Selective Serotonin Reuptake Inhibitors (SSRIs)

This chapter provides a comprehensive and clinically grounded exploration of selective serotonin reuptake inhibitors (SSRIs) in paediatric practice, with a particular focus on their role in managing anxiety, depression, obsessive–compulsive behaviours and associated emotional dysregulation in neurodivergent children and adolescents. The chapter outlines how SSRIs have evolved since fluoxetine’s introduction, explains why anxiety and depression exist on a clinical continuum, and emphasises especially high anxiety burden in autistic youth. Each of the commonly used SSRIs—fluoxetine, fluvoxamine, sertraline, and escitalopram—is discussed in detail, highlighting practical differences in activation profiles, dosing considerations, tolerability, and suitability for specific symptom clusters. The chapter also integrates real-world clinical insights regarding safety, side-effect monitoring, switching protocols, and strategies to support engagement in therapy. Additional clinical pearls illustrate how SSRIs may reduce stimulant-related irritability, unmask ADHD traits, and support the management of repetitive or self-injurious behaviours in combined presentation neurodivergent children with autism and ADHD.