Abstract
Depression is the most prevalent psychiatric disorder in the world, affecting 4.4% of the global population. Despite an array of treatment modalities, depressive disorders remain difficult to manage due to many factors. Beginning with the introduction of fluoxetine to the United States in 1988, selective serotonin reuptake inhibitors (SSRIs) quickly became a mainstay of treatment for a variety of psychiatric disorders. The primary mechanism of action of SSRIs is to inhibit presynaptic reuptake of serotonin at the serotonin transporter, subsequently increasing serotonin at the postsynaptic membrane in the serotonergic synapse. The six major SSRIs that are marketed in the USA today, fluoxetine, citalopram, escitalopram, paroxetine, sertraline, and fluvoxamine, are a group of structurally unrelated molecules that share a similar mechanism of action. While their primary mechanism of action is similar, each SSRI has unique pharmacokinetics, pharmacodynamics, and side effect profile. One of the more controversial adverse effects of SSRIs is the black box warning for increased risk of suicidality in children and young adults aged 18–24. There is a lack of understanding of the complexities and interactions between SSRIs in the developing brain of a young person with depression. Adults, who do not have certain risk factors, which could be confounding factors, do not seem to carry this increased risk of suicidality. Ultimately, when prescribing SSRIs to any patient, a risk–benefit analysis must factor in the potential treatment effects, adverse effects, and dangers of the illness to be treated. The aim of this review is to educate clinicians on potential adverse effects of SSRIs.
Highlights
This article is an open access articleDepression is the most prevalent psychiatric disorder in the world, affecting 4.4% of the global population [1]
The six major selective serotonin reuptake inhibitors (SSRIs) that are marketed in the USA today, fluoxetine, citalopram, escitalopram, paroxetine, sertraline, and fluvoxamine, are a group of structurally unrelated molecules that share a similar mechanism of action
This does not increase their rate of adverse effects, but care should be taken when prescribing these drugs to a patient with impaired drug elimination due to liver disease, kidney disease, or advanced age [86]
Summary
Kaye 3 , Omar Viswanath 4,5,6 , Ivan Urits 3,7 , Andrea G. Valley Anesthesiology and Pain Consultants—Envision Physician Services, Phoenix, AZ 85004, USA. Southcoast Physicians Group Pain Medicine, Southcoast Health, Wareham, MA 02571, USA. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil-
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