SSRI's and Panic Disorder
Selective Serotonin Reuptake Inhibitor
There are seven SSRI's, Luvox (fluvoxamine), Paxil and Paxil CR (paroxetine), Prozac (fluoxetine), Celexa (citralopam), Lexapro (escitalopram), Effexor and Effexor XR (venlafaxine) and Zoloft (sertraline), available in the US at this time. Luvox is generally only used for Obsessive Compulsive Disorder though, so it's been left out of this web page, for that reason.
SSRI's, like all anti-depressants, are supposed to elevate your mood by making serotonin more available in your brain, which means that messages in the form of nerve impulses are going to be more readily transferred and dealt with. You will generally see some effect of taking these meds after several weeks, usually 2 to 4. It can take several months of taking this type of medicine before you get the full effect. However, the side effects can be noted within a short time, often within the first few days. For this reason, many doctors prescribed a benzodiazapine (benzo's include xanax and others) type medicine to take until the SSRI kicks in.
General Information
· Prozac - 1988 - Manufactured by Eli Lilly & Co.
· Zoloft - 1991 - Manufactured by Pfizer, approved by FDA for panic disorder, with or without agoraphobia in July of 1997.
· Paxil - 1992 - Manufactured by SmithKline Beecham, approved in may of 1996 for treatment of panic disorder and OCD. Available in 10, 20, 30 & 40mg tablets.
· Celexa - 1998 - TManufactured by Forest Labs
· Lexapro - 2002 - Manufactured by Forest Labs as being nearly the same as Celexa.
What SSRI's Treat
· Anorexia Nervosa
· Anxiety
· Bulimia
· Depression
· Obsessive-Compulsive Disorder
· Panic
· Premenstrual Tension
· Substance Abuse Disorders


Common Side Effects of SSRI's
· Headache
· Excessive Sweating
· Nausea
· Upset Stomach
· Diarrhea
· Sleep disturbances
· Drowsiness
· Tremor
· Weight gain
· Decreased libido
SSRI's are extremely expensive and there are no generic forms available for several of them. (Celexa, Lexapro, Effexor, Effexor XR and Paxil CR as of December 2004.) They work effectively in about 70% of people who take them for panic disorder as instructed by their physician. Because of their expense, and to ensure maximum benefit, doses should be kept to the lowest working level for you. More is not necessarily better - do not alter your dose of any medication without consulting your doctor first. Start up SSRI's at the lowest possible dose - even if that means splitting a 5mg Lexapro tablet into halves with a pill cutter (talk to your doctor about this - it's much easier on a person with panic disorder to gradually introduce these medicines into their system over a longer period of time, rather than full dosage right away.)
Standard Dosing For SSRI's
· Celexa - 20mg/day for one week, then an increase to 40mg/day, maximum 80mg/day
· Paxil - 10mg/day or 20mg/day to start, max at 50mg/day.
· Prozac - 20mg/day to start, max at 80mg/day
· Zoloft - 25mg/day or 50mg/day to start, max at 200mg
Fact: You are NOT supposed to drink alcohol while taking an SSRI.
Fact: Paxil and Zoloft stay in your system a shorter amount of time than Luvox and Prozac - if you are going to switch to a new medication, it takes longer for what is called "the washout period", which means DELAYS in switching meds. Switching to a MAOI type medicine will be held up for five weeks if you were taking Prozac, 1-2 weeks if you were taking Luvox, Paxil or Zoloft.
Fact: Studies show that pregnant woman can take SSRI's. Talk to your doctor about this.
FYI - Many woman see an increase in sexual functioning, however men seem to see a decrease while taking an SSRI. Sexual dysfunction is one of the effects of taking this type of medicine, and is often seen after several weeks (6) of treatment.


FYI - Serzone, Wellbutrin, Desyrel, as well as the groups of antidepressants known as Tricyclic Antidepressant and MAO Inhibitors all work on serotonin also, but they differ in their effect, which other chemicals they affect, and their actions. This page is dedicated to selective serotonin reuptake inhibitors.