Updated: 4/1/2020

Selective Serotonin Reuptake Inhibitors (SSRIs)

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Psychiatric Drug Introduction
  • Psychiatric medications can be broken down into the following categories
    • antidepressants
    • antipsychotics
    • bipolar medications
    • anxiolytics
 
Overview
  • Drugs
    • fluoxetine
    • paroxetine
    • sertraline
    • citalopram
    • fluvoxamine
  • Mechanism 
    • serotonin-specific reuptake inhibitors (SSRIs)
    • takes 2-3 weeks for antidepressants to have an effect
      • should try for at least 6 weeks 
      • prior to this time, persistence of symptoms indicates inadequate trial 
  • Clinical use
    • depression 
    • OCD
    • bulimia
    • social phobias
  • Toxicity 
    • much milder than other depression therapies
    • anxiety, agitation, insomnia
    • weight gain
    • GI distress
    • sexual dysfunction (anorgasmia)
    • serotonin syndrome
      • diagnose using using the Hunter Serotonin Toxicity Criteria  
        • presence of one of the following sets of features
          • spontaneous clonus
          • inducible clonus with agitation or diaphoresis
          • ocular clonus with agitation or diaphoresis
          • tremor and hyperreflexia
          • hypertonia, temperature above 100.4° F (38° C), and ocular or inducible clonus. 
      • characterized by autonomic instability (HR changes, sweating, shivering, flushing), mental status changes
      • treatment includes:
        • withdrawal of the offending agent
        • benzodiazepines to treat agitation and tremor
        • cyproheptadine as an antidote 
        • neuromuscular paralysis, sedation, and intubation for criticall ill patients
      • risk factors
        • dietary tryptophan 
        • concurrent medications 
          • anti-depressants, amphetamines, and analgesics 
 

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