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

4. Principal risks

Man with a headache

Some noteworthy risks for SSRIs are discussed in this module. Summaries of product characteristics and the BNF should be consulted for a fuller account of the risks of individual SSRIs.

Very common (> 10%) and common (1–10%) adverse effects:

Rare (0.1–0.01%) and very rare (< 0.01%), but potentially serious adverse effects:

Important drug interactions:

  • Other psychiatric medications—antidepressants (especially serotonergic eg MAOIs), lithium
  • 5HT1 agonists for treating migraine (‘triptans’)
  • Antiepileptics
  • Antiplatelet medications (aspirin, clopidogrel)
  • Linezolid (antibacterial with monoamine oxidase inhibiting activity)
  • Monoamine oxidase B inhibitors (rasagiline, selegiline)
  • Non-steroidal anti-inflammatory drugs
  • Oral anticoagulants, including warfarin
  • Pimozide
  • Tamoxifen—interaction with potent inhibitors of isoenzyme CYP2D6, fluoxetine and paroxetine
  • Tramadol

Pregnancy and breast-feeding:

  • The decision to prescribe an antidepressant during pregnancy involves very careful assessment of the risk of untreated depression to both the mother and the fetus and the risk to the fetus of adverse effects including teratogenic effects from exposure to an antidepressant.


  • Features of overdose include the usual adverse effects of SSRIs, but very large overdoses can also lead to cardiac features (tachycardia, rhythm disorders, hypotension or hypertension), convulsions, and coma. SSRI overdosage is managed by treating specific symptoms as they arise.

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Page last modified: 17 February 2015