SSRI medicines

What is an SSRI?

Selective serotonin reuptake inhibitor (SSRI) relates to how this group of medicines works in the brain. It is a group of medicines which are similar in some ways. It includes the most well known medicine of the group called fluoxetine (also known as Prozac).

What are SSRIs used for in child psychiatry?

SSRIs are used to treat a number of conditions including depression and obsessive compulsive disorders (OCD), and sometimes eating disorders, post traumatic stress disorder (PTSD), and some anxiety disorders.

Some preparations are licensed for use in children and teenagers but others may be used when no license exists. This practice is known as ‘off license’ or ‘off label’ prescribing and is common in children’s medicine. Do not be alarmed, it is based on research evidence, and is considered good practice.

How does it work?

In depression and OCD the medicines change the levels of naturally occurring chemicals in the brain known as neurotransmitters. These chemicals are reduced in people suffering from the disorders. The treatment helps to boost active levels of these chemicals in the brain.

In what form are the medicines available?

The dosage and form of the medicine may vary such as a tablet or capsule of liquid.

Why is this medication prescribed?

Your doctor will explain why you need to be on this medication and which symptoms should improve by taking it.

How well will this medication work?

These powerful medicines are useful for a lot of young people suffering one of the disorders mentioned above. However, they are rarely prescribed alone and would usually form part of an overall treatment package. Not everyone will respond, but your doctor will discuss your progress. If needed they might alter the dose or the medicine you are taking.

What should my doctor check before starting this medication?

Your doctor will check if you suffer from any medical conditions which may affect the medicine treatment, and other medicines you may already be taking. You need to inform your doctor if you are on any regular medication.

Before starting the medication, your doctor may ask you to have some blood tests done and an electrocardiogram (known as an ECG tests your heart’s functioning). Your doctor will also record your height, weight, blood pressure and pulse.

What are its side effects?

Different people can have different side effects. The side effects can be managed by:

• building up the dose slowly
• decreasing the dose
• changing to a different preparation

Not everyone experiences major side effects. The most common side effects include:

• gastro-intestinal symptoms:
  • nausea (feeling sick)
  • vomiting (being sick)
  • diarrhoea
  • abdominal (tummy) pain
  • loss of appetite
  • weight loss
• hypersensitivity (rash)
• sweating
• headaches
• dizziness
• sleep difficulties

Some people may also experience an unpleasant feeling of restlessness in their arms or legs.

You may have heard that SSRIs can cause a slight rise in the incidence of suicidal ideas, but this rarely happens. Your doctor will discuss how to manage this risk if it is relevant to you.

This medicine may reduce your ability to drive and it is recommended to stop drinking alcohol while taking this medicine.

How long will it take to act?

These medicines will usually take some time (around 10 to 14 days) before its benefits start to become effective. You should carry on with treatment even if it initially appears to be having no effect.

What is the right dose of this medication?

It is not possible to state the right dose, since this will depend on:

• the medicine chosen
• the condition being treated
• your age and weight

The dose will be discussed with you when treatment is being considered.

How often should the medicine be taken in the day?

These medicines are normally given once daily. This can be done in the morning or in the evening, depending upon your situation and symptoms.

What happens if a dose is missed?

Do not worry too much if you miss a single dose. If you miss the time you usually take the dose you can just take the dose when you remember.

If you miss a day, continue as normal the following day. Do not take double to make up for the missed dose.

If you miss taking the medication for a week or more contact your doctor as you may need to start again at a lower dose and build up as advised.

What should be done if I take more than the prescribed dose?

You should immediately contact your specialist or your GP, or go to the Emergency Department of the Sheffield Children’s Hospital.

Symptoms of overdose can range from:

• excessive sleepiness
• nausea and vomiting
• abdominal pain
• blurred vision

These symptoms will depend on how much of the medication has been taken.

How long should I take this medication?

SSRIs are recommended to be taken for at least 6 months after the symptoms of your disorder have disappeared. This helps stop a relapse of the condition.

You should not stop the medication suddenly as this can cause symptoms such as:

• headache
• nausea
• pins and needles
• dizziness
• anxiety

Withdrawal symptoms are temporary and are not because of addiction or dependence on the medicine. They are rare with fluoxetine, because it remains in your system for few weeks after you stop taking it.

How does this medication react with alcohol and smoking?

Alcohol is not recommended as it can increase some side effects and worsen your symptoms. Smoking can increase your body’s metabolism which in turn might mean you will need a higher dose of medication to be effective.

What monitoring is needed for this medication?

Your specialist will continue to check your need to be on this medication and the side effects you are experiencing.