The main indication for<unk> s is major depressive disorder; however, they are frequently prescribed for anxiety disorders, such as social anxiety disorder, generalized anxiety disorder, panic disorder, obsessive–compulsive disorder (OCD), eating disorders, chronic pain, and, in some cases, for posttraumatic stress disorder (PTSD). They are also frequently used to treat depersonalization disorder, although with varying results. Depression Antidepressants are recommended by the UK National Institute for Health and Care Excellence (NICE) as a first-line treatment of severe depression and for the treatment of mild-to-moderate depression that persists after conservative measures such as cognitive therapy. They recommend against their routine use in those who have chronic health problems and mild depression. There has been controversy regarding the efficacy of<unk> s in treating depression depending on its severity and duration. * Two meta-analyses published in 2008 (Kirsch) and 2010 (Fournier) found that in mild and moderate depression, the effect of<unk> s is small or none compared to placebo, while in very severe depression the effect of<unk> s is between "relatively small" and "substantial". The 2008 meta-analysis combined 35 clinical trials submitted to the Food and Drug Administration (FDA) before licensing of four newer antidepressants (including the<unk> s paroxetine and fluoxetine, the non-SSRI antidepressant nefazodone, and the serotonin and norepinephrine reuptake<unk>  (SNRI) venlafaxine). The authors attributed the relationship between severity and efficacy to a reduction of the placebo effect in severely depressed patients, rather than an increase in the effect of the medication. Some researchers have questioned the statistical basis of this study suggesting that it underestimates the effect size of antidepressants. * A 2012 meta-analysis of fluoxetine and venlafaxine concluded that statistically and clinically significant treatment effects were observed for each drug relative to placebo irrespective of baseline depression severity; some of the authors however disclosed substantial relationships with pharmaceutical industries. * A 2017 systematic review stated that "SSRIs versus placebo seem to have statistically significant effects on depressive symptoms, but the clinical significance of these effects seems questionable and all trials were at high risk of bias. Furthermore,<unk> s versus placebo significantly increase the risk of both serious and non-serious adverse events. Our results show that the harmful effects of<unk> s versus placebo for major depressive disorder seem to outweigh any potentially small beneficial effects". Fredrik Hieronymus et al. criticized the review as inaccurate and misleading, but they also disclosed multiple ties to pharmaceutical industries and receipt of speaker's fees. In 2018, a systematic review and network meta-analysis comparing the efficacy and acceptability of 21 antidepressant drugs showed escitalopram to be one of the most effective. In children, there are concerns around the quality of the evidence on the meaningfulness of benefits seen. If a medication is used, fluoxetine appears to be first line. Social anxiety disorder Some<unk> s are effective for social anxiety disorder, although their effects on symptoms is not always robust and their use is sometimes rejected in favor of psychological therapies. Paroxetine was the first drug to be approved for social anxiety disorder and it is considered effective for this disorder, sertraline and fluvoxamine were later approved for it, too, escitalopram and citalopram are used off label with acceptable efficacy, while fluoxetine is not considered to be effective for this disorder. Post-traumatic stress disorder PTSD is relatively hard to treat and generally treatment is not highly effective;<unk> s are no exception. They are not very effective for this disorder and only two<unk>  are FDA approved for this condition, paroxetine and sertraline. Paroxetine has slightly higher response and remission rates for PTSD than sertraline, but both are not fully effective for many patients. Fluoxetine is used off label, but with mixed results, venlafaxine, an SNRI, is considered somewhat effective, although used off label, too. Fluvoxamine, escitalopram and citalopram are not well tested in this disorder. Paroxetine remains the most suitable drug for PTSD as of now, but with limited benefits. Generalized anxiety disorder<unk> s are recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of generalized anxiety disorder (GAD) that has failed to respond to conservative measures such as education and self-help activities. GAD is a common disorder of which the central feature is excessive worry about a number of different events. Key symptoms include excessive anxiety about multiple events and issues, and difficulty controlling worrisome thoughts that persists for at least 6 months. Antidepressants provide a modest-to-moderate reduction in anxiety in GAD, and are superior to placebo in treating GAD. The efficacy of different antidepressants is similar. Obsessive–compulsive disorder In Canada,<unk> s are a first-line treatment of adult obsessive–compulsive disorder (OCD). In the UK, they are first-line treatment only with moderate to severe functional impairment and as second line treatment for those with mild impairment, though, as of early 2019, this recommendation is being reviewed. In children,<unk> s can be considered a second line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects.<unk> s, especially fluvoxamine, which is the first one to be FDA approved for OCD, are efficacious in its treatment; patients treated with<unk> s are about twice as likely to respond to treatment as those treated with placebo. Efficacy has been demonstrated both in short-term treatment trials of 6 to 24 weeks and in discontinuation trials of 28 to 52 weeks duration. Panic disorder Paroxetine CR was superior to placebo on the primary outcome measure. In a 10-wk randomized controlled, double-blind trial escitalopram was more effective than placebo. Fluvoxamine, another<unk> , has shown positive results. However, evidence for their effectiveness and acceptability is unclear. Eating disorders Antidepressants are recommended as an alternative or additional first step to self-help programs in the treatment of bulimia nervosa.<unk> s (fluoxetine in particular) are preferred over other anti-depressants due to their acceptability, tolerability, and superior reduction of symptoms in short-term trials. Long-term efficacy remains poorly characterized. Similar recommendations apply to binge eating disorder.<unk> s provide short-term reductions in binge eating behavior, but have not been associated with significant weight loss. Clinical trials have generated mostly negative results for the use of<unk> s in the treatment of anorexia nervosa. Treatment guidelines from the National Institute of Health and Clinical Excellence recommend against the use of<unk> s in this disorder. Those from the American Psychiatric Association note that<unk> s confer no advantage regarding weight gain, but that they may be used for the treatment of co-existing depressive, anxiety, or OCD. Stroke recovery<unk> s have been used off-label in the treatment of stroke patients, including those with and without symptoms of depression. A 2019 meta-analysis of randomized, controlled clinical trials found a statistically significant effect of<unk> s on dependence, neurological deficit, depression, and anxiety but the studies had a high risk of bias. No reliable evidence points to their routine use to promote recovery following stroke. Thrombosis risk is reduced because<unk> s limit serotonin availability to platelets, so benefits, such as stroke recovery, of reduced clotting go up, with<unk> s. Premature ejaculation<unk> s are effective for the treatment of premature ejaculation. Taking<unk> s on a chronic, daily basis is more effective than taking them prior to sexual activity. The increased efficacy of treatment when taking<unk> s on a daily basis is consistent with clinical observations that the therapeutic effects of<unk> s generally take several weeks to emerge. Sexual dysfunction ranging from decreased libido to anorgasmia is usually considered to be a significantly distressing side effect which may lead to noncompliance in patients receiving<unk> s. However, for those suffering from premature ejaculation, this very same side effect becomes the desired effect. Other uses<unk> s such as sertraline have been found to be effective in decreasing anger.
Selective serotonin reuptake inhibitor
Atypical antidepressant
Tricyclic antidepressant
Tetracyclic antidepressant
Heterocyclic antidepressant
Glycine reuptake inhibitor
Serotonin–dopamine reuptake inhibitor
Dopamine reuptake inhibitor