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Updated: Apr 1 2020

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • 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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