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Bipolar disorder - Management
What are the drug interactions of SSRIs?
- St John's wort should be stopped in people taking a selective serotonin reuptake inhibitor (SSRI) because of the risk of increased serotonergic effects and the increased incidence of adverse effects [CSM, 2000a]. Advise people that they should not take St John's wort while they are taking an SSRI.
- Co-administration of SSRIs with other serotonergic drugs (e.g. tramadol, triptans) or with dopaminergic drugs (e.g. selegiline) may also increase the risk of serotonin syndrome, and close monitoring is advised [Baxter, 2008].
- SSRIs have a low proconvulsant effect, the seizure risk being dose-related, and are a good choice of antidepressant for people with epilepsy. However, fluoxetine and paroxetine (and to a lesser extent sertraline) can increase serum levels of phenytoin and carbamazepine through the inhibition of hepatic enzymes. Serum phenytoin levels should be monitored and the dosage adjusted accordingly when starting, stopping, or changing the dose of these SSRIs. Citalopram is a weak enzyme inhibitor and has a low potential for clinically-significant interactions [Taylor et al, 2007].
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