Because of its epileptogenic effect, selective serotonin reuptake inhibitors (SSRIs) should be used with caution in patients with epilepsy or a history of such disorders (and should be avoided if the epilepsy is poorly controlled). Treatment should be stopped if seizures develop or when there is an increase in seizure frequency. Care is advised in patients receiving electroconvulsive therapy (ECT) as prolonged seizures have occurred rarely. SSRIs should also be used with caution in patients with cardiac disease or a history of bleeding disorders. Although SSRIs are preferred to tricyclics for the treatment of depression in patients with diabetes, that may alter glycemic control and therefore, caution is also warranted in diabetic subjects. SSRIs should also be used with caution in patients with angle-closure glaucoma.
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