Makindo Medical Notes

💊 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