRI- Indications: First Line
- Major Depression
- Generalized Anxiety Disorder
- Premature Ejaculation
- Indications: Adjunctive
- Adverse Effects: All SSRI
- Increased Suicidality in children and teens (FDA black box warning)
- Appetite suppression
- Sleep disturbance
- Galactorrhea
- Sexual Dysfunction
- Hyponatremia
- Consider monitoring Serum Sodium
- Upper Gastrointestinal Bleeding in over age 65 years
- Average rate: 7.3 per 1000 person years (6.6 - 7.9)
- Bleeding risk increased with SSRI potency
- Other Risk Factors
- Very old patients (where young is age 65 years)
- Prior history of Gastrointestinal Bleeding
- Diabetes Mellitus
- Medications (Coumadin, ASA, NSAIDs, Corticosteroid)
- References
- Average rate: 7.3 per 1000 person years (6.6 - 7.9)
- Bleeding risk (antiplatelet activity)
- Hemorrhagic CVA risk (postmenopausal women): 2.12 Hazard Ratio
- SSRI in combination with NSAID
- Serious upper gastrointestinal event (GI Bleed): 4.19 Adjusted Odds Ratio
- Hellin-Salmivaara (2007) Eur J Clin Pharmacol 63:403-8 [PubMed]
- Precautions
- Increased Suicidality in children and teens (FDA black box warning)
- Avoid concurrent use with MAO inhibitor
- Risk of Serotonin Syndrome
- Pregnancy
- Persistent Pulmonary Hypertension
- Increased risk by 6 fold if SSRIs used after 20 weeks
- Number needed to harm: 286-351
- Grigoriadis (2014) BMJ 348:f6932 [PubMed]
- SSRIs have shown mixed or weak associations with Autism (as one of many contributing factors)
- Persistent Pulmonary Hypertension
- Adverse Effects: Overdose Symptoms and Signs
- Usually mild and non-life threatening
- Cardiovascular effects unlikely
- Nausea or Vomiting
- Diarrhea
- Dizziness or Somnolence
- Seizures
- Serotonin Syndrome
- Classes: Selective Serotonin Reuptake Inhibitors (SSRI)
- Monocyclic
- Bicyclic
- Fluoxetine HCl (Prozac)
- Tricyclic
- Sertraline HCl (Zoloft)
- Tetracyclic
- Paroxetine HCl (Paxil)
- Classes: Other new Antidepressants (non-SSRI)
- See Antidepressant
- Serotonin Modulator and Stimulator (same activity as SSRI)
- Vortioxetine (Brintellix)
- New in 2013, similar to generic SSRIs, with more Nausea at 10x the cost
- Vortioxetine (Brintellix)
- Serotonin Norepinephrine Reuptake Inhibitors (SNRI)
- Venlafaxine (Effexor)
- Same class as Tricyclic Antidepressants
- Norepinephrine Dopamine Reuptake Inhibitor (NDRI)
- Serotonin Antagonist and Reuptake Inhibitor (SARI)
- Nefazodone (Serzone)
- Same class as Trazodone (Desyrel)
- Norepinephrine Antagonist Serotonin Antagonist (NASA)
- References