Selective serotonin reuptake inhibitors (SSRIs) for anxiety disorders

Selective serotonin reuptake inhibitors (SSRIs) are antidepressant medicines that are often used to treat people with anxiety problems, depression, or phobias. These medicines affect certain brain chemicals called neurotransmitters and can relieve symptoms of anxiety and depression. Examples of SSRIs include paroxetine (such as Paxil), sertraline (Zoloft), fluoxetine (such as Prozac), fluvoxamine (such as Luvox), and citalopram (Celexa).

SSRIs are usually started at a low dose that is gradually increased until symptoms improve. SSRIs should not be used in people who have had periods of abnormally intense energy (mania or hypomania); taking SSRIs may cause these symptoms to return.

SSRIs such as sertraline (Zoloft) and paroxetine (Paxil) have been proven to effectively reduce symptoms associated with PTSD. Other SSRIs, such as fluoxetine (Prozac), are currently being studied and are generally thought to be effective for post-traumatic stress disorder, but research is ongoing.¹

Paroxetine (Paxil) is effective at reducing relapses of social anxiety disorder.² However, it should not be used by children under the age of 18.

Side effects of SSRIs include:

• Nausea, changes in appetite, and diarrhea.
• Anxiety or drowsiness.
• Sleep problems.
• Restlessness or agitation.
• Loss of sexual desire or ability.
• Headaches.

SSRIs can take several weeks to start working, although they may be effective much sooner. Sexual dysfunction can be a significant problem for some people while taking an SSRI.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• A warning on the antidepressants Paxil and Paxil CR (paroxetine) and birth defects. One new study showed that women who took Paxil during their first 12 weeks of pregnancy had a slightly higher chance of having a baby with birth defects.
• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend 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.
• A warning about taking triptans, used for migraines, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a serious condition called serotonin syndrome.

Citations

1. Bisson J (2004). Post-traumatic stress disorder. Clinical Evidence (11): 1343–1360.

2. Stein DJ, et al. (2002). Efficacy of paroxetine for relapse prevention in social anxiety disorder. Archives of General Psychiatry, 59(12): 1111–1118.

Author:	Stuart J. Bryson Christine Wendt, R.D., L.D.	Last Updated June 13, 2005
Medical Review:	Patrice Burgess, MD - Family Medicine Adam Husney, MD - Family Medicine Malin K. Clark, MD, FRCPC - Psychiatry Jessica Hamblen, PhD - Post Traumatic Stress Disorder
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