SSRIs

Key points

• SSRIs (fluoxetine, sertraline, citalopram): block serotonin reuptake; first-line for depression and anxiety disorders.
• Side effects: GI upset (most common), sexual dysfunction, hyponatraemia (SIADH — check sodium especially in elderly), bleeding risk (platelet serotonin).
• Fluoxetine: long half-life (active metabolite norfluoxetine) — less discontinuation effect.
• Discontinuation syndrome if stopped abruptly (dizziness, electric-shock sensations, anxiety) — worst with short half-life drugs (paroxetine, venlafaxine).
• Take 4–6 weeks for full effect; may initially increase anxiety/agitation.

Decision points in this pathway

• Stopping an SSRI?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.