Selective serotonin reuptake inhibitor (SSRI's)

Question 1

What are the generic and brand names of SSRI’s?

Answer 1

• Sertraline (Lustral)
• Citalopram (Cipramil)
• Escitalopram (Cipralex)
• Fluoxetine (Prozac)

Question 2

What is the method of action of SSRI’s?

Answer 2

• Inhibit neural reuptake of serotonin from the synaptic cleft
• ↑ availability of neurotransmitter

Question 3

What are the indications for SSRI’s?

Answer 3

• 1st line treatment for moderate/severe depression (and mild depression if psychological treatments fail)
• Panic disorder
• Obsessive compulsive disorder

Question 4

What are the contraindications for SSRI’s?

Answer 4

• Epilepsy
• Peptic ulcer disease
• Young people - ↑ risk of self harm/suicidal thoughts
• Hepatic impairment

Question 5

What are the side effects of SSRI’s?

Answer 5

• GI upset
• Appetite/weight disturbances (loss or gain)
• Hyponatraemia – present as confusion/reduced consciousness
• Suicidal thoughts and behaviours
• Lower seizure threshold
• Prolonged QT interval/arrhythmias – citalopram
• ↑ risk of bleeding
• Serotonin syndrome – autonomic activity, altered mental state and neuromuscular excitation
• GI upset – withdrawal symptoms
• Neurological/influenza like symptoms - withdrawal symptoms
• Sleep disturbances – withdrawal symptoms

Question 6

What are the interactions with SSRI’s?

Answer 6

• Monoamine oxidase inhibitors - ↑ synaptic serotonin levels leading to serotonin syndrome
• Aspirin/NSAIDs - ↑ risk of GI bleed so gastro protection should be prescribed
• Anticoagulants - ↑ risk of bleeding
• Drugs that prolong QT interval e.g. antipsychotics

Question 7

What organ eliminates SSRI’s?

Answer 7

Kidneys

Question 8

What information should be given to a patient on SSRI’s?

Answer 8

• Improve symptoms over a few weeks
• Carry on with treatment for at least 6 months after they feel better to stop the depression from coming back
• Do not stop treatment suddenly as this may cause withdrawal symptoms