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Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the amount of the neurochemical serotonin in the brain. Brain serotonin levels are low in depression. The SSRIs work by selectively inhibiting or blocking serotonin reuptake in the brain. This block occurs at the synapse, the place where brain cells are connected to each other. Serotonin is one of the chemicals in the brain that carries messages across these connections from one neuron to another. The SSRIs work by keeping the serotonin present in high concentrations in the synapses. These drugs do this by preventing the reuptake of serotonin back into the sending nerve cell. The reuptake of serotonin is responsible for turning off the production of new serotonin. Therefore, the serotonin message keeps on coming through. This, in turn, helps arouse or activate cells that have been deactivated by depression, and relieves the depressed persons symptoms. In the United States, SSRIs have been used successfully for over a decade to treat depression.
Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and fluvoxamine (Luvox). SSRIs are generally well tolerated and side effects are usually mild. The most common side effects are nausea, diarrhea, agitation, insomnia, and headache. However, these side effects generally go away within the first month of SSRI use. Some patients experience sexual side effects, such as decreased sexual desire, delayed orgasm, or an inability to have an orgasm. Some patients experience tremors with SSRIs. The so-called serotonergic (meaning caused by serotonin) syndrome is a serious neurologic condition associated with the use of SSRIs. It is characterized by high fevers, seizures, and heart rhythm disturbances. This condition is very rare and has been reported only in very ill psychiatric patients taking multiple psychiatric medications.
Action Antidepressants: The biochemical reality is that all classes of medications
that treat depression (MAOIs, SSRIs, TCAs, and atypical antidepressants) have
some effect on both norepinephrine and serotonin, as well as on other neurotransmitters.
However, the various medications affect the different neurotransmitters in varying
antidepressants are so named because they work in a variety of ways. Thus,
atypical antidepressants are not SSRIs, but they act similarly. More specifically,
they increase the level of certain neurochemicals in the brain synapses. Examples
of atypical antidepressants include nefazodone(Serzone), trazodone (Desyrel),
venlafaxine (Effexor), and bupropion (Wellbutrin). Lithium (Eskalith, Lithobid),
valproate (Depakene, Depakote), carbamazepine (Epitol, Tegretol), neurontin (Gabapentin),
and lamictal (Lamotrigine) are mood stabilizers and anticonvulsants. They have
been used to treat bipolar depression. Certain antipsychotic medications, such
as ziprasidone (Geodon), risperidone (Risperdal), and quetiapine (Seroquel), have
sometimes also been used to treat bipolar depression, usually in combination with
other antidepressants and/or the mood stabilizers.
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