SSRIs and serotonin levels

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SSRIs are approved by the Food and Drug Administration (FDA) to treat depression and are the most commonly prescribed antidepressants. Common examples of SSRIs are fluoxetine (Prozac), citalopram (Celexa) and sertraline (Zoloft). The less commonly used MAOI (monoamine oxidase inhibitors) such isocarboxazid (Marplan) prevent serotonin breakdown.
Probably the most famous medical use of serotonin alteration is in the role of anti-depressants with selective serotonin (SSRIs) and norepinephrine (SNRIs) reuptake inhibitors.
Normally once a neurotransmitter has transmitted its neural impulse it is generally reabsorbed. SSRIs inhibit the re-absorption of serotonin (and norepinephrine) neurotransmitters and thus increase the levels in the synapse of the nerves in the brain, and thus elevate mood.
They are also effective in the treatment of anxiety, panic disorders and obsessive-compulsive disorders.
Recreational drugs such as MDMA and cocaine also inhibit the re-absorption of serotonin in order to create their highs.
Minor side effects of SSRIs and SNRIs that typically decrease after the first or second week of use include:4

SSRIs and suicide

Zoloft causes some younger users of the drug to report being suicidal. The FDA requires all antidepressants to carry a black-box warning about the danger of suicide during the initial stages of treatment, especially in children.

Antiemetics - preventing and treating nausea

The antiserotonergic drugs that act on the 5-HT3 receptors e.g. ondansetron (Zofran) are extremely important drugs used in nausea from chemical toxins such as chemotherapy drugs and drugs used in general anesthesia.
They act centrally on the area in the brain involved with nausea.

Migraine - the treatment of migraine headaches

Migraine is the most frequent neurological disorder in the adult population worldwide, affecting up to 12% of the general population.
Serotonergic vasoconstrictive antimigraine drugs - the Triptans - e.g. almotriptan (Axert), Rizatriptan (Maxalt), sumatriptan (Alsuma) and zolmitriptan (Zomig) are effective in reducing migraine symptoms and are well tolerated.5

Appetite suppressants - to help reduce obesity

Serotonergic appetite suppressants such as fenfluramine (Pondimin) and chlorphentermine - are no longer licensed for this use.

Parkinson's disease

Several functions have been attributed to the serotonergic system including cognition, emotion and motor behavior; thus altered serotonergic neurotransmission may contribute to the motor and non-motor features commonly associated with Parkinson's disease.6
Serotonergic anti-Parkinsonian drugs (pergolide, cabergoline) have been used in the treatment of Parkinson's disease and are no longer licensed, but research continues in this area.

Premenstrual syndrome

The cause of premenstrual syndrome (PMS) is unknown, but an over sensitivity to one of the female hormones, progesterone, seems to reduce the level of serotonin in the brain.
Some SSRIs are licensed to help women through difficult physical and emotional symptoms around the changes in their monthly menstrual cycle, even if the woman is not clinically depressed. The drug need not be taken throughout the whole cycle, and women may find relief within a few days of starting to take it.7

Obesity

New research is examining the role of serotonin inhibition in treating obesity.8

Irritable bowel syndrome

Work continues to evaluate the evidence of the value and safety of serotonin receptor modulation in irritable bowel syndrome. Alosetron and cilansetron are currently in use in the US.
The FDA have issued a warning about taking SSRIs or SNRIs (used for depression, anxiety, pain, and many other conditions) with triptans. Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

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