Selective Serotonin Re-uptake Inhibitors (SSRIs)

SSRIs are better tolerated and are safer in overdose than other classes of antidepressants and should be considered first-line for treating depression. In patients with unstable angina or who have had a recent myocardial infarction, sertraline has been shown to be safe.

CITALOPRAM:

Indications: Depression, Depression associated with Manic Depressive Disorder, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Post Traumatic Stress Disorder, Vasomotor Symptoms associated with Menopause.

Contraindications: Hyponatremia, SIADH Syndrome, Suicidal Ideation, Upper GI Bleed

Dose and Administration: Depressive illness, 20 mg once daily increased if necessary in steps of 20 mg daily at intervals of 3–4 weeks; max. 60 mg daily (elderly over 65 years, max. 40 mg daily). Panic disorder, initially 10 mg daily increased gradually if necessary in steps of 10 mg daily, usual dose 20–30 mg daily; max. 60 mg daily (elderly over 65 years, max. 40 mg daily).

ESCITALOPRAM:

Indications: Generalized Anxiety Disorder, Major Depressive Disorder, Depression associated with Manic Depressive Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Post Traumatic Stress Disorder, Vasomotor Symptoms associated with Menopause

Contraindications: Hyponatremia, SIADH Syndrome, Suicidal Ideation, Upper GI Bleed.

Dose and Administration: adult over 18 years, depressive illness, generalised anxiety disorder, and obsessive-compulsive disorder, 10 mg once daily increased if necessary to max. 20 mg daily; elderly initially half adult dose, lower maintenance dose may be sufficient; child not recommended. adult over 18 years, panic disorder, initially 5 mg once daily increased to 10 mg daily after 7 days; max. 20 mg daily; elderly initially half adult dose, lower maintenance dose may be sufficient. adult over 18 years, social anxiety disorder, initially 10 mg once daily adjusted after 2–4 weeks; usual dose 5–20 mg daily.

FLUOXETINE:

Indications: Bulimia Nervosa, Depression, Obsessive-Compulsive Disorder, Panic Disorder, And Premenstrual Dysphoric Disorder.

Contraindications: Abnormal Sexual Function, Anorexia, Bipolar Disorder, and Disease of Liver, Neuroleptic Malignant Syndrome, Serotonin Syndrome, Suicidal Ideation, Upper GI Bleed.

Dose and Administration: Major depression, 20 mg once daily increased after 3–4 weeks if necessary, and at appropriate intervals thereafter; max. 60 mg once daily (elderly usual max. 40 mg once daily but 60 mg can be used). Bulimia nervosa, 60 mg once daily; child and adolescent under 18 years not recommended. Obsessive-compulsive disorder, 20 mg once daily; if inadequate response after 2 weeks increase gradually to max. 60 mg once daily (elderly usual max. 40 mg once daily but 60 mg can be used).

FLUVOXAMINE MALEATE:

Indications: depressive illness, obsessive-compulsive disorder.

Contraindications: Lactating Mother, Bipolar Disorder, Hypomania, Manic Disorder, Neuroleptic Malignant Syndrome, Serotonin Syndrome, Suicidal Ideation, And Upper GI Bleed.

Dose and Administration: Depression, initially 50–100 mg daily in the evening, increased gradually if necessary to max. 300 mg daily (over 150 mg in divided doses); usual maintenance dose 100 mg daily; child and adolescent under 18 years not recommended. Obsessive-compulsive disorder, initially 50 mg in the evening increased gradually if necessary after some weeks to max. 300 mg daily (over 150 mg in divided doses); usual maintenance dose 100– 300 mg daily; child over 8 years initially 25 mg daily increased if necessary in steps of 25 mg every 4–7 days to max. 200 mg daily (over 50 mg in 2 divided doses).

PAROXETINE:

Indications: major depression, obsessive-compulsive disorder, panic disorder; social anxiety disorder; post-traumatic stress disorder; generalised anxiety disorder.

Contraindications: Pregnancy, Bipolar Disorder, Neuroleptic Malignant Syndrome, Serotonin Syndrome, Suicidal Ideation, And Upper GI Bleed.

Dose and Administration: Major depression, social anxiety disorder, post-traumatic stress disorder, generalised anxiety disorder, usually 20 mg each morning, higher doses on specialist advice only (see also CSM advice, below); max. 50 mg daily (elderly 40 mg daily); child and adolescent under 18 years not recommended. Obsessive-compulsive disorder, initially 20 mg each morning, increased gradually in steps of 10 mg to usual dose of 40 mg daily, higher doses on specialist advice only (see also CSM advice, below); max. 60 mg daily (elderly 40 mg daily); child and adolescent under 18 years not recommended. Panic disorder, initially 10 mg each morning, increased gradually in steps of 10 mg to usual dose of 40 mg daily, higher doses on specialist advice only (see also CSM advice, below); max. 60 mg daily (elderly 40 mg daily); child and adolescent under 18 years not recommended.

SERTRALINE:

Indications: depressive illness, obsessive-compulsive disorder (under supervision in children), and post-traumatic stress disorder in women.

Contraindications: Bipolar Disorder, Neuroleptic Malignant Syndrome, Serotonin Syndrome, Suicidal Ideation, And Upper GI Bleed.

Dose and Administration: Depressive illness, initially 50 mg daily, increased if necessary by increments of 50 mg over several weeks to max. 200 mg daily; usual maintenance dose 50 mg daily. Obsessive-compulsive disorder, adult and child over 12 years initially 50 mg daily, increased if necessary in steps of 50 mg over several weeks; usual dose range 50–200 mg daily; child 6–12 years initially 25 mg daily, increased to 50 mg daily after 1 week, further increased if necessary in steps of 50 mg at intervals of at least 1 week (max. 200 mg daily). Post-traumatic stress disorder, initially 25 mg daily, increased after 1 week to 50 mg daily; if response is partial and if drug tolerated, dose increased in steps of 50 mg over several weeks to max. 200 mg daily; child and adolescent under 18 years not recommended.