SSRIs on the NCLEX
SSRI class for NCLEX: onset, side effects, serotonin syndrome, MAOI washout, suicidality in young adults.
SSRIs are first-line for depression and many anxiety disorders. The NCLEX tests onset of effect, serotonin syndrome, and the MAOI washout.
Common drugs
Sertraline (Zoloft), fluoxetine (Prozac), escitalopram (Lexapro), paroxetine (Paxil), citalopram (Celexa).
Onset
4-6 weeks for full antidepressant effect. Teach patient to continue even when feeling worse initially, early activation can increase anxiety.
Side effects
Sexual dysfunction. GI upset. Insomnia or sedation. Weight changes. Hyponatremia (especially elderly). QT prolongation with citalopram at higher doses.
Serotonin syndrome
Triad: mental status changes (confusion, agitation), autonomic instability (tachy, HTN, hyperthermia), neuromuscular (clonus, hyperreflexia). Discontinue offender. Supportive care. Cyproheptadine in severe cases.
MAOI washout
2 weeks washout between SSRI and MAOI in both directions (5 weeks for fluoxetine due to long half-life). Serotonin syndrome risk.
Suicidality warning
Black box: increased suicidal ideation in patients <24. Monitor closely first 4-6 weeks.
Frequently asked
How long before patient feels better?
4-6 weeks for full effect. Some improvement in sleep/appetite sooner.
Stop abruptly?
Don't. Discontinuation syndrome, flu-like symptoms, dizziness, electric-shock sensations. Taper over weeks.
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