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Choosing an SSRI antidepressant

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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.


  1. NICE (October 2009). Depression updated guideline

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