Selective serotonin reuptake inhibitors labeling

Weiss EL, Potenza MN, McDougle CJ, et al. Olanzapine addition in obsessive-compulsive disorder refractory to selective serotonin reuptake inhibitors an open-label case series. J Clin Psychiatry 1999 60 524-527. 

Marangell LB, Johnson CR, Kertz B, Zboyan HA, Martinez JM. Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors an open-label, flexible-dose study. J Clin Psychiatry 2002 63(5) 391-5. 

Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have been associated with increasing suicidal ideation in some populations of patients. Recent studies have led the British Department of Health to warn physicians against using paroxetine off label. Fluoxetine was specifically exempted from this recommendation. Long-term studies of patients with depression who were treated with fluoxetine have shown it to be fairly well tolerated. Primary adverse effects include nausea (23%), headache (21%), and insomnia (20%). 

Because serotonin may have a role in regulating sympathetic nervous system activity (25,82,83), selective serotonin-reuptake inhibitors have been proposed as a potential therapy and open-label studies have found that these agents may reduce recurrent NCS (25,84). In a randomized placebo-controlled trial, 82% of patients who were randomly assigned to receive paroxetine were free of syncope for 25 months, compared with 53% of the placebo group (p < 0.001) (85). 

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