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1st line Rx for depression
Citalopram or Fluoxetine are 1st choice
Sertraline is useful post MI
Be careful in children and adolescents - and if necessary use Fluoxetine

''SE''
GI most common
Inc risk of GI bleed - if also taking NSAID, needs PPI
Inc anxiety and agitation in few weeks post starting
Fluoxetine and Paroxetine - more drug interactions

''Citalopram and QT interval'' - warning (MHRA)
(also escitalopram)
asssociated with dose dependant QT interval prolongation
avoid if congenital long QT or known long QT or other drugs that prolong QT
Max dose 40mg (or 20mg if >65yr or hepatic impairment

''Drug Interactions''
NSAID - avoid or give PPI as well
warfarin / heparin - avoid - use Mirtazapine
triptans - avoid

When starting - review at 2/52 (1/52 if <30yr or inc suicide risk) 
If good response - continue for at least 6/12 post remission to reduce relapse risk
when stopping tail dose over 4/52 (not necessary with fluoxetine)

''Discontinuation Sx (esp Paroxetine)''
Inc mood change
restless
difficulty sleeping
unsteadiness
sweating
GI - pain, cramps, d&v
paraesthesia