Selective serotonin reuptake inhibitors, abbreviated SSRIs, are a class of antidepressants used to treat both depression and anxiety. They are generally a very effective medication, although there are some side effects and adverse reactions you'll want to be aware of. In this mnemonic video, I'll go over everything you need to know about SSRIs in a way that will make it easy for you to remember come test day. Today's mnemonic video is taking place inside of my sushi restaurant.
As the head sushi chef, I am making some sushi rolls right now. I've just laid down the sushi rice, which reminds me. Sushi rice is our symbol for the drug class SSRIs.
Sushi rice for SSRIs, get it? Because SSRI stands for sushi rice. Well, actually, SSRI stands for Selective Serotonin Reuptake Inhibitors.
As suggested by their name, SSRIs block or inhibit the reuptake of serotonin so that there is more serotonin available to the brain. And since serotonin is known as the feel-good neurotransmitter, it should make sense that this can help improve mood. But before we get too far into the details of SSRIs, let's start by introducing the most common drug names that you need to know for test day. Unfortunately, there's no common ending for these guys, so we'll go through each one individually.
A couple is sitting in front of me at the sushi bar and are finishing up their date. The man is holding out his Citi credit card, ready to pay for the meal. You know, the word Citi reminds me a lot of our first SSRI drug, Citalopram. Get it? Citi for Citalopram?
In addition to citalopram, you might want to know that there is another related drug called S-citalopram, which is also an SSRI. Remembering the city here should get you both drug names in one fell swoop. Let's move on to the next drug name you should know. Did I mention that I have been officially certified as a sushi chef? No?
Well, the proof is right over there on the certificate hanging on the wall. By the way, this certificate is the symbol for the drug sertraline. Certificate for sertraline.
Sounds pretty similar, don't you think? Okay, great. So we have citalopram, escitalopram, and sertraline so far.
Let's see what's next. Where was I? Oh yeah, the sushi rice. Next up is adding the fish to the sushi.
In this roll, I was thinking about adding some parrotfish. You know, since tropical fish like this parrotfish make for the best sushi. This parrot fish here can help you remember the drug paroxetine. Parrot for paroxetine, got that?
After adding the parrot fish, I will roll this up and dip it in a flour mixture before frying it. Which reminds me, the flour here is our symbol for the last SSRI called fluoxetine. You know, since flour reminds me of the beginning of the drug, fluoxetine.
So if you see fluoxetine on test day, now you know that you're dealing with an SSRI. With all the drug names out of the way, let's move on to the clinical uses of SSRIs. It's hard to focus with this couple sitting here at the bar.
The woman is making quite a scene the way she is crying. To me, this looks like a classic breakup scene. You know how it's pretty common for people to cry when ending a relationship.
This crying, depressed customer is here to help you remember that SSRIs treat depression. You know, since this customer is definitely feeling depressed right now. SSRIs are antidepressants used first line to treat clinical depression. These drugs work by increasing the amount of serotonin in the body and brain, since serotonin works as the feel-good neurotransmitter, right? SSRIs are preferred over most other drugs as they generally have fewer side effects compared to other antidepressants like TCAs or MAOIs.
Before moving on, I wanted to point out that just like with any antidepressant, SSRIs have the potential to increase suicidal thoughts and tendencies in short term before the patient sees an improvement. Functionally, this happens because patients tend to get an increase in energy before they get an increase in mood. This imbalance puts patients at high risk for suicide immediately after starting an antidepressant. As a nurse, this is high priority for you because it deals directly with patient safety. And you know how much the NCLEX loves both the words priority and safety.
As the drug eventually begins to act on mood, which may take up to four weeks, these suicidal feelings should diminish. Let's look at the other half of this breakup. This man here is looking extremely anxious. He thought the date was going great, and it took everything in him to overcome his anxiety and just go for the kiss. Obviously, that didn't go as he planned.
But for now, let's focus on the man's anxiety. SSRIs can also be prescribed to treat patients with anxiety. This can be general anxiety disorder or other forms of anxiety like PTSD or panic disorders. Alright, now that we know the names and uses of SSRIs, let's move on to some side effects and adverse reactions. After the breakup, this woman here is rejecting the man's kiss.
See the way that the woman is putting her hand up, rejecting the kiss of her anxious lover? This rejected advance should remind you of sexual dysfunction, a common side effect associated with SSRIs. So common, in fact, that it is experienced in over 50% of patients taking SSRIs.
It's not entirely clear how SSRIs cause this side effect, but as you might imagine, this can become a big concern to patients when they are experiencing a low libido or low sex drive or difficulty achieving orgasm or anorgasmia. For some, this side effect can be so detrimental that it might even make them stop taking the medication. While sexual dysfunction is not a nursing priority, meaning it doesn't have to do directly with patient safety, it is still a sensitive and important subject and the patient can discuss their options with the provider. Remember the paroxetine parrot we talked about earlier? It's pretty hard to miss considering how massive it is.
I mean, just look at the scale. The parrotfish is much bigger than normal, and the scale is reading it as overweight. Which reminds me, another very common side effect of SSRIs is weight gain.
Like we talked about with sexual dysfunction, weight gain is an unpleasant side effect that makes people want to stop taking the medication. As the nurse, you can encourage people taking SSRIs to eat a healthy diet and exercise regularly to combat weight gain. The portions at my restaurant here are pretty big, and the woman on the date wasn't able to finish all of her food after all the drama. But no worries, we have her all taken care of, with her extra food backed up in a happy face takeout bag. You know how these takeout bags always have happy faces on them?
Coincidentally, the big happy face on this takeout bag is our symbol for serotonin, because serotonin is the feel-good hormone that boosts mood and happiness. Like I mentioned before, SSRIs increase the amount of serotonin, which is how they treat depression. But too much serotonin can actually be a bad thing and lead to what we call serotonin syndrome.
This is basically an overload of serotonin represented here by a big happy face bag. Serotonin syndrome is a life-threatening illness involving unstable vitals and other symptoms like tachycardia, hypertension, muscle rigidity, agitation, and restlessness, diarrhea, and so on. An easy way to think about it is to remember that everything is overactive.
Overactive heart, overactive bowels, overactive muscles and reflexes, etc. If the patient is experiencing these symptoms, the SSRI should not be given and the provider should be notified. Serotonin syndrome is a medical emergency.
Ah, we finally see what caused the breakup here. As much as she likes this guy, the woman on the date isn't going to be able to go on another date with him. She clearly feels awful about rejecting his kiss, but it's best not to drag this one out. You see, she's holding a one-way ticket to Maui and doesn't want a long-distance relationship. Maui is our symbol for the drug class MAOIs because they're spelled almost exactly the same.
Maui for MAOI. Get it? It's important that patients taking SSRIs do not take MAOIs at the same time.
You see, both SSRIs and MAOIs increase the amount of serotonin in the body, and taking them together can lead to serotonin syndrome. In fact, SSRIs and MAOIs should not be taken within 14 days of each other. This means that SSRIs have to be completely discontinued for two weeks before starting an MAOI and vice versa.
Got that? Great. There are just a few more things your patients taking SSRIs need to avoid.
The man on the date is wearing a Saint's jersey, who have recently changed their mascot to this ferocious-looking warthog. Maybe the man thought his lucky jersey would help him calm his anxiety or perhaps impress the girl. But either way, the man and this jersey are out of luck.
The Saint's Warthog jersey is our symbol here at Pixerize for the herbal supplement St. John's Wort. Get it? The saint's warthog for St. John's wort?
St. John's wort is a plant with yellow flowers that is used by some people as an over-the-counter mental health supplement. It is thought to increase serotonin and help treat depression. But like we've mentioned, using SSRIs with other serotonin-altering substances can lead to increased risk of causing the life-threatening serotonin syndrome.
Remind your patients, while they are taking SSRIs, they need to stay away from St. John's wort. as well as anything else that may alter serotonin levels. And finally, if only you would have stopped by a little earlier, I had a drink special for a delicious grapefruit drink. It was such a hit that unfortunately we are now completely out of grapefruit.
Oh well, at least this no grapefruit sign can help you remember that patients taking SSRIs should avoid grapefruit. As you probably have heard a few times in nursing school, grapefruit can alter the metabolism of many drugs, including SSRIs, in the body. The resulting increase in drug levels can also lead to a dangerous increase in serotonin. It's just safer for the patient to avoid grapefruit while taking SSRIs. That's everything for SSRIs.
I know that was a lot, so let's review to make sure you got everything locked down. Selective serotonin reuptake inhibitors, abbreviated SSRIs, are antidepressant drugs used to treat both depression and anxiety. Drug names of the SSRIs to know include citalopram, escitalopram, sertraline, paroxetine, and fluoxetine.
Common side effects include sexual dysfunction and weight gain. Another important adverse effect is serotonin syndrome, which is a medical emergency resulting from an overload of serotonin in the body, manifesting as hypertension, tachycardia, muscle rigidity, and diarrhea. The risk for serotonin syndrome can be reduced by teaching the patient to avoid other serotonin-altering substances, like MAOIs, St. John's wort, as well as avoiding any and all grapefruit products.
Now if you'll excuse me, I need to get back to making sushi. But feel free to stick around and check out some of our other NCLEX mnemonic videos. I'll see you next time.