PHARM | SSRIs-Fluoxetine

💊 HIGH-YIELD SSRI OVERVIEW (80/20 Rule) (Selective Serotonin Reuptake Inhibitors)🧠 Core Concept: SSRIs ↑ serotonin levels by blocking reuptake in the synaptic cleft — boosting mood, reducing anxiety, and stabilizing emotional regulation.📋 Top Drugs to Know: Fluoxetine (Prozac) 🌀 Sertraline (Zoloft) 🌊 Escitalopram (Lexapro) 💎 Citalopram (Celexa) 🌤 Paroxetine (Paxil) ⚠️ (sedating, more withdrawal risk)🩺 Main Indications (What You’ll Actually See):Depression (MDD)Anxiety Disorders (GAD, panic, OCD, PTSD, social anxiety)PMDD & Bulimia (Fluoxetine)Panic Disorder (Sertraline)⚡️ Mechanism of Action (Simple): Blocks serotonin reuptake pump → serotonin stays longer in the synapse → improved mood & less anxiety.⏱ Onset: Takes 2–4 weeks for full effect. Educate patients early: “You won’t feel better overnight.”⚠️ Major Side Effects (Know These Cold):Sexual dysfunction (↓ libido, anorgasmia)GI upset (nausea, diarrhea early on)Insomnia or sedation (drug-dependent)Weight changes (gain with Paroxetine)HeadacheSerotonin Syndrome 💀 → mental status changes, hyperreflexia, myoclonus, fever, shivering (esp. with MAOIs, St. John’s Wort, or triptans). 👉 Tx: Stop SSRI, give benzodiazepines, supportive care, ± cyproheptadine.💣 Black Box Warning: ↑ suicidal thoughts in adolescents & young adults (esp. in first few weeks).🚫 Contraindications & Cautions:MAOIs — must wait 14 days between use → risk of serotonin syndrome.Avoid abrupt discontinuation — causes flu-like withdrawal (esp. Paroxetine).💉 Nursing Implications:Monitor mood, anxiety, suicidal ideation early in therapy.Educate on delayed effect & adherence.Watch for serotonin syndrome if combined with other serotonergic agents.Encourage taking same time daily.Sertraline often best for patients with cardiac disease (safe profile).🧩 Clinical Pearls:Fluoxetine = longest half-life (good for poor adherence).Paroxetine = most sedating, highest withdrawal risk.Sertraline = go-to for anxiety & PTSD.Escitalopram = cleanest side effect profile.🧠 80/20 Takeaway: SSRIs = first-line for depression/anxiety. Know onset delay, serotonin syndrome signs, sexual dysfunction, and black box warning.⏳ 2–4 weeks to work. Watch early mood shifts. Don’t mix with MAOIs.✨ Start low, go slow, and monitor the glow (serotonin).