SSRIs: types, functioning and effects of this antidepressant

This psychopharmaceutical is one of the most useful in the treatment of certain mental disorders.

Of all the psychotropic drugs, serotonin reuptake inhibitors (SSRIs) are the most prescribed in Spain and in most other countries. in Spain and in most industrialized countries. This type of Antidepressant is popular for several reasons: it is indicated for the most prevalent disorders such as major depression or anxiety disorders, they are effective and their side effects are almost always well tolerated.

If we understand why depression occurs, we can also understand how SSRIs are effective. how SSRIs are effective in the treatment and through what mechanism they work.. We will make a brief review of how they work, what are their properties and adverse effects and in which disorders they are most frequently prescribed.

What is an SSRI?

Although it can be cumbersome, it is necessary to understand how neurons function at the cellular level when communicating with when they communicate with each other through neurotransmitters in order to understand how serotonin reuptake inhibitors modify neuronal activity.

Release and reuptake of serotonin

When neurons communicate with each other, the presynaptic neuron (the sender of chemicals that the other will receive) releases neurotransmitters into the synaptic space, which are picked up by the receptors of the presynaptic neuron. are taken up by receptors on the postsynaptic neuron.. In the case of neurotransmitter circuits called serotonin, neurons use this neurotransmitter to communicate. One neuron releases serotonin into the space and the other picks it up, understanding that it must be activated.

What happens is that not all neurotransmitters are received and sometimes remain floating in the intersynaptic space. There are pumps that are in charge of cleaning this excess neurotransmitter and returning it to the presynaptic neuron.

In depression and other disorders it is hypothesized that there is very little serotonin in this space, so that the postsynaptic neurons, hungry for serotonin, create many receptors to receive neurotransmitters but do not activate and do not release anything, as in a state of hibernation.

The SSRIs block the reuptake pumps and allow more and more serotonin to accumulate in space. The postsynaptic neurons, perceiving that the concentration of serotonin in the space is higher and more neurotransmitter is available, begin to decrease the number of receptors because they no longer think they need so many. The neuron relaxes its strict rule of not releasing anything, and begins to let go of serotonin and activate the rest of the neurons in the circuit.

Types of SSRIs

Not all SSRIs are the same. Each drug uses a different active ingredient that will have a specific therapeutic dose. In addition, as each active ingredient acts on each active ingredient acts on different serotonin receptors, their side effects will also be different.receptors, their side effects will also be different. It is this relationship between the efficacy, safety and tolerance of the drug that defines whether it is preferable to use one or the other.

Below is a list of commercially available SSRIs. In pharmacies you will find them under different trade names depending on the country. For example, fluoxetine is more widely known as Prozacor escitalopram under the name Cipralex:

• Citalopram
• Escitalopram
• Fluoxetine
• Fluvoxamine
• Paroxetine
• Sertraline

Safety, tolerance and side effects

In general, SSRI psychotropic drugs are safe.. Contrary to what happens with lithium salts, the toxic dose is difficult to reach by mistake when taking SSRIs. Also, they do not produce the same tolerance as other drugs such as benzodiazepines, so it is not necessary to increase the dose due to the properties of the SSRI.

On the other hand, the side effects it produces are minor.. They can produce nausea, dry mouth, sweating, anorgasmia, decreased sexual desire and blurred vision, among others much less frequent. The abrupt cessation of SSRI consumption, although it does not generate addiction, can cause withdrawal, since the brain gets used to the presence of the substance. For this reason, the withdrawal of the drug is done gradually.

SSRIs interact with many other drugsThe use of antidepressants is not recommended, so close supervision by the prescribing psychiatrist is necessary. For example, there are some antidepressants that remain in the system for days or weeks after cessation of their administration. When someone taking this type of antidepressant switches to SSRIs, there may be an overlap between the effects of the previous medication that has not yet been excreted and that of the SSRIs. This causes the patient to suffer a serotonergic syndrome, an excess of serotonin that causes a confusional state, agitation, headache, nausea, etc. and must be treated urgently.

Uses in psychiatry

In the same way as tricyclic antidepressants, SSRIs are used for a wide variety of disorders. Naturally, the main use is in patients with major depressive episodes or depressive symptoms. The use of SSRIs is very effective in terminating depressive symptomatology. that can be found in patients with anxiety disorders, personality disorders, gender dysphoria, bulimia nervosa, autism, and so on.

Since serotonin is also involved in anxiety, the benefit of SSRIs in anxiety disorders is often twofold. On the one hand, it calms the negative mood, and on the other hand, it reduces the experience of anxiety.. Especially in patients experiencing chronic levels of anxiety such as in generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder or acute stress reactions, serotonin reuptake inhibitors will be very useful.

These patients, when taking SSRIs, experience a significant decrease in anxiety levels. This allows them to loosen the worries and restlessness that torment them, recovering much of their quality of life and leading a functional life.