Selective Serotonin Reuptake Inhibitors (SSRIs) Antidepressants

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Category: Medical Options

What is it?

Selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor (SSRIs) are a class of medications used in the treatment of depression, anxiety disorders and some other conditions. SSRIs are commonly prescribed to assist patients with PTSD symptoms.

There are several SSRIs available which have slightly different chemical makeup’s and effects.

  • Citalopram
    - trade names include Celexa, Cipramil, Dalsan, Recital, Emocal, Sepram, Seropram
  • Escitalopram
    - trade names include Lexapro, Cipralex, Esertia
  • Fluoxetine
    - trade names include Prozac, Fontex, Seromex, Seronil, Sarafem, Lovan
  • Fluvoxamine
    - trade names include Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox
  • Paroxetine
    - trade names include Paxil, Seroxat, Sereupin, Aropax, Deroxat, Rexetin, Xetanor, Paroxat
  • Sertraline
    - trade names include Zoloft, Lustral, Serlain
  • Zimelidine
    - trade names include Zelmid, Normud

How does it work?

In the brain, messages are passed between nerve cells via a synapse, a small gap between the cells. Naturally occurring chemicals known as neuro-transmitters (of which serotonin is one) allow the messages to pass across that gap. It is believed that incorrect levels of serotonin in some people lead to symptoms such as depression. It is thought that SSRIs improve the level of serotonin available and thus help to normalise brain function.

Is it effective?

SSRIs are commonly prescribed for the treatment of PTSD however there is still mixed evidence of their effectiveness. Higher levels of evidence from systematic reviews are available to support the use of SSRIs for depression and anxiety generally but the same level of evidence does not exist specifically for PTSD. Clinical trials conducted with PTSD patients have found that some SSRIs are somewhat more effective than placebos in controlling PTSD symptoms, but the improvements gained have not reached levels of statistical significance. The majority of research to date has been on sertraline.

Are there any disadvantages?

There can be potential side effects from the use of SSRIs. Side effects include nausea, drowsiness, headaches, dizziness and skin irritations. Other side effects are possible and health practitioners should be made aware of any changes. At the end of the treatment period it is generally recommended that the dosage of SSRIs is gradually weaned off to avoid unwanted symptoms sometimes referred to a ‘discontinuation syndrome’.

Where do you get it?

SSRIs can only be prescribed by registered health practitioners.

What are the evidence limitations?

The evidence base for SSRI use in PTSD is still limited and further research is needed before effectiveness and safety can be established. Methods of diagnosing PTSD were not reported in the review literature. Therefore interpreting this evidence should be undertaken with caution.

Recommendations

Based on current limited evidence, SSRIs are not recommended as the first line of treatment for PTSD. Although evidence is emerging regarding the effectiveness of SSRIs for reducing some PTSD symptoms, this is not yet conclusive. SSRIs may be useful for patients unable to participate in other therapies, or as an adjunct to other interventions such as trauma focused cognitive behavioural therapy. It is important that any SSRI treatment is prescribed by a registered health professional, with appropriate assessment carried out prior to treatment as well as ongoing monitoring during the course of treatment.

Key References

Asnis, GM, Kohn, SR, Henderson, M & Brown, NL 2004, ‘SSRIs versus Non-SSRIs in Post-traumatic Stress Disorder: An Update with Recommendations’, Drugs, vol. 64, no. 4, pp. 383-404.

Bisson, JI 2007, ‘Pharmacological treatment of post-traumatic stress disorder’, Advances in Psychiatric Treatment, vol.13, pp. 119-126.

Cooper, J, Carty, J, Creamer, M 2005, ‘Pharmacotherapy for posttraumatic stress disorder: empirical review and clinical recommendations’, Australian and New Zealand Journal of Psychiatry, Vol. 39, pp. 674-682.

Green, B 2003, ‘Focus on paroxetine’, Current Medical Research and Opinion, vol. 19, no.1, pp. 13

Hurst, M & Lamb, HM 2000, ‘Fluoxetine. A Review of its use in anxiety disorders and mixed anxiety and depression’, CNS Drugs, Vol. 14, no. 1, pp. 51-80.

Ipser, J, Seedat, S & Stein, DJ 2006, ‘Pharmacotherapy for post traumatic stress disorder- a systematic review and meta-analysis’, South African Medical Journal, Vol. 96, no. 10, pp. 1088-96.

Mooney, P, Oakley, J, Ferriter, M & Travers, R 2004, ‘Sertraline as a treatment for PTSD: a systematic review and meta-analysis’, Irish Journal of Psychiatric Medicine, Vol. 21, no. 3, pp. 100-103.

Schoenfeld, F, Marmar, C & Neylan, T 2004, ‘Current concepts in pharmacotherapy for posttraumatic stress disorder’, Psychiatric Services, vol. 55, pp. 519-531.

Stein, DJ, Ipser, JC & Seedat, S 2006, ‘Pharmacotherapy for post traumatic stress disorder (PTSD)’, Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD002795.
DOI: 10.1002/14651858.CD002795.pub2.

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