Sexual dysfunction is often a side effect with SSRIs.<unk>  theoretically causes side effects by increasing the concentration of serotonin in other parts of the body (e.g., the intestines). Other side effects, such as increased apathy and emotional flattening, may be caused by the decrease in dopamine release associated with increased serotonin.<unk>  is also a mild antihistamine, which may be responsible for some of its sedating properties. Other common side effects of<unk>  include drowsiness, insomnia, nausea, weight changes (usually weight gain), increase in appetite, vivid dreaming, frequent urination, dry mouth, increased sweating, trembling, diarrhea, excessive yawning, severe tinnitus, and fatigue. Less common side effects include bruxism, vomiting, cardiac arrhythmia, blood pressure changes, dilated pupils, anxiety, mood swings, headache, hyperactivity and dizziness. Rare side effects include convulsions, hallucinations, severe allergic reactions and photosensitivity. If sedation occurs, the dose may be taken at bedtime rather than in the morning. Some data suggests<unk>  may cause nightmares.<unk>  is associated with a higher risk of arrhythmia than other SSRIs. Withdrawal symptoms can occur when this medicine is suddenly stopped, such as paraesthesiae, sleeping problems (difficulty sleeping and intense dreams), feeling dizzy, agitated or anxious, nausea, vomiting, tremors, confusion, sweating, headache, diarrhea, palpitations, changes in emotions, irritability, and eye or eyesight problems. Treatment with<unk>  should be reduced gradually when treatment is finished.<unk>  and other SSRIs can induce a mixed state, especially in those with undiagnosed bipolar disorder. According to an article published in 2020, one of the other rare side effects of<unk>  could be triggering visual snow syndrome; which does not resolve after the discontinuation of the medicine. Sexual dysfunction Some people experience persistent sexual side effects after they stop taking SSRIs. This is known as Post-SSRI Sexual Dysfunction (PSSD). Common symptoms in these cases include genital anesthesia, erectile dysfunction, anhedonia, decreased libido, premature ejaculation, vaginal lubrication issues, and nipple insensitivity in women. The prevalence of PSSD is unknown, and there is no established treatment. Abnormal heart rhythm In August 2011, the FDA announced,<unk>  causes dose-dependent QT interval prolongation.<unk>  should no longer be prescribed at doses greater than 40 mg per day". A further clarification issued in March 2012, restricted the maximum dose to 20 mg for subgroups of patients, including those older than 60 years and those taking an inhibitor of cytochrome P450 2C19.7. Endocrine effects As with other SSRIs,<unk>  can cause an increase in serum prolactin level.<unk>  has no significant effect on insulin sensitivity in women of reproductive age and no changes in glycaemic control were seen in another trial. Exposure in pregnancy Antidepressant exposure (including<unk>  during pregnancy is associated with shorter duration of gestation (by three days), increased risk of preterm delivery (by 55%), lower birth weight (by 75 g), and lower Apgar scores (by <0.4 points). Antidepressant exposure is not associated with an increased risk of spontaneous abortion. It is uncertain whether there is an increased prevalence of septal heart defects among children whose mothers were prescribed an SSRI in early pregnancy. Interactions<unk>  should not be taken with St John's wort, tryptophan or 5-HTP as the resulting drug interaction could lead to serotonin syndrome. With St John's wort, this may be caused by compounds in the plant extract reducing the efficacy of the hepatic cytochrome P450 enzymes that process<unk> . It has also been suggested that such compounds, including hypericin, hyperforin and flavonoids, could have SSRI-mimetic effects on the nervous system, although this is still subject to debate. One study found that Hypericum extracts had similar effects in treating moderate depression as<unk> , with fewer side effects. Tryptophan and 5-HTP are precursors to serotonin. When taken with an SSRI, such as<unk> , this can lead to levels of serotonin that can be lethal. This may also be the case when SSRIs are taken with SRAs (serotonin releasing agents) such as in the case of MDMA. It is possible that SSRIs could reduce the effects associated due to an SRA, since SSRIs stop the reuptake of Serotonin by blocking SERT. This would allow less serotonin in and out of the transporters, thus decreasing the likelihood of neurotoxic effects. However, these concerns are still disputed as the exact pharmacodynamic effects of<unk>  and MDMA have yet to be fully identified. SSRIs, including<unk> , can increase the risk of bleeding, especially when coupled with aspirin, NSAIDs, warfarin, or other anticoagulants.<unk>  is contraindicated in individuals taking MAOIs, owing to a potential for serotonin syndrome. Taking<unk>  with omeprazole may cause higher blood levels of<unk> . This is a potentially dangerous interaction, so dosage adjustments may be needed or alternatives may be prescribed. SSRI discontinuation syndrome has been reported when treatment is stopped. It includes sensory, gastrointestinal symptoms, dizziness, lethargy, and sleep disturbances, as well as psychological symptoms such as anxiety/agitation, irritability, and poor concentration. Electric shock-like sensations are typical for SSRI discontinuation. Tapering off<unk>  therapy, as opposed to abrupt discontinuation, is recommended in order to diminish the occurrence and severity of discontinuation symptoms. Some doctors choose to switch a patient to Prozac (fluoxetine) when discontinuing<unk>  as fluoxetine has a much longer half-life (i.e. stays in the body longer compared to<unk> . This may avoid many of the severe withdrawal symptoms associated with<unk>  discontinuation. This can be done either by administering a single 20 mg dose of fluoxetine or by beginning on a low dosage of fluoxetine and slowly tapering down. Either of these prescriptions may be written in liquid form to allow a very slow and gradual tapering down in dosage. Alternatively, a patient wishing to stop taking<unk>  may visit a compounding pharmacy where their prescription may be re-arranged into progressively smaller dosages. Overdose Overdosage may result in vomiting, sedation, disturbances in heart rhythm, dizziness, sweating, nausea, tremor, and rarely amnesia, confusion, coma, or convulsions. Overdose deaths have occurred, sometimes involving other drugs, but also with<unk>  as the sole agent.<unk>  and N-desmethylcitalopram may be quantified in blood or plasma to confirm a diagnosis of poisoning in hospitalized patients or to assist in a medicolegal death investigation. Blood or plasma<unk>  concentrations are usually in a range of 50-400 μg/l in persons receiving the drug therapeutically, 1000–3000 μg/l in patients who survive acute overdosage and 3–30 mg/l in those who do not survive. It is the most dangerous of SSRIs in overdose. Suicidality In the United States,<unk>  carries a boxed warning stating it may increase suicidal thinking and behavior in those under age 24.
Citalopram
Escitalopram
Atomoxetine
Sertraline
Dapoxetine
Duloxetine
Fluoxetine
Desipramine