Selective serotonin reuptake inhibitors for depression and pain after a stroke

Examples

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Brand Name	Chemical Name
Celexa	citalopram

Brand Name	Chemical Name
Lexapro	escitalopram

Brand Name	Chemical Name
Prozac	fluoxetine

Brand Name	Chemical Name
Paxil	paroxetine

Brand Name	Chemical Name
Zoloft	sertraline

How It Works

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Selective serotonin reuptake inhibitors (SSRIs) can balance certain brain chemicals called neurotransmitters. When these brain chemicals are in proper balance, symptoms of depression may be relieved.

Why It Is Used

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Selective serotonin reuptake inhibitors are used to treat depression and may help relieve pain after a stroke.

How Well It Works

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SSRIs are as effective in treating depression as other types of antidepressants, such as tricyclic or tetracyclic antidepressants and MAOIs(monoamine oxidase inhibitors), but they have different and often less severe side effects. Some studies show that these medicines also help relieve chronic pain, such as pain resulting from a stroke.

Side Effects

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Side effects of SSRIs include:

• Nausea, loss of appetite, diarrhea.
• Anxiety or irritability.
• Problems sleeping or drowsiness.
• Loss of sexual desire or ability.
• Headaches or dizziness.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.
• A warning about taking triptans, used for migraines, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a serious condition called serotonin syndrome.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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You may start to feel better within 1 to 3 weeks of taking an SSRI. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

SSRIs can be safer than tricyclic or tetracyclic antidepressants because they do not cause death if taken in large quantities (overdose). SSRIs usually are well-tolerated and effective. SSRIs also may be safer for older adults because the side effects are more tolerable.¹

Sexual dysfunction can be a significant problem for some people while taking an SSRI. Other antidepressants such as bupropion (Wellbutrin, for example) may be less likely to cause significant sexual dysfunction as a side effect and may be used instead of, or in addition to, an SSRI.

Sexual problems in men resulting from use of SSRIs may also be relieved by use of an erectile dysfunction medicine such as sildenafil (Viagra).²

Never suddenly stop taking antidepressants. The use of any antidepressant should be tapered off slowly and only under the supervision of a health professional. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse into another depressive episode.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Spigset O, et al. (1999). Drug treatment of depression. BMJ, 318(7192): 1188–1191.

2. Nurnberg HG, et al. (2003). Treatment of antidepressant-associated sexual dysfunction with sildenafil. JAMA, 289(1): 56–64.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Michele Cronen
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Last Updated	July 6, 2007