Selective Serotonin Reuptake Inhibitors (SSRIs)

What are selective serotonin reuptake inhibitors?

Citalopram (Celexa), escitalopram (Cipralex), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft) are a group of medicines called SSRIs. These medicines work by increasing levels of a chemical in the brain called serotonin.

SSRIs are available as a tablet or capsule, and fluoxetine? also comes as a liquid.

SSRIs are used in the treatment of a number of conditions including:

• depression
• anxiety disorders
• obsessive compulsive disorder
• panic disorder
• eating disorders
• social phobia
• post-traumatic stress disorder

Before giving selective serotonin reuptake inhibitors to your child

Tell your child's doctor if your child is:

• allergic to SSRIs or other medicines
• taking thioridazine or medicines in the monoamine oxidase inhibitor (MAO-I) drug class

Talk with your child's doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with these medicines if your child has:

• thoughts of suicide
• bipolar disorder
• liver or kidney disease, because the dose of the SSRI may need to be adjusted
• history of seizures
• heart problems
• diabetes mellitus, because the blood glucose levels may be affected

How to give your child selective serotonin reuptake inhibitors

• Regularly, exactly as your doctor or pharmacist tells you.
• With or without food. Give with food if it causes an upset stomach.
• If your child is taking a liquid medicine, measure the dose carefully with the special spoon or oral syringe that the pharmacist gave you. If your child has a feeding tube, flush the tube before and after the liquid is given.
• Tablets or capsules should be swallowed whole, if possible. Ask your pharmacist about what to do if your child cannot swallow whole tablets or capsules.

If your child misses a dose of selective serotonin reuptake inhibitors

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

How long selective serotonin reuptake inhibitors takes to work

• Your child may start to feel better a few weeks after starting this medicine.
• It may take six weeks to see the full effect of SSRIs.

Possible side effects of selective serotonin reuptake inhibitors?

Your child may have some of these side effects while they take an SSRI. Check with your child's doctor if your child continues to have any of these side effects, if they do not go away, or they bother your child:

• Unusual tiredness, sleepiness, weakness, or difficulty thinking clearly. Have your child avoid tasks that require alertness until you see how this medicine affects them.
• Feeling nervous, excitable, irritable, or restlessness.
• Headache.
• Dizziness.
• Nausea, vomiting (throwing up), or diarrhea (loose, watery stools). Taking the medicine with food or eating small frequent meals may help.
• Dry mouth. Sucking on a hard candy or ice chips may help.
• Difficulty sleeping. Giving this medicine in the morning may help.

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to Emergency if your child has any of these side effects:

• high fever, excessive sweating, confusion, shivering, or shaking
• seizures
• unusual behaviour, such as increased agitation, hostility, or thoughts of self-harm or harm to others; if this happens, call your child's doctor immediately, but do not stop the SSRI on your own
• swelling of the face, tongue or lips
• sudden trouble in swallowing or breathing
• shortness of breath
• rash or itchy skin

Safety measures you should take when your child is using selective serotonin reuptake inhibitors

• This medicine may cause your child to be less alert. Watch your child's activities closely until you see how the SSRI affects them. You may also have your child avoid tasks that require alertness, such as riding a bicycle, rollerblading, or contact sports?
• Your child can get sunburned more easily. Avoid lots of sun, sunlamps, and tanning beds. Use sunscreen; dress your child in protective clothing and encourage them to wear sunglasses.
• Do not stop the SSRI suddenly until you have talked to your child's doctor first. The doctor may want to slowly decrease the dose of the SSRI before stopping to prevent withdrawal symptoms such as nausea, restlessness, trouble sleeping, sweating, dizziness, and pins and needles feeling in the hands or feet.
• Keep your appointments with the doctor to have your child checked regularly.
• It is important that you tell your doctor and pharmacist if your child takes any other medicines, such as prescription, over the counter, or herbal. These may include: lithium, St. John's Wort, linezolid, tramadol, certain heart medicines, diazepam, tryptophan, antidepressants, such as trazodone, SSRIs, and MAO-Is, migraine medicines, such as sumatriptan, or blood thinners, such as warfarin.

Other important information you should know about selective serotonin reuptake inhibitors

• Keep a list of all medicines your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others. Do not give anyone else's medicine to your child.
• Make sure you always have enough of your child's medicine to last through weekends, holidays, and vacations. Call your pharmacy at least two days before your child runs out of medicine to order refills.
• Keep your child's medicine at room temperature in a cool, dry place away from sunlight. Do not store it in the bathroom or kitchen.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep selective serotonin reuptake inhibitors (ssris) out of your child's sight and reach and locked up in a safe place. If your child takes too much selective serotonin reuptake inhibitors (ssris), call the Ontario Poison Centre at one of these numbers. These calls are free.

• Call 416-813-5900 if you live in Toronto.
• Call 1-800-268-9017 if you live somewhere else in Ontario.
• If you live outside of Ontario, call your local Poison Information Centre.