Selective serotonin reuptake inhibitor: Difference between revisions

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SSRIs can be dangerous when used in combination with other substances that increase or modulate serotonin such as [[MDMA]] and [[MAOI|Monoamine Oxidase Inhibitors]] (MAOIs). A combination with these substances can lead to [[serotonin syndrome]] and potentially be fatal. SSRIs do not work for everyone and take 3-6 weeks to start having noticeable effects.<ref>{{Citation | year=2021 | title=Do Antidepressants Work Right Away? | url=https://psychcentral.com/depression/how-long-do-antidepressants-take-to-work}}</ref>

SSRIs are reported to have fewer side effects than older antidepressants like [[MAOI|monoamine oxidase inhibitors]] and [~~https://psychonautwiki.org/wiki/Antidepressants#Tricyclic_antidepressants_.28TCA.29_and_tetracyclic_antidepressants_.28TeCAs.29~~ tricyclic antidepressants].{{citation needed}} [[MAOI|Monoamine oxidase inhibitors]] also interact with many other medications and foods, leading to a hypertensive crisis that can potentially be fatal. SSRIs can cause sexual dysfunction and compulsive yawning as side effects. Discontinuation of SSRIs can lead to withdrawal symptoms which include flu-like symptoms, as well as [[brain zaps]].

SSRIs are reported to have fewer side effects than older antidepressants like [[MAOI|monoamine oxidase inhibitors]] and [[tricyclic antidepressants]].{{citation needed}} [[MAOI|Monoamine oxidase inhibitors]] also interact with many other medications and foods, leading to a hypertensive crisis that can potentially be fatal. SSRIs can cause sexual dysfunction and compulsive yawning as side effects. Discontinuation of SSRIs can lead to withdrawal symptoms which include flu-like symptoms, as well as [[brain zaps]].

[[File:SSRIs.png|400px|thumbnail|right|A comparison of the structure of commonly prescribed SSRIs.]]

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*'''[[Effect::Physical fatigue]]'''

*'''[[Effect::Appetite enhancement]]''' ''or'' '''[[Effect::appetite suppression]]'''

*'''[[Effect::Decreased libido]]''' - ~~Decreased libido and sexual dysfunction are among the most commonly reported side effects of SSRIs~~. ~~In some cases these effects may~~ persist ~~after use is discontinued, this is known~~ as PSSD.<ref>{{cite web|author=Pharmacovigilance Risk Assessment Committee (PRAC)|date=11 June 2019|title=New product information wording – Extracts from PRAC recommendations on signals|url=https://www.ema.europa.eu/en/documents/other/new-product-information-wording-extracts-prac-recommendations-signals-adopted-13-16-may-2019-prac_en.pdf#page=2|publisher=European Medicines Agency|id=EMA/PRAC/265221/2019}}</ref> On the other hand, suppression of depression may enhance libido.

*'''[[Effect::Decreased libido]]''' - Very common. Could persist as PSSD after discontinuation.<ref>{{cite web|author=Pharmacovigilance Risk Assessment Committee (PRAC)|date=11 June 2019|title=New product information wording – Extracts from PRAC recommendations on signals|url=https://www.ema.europa.eu/en/documents/other/new-product-information-wording-extracts-prac-recommendations-signals-adopted-13-16-may-2019-prac_en.pdf#page=2|publisher=European Medicines Agency|id=EMA/PRAC/265221/2019}}</ref> On the other hand, suppression of depression may enhance libido.

*'''[[Effect::Orgasm suppression]]''' - This effect is usually mild and only delays orgasms, however in some people, particularly older users, SSRIs can make one completely unable to reach orgasm. This is usually treated by either switching to a different antidepressant, or adding a DNRI such as [[bupropion]]. Short-acting SSRIs such as dapoxetine are approved drugs for premature ejaculation.

*'''[[Effect::Pain relief]]''' - Some studies suggest they can be effective as analgesics (painkillers).<ref>https://www.med.unc.edu/ibs/files/2017/10/IBS-and-Antidepressants.pdf</ref>

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}}

{{effects/cognitive|

*'''[[Effect::~~Apathy~~]]'''<ref>{{cite journal |last1=Barnhart |first1=WJ |last2=Makela |first2=EH |last3=Latocha |first3=MJ |title=SSRI-induced apathy syndrome: a clinical review. |journal=Journal of psychiatric practice |date=May 2004 |volume=10 |issue=3 |pages=196-9 |doi=10.1097/00131746-200405000-00010 |pmid=15330228}}</ref>

*'''[[Effect::Amotivational syndrome]]'''<ref>{{cite journal |last1=Barnhart |first1=WJ |last2=Makela |first2=EH |last3=Latocha |first3=MJ |title=SSRI-induced apathy syndrome: a clinical review. |journal=Journal of psychiatric practice |date=May 2004 |volume=10 |issue=3 |pages=196-9 |doi=10.1097/00131746-200405000-00010 |pmid=15330228}}</ref>

*'''[[Effect::Motivation suppression]]''' ''or'' '''[[Effect::Motivation enhancement]]''' - Lack of motivation is anecdotally reported with SSRIs, though on the other hand, suppression of depression or anxiety may enhance motivation.

*'''[[Effect::Anxiety suppression]]'''

*'''[[Effect::Cognitive fatigue]]'''

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===Escitalopram===

Escitalopram is an SSRI sold under the brand name '''Lexapro''' in the United States. Escitalopram is indicated for the treatment of major depressive disorder and anxiety disorders. It is the s-enantiomer of citalopram, and both have similar efficacy. Escitalopram was FDA approved in 2002.<ref>Escitalopram | https://www.drugs.com/cdi/escitalopram.html</ref>

Escitalopram is an SSRI sold under the brand name '''Lexapro''' in the United States. Escitalopram is indicated for the treatment of major depressive disorder and anxiety disorders. It is the s-enantiomer of citalopram, and both have similar efficacy. Escitalopram was FDA approved in 2002.<ref>Escitalopram | https://www.drugs.com/cdi/escitalopram.html</ref> It is a newer SSRI with proved positive effects and less unwanted side effects. Escitalopram in combination with the use of stimulants such as cocaine or amfetamines, increases the risk for heart problems exponentially and thus is highly discouraged.

===Fluoxetine===

@@ Line 5: / Line 5: @@
 SSRIs can be dangerous when used in combination with other substances that increase or modulate serotonin such as [[MDMA]] and [[MAOI|Monoamine Oxidase Inhibitors]] (MAOIs). A combination with these substances can lead to [[serotonin syndrome]] and potentially be fatal. SSRIs do not work for everyone and take 3-6 weeks to start having noticeable effects.<ref>{{Citation | year=2021 | title=Do Antidepressants Work Right Away? | url=https://psychcentral.com/depression/how-long-do-antidepressants-take-to-work}}</ref>
-SSRIs are reported to have fewer side effects than older antidepressants like [[MAOI|monoamine oxidase inhibitors]] and [https://psychonautwiki.org/wiki/Antidepressants#Tricyclic_antidepressants_.28TCA.29_and_tetracyclic_antidepressants_.28TeCAs.29 tricyclic antidepressants].{{citation needed}} [[MAOI|Monoamine oxidase inhibitors]] also interact with many other medications and foods, leading to a hypertensive crisis that can potentially be fatal. SSRIs can cause sexual dysfunction and compulsive yawning as side effects. Discontinuation of SSRIs can lead to withdrawal symptoms which include flu-like symptoms, as well as [[brain zaps]].
+SSRIs are reported to have fewer side effects than older antidepressants like [[MAOI|monoamine oxidase inhibitors]] and [[tricyclic antidepressants]].{{citation needed}} [[MAOI|Monoamine oxidase inhibitors]] also interact with many other medications and foods, leading to a hypertensive crisis that can potentially be fatal. SSRIs can cause sexual dysfunction and compulsive yawning as side effects. Discontinuation of SSRIs can lead to withdrawal symptoms which include flu-like symptoms, as well as [[brain zaps]].
 [[File:SSRIs.png|400px|thumbnail|right|A comparison of the structure of commonly prescribed SSRIs.]]
@@ Line 19: / Line 19: @@
 *'''[[Effect::Physical fatigue]]'''
 *'''[[Effect::Appetite enhancement]]''' ''or'' '''[[Effect::appetite suppression]]'''
-*'''[[Effect::Decreased libido]]''' - Decreased libido and sexual dysfunction are among the most commonly reported side effects of SSRIs. In some cases these effects may persist after use is discontinued, this is known as PSSD.<ref>{{cite web|author=Pharmacovigilance Risk Assessment Committee (PRAC)|date=11 June 2019|title=New product information wording – Extracts from PRAC recommendations on signals|url=https://www.ema.europa.eu/en/documents/other/new-product-information-wording-extracts-prac-recommendations-signals-adopted-13-16-may-2019-prac_en.pdf#page=2|publisher=European Medicines Agency|id=EMA/PRAC/265221/2019}}</ref> On the other hand, suppression of depression may enhance libido.
+*'''[[Effect::Decreased libido]]''' - Very common. Could persist as PSSD after discontinuation.<ref>{{cite web|author=Pharmacovigilance Risk Assessment Committee (PRAC)|date=11 June 2019|title=New product information wording – Extracts from PRAC recommendations on signals|url=https://www.ema.europa.eu/en/documents/other/new-product-information-wording-extracts-prac-recommendations-signals-adopted-13-16-may-2019-prac_en.pdf#page=2|publisher=European Medicines Agency|id=EMA/PRAC/265221/2019}}</ref> On the other hand, suppression of depression may enhance libido.
 *'''[[Effect::Orgasm suppression]]''' - This effect is usually mild and only delays orgasms, however in some people, particularly older users, SSRIs can make one completely unable to reach orgasm. This is usually treated by either switching to a different antidepressant, or adding a DNRI such as [[bupropion]]. Short-acting SSRIs such as dapoxetine are approved drugs for premature ejaculation.
 *'''[[Effect::Pain relief]]''' - Some studies suggest they can be effective as analgesics (painkillers).<ref>https://www.med.unc.edu/ibs/files/2017/10/IBS-and-Antidepressants.pdf</ref>
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 }}
 {{effects/cognitive|
-*'''[[Effect::Apathy]]'''<ref>{{cite journal |last1=Barnhart |first1=WJ |last2=Makela |first2=EH |last3=Latocha |first3=MJ |title=SSRI-induced apathy syndrome: a clinical review. |journal=Journal of psychiatric practice |date=May 2004 |volume=10 |issue=3 |pages=196-9 |doi=10.1097/00131746-200405000-00010 |pmid=15330228}}</ref>
+*'''[[Effect::Amotivational syndrome]]'''<ref>{{cite journal |last1=Barnhart |first1=WJ |last2=Makela |first2=EH |last3=Latocha |first3=MJ |title=SSRI-induced apathy syndrome: a clinical review. |journal=Journal of psychiatric practice |date=May 2004 |volume=10 |issue=3 |pages=196-9 |doi=10.1097/00131746-200405000-00010 |pmid=15330228}}</ref>
-*'''[[Effect::Motivation suppression]]''' ''or'' '''[[Effect::Motivation enhancement]]''' - Lack of motivation is anecdotally reported with SSRIs, though on the other hand, suppression of depression or anxiety may enhance motivation.
 *'''[[Effect::Anxiety suppression]]'''
 *'''[[Effect::Cognitive fatigue]]'''
@@ Line 90: / Line 89: @@
 ===Escitalopram===
-Escitalopram is an SSRI sold under the brand name '''Lexapro''' in the United States. Escitalopram is indicated for the treatment of major depressive disorder and anxiety disorders. It is the s-enantiomer of citalopram, and both have similar efficacy. Escitalopram was FDA approved in 2002.<ref>Escitalopram | https://www.drugs.com/cdi/escitalopram.html</ref>
+Escitalopram is an SSRI sold under the brand name '''Lexapro''' in the United States. Escitalopram is indicated for the treatment of major depressive disorder and anxiety disorders. It is the s-enantiomer of citalopram, and both have similar efficacy. Escitalopram was FDA approved in 2002.<ref>Escitalopram | https://www.drugs.com/cdi/escitalopram.html</ref> It is a newer SSRI with proved positive effects and less unwanted side effects. Escitalopram in combination with the use of stimulants such as cocaine or amfetamines, increases the risk for heart problems exponentially and thus is highly discouraged.
 ===Fluoxetine===