SSRI Medications

Question 1

Escitalopram/Lexapro

Answer 1

Use: MDD, panic d/o, OCD, PTSD, social anxiety, PMDD

12 years old+
-Start 5-10 mg, max 20mg
- Tabs in 5, 10, 20 (scored); solution 5mg/5mL
- May take at bedtime if sedating
- Good with stimulants

Side effects
-Well tolerated, minimal side effects
- Less sexual side effects
-QTC prolongation
- 10mg= Celexa 40mg
- Give adequate trial @ 10mg

Question 2

Citalopram/Celexa

Answer 2

Use: MDD, PMDD, OCD, GAD, social anxiety.
- Good 1st choice, better tolerance
-Choice for poor sleep, fatigue
- Better response @ 40mg
- >60 years of age=dose @ 20mg

• Start 20mg, max 40mg for MDD
• Start 20mg, max 60mg for OCD
• Tabs in 10, 30, 40 (scored)

Side effects
- Baseline labs (K, NA, MG-hyponatremia, SIADH)
- Risk of QT prolongation
-Well tolerated in elderly with EKG
- No warfarin, tagamet,
- Antihistamine properties
-CYP450

Question 3

Sertraline/Zoloft

Answer 3

Use: MDD, PMDD, Panic, PTSD, social anxiety, OCD, GAD.
- 1st choice atypical sx, especially hypersomnia, low energy
- AM dosing- insomnia

OCD ages 6+, 12+ start 25mg, max 200mg
-Tabs in 25, 50, 100mg (scored tabs); solutions in 20 mg/mL

Side effects
-Lower dose for hepatic
- May increase Xanax, buspar, some cholesterol meds
- Beta blockers, strattera, codeine, thioridazine can inhibit breakdown
-Best for cardiac issues

Question 4

Fluoxetine/Prozac

Answer 4

Use: MDD, OCD, PMDD, Bulimia, Panic D/O, social anxiety, PTSD, bipolar depression
-Good for atypical sx-activating
- Less tolerated in anxiety/panic-avoid/give lower dose
- Symbyax (olanzapine-fluoxetine) great for tx resistant unipolar and bipolar depression

Ages 8+ MDD
Age 7+ OCD
-Start 20mg, max 80mg
-60mg bulimia
- 20mg for panic disorder
- Capsules: 10, 20, 40

Side effects:
-Take am only
- good for trichotillomania
- May increase levels of xanax, buspar, some cholestrerol meds
- May reduce clearance of trazodone, valium, some cholestrerol meds
- CYP450

Question 5

Paroxetine/Paxil

Answer 5

Use: MDD, OCD, Panic, PTSSD, Social anxiety, GAD, PMDD
- Relief of insomnia, anxiety
- Helps anxiety more than depression

-Start 20mg, max 50mg
- Tabs in 10, 20, 30, 40
- NO KIDS

Side effects:
- Can be sedating-take at night
- NO pregnancy
- avoid if ACH sensitivity
- Lower dose hepatic and renal

Question 6

Fluoxamine/Luvox CR

Answer 6

Use: OCD, social anxiety, depression GAD, panic d/o, PTSD
- Advantage in mixed anxiety/depression
- sedating, take at night
- relief in insomnia or anxiety
- OCD- augment with atypicals

Dose
1st line OCD
Start 100 mg, max 300 mg
ER cap 100, 150

Side effects:
- <24 years of age, increase risk of SI
- Taper 50% 3 days. SOme need long taper- 3 months
- CYP450
- Less sexual side effects