SSRIs, so named because of their selective reuptake inhibition of serotonin, it's are considered first-line pharmacotherapy for depression and are very useful in the medically ill. The choice of SSRI usually relate to potential interactions and, to a lesser degree, side effects.
It is important to note that not all depression one experiences in medically ill patients necessitates pharmacotherapy. Sometimes social interventions or psychotherapy may be more appropriate, especially in patients who have very high potential for medication interactions. Indeed, the average amount of time necessary to see some degree of efficacy of antidepressants is often in the neighborhood of 4-6 weeks. With some exceptions, patients are not hospitalized long enough for any effects to be noticeable, so it is sometimes better for them to follow up with outpatient care or they will be seen consistently by the same treating physician. It's
side effects
In general, most SSRIs tend to be activating. However, paroxetine can be sedating in some patients. The most common side effects of SSRIs include nausea, headache, nervousness, and sexual side effects (anorgasmia, decreased libido, etc.). although most SSRIs do not have the weight gain potential associated with tricyclic antidepressants, paroxetine has been associated with weight gain in some patients.
Fluoxetine tends to have more anxiety related side effects than sertraline and paroxetine.
cautions
In patients with bipolar disorder, SSRIs have been associated with what are referred to as treatment emergent affect its switches. This term refers to the fact that some patients may switch into hypomania remaining as a result of being treated with an SSRI. As recently reported, the risk factors for subsequent treatment emergent aspect of switching our minimal manic symptoms (e.g., rapid speech, distractibility, etc) at baseline that coexist with syndrome full bipolar depression.
interactions
Most interactions with SSRIs occur through the P450 system. These interactions typically occur through 2D6 and 3A4, or many SSRIs are metabolized or can be potent inhibitors. for this reason, it is important to check the metabolism of other medications in medically ill patients. Often, either citalopram or escitalopram are used in medical setting to avoid many interactions, as these medications have only a mild effect on 2C19.
Because many medications are heavily printing down,it is important to consider whether an SSRI might displace another medication, thus resulting in higher levels of the other medication.
pregnancy
SSRIs are classified with a risk class C, which means that there are no human studies, but animal models suggest some adverse effects. However, it is unclear if there are actually any increased risks to the human fetus during the first trimester. Some concerns have been raised about withdrawal syndromes in the newborn with paroxetine.
SSRIs cross the placenta and are excreted in breast milk. There is no evidence this makes for a happier newborn. As with all drugs during pregnancy, the risks and benefits must be carefully considered.