Selective Serotonin Re-uptake Inhibitors Syndrome

A growing number of studies have evaluated members of the SSRI class of antidepressant. Two open clinical trials of paroxetine have suggested efficacy both in symptom distress and disabilities. A large-scale, 12-week, double-blind, placebo-controlled trial involving 187 patients has demonstrated the efficacy of paroxetine in reducing work and social life disabilities as well as fear and anticipatory anxiety.

Paroxetine has also been found to be effective in placebo-controlled studies in treating a number of anxiety disorders such as panic disorder and obsessive compulsive disorder that often coexist with SP; for this reason this drug can be considered one of the main options for first-line treatment of choice in SP patients with comorbidity. The appropriate dosage has been defined for paroxetine: an initial dose of 20 mg/day for two to four weeks, then increased as necessary to obtain a response. An adequate trial of treatment is generally six to eight weeks, but treatment may have to be continued for several months to consolidate response and achieve a full remission.

For the other members of the SSRI drug class, only limited clinical data are available. Fluvoxamine was the first SSRI shown to be superior to placebo in the treatment of SP, in a parallel, double-blind, 12-week study involving 30 patients. In this study, approximately three-quarters of the sample had the generalised subtype of SP . Further studies will have to investigate whether specific subtypes do better or worse in specific treatments. Sertraline has also been reported to be potentially useful as treatment for SP, but further controlled data are needed to confirm these early encouraging results.

An open study with fluoxetine in 16 patients reported that 10 of the subjects were considered to be responders at the end of treatment while a case series regarding patients with social phobia treated with citalopram has suggested the efficacy of this drug in this disorder.

Overall, it seems reasonable to affirm that all the SSRIs, though with varying levels of evidence due to the different depth in which they have been studied, are effective in SP. Efficacy and tolerability of this class of drugs permit application as a true first-line drug therapy, especially considering the long-lasting treatment of SP. Limitations of SSRIs are their cost, and some side-effects that, though fewer than with antidepressants, should be taken into account for a chronic treatment, e.g. sexual problems.

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