Selective Serotonin Reuptake Inhibitors (SSRIs)

Question 0

Fluvoxamine (Luvox)

Answer 0

SSRI

Question 1

Fluoxetine (prozac)

Answer 1

Is an SSRI. Converted to norfluoxetine (long t1/2). Wait 5 wks after d/c to switch. Also effects NE reuptake. Can cause insomnia/agitation, take in the morning. Can use in PMS.

Question 2

Paroxetine (Paxil)

Answer 2

More selective for 5-HT reuptake than fluoxetine, approved for OCD, social anxiety disorder, depression. May cause sedation(no insomnia), should be taken at night, anorexia/nausea possible. Inactive metabolites. DOC for OCD, contraindicated in pregnancy due to cardiac effects.

Question 3

Sertraline (Zoloft)

Answer 3

More selective for 5-HT than fluoxetine, shorter action (metabolites not active). Less hepatic inhibition (fewer interactions). Approved for OCD, social anxiety disorder, depression. Less sexual side effects than fluoxetine.

Question 4

Citalopram (Celexa)

Answer 4

Similar to fluoxetine, faster onset. Little effect on CYP2D6-few interactions.

Question 5

Escitalopram (Lexapro)

Answer 5

Similar to fluoxetine, faster onset, S-enantiomer of citalopram. Little effect on CYP2D6-few interactions.

Question 6

SSRIs

Answer 6

Inhibit reuptake of 5-HT into synaptic terminal. Effects take 2-3 wks. Oral, extensive protein binding. T1/2= 2-3 days. Drug interactions w/ MAOIs, st john wort, TCA, warfarin, phenytoin, carbamazepine, b-blockers, opioids, tramadol (seizures), tamoxifen. DOC for depression and panic disorder, bulimia, alcoholism, can be used in adolescents and young adults (despite black box warning of inc suicide risk).

Question 7

Vortioxetine

Answer 7

Inihibts 5-HT reuptake, also antagonizes 5-HT3a and 5-HT7 receptors, 5-HT1b partial agonist, 5-HT1a agonist. Inc. serotonergic activity. SE: N/D, dizziness, dry mouth, abnormal dreams, sexual disfunciton.

Question 8

Vilazodone

Answer 8

SSRI and 5-HT1a partial agonist. Metab by CYP3A4. SE: N/D, dizziness, abnormal dreams, dry mouth. Less sexual dysfunction than other SSRIs.