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Selective Serotonin Reuptake Inhibitors (SSRI) Cheat Sheet by

Antidepressant Medication




SSRIs select­ively block reuptake of the monoamine neurot­ran­smitter serotonin in the synaptic space, thereby intens­ifying the effects of serotonin. Considered the first line treatment for depres­sion.
Paroxetine select­ively inhibits serotonin reuptake, allowing more serotonin to stay at the junction of the neurons
It doesn't block the reuptake of dopamine or norepi­nep­hrine.
The medication has a long effective half-life. A time frame of up to 4 weeks is necessary to produce therap­eutic medication levels.

Therap­eutic Uses

Genera­lized anxiety disorder (GAD). Panic disorder: decreasing both the frequency and intensity of panic attacks and also prevent antici­patory anxiety about attacks. Obsessive Compulsive Disorder (OCD): reduces manife­sta­tions by increasing serotonin. Social Anxiety disorder. Trauma and stressor related disorders. Dissoc­iative disorders. Depressive disorders. Adjustment disorders.
Indicated for panic disorder, OCD, anxiety disorder, and PTSD.
Indicated for GAD and OCD
Used for OCD and social anxiety disorder.


Early Adverse Effects
Client Education
First few days/w­eeks: Nausea, diapho­resis, tremors, fatigue, drowsiness
Report adverse effects to the provider, Take medication as prescr­ibed. These effects should soon subside
Later Adverse Effects
After 5 to 6 weeks of therapy. Insomnia, headache, and sexual dysfun­ction (impot­ence, delayed, or absent orgasm, delayed or absent ejacul­ation, decreased sexual interest)
Report problems with sexual function (managed with dose reduction, medication holiday, changing medica­tion)
Weight Changes
Occurrence of weight loss early in therapy that can be followed by weight gain with long term treatment
Monitor client's weight. Follow a well balanced diet and exercise regularly.
GI Bleeding
Use caution in clients who have a history of GI bleed or ulcers and in cleitns taking other medica­tions that affect blood coagul­ation
Report indica­tions of bleeding (dark stool, coffee­-ground emesis)
More likely in older adult clients taking diuretics
Obtain baseline blood sodium levels, monitor levels period­ically throughout treatment
Serotonin Syndrome
Agitation, confusion, disori­ent­ation, difficulty concen­tra­ting, anxiety, halluc­ina­tions, Myoclonus (spastic, jerky muscle contra­cti­ons), hyperr­efl­exia, incoor­din­ation, tremors, fever, diapho­resis, hostility, delirium, seizures, tachyc­ardia, labile blood pressure, nausea, vomiting, diarrhea, abdominal pain, coma leading to apnea, and death in severe cases.
Serotonin syndrome usually begins true to 72 hours after initiation of treatment. This resolves when the medication is discon­tinued. Watch for and advise clients to withhold the medication and report any of these manife­sta­tions, which could indicate a little problem.
Grinding and clenching of teeth usually during sleep
Report to the provider, who may switch the client to another class of medica­tion. Treat with low dose Buspirone. Use mouth guard during sleep
Withdrawal Syndrome
Nausea, sensory distur­bances, anxiety, tremors, malaise, unease
Minimized by tapering dose slowly. Do not discon­tinue use of abruptly but slowly taper medication before stopping especially with long-term use.
Postural Hypote­nsion
when your blood pressure drops when you go from lying down to sitting up, or from sitting to standing
Monitor for hypote­nsion and advise client to change positions slowly
Suicidal Ideations
Monitor and report manife­sta­tions of depression and thoughts of suicide

Contra­ind­ica­tions/ Precau­tions

Paroxetine is a pregnancy risk category D medica­tion.
Paroxetine Tina is contra­ind­icated in clients taking MAOIs or a TCA.
Clients taking paroxetine and should avoid alcohol.
Use Paroxetine cautiously in clients who have liver and renal dysfun­ction, seizure disorders, or a history of GI bleeding.


Use of St. Johns worts, MAOI antide­pre­ssants, or TCA's can cause serotonin syndrome
Educate the client about this combin­ation. Avoid concurrent use
Antipl­atelet medica­tions and antico­agu­lations can increase risk for bleeding
Monitor for bleeding. Avoid concurrent use.

Nursing Admini­str­ation

Administer with food

Client Education

It can take up to 4 weeks to achieve therap­eutic effects.
Taking the medication at the same time daily promotes therap­eutic levels.
Taking the medication in the morning can prevent sleep distur­bances.


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