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SSRIs
- 2. Selective Serotonin Reuptake Inhibitors Fluoxetine Sertraline Citalopram Paroxetine Fluvoxamine Escitalopram
- 3. Clinical indications Major depressive disorder Bipolar depression Anxiety disorders panic disorder / PTSD / OCD / GAD / social anxiety disorder Premenstrual Dysphoric Disorder Eating disorders Bulimia nervosa / Anorexia nervosa Premature ejaculation Smoking cessation
- 4. Some obssessional conditions that SSRIs are helpful but in higher doses: Trichotillomania Nose picking Nail biting Compulsive shopping Acne picking
- 5. Pregnancy and breastfeeding : It is allowed during this period exept Paroxetine
- 8. Sexual dysfunction The most common side effect of SSRIs. It may appear as decreased libido or being unable to have orgasm More problematic with paroxetine Dose dependent continues as long as the drug is taken
- 9. In order to relive the side effect: Dose declination Adding bupropion once or twice per day Sildenafil Rx Stop SSRI and start bupropion Small doses of amphetamines (2.5 mg) may also be of use
- 10. Gastrointestinal side effect Nausea, diarrhea , dyspepsia, vomiting and anorexia Dose related May increase or decrease weight Paroxetine is with the highest risk of weight gain(but can occur with anyone) Fluoxetine-induced loss of appetite and loss of weight begin as soon as the drug is taken and peak at 20 weeks
- 11. Cardiac side effects It may increase QT interval Citalopram causes this more than others
- 12. CNS side effects Headache(Fluoxetine causes the most)/ anxiety(Fluoxetine is more responsible also for agitation and restlessness) It may be useful to provide patients with a few 5-mg diazepam tablets that they can take if anxiety occurs when they first start the SSRI. sleep impairments(paroxetine and citalopram causes somnolence | Fluoxetine causes insomnia the most)
- 13. Extrapyramidal side effects (Tremor is seen in 5% to 10% of people taking SSRIs. SSRIs may rarely cause akathisia , dystonia, tremor, cogwheel rigidity, torticollis, opisthotonos , gait disorders, and bradykinesia more due to Fluoxetine)
- 14. Anticholinergic side effects Paroxetine has slight anticholinergic effects such as dry mouth, constipation and sedation Dry mouth in others is not due to anticholinergic effect
- 15. Hematologic side effects May cause platelets accumulation but not thrombocytopenia May cause easy brusing or prolonged BT
- 16. Glucose and electrolyte impairment SSRI uptake may cause acute hypoglycemia Rare cases of hyponatremia and SIADH has been seen esp in patients using diuretics too
- 17. Allergic reaction and rash Generalized allergic reaction and dermal rash may occur
- 18. Hyperprolactinemia Hyperprolactinemia and Galactorrhea also occur
- 21. Concurrent administration of an SSRI with an MAOI can raise plasma serotonin concentrations to toxic levels and produce a constellation of symptoms called serotonin syndrome:
- 22. I. diarrhea II. restlessness III. extreme agitation, hyperreflexia , and autonomic instability with possible rapid fluctuations of vital signs; IV. myoclonus, seizures, hyperthermia, uncontrollable shivering, and rigidity V. Delirium , coma, status epilepticus , cardiovascular collapse, and death
- 24. Treatment removing the offending agents nitroglycerine, Methysergide ( Sansert ), cyproheptadine , cooling blankets, chlorpromazine (Thorazine), dantrolene (Dantrium), benzodiazepines, anticonvulsants, mechanical ventilation, paralyzing agents.
- 26. Appears after at least 6 weeks of treatment and generally resolves spontaneously in 3 weeks dizziness, weakness, nausea, headache, rebound depression, anxiety, insomnia, poor concentration, upper respiratory symptoms, paresthesias, and migrainelike symptoms
- 27. Drug interactions The combination of lithium and all serotonergic drugs should be used with caution because of the possibility of precipitating seizures