Selective serotonin reuptake inhibitors for depression and pain after a stroke

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Selective serotonin reuptake inhibitors for depression and pain after a stroke

Examples

Generic NameBrand Name
citalopramCelexa
escitalopramCipralex
fluoxetineProzac
paroxetinePaxil
sertralineZoloft

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.

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

  • Advisories on antidepressant medicines and the risk of suicide. It is not recommended that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. 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.
  • Warnings about taking triptans, used for headaches, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

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

What To Think About

You may start to feel better after 1 to 3 weeks of taking an SSRI. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

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.

Studies have found daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Talk to your doctor about this risk before taking an SSRI.

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.

A medicine such as sildenafil (Viagra) may help both men and women who have sexual problems caused by SSRIs.2, 1

Never suddenly stop taking antidepressants. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse into another depressive episode.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. Nurnberg GH, et al. (2008). Sildenafil treatment of women with antidepressant-associated sexual dysfunction: A randomized controlled trial. JAMA, 300(4): 395–404.
  2. Nurnberg HG, et al. (2003). Treatment of antidepressant-associated sexual dysfunction with sildenafil. JAMA, 289(1): 56–64.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Specialist Medical Reviewer Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
Last Revised October 20, 2009

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.