Selective Serotonin Reuptake Inhibitors

(SSRIs)

• Safer in overdose than other drugs

• Don’t increase appetite 

• Fewer anti-muscarinic side-effects than tricyclics

• Well tolerated in the elderly

• “Best” drug to use in epileptics. 

• Non-sedating

Indications

•  e.g.fluoxetine, sertraline 
• Depression 
• Chronic Anxiety 
• Obsessive Compulsive 
• Bulimia 
• Seasonal Affective Disorder 
• Prophylaxis against recurrent depression

Mechanism Of Action

• Block neuronal uptake of 5H-T 

Side Effects

GI

• dry mouth
• Nausea
• dyspepsia
• bloating
• flatulence
• diarrhoea
• upper GI bleeding

Neuropsychiatric

• Insomnia
• daytime somnolence
• agitation
• tremor
• restlessness
• irritability
• headache
• seizures
• mania in BAD

Extrapyramidal

• parkinsonism
• akisthisia

Other

• Sexual dysfunction
  • erectile dysfunction
  • delayed orgasm
• sweating
• SIADH leading to low sodium

Contra-Indications

• Hepatic and renal failure 
• Epilepsy 
• Manic phase of Bipolar Disorder

Interactions

•  Lithium / MAOIs
  • 5HT syndrome
    • agitation
    • hyperpyrexia
    • rigidity
    • myoclonus
    • coma
    • death
• P450 inhibition
  • tricyclics
  • antipsychotics
  • anticonvulsants
  • warfarin

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