choosing an SSRI antidepressant

Last reviewed 06/2022

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