A report on Selective serotonin reuptake inhibitor

Serotonin, the neurotransmitter that is involved in the mechanism of action of SSRIs.
Neurotransmitter transporters inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions.

- Selective serotonin reuptake inhibitor
Serotonin, the neurotransmitter that is involved in the mechanism of action of SSRIs.

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Overall

The skeleton structure of the SNRI venlafaxine, a typical example of an antidepressant.

Antidepressant

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Antidepressants are medications used to treat major depressive disorder, some anxiety disorders, some chronic pain conditions, and to help manage some addictions.

Antidepressants are medications used to treat major depressive disorder, some anxiety disorders, some chronic pain conditions, and to help manage some addictions.

The skeleton structure of the SNRI venlafaxine, a typical example of an antidepressant.
The skeleton structure of the SNRI venlafaxine, a typical example of an antidepressant.
Blister pack of Prozac (fluoxetine), a selective serotonin reuptake inhibitor
The chemical structure of venlafaxine (Effexor), an SNRI
St John's wort
Structural formula of the SSRI sertraline

The guidelines further note that antidepressant treatment should be used in combination with psychosocial interventions in most cases, should be continued for at least six months to reduce the risk of relapse, and that selective serotonin reuptake inhibitor (SSRIs) are typically better tolerated than other antidepressants.

Fluoxetine (top),
(R)-fluoxetine (left), (S)-fluoxetine (right)

Fluoxetine

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Fluoxetine (top),
(R)-fluoxetine (left), (S)-fluoxetine (right)
Fluoxetine blister pack 20 mg capsules
Fluoxetine 10 mg tablets
The S enantiomer of norfluoxetine, fluoxetine's chief active metabolite.

Fluoxetine, sold under the brand names Prozac and Sarafem, among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.

Serotonin

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Monoamine neurotransmitter.

Monoamine neurotransmitter.

Serotonin system, contrasted with the dopamine system
The pathway for the synthesis of serotonin from tryptophan.
process

Several classes of antidepressants, such as the SSRIs and the SNRIs among others, interfere with the normal reabsorption of serotonin after it is done with the transmission of the signal, therefore augmenting the neurotransmitter levels in the synapses.

Sertraline

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Desmethylsertraline, the major metabolite of sertaline.
Skeletal formulae of thiothixene, lometraline and tametraline, from which sertraline was derived. Commonalities to the structure of sertraline are highlighted in green.

Sertraline, sold under the brand name Zoloft among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.

Anxiety by Edvard Munch (1894)

Generalized anxiety disorder

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Mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities.

Mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities.

Anxiety by Edvard Munch (1894)
Facial expression of someone with Chronic anxiety
Amygdala (in red) brain structures linked to anxiety disorders
Facial expression of someone with Chronic anxiety

CBT and selective serotonin reuptake inhibitors (SSRIs) are first line psychological and pharmacological treatments; other options include selective norepinephrine reuptake inhibitors (SNRIs).

Sorrowing Old Man (At Eternity's Gate)
by Vincent van Gogh (1890)

Major depressive disorder

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Mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities.

Mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities.

Sorrowing Old Man (At Eternity's Gate)
by Vincent van Gogh (1890)
An 1892 lithograph of a woman diagnosed with melancholia
A cup analogy demonstrating the diathesis–stress model that under the same amount of stressors, person 2 is more vulnerable than person 1, because of their predisposition.
Caricature of a man with depression
Physical exercise is one recommended way to manage mild depression.
Sertraline (Zoloft) is used primarily to treat major depression in adults.
Diagnoses of depression go back at least as far as Hippocrates.
The 16th American president, Abraham Lincoln, had "melancholy", a condition that now may be referred to as clinical depression.

Further countering the monoamine hypothesis is the fact that rats with lesions of the dorsal raphe are not more depressive than controls, the finding of increased jugular 5-HIAA in people who are depressed that normalized with selective serotonin reuptake inhibitor (SSRI) treatment, and the preference for carbohydrates in people who are depressed.

Frequent and excessive hand washing occurs in some people with OCD.

Obsessive–compulsive disorder

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Mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general function.

Mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general function.

Frequent and excessive hand washing occurs in some people with OCD.
People with OCD may face intrusive thoughts, such as thoughts about the devil (shown is a painted interpretation of Hell).
Skin-picking disorder
Some parts of the brain showing abnormal activity in OCD
One exposure and ritual prevention activity would be to check the lock only once and then leave.
A blister pack of clomipramine under the brand name Anafranil
This ribbon represents trichotillomania and other body-focused repetitive behaviors. Concept for the ribbon was started by Jenne Schrader. Colors were voted on by the Trichotillomania Facebook community, and made official by the Trichotillomania Learning Center in August 2013.
Age-standardized disability-adjusted life year estimated rates for obsessive-compulsive disorder per 100,000 inhabitants in 2004.
no data
<45
45–52.5
52.5–60
60–67.5
67.5–75
75–82.5
82.5–90
90–97.5
97.5–105
105–112.5
112.5–120
>120

Selective serotonin reuptake inhibitors (SSRIs) are a common antidepressant used to treat OCD.

Duloxetine, an example of an SNRI.

Serotonin–norepinephrine reuptake inhibitor

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Serotonin–norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant drugs used to treat major depressive disorder (MDD), anxiety disorders, obsessive–compulsive disorder (OCD), social phobia, attention-deficit hyperactivity disorder (ADHD), chronic neuropathic pain, fibromyalgia syndrome (FMS), and menopausal symptoms.

Serotonin–norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant drugs used to treat major depressive disorder (MDD), anxiety disorders, obsessive–compulsive disorder (OCD), social phobia, attention-deficit hyperactivity disorder (ADHD), chronic neuropathic pain, fibromyalgia syndrome (FMS), and menopausal symptoms.

Duloxetine, an example of an SNRI.
Timeline of approved SNRIs.
Timeline of development of antidepressant agents.
Inhibiting the reuptake transport protein results in increased concentrations of serotonin and norepinephrine in the synaptic clefts, leading to improvement of depression symptoms.
Aryloxypropanamine scaffold and agents containing it.
Cycloalkanol ethylamine scaffold and agents containing it.
Structure of milnacipran.

SNRIs can be contrasted with the more widely used selective serotonin reuptake inhibitors (SSRIs), which act upon serotonin only.

Social anxiety disorder

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Anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects of daily life.

Anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects of daily life.

Prescribed medications include several classes of antidepressants: selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs).

Service members use art to relieve PTSD symptoms.

Post-traumatic stress disorder

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Mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life.

Mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life.

Service members use art to relieve PTSD symptoms.
No quieren (They do not want to) by Francisco Goya (1746–1828) depicts an elderly woman wielding a knife in defense of a girl being assaulted by a soldier.
Regions of the brain associated with stress and post-traumatic stress disorder
The diagram depicts how emotions, thoughts, and behaviors all influence each other. The triangle in the middle represents CBT's tenet that all humans' core beliefs can be summed up in three categories: self, others, future.
Vietnam Veterans Memorial, Washington, D.C.
Statue, Three Servicemen, Vietnam Veterans Memorial
Disability-adjusted life year rates for post-traumatic stress disorder per 100,000 inhabitants in 2004 
no data
< 43.5
43.5–45
45–46.5
46.5–48
48–49.5
49.5–51
51–52.5
52.5–54
54–55.5
55.5–57
57–58.5
> 58.5

Antidepressants of the SSRI or SNRI type are the first-line medications used for PTSD and are moderately beneficial for about half of people.