Comparing SSRIs: From chemistry to clinical choice

Selective serotonin reuptake inhibitors (SSRIs) are widely accepted as the best available treatment for most forms of depression. However, to date, there has been little attempt to differentiate between the members of this class of drugs. Since, unlike the tricyclic antidepressants, the SSRIs have very different chemical structures, it is not unexpected that they may have different pharmacological properties. These differences in pharmacology may, in turn, be expressed in varying pharmacokinetic, efficacy, safety and tolerability profiles which mean that the SSRIs may be a less homogeneous class of compounds than is generally assumed. This review analyses the differences between the SSRIs with the intention of helping the practising clinician to select the most appropriate drug for a particular patient.