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Simplistic Definition of SSRI's And Treatments Sid

Posted by Phillipa on July 17, 2010, at 12:25:33

Just browsing and found this. Very simplistic definition of SSRI's what used for and common side effects for the beginner. Phillipa

Selective serotonin re-uptake inhibitors
Written by Dr Adrian Lloyd, lecturer and honorary specialist registrar in psychiatry

Selective serotonin re-uptake inhibitors (SSRIs) is the name given to a group of antidepressant medicines. When used in reference to medicines, the term 'group' means that each of the drugs in the group is broadly similar to the others in the way that it works.

Differences between medicines within a group are usually fairly small, for example they may differ in dosage frequency or in their particular spectrum of side effects.

There are a number of SSRIs that are frequently used to treat depression. There is detailed information about these individual medicines in the factsheets linked below:

citalopram (eg Cipramil)
escitalopram (Cipralex)
fluoxetine (eg Prozac)
fluvoxamine (eg Faverin)
paroxetine (eg Seroxat)
sertraline (eg Lustral)
What is the difference between SSRIs and other antidepressants?
As far as their effectiveness in treating depression goes, all antidepressants are about as good as each other. There is little to choose in this respect between any of the SSRIs, or for that matter between the SSRIs and other types of antidepressant.

Generally, about two thirds of people with depression who take any one type of antidepressant will find that it improves the way they feel.

If one medicine doesn't work, it is well worth trying another group of antidepressants such as tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs), rather than another antidepressant from the same group.

What gives SSRIs their name and makes them a unique group is the way that they work.

Serotonin is one of several chemicals called neurotransmitters that pass messages between nerve cells that are involved in depression.
Each nerve cell generally uses one of these chemicals to pass on messages to adjacent nerve cells.
If there is not enough serotonin released by the first nerve cell, it won't be able to cause the next one to 'fire' - the message won't get through. This is one of the changes that appears to be important in causing depression.
The nerve cells normally recycle serotonin by soaking it back up again. The SSRIs work by stopping (inhibiting) this re-uptake of serotonin. As the serotonin is not soaked up again, more will be present to pass on messages to nerve cells nearby.
SSRIs work selectively on serotonin - they don't stop the other types of neurotransmitter chemical being soaked up by the nerve cells.
For someone taking these antidepressants, the most significant differences between them are the effects that they have in addition to treating depression. Some of these are helpful and others are unwanted side effects.

How can you tell if an SSRI will work?
The straight answer to this question is that until an antidepressant is tried it is impossible to know whether it is the right one for any individual, and it takes a number of weeks (two to eight) to know whether it is going to work.

The first medicine to try is often decided on the grounds of its other effects rather than its antidepressant properties (since all antidepressants are equally effective). Some of these considerations are listed below.

Is it sedative?
Is it more alerting?
Will it help anxiety as well? (Anxiety often goes hand-in-hand with depression.)
Will it help another disorder, eg obsessive compulsive disorder, that coexists with the depression?
Does it mix well with other medicines that a person is taking?
Is it okay if the person has other illnesses?
Has the person taken it before to good effect?
To make the best initial choice, the doctor needs to know exactly how a person is affected by depression. Some of these other effects may be very helpful in one person, but a problematic side effect in another: sedation is useful in someone whose sleep is disrupted, but not for someone who is sleeping too much.

SSRIs are different to the tricyclic antidepressants - the other main group of drugs that are frequently used as a first option for treating depression. SSRIs are:

less sedating.
better for people with heart problems.
helpful in people who feel slowed up by their depression.
helpful for people with marked anxiety, especially obsessive compulsive symptoms, along with their depression.
less likely to cause abnormally high mood when used to treat the depressive phase of manic depression.
Who will prescribe them?
GPs often prescribe SSRIs for depression, as do psychiatrists if they have been asked by a person's GP to give further help in treating depression.

How long do they take to work?
As with all antidepressants, the SSRIs need some time (two to eight weeks) to start having an effect, so you may not feel better immediately when you start treatment with one. It is vitally important to keep taking them, even if they don't seem to make much difference in the beginning. If you feel your depression has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.

How long will I have to take them for?
SSRIs usually help mood improve over a number of weeks or months. Even when things seem back to normal, you should keep taking them for a further six months to minimise the chances of the depression coming back.

Are they addictive?
No. It is possible for SSRIs to produce unpleasant withdrawal symptoms (sometimes called a discontinuation syndrome) when they are stopped. But this is temporary, does not involve a craving for the medication, and can usually be avoided if the drug is tapered off rather than stopped suddenly. This is not addiction.

Withdrawal symptoms may include dizziness, numbness and tingling sensations, digestive disturbances (particularly nausea and vomiting), headache, sweating, anxiety and sleep disturbances, including vivid dreams. It seems that paroxetine is more commonly associated with withdrawal symptoms than other SSRIs, and fluoxetine least commonly.

Withdrawal symptoms can be minimised or avoided entirely if the dose of the SSRI is gradually decreased over a period of a few weeks. Your doctor will help you do this.

Withdrawal symptoms can sometimes happen if you miss a dose of certain SSRIs, for example paroxetine. For this reason it is important to follow the dosing instructions given by your doctor.

What are the side effects?
Many people take these medicines with little or no side effects, and when they do occur they are usually mild and tend to disappear after one to two weeks.

Occasionally, side effects may be bad enough to warrant stopping a particular drug, but even in this case it is often possible to try another SSRI or to change to a different type of antidepressant.

Another strategy is to try the same drug, but to start off with a lower dose than usual and to increase it very gradually.

The side effects that the SSRIs tend to cause most commonly include:

nausea
diarrhoea
constipation
loss of appetite (sometimes increased appetite and weight gain)
dry mouth
headache
insomnia (sometimes drowsiness)
tremor (shakiness)
sweating
light-headedness
problems with sexual arousal and delayed orgasm.
Sometimes in the first few weeks of treatment SSRIs can make you feel agitated, restless, or like you cant sit or stand still. If you get this or any other distressing effect, you should let your doctor know.

SSRIs and anxiety
SSRIs can cause worsening of anxiety right at the start of treatment, even though they are prescribed to treat anxiety.

This only lasts for a brief period and usually settles down. The anxiety then starts to improve. If anxiety does briefly get worse at the start of treatment with an SSRI, this can be a good sign that the depression and anxiety will ultimately respond well to the treatment.

This side effect can be reduced by starting the SSRI at a lower dose than would normally be used and building it up slowly.

What should I do if I experience side effects with an SSRI?
If these effects are only slight and you have just started to take the medication, they will usually settle down on their own after a week or two.

If they are very problematic, or are not settling down at all, you need to discuss this with your doctor to decide how to handle the problem.

There are various options, such as reducing the dosage or changing to another antidepressant, and the benefits of treating the depression have to be weighed against the side effects of the treatment.

SSRIs and suicidal ideas
A lot of publicity has been given to a few reports of people becoming suddenly suicidal while taking Prozac (fluoxetine) or Seroxat (paroxetine).

As a result, this has been looked at very carefully in all the SSRIs by the Medicines and Healthcare Regulatory Authority (MHRA); the agency of the Department of Health that ensures medicines in the UK meet appropriate standards of safety, quality and effectiveness.

After studying all the available research, the MHRA decided in December 2003 that SSRIs (with the exception of fluoxetine) should not be prescribed for children under 18 because they may more do more harm than good in this age group.

In December 2004, the MHRA found that evidence linking SSRIs to suicidal behaviour in adults is weak and that the benefits of these medicines in adults generally outweigh any risks.

The SSRIs are proven to be very effective treatments for depression and most likely, it is the depressive illness itself that leads to suicidal feelings.However, as a precautionary measure, young adults over the age of 18 should be closely monitored when they start an SSRI, as suicidal behaviour in general is more common in this age group than in older adults.

It is important to tell your doctor immediately if you think your depression has got worse after starting treatment for depression. If you have any distressing thoughts or feelings at any time while taking an antidepressant, particularly in the first few weeks and after any dose changes, then you should also contact your doctor.

SSRIs in manic depression (bipolar affective disorder)
SSRIs are less likely than other antidepressants to cause abnormally high mood (mania or hypomania) in manic depression. However, they can still cause high mood.

Usually, a person who needs an SSRI to treat the depressive phase of bipolar disorder should stop taking it once the depression has gone. (This is quite different to the advice given for the more common type of depression, ie which is not associated with periods of elevated mood, in which the medicine should be continued for six months after the depression has gone.)

What are the other illnesses that SSRIs can be used for?
Lastly, there are other reasons that someone might be prescribed an SSRI. Although these drugs are called antidepressants, some can also treat:

panic disorder
generalised anxiety disorder
obsessive compulsive disorder
bulimia nervosa
social phobia
post traumatic stress disorder.

 

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