Selective serotonin reuptake inhibitors (SSRIs) are typically used in the treatment of major depressive disorder and anxiety disorders that work by altering the levels of a mood-enhancing chemical called serotonin. The first SSRI introduced in the market was fluoxetine in 1985.
SSRI are indicated in the treatment of major depression, anxiety disorder, panic disorder, social anxiety disorder, social phobia, bulimia nervosa, obsessive-compulsive disorder, personality disorder, premenstrual disorder and posttraumatic panic disorders. Off-label use of SSRI are a migraine, diabetic neuropathy, neurocardiogenic syncope, and fibromyalgia.
The main indicator of SSRIs is a major depressive disorder; however, they are often assigned to anxiety disorders, such as social anxiety disorder, bipolar disorder, obsessive-compulsive disorder (OCD), eating disorders, chronic pain, and, in some cases, due to post-traumatic stress disorder (PTSD). They are also used to treat a person's dysfunction, although there are various side effects.
Anti-depressants are recommended by the UK National Institute for Health and Care Excellence (NICE) as a first-line treatment for major depression and treatment for mild to moderate depression that goes on after a series of steps such as psychotherapy. They recommend its regular use for those with chronic health problems and mild depression. There has been controversy over the effectiveness of SSRIs in the treatment of depression in terms of its severity and duration.
Two meta-analyzes published in 2008 (Kirsch) and 2010 (Fournier) found that in mild and moderate depression, the effect of SSRIs was small or nonexistent compared with placebo, while in severe depression the effect of SSRIs was between "small" and " great ". The 2008 meta-analysis included 35 clinical trials submitted to the Food and Drug Administration (FDA) prior to licensing four new anti-depressants (including SSRIs paroxetine and fluoxetine, a non-SSRI antidepressant and fazodone, and serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine). The authors argue that the relationship between severity and efficacy in reducing placebo effect in severely depressed patients, rather than increased drug effect. Some researchers have questioned the validity of the study's data which suggests that we underestimate the magnitude of the effect of anti-depressants.
A 2012 meta-analysis of fluoxetine and venlafaxine concluded that statistically and clinically significant treatment effects are observed in each placebo-related drug regardless of the underlying depression; some of the authors however have expressed strong links with the pharmaceutical industry.
A 2017 systematic review states that "placebo-compared SSRIs appear to have significant effects in terms of depressive symptoms, but the clinical significance of these results appears questionable and all trials were at high risk of bias. In addition, placebo-compared SSRIs significantly increased the risk of both. serious and adverse events. Our results show that the adverse effects of SSRIs compared to placebo for major depressive disorder appear to outweigh any positive outcomes. " Fredrik Hieronymus et al. have criticized the review as inaccurate and misleading, but they have also exposed many links in the pharmaceutical industry.
In 2018, systematic reviews and meta-analyses comparing the effectiveness and acceptance of the 21 anti-depressant drugs have shown escitalopram to be one of the most effective. In children, there is concern about the quality of evidence with an understanding of the perceived benefits. When a drug is used, fluoxetine appears to be the first line.
Some SSRIs are effective in disrupting social anxiety, although their effects on companies are not always strong and their use is sometimes banned due to psychotherapy. Paroxetine was the first drug to be approved for social anxiety disorders and is considered an effective treatment for the disease, sertraline, and fluvoxamine were later approved, and, escitalopram and citalopram are used off-label for legal use, while fluoxetine may be considered effective in this condition.
Post-traumatic stress disorder (PTSD) is difficult to treat and treatment is often less effective; SSRIs are also different. They do not work well for this disease and only two SSRIs are approved by the FDA for this condition, paroxetine, and sertraline. Paroxetine has higher response rates and relief from PTSD than sertraline, but both do not work well in most patients. Fluoxetine is used off-label, but with mixed results, venlafaxine, SNRI, is considered to be somewhat effective, even though it is used off-label. Fluvoxamine, escitalopram, and citalopram are not well tested in this disease. Paroxetine remains the most appropriate drug for PTSD right now, but there are limited benefits. SSRIs are recommended by the National Institute for Health and Care Excellence (NICE) in the treatment of anxiety disorder (GAD) which has failed to respond to conservative measures such as educational and self-help activities. GAD is a common disease in which the central factor is excessive worry about a wide variety of events. Key symptoms include excessive anxiety about many events and problems, and difficulty controlling anxious thoughts that last for at least 6 months. Anti-depressants provide moderate to moderate reductions in reducing anxiety in GAD, and are superior to placebo in the treatment of GAD. The effectiveness of different anti-depressants is the same.
In Canada, SSRIs are a form of first-line treatment for obsessive-compulsive disorder (OCD). In the UK, they are only first-line treatment with moderate to severe disability and as a second-line treatment for those with minor disabilities, however, from the beginning of 2019, this recommendation is reviewed. In children, SSRIs can be considered a second-line treatment for those with moderate to severe disabilities, with close monitoring of adverse psychological effects. SSRIs, especially fluvoxamine, which is the first FDA approved for OCD, are effective in its treatment; Patients treated with SSRIs are about twice as likely to respond to treatment as those treated with placebo. Efficacy has been shown for short-term treatment trials for 6 to 24 weeks and for a period of 28 to 52-week duration trials.
Doctors often put SSRIs ahead of other anti-depressants because they usually have fewer side effects. That is, SSRIs are generally safe. "Selected serotonin reuptake inhibitors are the safest drugs, in general," said Danny Carlat, MD, Associate Clinical Professor of Psychiatry at Tufts University School of Medicine.
In 2004, the FDA added a black box warning labels for SSRIs. The warning points to an increased risk of suicidal thoughts and behavior in children and adolescents. However, other studies have suggested that the benefits of antidepressant drugs may outweigh the risks of suicidal thoughts.
Physicians and mothers-to-be should compare the risks of SSRI treatment with the risks of untreated depression. Depression without treatment can also have a negative impact on pregnancy. For example, depressed women may not want the prenatal care they need.
Some pregnant women may change their SSRI to reduce the risk while treating their depression. For example, Paroxetine (Paxil) has been linked to congenital heart disease and respiratory distress, and brain disorders in the newborn. Female doctors taking paroxetine may recommend switching to fluoxetine (Prozac) or citalopram (Celexa) during pregnancy. These SSRIs have been linked to very serious side effects.
SSRIs are not for everyone. It is rarely recommended if you are pregnant, breastfeeding, or under the age of 18 because there is an increased risk of serious side effects. However, the opposite can be done if the benefits of treatment are considered to outweigh the risks. SSRIs should also be used with caution if you have any health problems, including diabetes, epilepsy, and kidney disease.
Some SSRIs may respond unexpectedly to other medications, including other over-the-counter pain medications and medications, such as St John's wort. Always read the information sheet that comes with your SSRI medication to see if there are any medications you need to avoid.
It is believed that all Ssri drugs work in a similar way, and can often cause similar side effects, though some people who are not familiar with them. Many of the side effects can occur, and then, for the first few weeks of treatment, while the other is removed, your doctor may try a different medicine.
You have to tolerate one SSRI, you have to tolerate the other, as the SSRIS, changes in the ability to block serotonin reuptake inhibitor, and this, is how quickly your body will take up the drug. If any of the side effects of Ssris can include, but are not limited to: · Nausea, vomiting, or diarrhea · Headache · Drowsiness. · Mouth · Insomnia · Nervousness, agitation or restlessness · Vertigo
The intake of a meal reduces the risk of nausea. In addition, as long as your medication interferes with your sleep, you can help reduce the effects of the disease by taking this before bed.
As for the anti-depressant drugs, which one is best for you will depend on a number of issues, your symptoms, and any other health problems you may have. Asking the doctors and pharmacists about the most common potential side effects, especially for those of SSRIs, and read patient management guide-to-follow recipes.
SSRIs are generally safe for most people. However, in some cases, it can cause problems for them. For example, a high dose of this medication can result in dangerous abnormal heart rhythms, it is necessary to prevent a denial of the more than 40 years of age, in which (mg) per day, according to the FDA and the manufacturer. It comes with a maximum daily dose of citalopram is 20 mg for people over the age of 60.
Anyone taking antidepressants should be closely monitored for exacerbation, depression, or unusual behavior. If you or someone you know is having thoughts about suicide while taking antidepressant medication, consult your doctor or the emergency contacts immediately.
Remember that anti-depressants are more likely to reduce the risk of suicide in the long run, it started in the mood.