Selective serotonin reuptake inhibitors

Question 1

name the SSRI and their action

Answer 1

SSRI block the SERT. so inhibit the reuptake of serotonin back to the nerve terminal.

1. fluoxetine
   - -> 4-6 weeks for elimination and its active metabolite, norfluoxetine needs another 7-9 days to eliminate.
2. dapoxetine
3. fluvoxamine
4. sertraline
5. paroxetine
   - –> 4 & 5 have a half life of 25-35hours, safer to take, only once per day
6. citalopram
7. escitalopram

Question 2

indications for SSRI

Answer 2

1. 1st choice drugs for depression because they lack TCA side effects !! (2-3 weeks needed to actually see the antidepressive effect so you should combine them with a drug with acute effect first eg.BZD and slowly discontinue it until the effect of the SSRI arise)
2. general anxiety & panic anxiety
3. eating disorders (bulimia but not anorexia because they make you loose weight)
4. premenstrual disphoria
5. dapoxetine given to treat premature ejaculation

Question 3

side effects of SSRI & disadvantage

Answer 3

1. increased serotonin in the synaptic cleft activates the 5HT2 : anxiety, insomnia, sexual disfunction such as decreased libido.
   activates 5HT3: nausea, vomiting, diarrhea, headaches,weight loss.
2. given together with MAOi causes serotonin syndrome. even of not given together, there is still a chance to develop the syndrome, since the elimination of the SSRI is very long and if they were not successful, you should switch to TCA BUT you have to correctly estimate and be sure that the SSRI where fully eliminated!
3. BRUXISM is the grinding of the teeth which comes as a side effect with drugs that increase serotonin