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Selective serotonin reuptake inhibitors (SSRI)
💊 SSRIs (Selective Serotonin Reuptake Inhibitors) are usually the first-line choice for moderate–severe depression in adults due to their safety profile, particularly in overdose. ⏳ Full response may take ≥6 weeks, and treatment should continue for at least 6 months after recovery to reduce relapse risk.
📖 About
- Less cardiotoxic and with fewer muscarinic side effects than TCAs.
- Some newer agents (SNRIs) also block noradrenaline reuptake, offering broader efficacy.
- Check BNF here for prescribing details.
⚙️ Mechanism of Action
- SSRIs: Inhibit serotonin reuptake → ↑ serotonin in synaptic cleft.
- SNRIs: Block serotonin and noradrenaline reuptake (e.g., venlafaxine, duloxetine).
- Improves mood, anxiety, and related symptoms over time.
🎯 Indications
- Moderate–severe depression (adults only — not recommended in under-18s in the UK).
- Anxiety disorders (GAD, panic disorder, social anxiety, OCD, PTSD).
- Bulimia nervosa (fluoxetine licensed).
- Premenstrual dysphoric disorder.
💊 Common SSRIs (typical adult doses)
- Fluoxetine: start 20 mg OD → max 60 mg.
- Citalopram: start 20 mg OD → up to 40 mg (QT caution).
- Sertraline: start 50 mg OD → up to 200 mg.
- Paroxetine: start 20 mg OD → up to 50 mg.
⚠️ Side Effects (serotonin-related)
- Nausea, diarrhoea, dyspepsia.
- Insomnia or excessive somn
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