SSRI Initiation

How long before increasing dose?

 • 4 wks. Initial response in 2-4 wks, max response at 4-6 weeks.

Side effects? (Initial and subsequent improvement)

 • Initial: transient Gl upset (nausea, vomiting, diarrhea). Subsequent: decreased libido, sexual side effects.

PHQ-9 improvement expected?

 • Depression: 50% reduction in PHQ-9

 • Anxiety: 25-50% reduction in GAD-7

Longest half life?

 • Fluoxetine: for cross-titration need to wait 3-4 days before starting new med. Can be useful in patients with intermittent adherence (less discontinuation sx).

Least preferred?

 • Paroxetine: Weight gain. Shortest half life. Sedating.

Most QTc-prolonging?

 • Citalopram, Escitalopram



- BWH Medicine Chiefs @BrighamChiefs



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