Choosing an SSRI antidepressant

The following symptoms may be treated with the corresponding drugs:

• depression:
  • all SSRIs
  • in the management of depression (1)
    • normally choice is an SSRI in generic form. Clinicians should also consider::
      • SSRIs are associated with an increased risk of bleeding
        • consider prescribing a gastroprotective drug in older people who are taking non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin
      • fluoxetine, fluvoxamine and paroxetine have a higher propensity for drug interactions
      • for people who also have a chronic physical health problem, consider using citalopram or sertraline as these have a lower propensity for interactions
      • paroxetine is associated with a higher incidence of discontinuation symptoms
    • take into account toxicity in overdose for people at significant risk of suicide:
      • compared with other equally effective antidepressants recommended in primary care, venlafaxine is associated with a greater risk of death from overdose
      • greatest risk in overdose is with tricyclic antidepressants (TCAs), except for lofepramine
        
        
• panic disorder:
  • citalopram
  • paroxetine
    
    
• obsessive-compulsive disorder:
  • fluoxetine
  • fluvoxamine
  • paroxetine
    
    
• social phobia:
  • paroxetine
    
    
• bulimia nervosa:
  • fluoxetine
    
    
• premenstrual dysphoric disorder
  • fluoxetine

The appropriate summary of product characteristics must be consulted before prescribing one of the drugs mentioned above.

Reference:

1. NICE (October 2009). Depression updated guideline