Clinical Uses and Differences Among the Selective Serotonin Reuptake Inhibitors

The selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed agents for treating depressive disorders in the United States. Differences between the individual SSRIs may guide the choice of a particular agent. These differences include pharmacokinetic profiles, side effects, relative doses, FDA-approved indications, and cost. This article discusses the role of these differences in the selection of a particular agent. Since the SSRIs inhibit neuronal serotonin reuptake and have minimal effects on sites affected by other antidepressants, the SSRIs have a different pharmacodynamic and tolerability profile from other antidepressants. The SSRIs are effective in treating many disorders, including major depression, obsessive-compulsive disorder, panic attacks, bulimia, alcoholism, bipolar disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, and perhaps migraine headaches. Common adverse reactions of the SSRIs include central nervous system activation, insomnia, sedatio...