SSRIs (Selective Serotonin Reuptake Inhibitors): medications in this class

Overview

Selective serotonin reuptake inhibitors increase the amount of serotonin available between nerve cells. They are often chosen first because they work for depression and most anxiety disorders, are safer in overdose than older drugs, and are tolerated well by most people.

Sertraline and escitalopram are the usual first choices; fluoxetine has a long half-life that makes it forgiving of missed doses; citalopram has a dose ceiling because of its effect on heart rhythm; paroxetine is more sedating and harder to stop. They differ more in side effects than in effectiveness, so the choice is individual.

They take several weeks to work. Nausea, sleep changes and sexual side effects are the common complaints, and the class carries a boxed warning about suicidal thinking in young people. Stopping needs a taper.

How the drugs in this class differ when you pay cash

All five are available as generics, and quotes for the same prescription can differ between pharmacies. Brands such as Zoloft, Lexapro and Prozac contain the same active ingredients as their generics. Scored tablets at a higher strength, split, can halve the tablet count where the prescriber agrees.

Capsules and tablets of the same drug, and the oral solutions, are separate products; fluoxetine in particular comes as capsules, tablets and a weekly delayed-release capsule, so a quote applies only to the form on the prescription.

Paroxetine is also sold as a controlled-release tablet and sertraline as an oral concentrate; both are separate products from the plain tablets. If a prescription names a brand, ask the prescriber to allow generic substitution so the pharmacy can dispense the maker it stocks.

Medicines at a glance

How the medicines in this group are supplied and usually taken. Each guide has the full details.

• Sertraline
  Tablets (Zoloft and generic), Oral concentrate (Zoloft oral solution and generic), Capsules (150 and 200 mg)
  Generic: Yes · Once a day
• Escitalopram
  Tablets (Lexapro and generic), Oral solution (generic)
  Generic: Yes · Once a day
• Fluoxetine
  Capsules, Tablets, Oral solution
  Generic: Yes · Once a day
• Citalopram
  Tablets (Celexa and generic), Oral solution (generic), Capsules (30 mg)
  Generic: Yes · Once a day
• Paroxetine
  Tablets (Paxil and generic), Extended-release tablets (Paxil CR and generic), Oral suspension (generic)
  Generic: Yes · Once a day

Medications

Which of these is right for a given person is a decision for the prescriber. The guides explain what each drug is, how it is supplied, and why its cash price varies between pharmacies. No page on this site shows a price; prices come from pharmacies responding to your actual prescription.

Questions worth asking

• How long before this should help, and how will we judge it?
• Which side effects are common in the first weeks?
• Is the capsule or the tablet the right form for me?
• Is a ninety-day prescription appropriate once the dose is stable?
• How is it tapered if I stop?