SSRIs (sertraline / escitalopram / fluoxetine)
Mental Health · Selective serotonin reuptake inhibitor
Tier B
What this is
Workhorse antidepressant class; ~75% of US antidepressant Rx. Kirsch 2008 meta debate remains unresolved for mild cases; STAR*D and more recent reanalyses support modest effect in moderate-severe. PSSD (post-SSRI sexual dysfunction) is a growing patient-report phenomenon with emerging acknowledgment. Cipriani 2018 network meta-analysis ranks among the most-cited efficacy comparisons.
Mechanism
Block SERT transporter → elevated synaptic serotonin → downstream BDNF, neuroplasticity, HPA axis modulation over weeks; class effect on depression and anxiety
Dose & route
Sertraline 25-200 mg; escitalopram 5-20 mg; fluoxetine 10-80 mg PO daily
Citations
- https://pubmed.ncbi.nlm.nih.gov/29477251/
- https://pubmed.ncbi.nlm.nih.gov/18303940/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC5889145/
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This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.