What is the best Selective Serotonin Reuptake Inhibitor (SSRI) for treating mood swings?

Sertraline is the Best SSRI for Mood Swings

Based on the most recent and highest quality evidence, sertraline is the recommended SSRI for treating mood swings due to its balanced efficacy and favorable side effect profile compared to other SSRIs.

Comparing SSRIs for Mood Swings

Efficacy Considerations

• All second-generation antidepressants (including SSRIs) have similar efficacy for treating depressive disorders according to the American College of Physicians guidelines 1
• However, important differences exist in side effect profiles and drug interactions that make sertraline particularly suitable for mood swings

Advantages of Sertraline

• Sertraline has demonstrated effectiveness for both mood and anxiety disorders, making it ideal for mood swings which often involve both components 2, 3
• It has a favorable tolerability profile compared to other SSRIs, particularly regarding:
  • Lower rates of sexual dysfunction than paroxetine 1
  • Lower potential for drug interactions compared to paroxetine, fluoxetine, and fluvoxamine 4
  • Minimal anticholinergic effects compared to tricyclic antidepressants 4

Dosing and Administration

• Starting dose: 25-50 mg daily 5
• Target dose: Up to 200 mg daily 5
• FDA approved for major depressive disorder, panic disorder, and OCD 6
• Evaluate initial response after 2-3 weeks and assess full effect at 4-6 weeks 5

Side Effect Considerations

Common Side Effects

• Most common side effects include:
  • Gastrointestinal: nausea, diarrhea
  • Neurological: headache, insomnia, dizziness
  • Sexual dysfunction (though less than with paroxetine) 1, 4

Important Monitoring Considerations

• Monitor for suicidality, especially in the first months of treatment and following dosage adjustments 5
• Watch for behavioral activation/agitation which may occur early in treatment or with dose increases 5
• Avoid abrupt discontinuation to prevent withdrawal symptoms 5

Alternatives to Consider

When Sertraline May Not Be Appropriate

• If patient has had previous poor response or intolerance to sertraline
• Consider escitalopram or citalopram for patients with concerns about drug interactions 7
• For patients with significant anxiety component alongside mood swings, venlafaxine (an SNRI) may be considered as an alternative 8

Special Populations

• Elderly patients: Sertraline is particularly suitable due to minimal cardiovascular effects and low potential for drug interactions 4
• Patients with comorbid medical conditions: Sertraline efficacy is not affected by vascular morbidity, diabetes mellitus, or arthritis 4

Treatment Duration and Discontinuation

• Continue effective treatment for approximately 1 year following symptom remission 5
• When discontinuing, reduce dose gradually (by no more than 25% every 1-2 weeks) to minimize withdrawal symptoms 5

Sertraline's balanced efficacy for both mood and anxiety components, favorable side effect profile, and lower potential for drug interactions make it the optimal SSRI choice for treating mood swings in most patients.