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anti-depressants:

selective serotonin reuptake inhibitors (SSRI)

Written by Jessica Lui

Last Reviewed: September 2019

Review Due: September 2020

 

examples

Citalopram 

Fluoxetine 

Sertraline

 

mechanism of action

In normal physiology, neurotransmitters are stored in presynaptic neuron vesicles and are released into the synapse when appropriate, going on to take effect on different receptors on postsynaptic neurons, either through agonistic or antagonistic mechanisms. 

 

Some of the neurotransmitters, when released into the synapses, are taken back up into the presynaptic neuron, to be stored and re-released in future transmissions. 

 

This re-uptake mechanism reduces the amount of neurotransmitter present in the instant required for synaptic transmission.

 

This physiological mechanism of neurotransmitter reuptake is manipulated by selective serotonin reuptake inhibitor antidepressants (SSRIs). SSRIs inhibit the reuptake of serotonin back into the presynaptic neuron. This results in higher synaptic concentrations of serotonin. This consequently increases the amount of neurotransmission of serotonin on the postsynaptic neurons, due to their increased presence in the synapse. This causes an antidepressant effect.


SSRIs have no effect on other neurotransmitters such as noradrenaline, dopamine.

indications

Citalopram 

  • Depressive illness 

  • Panic disorder 

 

Fluoxetine 

  • Major depression 

  • Bulimia nervosa 

  • Obsessive-compulsive disorder

  • Menopausal symptoms – hot flushes 

 

Sertraline 

  • Depressive Illness 

  • Obsessive-compulsive disorder 

  • Panic Disorder 

  • Post-traumatic stress disorder

  • Social anxiety disorder

 

side effects

QT interval prolongation 

GI upset 

Arthralgia 

Nausea 

Vomiting

 

Contraindications

All

Poorly controlled epilepsy 

 

Citalopram 

QT interval prolongation 

MAOIs

 

Fluoxetine 

MAOIs 

Metoprolol used in cardiac failure

 

dose adjustments

Hepatic Impairment

Impairs half-life of SSRIs

 
 

interactions

MAOIs 

Metoprolol 

Fluoxetine

counselling

Patients should not take SSRIs if: 

Recently taken an MAOI

Currently taking Pimozide medication 

Have a history of seizures

It is important that patients do not stop taking their medication without consulting their doctor, to prevent withdrawal symptoms.

REFERENCES

  1. Electronic Medicines Compendium, Sertraline package leaflet: information for the patient (2018)

  2. Sertraline. British National Formulary. (2019)