Selective serotonin reuptake inhibitors (SSRIs) learning module - main section

3. Prescribing points

SSRIs are generally taken once daily. Although depressive symptoms can improve significantly within two weeks it usually takes four to six weeks for maximal response to SSRIs.

An SSRI should generally be initiated at the lowest possible effective dose. Raising the dose may not always be beneficial and could increase adverse effects. If a higher dose is necessary, sufficient time (up to four weeks) should be allowed for an antidepressant response to develop before raising the dose. Dose increase may also be considered if symptoms recur in a patient established on an SSRI.

Careful supervision during early treatment can help to identify unusual changes in behaviour including worsening of symptoms, suicidal thoughts and behaviour, and aggression. Patients considered at risk of suicide or of causing harm should be referred to psychiatric services.

The patient should be closely questioned about the use of psychotropic drugs substances (including benzodiazepine use and alcohol intake) because they could affect the outcome of antidepressant treatment.

Some adverse effects of SSRIs commonly diminish with continuing use (for example, initial anxiety and nausea). Dose-related side effects of SSRIs may also improve by lowering the dose. If a particular SSRI is not well tolerated and adverse effects persist, it may be necessary to switch to another SSRI or to another class of antidepressant drugs. However, when switching, care is required to avoid excessive serotonin potentiation; the first SSRI should not be present in any clinically significant amount before the second SSRI is introduced.

SSRIs: comparison of licensed dose ranges and typical half lives

Note: full product information should be consulted for clinical decisions about use.

  Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
Licensed dose range 20–40 mg daily 10–20 mg daily 20–60 mg daily 50–300 mg daily 20–50 mg daily 50‑200 mg daily
Half-life 36 hours 36 hours Up to two weeks for active metabolite 15–20 hours 24 hours 26 hours

Page 4 of 29

Page last modified: 17 February 2015