SSRIs: Side Effects

Although fluoxetine was generally safe and well tolerated (Hagerman et al. 1994), the occasional occurrence of suicidal ideation or the development of hypomania reinforces the need for weekly counseling to monitor a patient's response to the SSRI and to treat emotional problems, such as depression, anxiety, or obsessive-compulsive behavior. Suicidal ideation with fluoxetine has been somewhat sensationalized in the lay press; however, controlled studies have shown suicidal ideation to be less in patients taking fluoxetine (1.2%) compared to tricyclic antidepressants (3.6%) or placebo (2.6%) (Beasley et al. 1991). Fluoxetine and other SSRIs are relatively safe in an overdose in contrast to tricyclics, which can cause fatal arrhythmias. In general SSRIs are relatively nontoxic. They do not cause cardiac or liver problems, and blood levels or EKGs do not need to be monitored. However, fluoxetine and paroxetine are inhibitors of the cytochrome P450 enzyme system, which metabolizes other medications, so that the blood level of other concurrent medications, particularly anticonvulsants, may increase significantly.

SSRIs: Sertraline (Zoloft) and Citalopram (Celexa)

Sertraline interferes very little with the P450 system, and citalopram, which is the most recent addition to the SSRIs, has no effect on the P450 system. Citalopram is the most selective for blocking serotonin reuptake of all of the SSRIs, and it has very little effect on reuptake inhibition of norepinephrine (Thomsen 1997). A rare patient may experience extrapyramidal side effects, including an acute dystonic reaction, particularly when SSRIs are used in combination with other medications (Bouchard et al. 1989; Budman et al. 1995).

SSRIs: Decrease in Libido

In adult patients treated with SSRIs, a decrease in libido is a frequent complaint. The use of a serotonin receptor blocker, such as cyproheptadine (Periactin), which is also an antihistamine with anticholinergic properties, can improve the libido when taken on appropriate occasions.

Another approach to the treatment of the sexual dysfunction is to increase dopamine levels either with stimulants on the day of sex or by using buproprion augmentation. Switching to a different antidepressant, such as Serzone or Rimeron, which is associated with less sexual dysfunction may be helpful. Last, use of Viagra in a dose of 50 to 100 mg approximately one hour before intercourse is perhaps the most effective intervention.

This article is not intended to give medical advice for individual cases.  Any change in medical treatment should be done in consultation with appropriate medical personnel. This article is written for medical professionals.  Some of the terms will be unfamiliar to those who are not trained in medical fields. *This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002.  It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in the book which are not included as part of this website. The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling 1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.

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