Selective Serotonin Reuptake Inhibitors (SSRIs)

Question 1

What are SSRIs first-line treatment for?

Answer 1

Depression

Question 2

Which SSRIs are the preferred ones?

Answer 2

Citalopram

Fluoxetine

Question 3

What are the main adverse effects of SSRIs?

Answer 3

GI symptoms
Increased risk of GI bleeding (PPI if also on an NSAID)
Increased anxiety + agitation after starting

Question 4

Which SSRIs have a higher chance of drug interaction?

Answer 4

Fluoxetine

Paroxetine

Question 5

What is the warning associated with citalopram and who should it not be used in?

Answer 5

QT interval prolongation

Shouldn’t be used if those with congenital long QT syndrome, known pre-existing QT interval prolongation, or if they’re already taking a QT-prolonging drug

Question 6

What are the main SSRI drug interactions?

Answer 6

NSAIDs - give PPI
Warfarin/heparin/aspirin - give mirtazapine instead
Triptans and monoamine oxidase inhibitors - increased risk of serotonin syndrome

Question 7

When should patient first receiving antidepressants be reviewed?

Answer 7

After 2 weeks

<30/at increased risk of suicide then 1 week

Question 8

How long should patients be on antidepressants minimum and why?

Answer 8

6 months even if good response

Reduces risk of relapse

Question 9

How should an SSRi be stopped?

Answer 9

Gradually reduced over 4 weeks to avoid discontinuation symptoms

Question 10

What are the discontinuation symptoms of SSRIs?

Answer 10

Increased mood change
Restlessness
Difficulty Sleeping
Electric shock feeling/paraesthesia
Unsteadiness
Sweating
GI symptoms (pain, cramping, diarrhoea, vomiting)

Question 11

What 3 issues can SSRIs cause in pregnancy?

Answer 11

First trimester - small risk of congenital heart defects
Third trimester - persistent pulmonary hypertension (newborn)
Paroxetine - increased risk of congenital malformations (esp first trimester)