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Basics of SSRI Psychopharmacology

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Selective Serotonin Reuptake Inhibtors, or SSRI's for short, have become the mainstay of psychiatric mediation in recent years. From major depressive disorder, anxiety disorder, to even obscessive-compulsive disorder, SSRI's have been widely prescribed, partly because of heavy promotion of pharmaceutical companies who have one or more of these drugs on patent, and partly because physicians see SSRI's as having fewer side effects and less abuse potential than their predecessors. SSRI's include Prozac, Celexa, Lexapro, Luvox, along with several others.

Personally, I disagree with the overly positive presentation of SSRI's. First of all, they do have noticeable side effects, so much so that the Food and Drug Administration (FDA) has issued a black box warning for all SSRI's except for Prozac when concerning children and adolescents. A black box warning is the most serious warning a drug can receive in the USA short of it being pulled from the market. It is alleged that SSRI's, despite being prescribed for depression, can actualy increase sucidial ideation in children and adolescents. Even in adults, SSRI's have unignorable side effects such as negative effects on libido (sex drive), blunting of emotions, and a nasty withdrawal sydrome when the drug is discontinued. In fact, SSRI's do not work unless your neurotransmitters have adjusted due to exposure to the drug. In other words, you must be dependent on SSRI's for them to have a noticeable clinical effect. It is this modulation of neurotransmitters that is theorized to cause the antidepressant effect.

serotoninnerve.jpg

An example of a serotonin neuron. SSRI's interfere with the reuptake transporter, which would intuitively quickly increase the amount of serotonin in the synapse, but SSRI's also interfere with the serotonin-regulating- autoreceptors,causing no net change in serotonin. The prevailing theory is that these autoreceptors eventually lose their effectiveness to some extent upon repeated exposure to SSRI's, causing an antidepressant-inducing increase in serotonin in the synapse after about 4 to 6 weeks.

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