Selective serotonin reuptake inhibitors for depression and pain after a stroke

Examples

Generic Name	Brand Name
fluoxetine	Prozac
sertraline	Zoloft
paroxetine	Paxil
citalopram	Celexa
escitalopram	Cipralex

How It Works

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

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

How Well It Works

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

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.

If you take triptans for migraine headaches, talk to your doctor before taking them with an SSRI. Taking these medicines together can cause a serious problem called serotonin syndrome.

Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued:

• Advisories on antidepressant medicines and the risk of suicide. Health Canada and the FDA do not recommend that people stop using these medicines but to watch for warning signs of suicide in those using them. This is especially important at the beginning of treatment or when doses are changed.
• Warnings 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.

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

What To Think About

Selective serotonin reuptake inhibitors (SSRIs) can take 4 to 8 weeks to start working, although they may be effective much sooner.¹

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.²

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).³

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.

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Author:	Douglas Dana Monica Rhodes	Last Updated: October 19, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Colin Chalk, MD, CM, FRCPC - Neurology Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
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