Examples

Generic Name	Brand Name
fluoxetine	Prozac
fluvoxamine maleate	Luvox
paroxetine	Paxil
sertraline	Zoloft

How It Works

Selective serotonin reuptake inhibitors (SSRIs) balance brain chemicals (neurotransmitters) by making more serotonin available, which reduces the number and severity of panic attacks associated with panic disorder.

Why It Is Used

SSRIs are frequently the first choice of medication for treating panic disorder and are effective in reducing the number and severity of panic attacks. SSRIs also are effective in reducing anxiety associated with panic attacks and are effective in treating depression and agoraphobia, both of which frequently occur with panic disorder.¹

How Well It Works

SSRIs reduce the severity and number of panic attacks as well as anxiety related to anticipating a panic attack.² You may start to feel better within 1 to 3 weeks of taking an SSRI. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

Side Effects

Side effects of SSRIs include:

• Dry mouth.
• Headache.
• Nausea, loss of appetite, and diarrhea.
• Feeling irritable or anxious.
• Problems sleeping.
• Drowsiness.
• Loss of sexual desire or ability.
• Tremor or shaky hands.
• Weight gain.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide in children and adults. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
• A warning about taking triptans, used for headaches, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

SSRIs usually are started at low doses and increased gradually. You may start to feel better within 1 to 3 weeks of taking an SSRI. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor. If you experience side effects that won't go away (such as sexual dysfunction), your doctor may change your medication or combine it with another medication to help reduce such side effects.

Never suddenly stop taking antidepressants. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medications can cause negative side effects or a relapse into a depressive episode or panic disorder.

SSRIs generally have fewer side effects than tricyclic antidepressants, which also are used to treat panic attacks. SSRIs also are safer than tricyclic antidepressants in case of overdose, which makes SSRIs a better treatment choice for people who have thoughts of suicide.

People with liver disease usually require lower doses of SSRIs.

Studies have found daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Talk to your doctor about this risk before taking an SSRI.

SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.³

SSRIs are also used to treat depression. SSRIs alone are not commonly used if you have episodes of mania, such as in bipolar disorder.

Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant, you and your doctor must weigh the risks of taking an SSRI against the risks of not treating your panic disorder.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

1. Hollander E, Simeon D (2008). Anxiety disorders. In RE Hales et al., eds., American Psychiatric Publishing Textbook of Clinical Psychiatry, 5th ed., pp. 505–529. Washington, DC: American Psychiatric Publishing.
2. Kumar S, Oakley-Browne M (2007). Panic disorder, search date May 2006. Online version of BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
3. Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.