Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs were first introduced in 1987 and since that time have
become the most commonly prescribed group of antidepressants, racking up over $3
billion in sales annually. SSRIs are as effective as tricyclics but they do not
cause hypotension, sedation, or the anticholinergic effects. Another benefit of
these drugs is they do not cause cardiotoxicity if taken in an overdose and
death by overdose is very rare.
Selective Serotonin Reuptake Inhibitors do exactly what there name says. By
selectively inhibiting reuptake of serotonin they are able to intensify
transmission at serotonergic synapses. Much like with the tricyclics the
blockade of the transmitter uptake occurs quickly but the therapeutic effects
take longer to occur. It is thought the therapeutic effects take longer to
develop because of cellular changes that happen in response to the prolonged
serotonin reuptake blockade.
SSRIs are used to primarily treat major depression with the antidepressant
effects beginning to show after 1 to 3 weeks of treatment. These drugs are also
approved for use in people with obsessive-compulsive disorder, bulimia nervosa,
and premenstrual dysphoric disorder. They can also be used for panic-disorder,
post-traumatic stress disorder, social phobia, alcoholism,
attention-deficit/hyperactivity disorder, bipolar disorder, migraines,
Tourette's syndrome, and obesity.
As with any drug Selective Serotonin Reuptake Inhibitors have a series of
adverse side effects that their users need to be aware of.
1. Sexual Dysfunction – Almost 70% of men and women who take SSRIs experience
some form of sexual problem that can include impotence, delayed or absent
orgasm, delayed or absent ejaculation, or decreased sexual interest. The reasons
for this are unknown.
2. Weight Gain - Although most people see an initial weight loss when taking
these drugs with long term treatment nearly all patients see that weight
regained and about one-third of these people continue putting on weight. In some
cases up to twenty pounds or more.
3. Serotonin Syndrome – Because SSRIs increase serotonergic transmission in the
brainstem and spinal cord they can cause what is known as serotonin syndrome.
This is most likely to happen if the SSRI is taken in conjunction with an MAOI.
The signs of this syndrome include an altered mental status, uncoordination,
myoclonus, hyperreflexia, excessive sweating, tremors and fever. It can also
cause death.
4. Withdrawal Syndrome – Anyone who takes SSRIs is at risk for withdrawal
syndrome if they suddenly quit taking their medication. Symptoms can include
dizziness, headache, sensory disturbances, tremors, anxiety and dysphoria.
Resuming use of the drug will cause the symptoms to go away and the best way to
minimize withdrawal syndrome is to slowly taper the patient off the drug with
lower doses.
5. Neonatal Withdrawal Syndrome – Women who take SSRIs and are pregnant,
particularly late in their pregnancy, place their newly born baby at risk for
withdrawal symptoms. This can be managed with supportive care at the hospital
and usually goes away in several days. | 
