Selective Serotonin Reuptake Inhibitors (SSRIs): What to Know

SSRIs are a type of antidepressant. Learn about these commonly prescribed drugs, including side effects, how they work, and their pros and cons.

If you’re currently dealing with a mental health condition like depression, you are not alone.

According to the National Alliance on Mental Illness (NAMI), in the United States nearly 1 in 5 adults and 1 in 6 youth (ages 6 to 17 years) experience mental illness each year.

Selective serotonin reuptake inhibitors (SSRIs) are a class of medications most often used to treat depression as well as a few other mental health conditions.

What are SSRIs?

SSRIs are a first-line treatment for depression and a few other mental health conditions because they tend to be effective for the general population and have fewer side effects.

The main way that SSRIs help people manage conditions like depression is by increasing serotonin in the brain. While there’s still not a definitive answer, the consensus is that depleted serotonin plays a key role in depression.

Prescribing SSRIs: What they help treat

SSRIs are often used to treat depression. However, doctors may prescribe them for other conditions, such as:

obsessive-compulsive disorder (OCD)

generalized anxiety disorder

panic disorder

bulimia

bipolar depression

post-traumatic stress disorder (PTSD)

premenstrual dysphoric disorder (PMDD)

anxiety

There are several off-label uses for SSRIs too. “Off-label” means a medication is prescribed to treat an issue that it was not specifically developed for. In the case of SSRIs, off-label uses include:

fibromyalgia

binge eating disorder

body dysmorphic disorder

autism

How SSRIs work

Serotonin is one of many brain chemicals that transmit messages between brain cells. It has been called the “feel-good chemical” because it causes a relaxed state of well-being. Normally, serotonin circulates in the brain and then absorbs into the bloodstream.

Depression is linked with low levels of serotonin (as well as low levels of dopamine, norepinephrine, and other brain chemicals).

SSRIs work by preventing your blood from absorbing some of the serotonin from your brain. This leaves a higher level of serotonin in the brain. Increased serotonin can help relieve depression.

SSRIs don’t cause the body to make more serotonin, however. They simply help the body use what it has more effectively.

While SSRIs are fairly similar in terms of their effectiveness, they do vary slightly in what they’re used to treat, their side effects, their dosage, and other factors.

SSRI drugs

There are a number of SSRIs available today. These include:

citalopram (Celexa)

escitalopram (Lexapro)

fluoxetine (Prozac, Sarafem)

fluvoxamine (Luvox)

paroxetine (Paxil, Paxil CR, Pexeva)

sertraline (Zoloft)

vilazodone (Viibryd)

Possible side effects

Because SSRIs have very little effect on other neurotransmitters in the brain like dopamine and norepinephrine, there are fewer reported side effects than tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), which are other classes of antidepressants.

Still, side effects can still be possible with SSRIs. The most common ones include:

lowered libido and other sexual issues

sleep disturbances

weight changes

anxiety

dizziness

dry mouth (xerostomia)

headache

gastrointestinal issues

It’s also important to note that the Food and Drug Administration (FDA) has warned that antidepressants like SSRIs may increase the risk of suicidality among children and young adults.

However, because depression can also lead to an increase in suicidal thoughts, this side effect should be discussed with your doctor so you can weigh the pros and cons of starting the medication.

SSRI risks

“Selective serotonin reuptake inhibitors are very safe drugs, generally speaking,” says Danny Carlat, MD, associate clinical professor of psychiatry at Tufts University School of Medicine.

“While there are some pretty minor side effects, it would be very hard for people to do any damage to themselves by taking an SSRI,” he says.

That said, certain people should be cautious about using an SSRI. These include children and pregnant people.

For children

Because there’s less research about children and SSRIs than adults and SSRIs, younger people should be monitored for changes in mood and behavior.

For pregnant people

SSRIs may increase the risk of certain fetal developmental issues, especially heart and lung problems.

Doctors and moms-to-be must compare the risks of SSRI treatment to the risks of untreated depression. Depression without treatment can also have a negative impact on a pregnancy. For instance, mothers with depression may not seek the prenatal care they need.

Some pregnant people may opt to switch their SSRI to reduce their risk of side effects while still treating their depression. This is because different SSRIs have different side effects.

For instance, paroxetine (Paxil) has been linked with fetal heart issues in newborns.

If you take paroxetine and become pregnant, your doctor may suggest you switch to fluoxetine (Prozac) or citalopram (Celexa). These SSRIs aren’t linked with such serious side effects.

General risks

Make sure to tell your doctor about all your other underlying conditions. People with other health conditions such as epilepsy, diabetes, and kidney disease may have to be monitored more closely when taking SSRIs.

Certain SSRIs may also react with other medications you’re taking, as well as with certain supplements (such as St. John’s wort).

As with your underlying conditions, make sure to let your doctor know about any over-the-counter medications or supplements you take regularly.

When to consider taking SSRIs

Antidepressants like SSRIs are one method to help ease the symptoms of depression, but they’re typically just part of a treatment plan.

Your doctor may also recommend therapy, and if you chose to go, your therapist may have advice and methods to help you, depending on the severity of your symptoms and your personal history.

Some questions to ask yourself when you’re considering SSRIs include:

Do you feel as though your mental health condition is disrupting your life?

Do you feel less pleasure when it comes to the things you used to enjoy?

Do you consistently have trouble concentrating?

Have you taken antidepressants before? If so, did they help? Were the side effects severe?

If you think you may have depression but aren’t sure, there are several screening questionnaires that can be helpful. Discussing the results with your doctor is a great first step.

SNRIs vs. SSRIs

Like SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) keep the body from reabsorbing too much serotonin, allowing the brain to use more of it.

But unlike SSRIs, SNRIs also lessen the reuptake of the neurotransmitter norepinephrine.

SNRIs are sometimes used to treat nerve pain and certain anxiety disorders in addition to depression.

Some examples of SNRIs include:

venlafaxine (Effexor XR)

desvenlafaxine (Khedezla, Pristiq)

duloxetine (Irenka, Cymbalta)

milnacipran (Savella)

Based on your symptoms and underlying conditions, you and your doctor will decide whether an SNRI or SSRI is the best option for you to try.

Can you drink alcohol on SSRIs?

While some doctors advise against drinking alcohol while taking SSRIs, many people find it difficult to completely stop their alcohol consumption during treatment.

A key reason doctors advise against drinking is because both SSRIs and alcohol may influence your mood, and may also make you drowsy and less alert.

It’s also possible that consuming too much alcohol regularly could disrupt the effectiveness of your SSRIs.

The consensus seems to be: If you want to drink while taking SSRIs, it’s important to drink in moderation. That means approximately one drink a day for most people, which translates into:

12 oz. of beer

5 oz. of wine

1 oz. of liquor

Talk with your doctor and see what their advice is around moderate alcohol consumption and SSRIs.

The takeaway

If you think an SSRI might be a good option for you, make an appointment to talk with a doctor about your symptoms. They will review your health history with you and help decide whether an SSRI is a good fit.

Some questions you might want to ask your doctor include:

Am I at high risk of side effects from an SSRI?

Do I take any medications that might interact with an SSRI?

Is there a different type of medication that might work better for me?

Would talk therapy be a good option for me instead of medication?

How long will it take for an SSRI to start working?

Can I stop taking my SSRI if my depression gets better?

It may take a little bit of time to find the right SSRI, or the right antidepressant in general, that works for you. The good news is that many people find SSRIs to be helpful in treating their symptoms, allowing them to get back to a more fulfilling, happy life.

Posted : 2024-08-26 16:33

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