Selective serotonin reuptake inhibitors
ATC code: N06AB03 (Fluoxetine)
Selectively blocks serotonin reuptake at the presynaptic membrane. Its distinguishing feature is a long half-life: 1-4 days for fluoxetine itself and 7-15 days for the active metabolite norfluoxetine. A missed dose therefore barely affects plasma levels, and withdrawal syndrome on discontinuation is less common than with other SSRIs.
First line
The only SSRI with approval for bulimia nervosa. Recommended dose is 60 mg daily, higher than the standard antidepressant dose. In RCTs, fluoxetine reduced binge-purge episode frequency by 50-67% versus placebo. The effect is independent of comorbid depression.
First line
First-line treatment for major depressive disorder in adults. Efficacy confirmed in numerous RCTs and meta-analyses. Starting dose is 20 mg daily; therapeutic effect develops over 2-4 weeks. The long half-life allows once-daily dosing. Side-effect profile is comparable to sertraline.
First line
First-line OCD treatment. Doses above the antidepressant range are usually needed – 40-80 mg daily. Response develops more slowly than in depression: efficacy should be assessed no earlier than 8-12 weeks at an adequate dose.
1 pair found. Sorted from critical to minor.
Mechanism
Аддитивное серотонинергическое действие. Риск серотонинового синдрома: гиперрефлексия, миоклонус, гипертермия.
Management
Избегать. Если необходимо – минимальные дозы, мониторинг температуры и неврологического статуса.
Boxed warning
Antidepressants increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults under 25. Suicidality monitoring is mandatory during the first weeks of treatment and after dose changes.
FDA category C. Third-trimester use is associated with neonatal adaptation syndrome – respiratory distress, irritability, tremor. The decision to continue during pregnancy balances the risk of untreated maternal depression.
Passes into breast milk. Fluoxetine and norfluoxetine are detectable in infant serum. Per LactMed, SSRIs with shorter half-lives (sertraline, paroxetine) are preferred during breastfeeding.
fluoxetine is evaluated for the following indications with varying evidence strength: Obsessive-compulsive disorder (evidence tier A), Bulimia nervosa (evidence tier A), Major depressive disorder (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of fluoxetine (≥ 1 in 100): Nausea, diarrhea, Headache, Insomnia, anxiety, Sexual dysfunction – decreased libido, anorgasmia, Decreased appetite, Tremor. See the Safety section for uncommon and serious reactions.
FDA category C. FDA category C. Third-trimester use is associated with neonatal adaptation syndrome – respiratory distress, irritability, tremor. The decision to continue during pregnancy balances the risk of untreated maternal depression.
Passes into breast milk. Fluoxetine and norfluoxetine are detectable in infant serum. Per LactMed, SSRIs with shorter half-lives (sertraline, paroxetine) are preferred during breastfeeding.
fluoxetine is contraindicated in: Concurrent MAOI use or within 14 days of MAOI discontinuation; Concurrent use of thioridazine or pimozide; Hypersensitivity to fluoxetine. Full list in the Safety section.
Antidepressants increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults under 25. Suicidality monitoring is mandatory during the first weeks of treatment and after dose changes.