SSRI Protocols

Serotonin reuptake inhibitors have revolutionized the field of psychiatry, offering effective treatment options for individuals suffering from depression, panic disorder, obsessive-compulsive disorder and social phobias. The protocol for initiating and monitoring SSRI therapy involves recognizing side effects, harmful drug interactions and serotonin syndrome. Additionally, the protocol for stopping treatment with an SSRI requires monitoring the patient for withdrawal-like symptoms, a condition known as discontinuation syndrome.

Mechanism of Action

• According to Mayo Clinic, SSRIs function by increasing the levels of serotonin in the brain. This important chemical messenger is known as a neurotransmitter; it is used to communicate between nerve cells in the brain, also known as neurons. When a neuron in your brain is activated, it releases neurotransmitters into the synaptic cleft, or the space between other neighboring neurons. The chemical signals released in this process are neurotransmitters, which will diffuse through the synaptic cleft, eventually binding to protein receptors on neighboring neurons. Within milliseconds of release, however, the cells will begin to reabsorb neurotransmitters from the synaptic cleft in order to prepare for the next message to be sent. As the name implies, Serotonin reuptake inhibitors will prevent the reabsorption of serotonin by neurons after release into the synpase. As a result, the levels of serotonin in the brain are gradually increased as the rates of reuptake decrease. By shifting the balance in serotonin concentration throughout the brain, neurons are better equipped to send and receive messages, producing an elevated mood in patients.

Side Effects

• It is important to tell your doctor if you have experienced any unusual side effects since initiating SSRI therapy. Side effects of SSRIs include nausea, dry mouth, diarrhea, reduced sex drive, increased sweating, weight gain, drowsiness and insomnia. These side effects are common, effecting over half of patients taking antidepressants.

Drug Interactions and Other Health Risks

• While there are several safety concerns with SSRI therapy, overall it is a relatively safe drug. Whenever beginning a new medication it is important to tell your doctor all other medications and herbal supplements you are taking. Failing to do so may result in your doctor overlooking a dangerous drug interaction that could easily be avoided with full disclosure initially. Additionally, blood-thinning medications such as aspirin, NSAIDs, or warfarin may increase the risk of bleeding when taken with SSRIs. In some rare cases, SSRI therapy may cause dangerously high serotonin levels. Known as serotonin syndrome, this condition is characterized by confusion, rapid or irregular heartbeat, fever, dilated pupils and loss of consciousness. This syndrome may result from a harmful drug combination in which two medications, which both increase serotonin through different mechanisms, are combined.

Suicide Risk

• Children through young adults may be at an increased risk of suicide when first taking antidepressants. An important aspect of SSRI protocol includes closely watching young patients for increasing signs of depression during treatment. This phenomenon most commonly occurs when starting an SSRI; in the long run, however, these medications will decrease the risk of suicide by elevating mood.

Pharamacogenomics

• In the age of modern genetics, it is becoming more common for doctors to consider your inherited genes when making a diagnosis or recommending treatment. DNA tests can be used to predict how some patients will handle an SSRI treatment; for example, what side effects they can expect and whether a particular antidepressant is likely to relieve symptoms. These DNA tests examine the types of genes present in your genetic code; CYP450 is one example of a gene that might be analyzed prior to SSRI therapy.

Finding the Right SSRI

• Once SSRI therapy is begun, it takes several weeks for the medication to be fully effective. For some patients, the process of determining which SSRI is the right choice for them can be a long process. With patience, your doctor will help find a type of SSRI that works well with minimal side effects.

Terminating SSRI Therapy

• Your body will eventually adapt to the presence of the medication; its chemical balances in the brain will come to depend on the action of the antidepressant. If treatment is abruptly stopped, you may experience withdrawal-like symptoms including nausea, headache, dizziness, and lethargy. If you have decided to stop taking your medication, it is important to consult with your doctor on how to gradually wean yourself off the drug.