Selective serotonin reuptake inhibitors

e.g. fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram

• Fluoxetine and paroxetine 20 mg (o) mane

This dose is usually sufficient for most patients. If no response after 2 to 3 weeks, increase by 20 mg at 2 to 4 week intervals to 40-80 mg (o) daily in divided doses.

• Sertraline, 50 mg (o) daily, starting dose; can increase to 200 mg daily.

• Fluvoxamine, 50 mg (o) bd, starting dose; can increase to 200 mg daily.

These new drugs have a similar efficacy profile to the tricyclics. They do not appear to cause weight gain, interact with alcohol or cause serious cardiovascular effects.

Adverse effects

Nausea, nervousness, fatigue, agitation, diarrhoea, headaches, insomnia. Possible effects include sexual dysfunction, mainly ejaculatory disturbances, allergic reactions and hypomania (in some manic depressives).

They should not be used with MAOIs or the tricyclics.

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