There are several SSRIs, including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline.1 Although their primary mechanism of action is the inhibition of serotonin reuptake by SERT they typically have some minor effects on other neurotransmitter systems.1 Due to their hepatic metabolism and inhibition of specific cytochrome P450 enzymes, there is a risk of drug-drug interactions with other psychotropics, including antipsychotics, tricyclic antidepressants, opiates, and other drugs.1 Combination of an SSRI and a monoamine oxidase inhibitor (MAOI) is contraindicated due to the high risk of serotonin toxicity.1 Additionally, SSRIs are contraindicated in mania and should be used with caution in patients with bipolar disorder (particularly bipolar I disorder) as they can have a precipitating effect on mania.1
Reference:
1. McLaughlin P, Cleare A. Chapter 7: Drugs to treat depression. In: Haddad P, Nutt DJ. Seminars in Clinical Psychopharmacology. 3rd edition. Cambridge: Cambridge University Press; 2020.
2. Chu & Wadhwa. Selective serotonin reuptake inhibitors. StatPearls [internet]. 2023.
3. Richelson. Pharmacology of antidepressants. Mayo Clin Proc 2001; 76 (5): 511‒527.
4. Bandelow B, Allgulander C, Baldwin DS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders. World J Biol Psychiatry 2023; 24 (2): 79–117.
5. Kent JM, Coplan JD, Gorman JM. Clinical utility of the selective serotonin reuptake inhibitors in the spectrum of anxiety. Biol Psychiatry 1998; 44 (9): 812‒824.
6. Jakubovski E, Johnson JA, Nasir M, et al. Systematic review and meta-analysis: dose–response curve of SSRIs and SNRIs in anxiety disorders. Depress Anxiety 2019; 36 (3): 198–212.
7. Allgulander C, Florea I, Trap Huusom AK. Prevention of relapse in generalized anxiety disorder by escitalopram treatment. Int J Neuropsychopharmacol 2006; 9 (5): 495‒505.
8. Sinclair LI, Christmas DM, Hood SD, et al. Antidepressant-induced jitteriness/anxiety syndrome: systematic review. Br J Psychiatry 2009; 194 (6): 483‒490.
9. Masdrakis VG, Markianos M, Baldwin DS. Apathy associated with antidepressant drugs: a systematic review. Acta Neuropsychiatr 2023; 35 (4): 189‒204.
