SSRIs
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From: Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia
The selective serotonin reuptake inhibitors (commonly known as SSRI) are currently by far the most commonly prescribed antidepressants. They are frequently used in the treatment of CFS/ME, even though the benefits appear questionable. There is more evidence to support their use in fibromyalgia, but even then other classes of antidepressants (especially the serotonin and norepinephrine reuptake inhibitors) tend to be more effective. Nonetheless, some patients experience remarkable improvement on the SSRIs.
Compared to the tricyclics SSRIs have better tolerability, but despite this CFS/ME patients often tolerate them poorly. According to Canadian psychiatrist Eleanor Stein patients with CFS/ME generally tend to react badly to fluoxetine and paroxetine.34 Instead she recommends low doses of citalopram or venlafaxine for depression and sertraline or citalopram for anxiety. In general the starting doses should always be tiny.
SSRIs may sometimes relieve fatigue and tiredness, but often the effects are the opposite. The same goes for orthostatic hypotension and even interstitial cystitis—the condition can improve or get worse on the SSRIs. The effects may not only depend on the individual but also the particular drug. An exacerbation in fatigue may go away with time, though that may not be of much comfort to a patient who is even more disabled than usual.
Interestingly SSRI antidepressants have some immunomodulatory, particularly immunostimulatory properties.35 They also appear to have specific antibacterial36 and antifungal37 activity, though the former was mostly against Gram–positive bacteria, which have rarely been implicated in chronic infections. The clinical relevance of these findings is uncertain, but the SSRIs are clearly more than just mood enhancers.
The most common side effect is nausea. The likelihood depends on the drug, but may be as much as 40%. Sexual side effects such as erectile dysfunction and difficulty reaching orgasm are common. Additionally the SSRIs can cause e.g. insomnia, nervousness, tremor, loss of appetite, dry mouth, weight gain, headache, dizziness, sweating, stomach upset and rarely even epileptic seizures.
Abrupt discontinuation of an SSRI can cause marked “withdrawal” symptoms, especially with fluvoxamine and paroxetine which have short half–lives. The SSRIs should never be combined with MAO inhibitors. Combinations with tricyclics, dextromethorphan, tramadol and the triptans are usually not recommended.
See also: methadone, buprenorphine, dextromethorphan, diphenhydramine, chlorphenamine</p>