Antidepressants (SSRIs)
- First-line antidepressants/anxiolytics
- indications vary by individual SSRI
- Sertraline/escitalopram = versatile defaults
- Fluoxetine: long t½; often activating
- Paroxetine: withdrawal, weight, antimuscarinic
- Fluvoxamine: OCD + many CYP interactions
- GI + sexual adverse effects are common
- MAOI combination → dangerous serotonin toxicity
Class at a glance
- First-line antidepressants/anxiolytics
- indications vary by individual SSRI
Pharmacology
- Fluoxetine: long t½; often activating
- Fluvoxamine: OCD + many CYP interactions
Practical pearls
- Sertraline/escitalopram = versatile defaults
Safety / monitoring
- Paroxetine: withdrawal, weight, antimuscarinic
- GI + sexual adverse effects are common
- MAOI combination → dangerous serotonin toxicity
Pearls
- Start low, titrate slowly to limit early jitteriness and insomnia
- Class risks: hyponatremia (SIADH) and bleeding
- Weight gain can emerge with long-term use
- Fluoxetine least discontinuation syndrome; taper the others
- Avoid paroxetine in first trimester: cardiac malformations
Self-check
- Which SSRIs are versatile default choices?
Sertraline and escitalopram. - Which SSRI has a long half-life and is often activating?
Fluoxetine. - Which SSRI is notable for withdrawal, weight gain and antimuscarinic effects?
Paroxetine.
Drugs in this class (7)
Antidepressants (SSRIs) prescription history
Animated chart of estimated U.S. prescriptions per year, Antidepressants (1957–2026). SSRI highlighted from 1987.
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