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Selective serotonin re-uptake inhibitors (SSRIs)

Selective serotonin re-uptake inhibitors (SSRIs) Preparations Comments
Citalopram hydrobromide (Tabs) 10mg, 20mg, 40mg tablets

SSRI with lowest propensity for drug interactions.
Suitable choice in renal impairment.

Citalopram and escitalopram are the most toxic of SSRIs  in overdose (coma, seizures, arrhythmia).

QT interval prolongation

Contraindicated with other QT prolonging medications.
Baseline ECG advised in patients with cardiac disease.
Bioequivalence to drops. See Citalopram tablets to drops conversion

Citalopram hydrochloride (Drops) 40mg/ml oral drops
Escitalopram 5mg, 10mg and 20mg tablets
20mg/ml oral drops

For specialist initiation 
Suitable choice in mild to moderate renal impairment. Escitalopram and citalopram are the most toxic of SSRIs in overdose (coma, seizures, arrhythmia).

QT interval prolongation 

Contraindicated with other QT prolonging medications.
Baseline ECG advised in patients with cardiac disease.
Escitalopram is an isomer of citalopram. 
Demonstrated similar-to-better efficacy than citalopram.
Has similar tolerability to citalopram and other SSRIs.
Escitalopram may be useful in patients with overlapping 
generalized anxiety disorders with depression

Bioequivalence of oral drops to tablets  (10 drops = 10mg tablet)

Fluoxetine hydrochloride 10mg, 20mg, 30mg, and 60mg capsules
20mg/5ml oral liquid
Good option for patents with poor medication compliance due to its long half-life. Oral liquid can also be administered sublingually
Fluvoxamine maleate† 50mg and100mg  tablets Less cost-effective choice than other SSRIs. Use only when other SSRIs are not suitable.
Paroxetine† hydrochloride

10mg, 20mg, 30mg and 40mg tablets

10mg/5ml oral solution

Less preferred choice.

SSRI with greatest risk of discontinuation symptoms

Greater tendency to cause sexual dysfunction and weight gain

Sertraline hydrochloride 25mg, 50mg and 100mg, 150mg and 200mg tablets 100mg /5ml oral solution Drug of choice for those with cardiovascular disease (recent MI or unstable angina) or renal impairment. Reduced propensity for drug interactions. Sertraline levels modestly increased by grapefruit juice - manufacturer advises avoid grapefruit juice 

† - denotes a less preferred choice of medicine.

 

Back to Monoamine-oxidase inhibitors (MAOI's)

Continue to Tricyclic and related anti-depressant drugs

Continue to Other antidepressant drugs

 

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