5. Key points
By working through this module, you will have acquired an understanding of the principal risks of SSRIs and how the risks can be managed. The following is a quick reminder of the important points covered:
- SSRIs are licensed for depressive illness. Some are also licensed for other indications including anxiety disorders, obsessive–compulsive disorder and bulimia nervosa
- Clinical response to SSRIs usually occurs within two weeks, maximal response usually within four to six weeks
- Adverse effects of SSRIs such as headache, nausea, and anxiety/agitation are very common at the start of treatment; these effects often resolve spontaneously. Withdrawal reactions also occur frequently
- Sexual side effects occur frequently but may not be volunteered by the patient
- Rare but life-threatening adverse effects include serotonin syndrome (medical emergency), haemorrhage, convulsions, hyponatraemia and psychiatric disorders (mania, suicide risk)
- Important drug interactions include serotonergic agents (especially MAOIs, linezolid, ‘triptan’ antimigraine drugs, tramadol), antiplatelet drugs, anticoagulants, and NSAIDs
- As with other antidepressants the activating effects of SSRIs may lead to an increase in motivation before any mood-lifting effects occur, so close attention to suicide risk is advised especially in the early weeks of treatment
- SSRIs are generally safer in overdose than other classes of antidepressant medicine.
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