Serotonin Selective Reuptake Inhibitors

The serotonin selective reuptake inhibitors (SSRIs) are considered by most clinicians to be the first choice for the treatment of depression because of their relatively benign side effect profile. Their mechanism of action is similar to that of the TCAs but with a highly specific 5-HT reuptake inhibition action preventing the degradation of this neurotransmitter by MAO. There are currently five SSRI compounds marketed in the United States: fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram. Since these SSRIs differ in their potency, selectivity, and side effects profile, patients intolerant to one compound of this group can often be treated with another. SSRIs have a significant cytochrome P450 inhibition action that can result in a toxic level of coadministered drugs, such as alcohol, antihistamines, and anticholinergics.

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