Alternatives to SSRIs

• Dosage


  Dosage can be increased if it's not seen as effective after three to four months - e.g. up to 60mg a day for fluoxetine - or can be combined with other drugs.
• Tricyclics


  Tricyclics are sometimes used, such as clomipramine - this acts on various systems including the serotonin system where it has the same effect as SSRIs, however it has more severe side-effects so it is kept in reserve for people who do not respond to SSRIs.
• Serotonin-noradrenaline reuptake inhibitors (SNRIs)

  SNRIs have more recently been used to treat OCD. These are a different class of antidepressant drugs and are a second line of defence for people who don't respond to SSRIs. SNRIs increase levels of serotonin as well as noradrenaline - another neurotransmitter.
• Benzodiazepines (BZs)


  • Xanax, Vallium etc.
  • Enhances activity of neurotransmitter GABA
  • It has a quietening effect on nerves in the brain
  • Increases chloride ions, making it harder for the neurons to be stimulated by other neurotransmitters
• Antibiotics

  • E.g. D-Cycloserine
  • Reduces anxiety
  • Particularly effective when paired with psychotherapy
  • It also appears to enhance the transmission of GABA (Kushner et al.)