Nature and Working of SSRIs

These inhibitors retard re-absorption of serotonin that exists in the synaptic space. This synaptic space lies between nerve cells and acts as a medium to carry messages and communication between nerve ends. Serotonin, along with norepinephrine, and dopamine, are the neurotransmitters that are carriers of communications among nerve ends. Selective serotonin reuptake inhibitors obviously act on one particular neurotransmitter, the serotonin, impairing its re-absorption into nerve cells. This results in increased availability of serotonin in the space.

Serotonin is assumed to be associated with depression in a person in some way. A depressed person is known to contain low serotonin levels. Increase in the supply of serotonin will address the problem of depression in a person. These two share an unique relationship. The actual cause and effect equation is difficult to define. It can not be said for sure whether the depression causes low serotonin levels or low serotonin levels causes depression in a person. But one thing is clearly established that by elevating the serotonin levels in a depressed person, the depressive symptoms will abate in that person.

Serotonin is implicated in the regulation of moods, sleep, body temperature, and appetite. Medications that retard re-absorption of serotonin are also found to elevate moods of people suffering from severe depression. SSRIs are used as medications to treat chronic depression which hinders behavioral and cognitive functions in a person. These inhibitors assist in decreasing the depressive symptoms of gloominess, despondency, and apathy. These medications are also useful in treating obsessive-compulsive disorder, panic disorders, migraine, consumption anomalies, obesity, self-injury, etc.

SSRI Medications

The category of selective serotonin reuptake inhibitors (SSRIs) is permitted for use in the treatment of depression. These SSRI medications are available in various release formats such as extended-release (ER) or controlled-release (CR) medications. These formats are useful for better drug management. These medications will take at least two weeks time to take effect. So, one should wait for two weeks before changing the medication.

Here are the SSRIs that have been approved to treat depression. The generic names, with brand names in parentheses, are mentioned here. These are: citalopram (Celexa); escitalopram (Lexapro); fluoxetine (Prozac, Prozac Weekly); paroxetine (Paxil, Paxil CR); and sertraline (Zoloft).

Indications: These SSRIs are used for treating clinical depression, anxiety disorders, panic disorders, obsessive compulsive disorder (OCD) and bulimia. These medications are also used on occasions for treating irritable bowel syndrome and premature ejaculation.

About seventy percent of people suffering from OCD are shown to have got benefited with fluoxetine. It may take about two to three months to have full efficacy of the medication. Young people and children with OCD are treated with Luvox because of its lesser adverse effects.

Interactions: The side effects of tricyclics medications, such as insomnia, loss of appetite, heart problems, are likely to increase further when SSRI medications are also taken. But it is very risky to take SSRIs when MAOIs are in use. The combined effect of these medications causes fatal effects such as hypertension, nausea and vomiting, and acute distress. People that are taking MAOIs should wait for at least two weeks before they start taking the prescribed SSRIs. Or wait for at least five weeks after stopping SSRIs to take prescribed MAOIs.

Fluoxetine, paroxetine, and fluvoxamine maleate are found in human breast milk, so medications containing these should not be taken by nursing mothers.

Warning : The interaction between SSRIs and MAOIs, when concurrently used, may create a life-endangering situation called serotonin syndrome. This is a very high serotonin level situation in a person. It is caused when both SSRIs and MAOIs work to increase serotonin levels in their own separate ways in the system. This syndrome may also occur when SSRIs and supplements of St. John’s wort are taken together. Avoid other medications when SSRIs are in use.

Adverse Effects: The physical effects are - insomnia, skin irritations, cephalalgia, skeletal and muscular pains, diarrhea, nausea, etc.

It may cause hemophilia that will increase stomach and uterine bleeding. When patients use SSRIs and non-steroidal anti-inflammatory drugs concurrently, The risk of bleeding increases manifold, hence care should be exercised.

SSRIs are also known to impair sexual inclinations and functions. Dosage of SSRIs can be adjusted to diminish this problem.

Other adverse effects are: Restiveness, obesity, nervousness, anxiety, sleepiness, etc.