Overview
This lecture explains selective serotonin reuptake inhibitors (SSRIs), including their mechanism of action, uses, main drugs, nursing responsibilities, side effects, and patient education.
Introduction to SSRIs
- SSRIs stand for selective serotonin reuptake inhibitors.
- SSRIs work by inhibiting the reuptake of serotonin, increasing its levels in the brain.
- They are commonly prescribed for depression, anxiety, panic disorders, compulsion disorders, and PTSD.
Common SSRIs
- Main SSRIs in the US: paroxetine, fluoxetine, fluvoxamine, sertraline, citalopram, escitalopram, vilazodone.
- Some SSRIs have similar generic endings, aiding identification.
Mechanism of Action
- SSRIs block reuptake of serotonin by presynaptic neurons, increasing serotonin in the synaptic cleft.
- Serotonin is an inhibitory neurotransmitter that calms the brain and regulates mood, sleep, and appetite.
- Serotonin acts mainly in the brainstem’s raphe nucleus.
- The special protein transporter SERT reabsorbs serotonin; SSRIs block SERT.
Understanding Neurons and Neurotransmitters
- Neurons are cells responsible for sending signals in the brain.
- Neurotransmitters are chemicals that carry messages between neurons.
- Serotonin, as an inhibitory neurotransmitter, impacts mood, emotions, memory, sleep, and digestion.
Nursing Responsibilities & Patient Education (Mnemonic: SSRIs)
- Symptoms improve after about 4-6 weeks; educate patients on delayed effect.
- Slowly taper off with prescriber’s guidance to avoid discontinuation syndrome.
- Monitor for suicidal thoughts in young adults and pregnancy/breastfeeding risks.
- Interactions: avoid combining SSRIs with MAOIs, certain opioids, some cold medications, triptans, St. John’s Wort, and alcohol due to serotonin syndrome risk.
Side Effects & Serotonin Syndrome
- Common side effects: GI disturbances (especially nausea), low libido, weight gain, insomnia or drowsiness, and dry mouth.
- Adjust medication timing based on sleep side effects (morning for insomnia, bedtime for drowsiness).
- Recommend sugarless gum and good dental hygiene for dry mouth.
- Serotonin syndrome symptoms: sweating, fever, muscle rigidity, tremors, pupil dilation, GI upset, confusion, and anxiety.
Key Terms & Definitions
- Serotonin — Inhibitory neurotransmitter affecting mood, sleep, and digestion.
- Reuptake — Process where neurotransmitters are reabsorbed by the releasing neuron.
- SERT — Serotonin reuptake transporter protein blocked by SSRIs.
- Discontinuation syndrome — Withdrawal symptoms from abruptly stopping SSRIs.
- Serotonin syndrome — Dangerous increase in serotonin levels due to medication interactions.
Action Items / Next Steps
- Review and memorize main SSRIs and their uses.
- Learn the SSRI mnemonic for nursing responsibilities.
- Take the provided quiz on SSRI content.