SSRIs MOA = inhibit SHT reuptake in synaptic cleft -> increase serotonin levels DRUGS: Fluoxetine Fluvoxamine Escitalopram Citalopram Paroxetine Sertraline Indications: MDD (1st line) GAD OCD PTSD Binge-eating disorder Panic disorder Premature ejaculation Premenstrual dysphoric disorder Bulimia Nervosa SAD Gambling disorder Somatic symptom disorder IBS Side Effects: Early - onset & resolution within 1 wk of therapy start headache diarrhea nausea & vomit activating effects agitation anxiety insomnia SSRIs: serotonin syndrome insomnia sexual dysfunction SIADH Rocking (movement disorders) Late Sexual dysfunction SIADH Serotonin syndrome Risk when using another serotonergic drug e.g. MAOIs If cause by SSRIs alone -> mild -> nausea & mild tremor Drug Interactions Greater risk of serotonin syndrome if used concomitantly with serotonergic drugs e.g. MAOIs, St. John's Wort, dextromethorphan. Other Info take 4-6 wks to cause significant change in serotonin levels & thus features contraindicated in pregnant patients taking paroxetine Fetal cardiovascular malformations in 1st trimester Fetal pulmonary HTN in 3rd trimester SSRI's -> reactions agitation insomnia nausea diarrhea sexual dysfunction body weight dizziness