Everything you need to know about SSRIs

SSRIs are an acronym that stands for “selective serotonin reuptake inhibitors”. They are antidepressants used to treat diseases such as depression, anxiety, panic attacks, and other mental disorders. Doctors most often prescribe SSRIs as antidepressants because they are the safest and have fewer side effects than other types of drugs prescribed for depression. In addition, SSRIs can help treat relationship anxiety, where a person experiences constant fear or uncertainty about their relationships, which can lead to conflict or isolation. They also promote concentration, helping to reduce the distraction that often accompanies depression or anxiety. Approximately 13% of Americans over the age of 21 are taking antidepressants, with more women and older adults over the age of 60.

SSRI drugs enhance the functioning of nerve cells in the brain that are responsible for human emotions. All information is transmitted from one cell to another with the help of special signals - neurotransmitters. One of them is serotonin.

When neurons send signals to each other, a small amount of neurotransmitter is released to deliver the message, and then taken back to send another message to brain cells. This cycle of neurotransmitter replacement is called “reuptake”.

When dealing with depression, some parts of the human brain that are responsible for mood and emotions and send information through serotonin may not function properly. SSRIs increase the amount of serotonin and make it available by blocking the reuptake process. In this way, serotonin accumulates between brain cells, ensuring that messages are sent correctly. Such drugs are called selective serotonin reuptake inhibitors because they affect this type of hormone.

What are SSRIs used for?

The FDA, the U.S. Food and Drug Administration, has approved SSRIs for the treatment of major depression:

  • Major depressive disorder.
  • Generalized anxiety disorder.
  • Panic disorder.
  • Obsessive-compulsive disorder (OCD).
  • Post-traumatic stress disorder (PTSD).
  • Premenstrual dysphoric disorder (PMDD).
  • Bipolar personality disorder.
  • Bulimia nervosa.
  • Treatment-resistant depression.

  • Nighttime Anxiety

A specialist may prescribe SSRIs for other types of disorders that have not been listed by the FDA, i.e., off-label use. These include:

  • Body dysmorphic disorder.
  • Fibromyalgia.
  • Premature ejaculation.
  • Compulsive overeating.
  • Raynaud's phenomenon.
  • Autism.
  • Hot flashes during menopause.

Types of SSRIs

The FDA decides which medications are safe and effective for treating certain conditions. There are a number of SSRIs that have been approved for depression, and some are sometimes used to treat other conditions, including anxiety, OCD, compulsive eating, and other mental health disorders. These medications are taken orally (by mouth) and are sold as tablets, capsules, or liquids. They include:

  • Citalopram (Celexa).
  • Escitalopram (Lexapro).
  • Fluoxetine (Prozac).
  • Fluvoxamine (Luvox).
  • Paroxetine (Paxil, Paxil CR).
  • Sertraline (Zoloft).
  • Vilazodone (Viibrid).

Sometimes SSRIs are associated with suicidal thoughts in children and young adults, so not all types of these drugs can be bought without a doctor's prescription by people of this age group. For children and people under 25, the FDA has approved only:

  • Escitalopram.
  • Fluoxetine.
  • Fluvoxamine.
  • Sertraline.

What are the side effects of SSRIs?

Most people who take SSRIs do not experience serious side effects, but there are exceptions, because any medication carries a certain degree of risk. Common side effects of SSRIs include:

  • Poor sleep or insomnia.
  • Migraines.
  • Rashes.
  • Dry mouth.
  • Excited or nervous state.
  • Dizziness.
  • Pain in the muscles and joints.
  • Indigestion, gastrointestinal problems, nausea and diarrhea.
  • Decreased sexual activity.
  • Problems with erection and ejaculation.
  • Weight gain or loss.

Some side effects can be eliminated by changing the time of taking the drug. In case of nausea, it is better to take SSRIs with meals or in the evening before going to bed. In case of insomnia, it is better to take the medication early in the morning, and if it causes drowsiness, in the evening. If you have sexual problems, you can take the drug once a day or after sex.

Some young people under the age of 25 sometimes have suicidal thoughts when taking SSRIs. Studies have shown that compared to placebo, the percentage of suicidal thoughts increases from 1-2% to 2-4% when a person takes antidepressants of various types, including SSRIs. If you have such thoughts, you should seek professional help.

In addition, it is necessary to take into account how SSRIs work with other drugs and remember about your safety. In some cases, this combination can be hazardous to health. This applies to prescription and over-the-counter medications, as well as herbs and supplements. Therefore, before you start taking SSRIs, you should tell your doctor about other medications you are taking.

Since all SSRIs work in much the same way, their side effects are also similar. But, since each drug contains different chemicals, side effects from one drug may disappear if it is replaced with an analog of the same effect.

Although such cases do not occur often, if a large amount of serotonin accumulates in the body, a person may develop “serotonin syndrome”. This can happen at the beginning of taking a new drug or switching to another SSRI. Most often, this effect occurs if a patient takes two medications at the same time that increase the level of serotonin in brain cells. For example, two SSRIs or one SSRI and one MAOI (monoamine oxidase) prescribed to treat Parkinson's disease and depression with atypical symptoms (e.g., bulimia).

The following symptoms occur in serotonin syndrome:

  • Severe nervousness.
  • Stomach and gastrointestinal problems such as nausea, vomiting, and diarrhea.
  • Profuse sweating.
  • Trembling in the limbs.
  • Movement of the eyes from side to side.
  • Strongly dilated pupils.
  • Muscle twitching, contractions and spasms.
  • Confusion in the mind.
  • High blood pressure.
  • High temperature.
  • Seizures and convulsions.
  • Sudden fainting.

If you have signs of serotonin syndrome, you should immediately consult a doctor, as a serious condition without appropriate treatment can lead to death.

Some patients experience side effects, and some do not. Most often, they go away in 2-3 weeks. Therefore, it is very important to work with your doctor to choose a suitable SSRI.

SSRIs and pregnancy

Approximately 20% of women and people who are female suffer from depression during pregnancy, and 5 to 7% of them take antidepressants. There is some stigma associated with taking such medications during pregnancy, but only you and your doctor can choose the right medication.

Depression during pregnancy can affect not only the mother but also her unborn child in the womb. If left untreated, this condition can increase the risk of health problems, including

  • Pre-eclampsia.
  • High risk of suicide.
  • High risk of postpartum depression.
  • Problems and difficulties in establishing a bond with the newborn child.

If depression is not treated, the child is at risk of acquiring a number of diseases, and factors such as

  • Premature birth.
  • Underweight at birth.
  • Irritability after childbirth.
  • Increased levels of norepinephrine and cortisol (stress hormones and the “fight or flight” response).
  • Decreased levels of serotonin and dopamine (hormones associated with good mood and emotions).
  • Other cognitive and emotional problems after birth.

A specialist may prescribe SSRI medications such as:

  • Citalopram.
  • Escitalopram.
  • Sertraline.
  • Fluoxetine.

At the same time, there are a number of potential risks to the child if the mother takes these drugs during pregnancy. Among them:

  • Excessive irritability.
  • Severe nervousness.
  • Poor eating habits.
  • Difficulty breathing.
  • Premature births.
  • High risk of stillbirth.
  • High risk of spontaneous abortion.

Speaking of bad eating habits, it is worth noting excessive sugar consumption, which can cause health and weight problems. As a sugar substitute, erythritol is often used, which is low in calories and does not affect blood sugar levels. However, although erythritol is a safer option, it is important not to overuse it, as excessive consumption can lead to unpleasant side effects such as stomach upset.

Taking antidepressants in the third trimester of pregnancy can increase the risk of low Apgar scores (a method of assessing the health of a baby within 1-2 minutes of birth). Also, the child may be overly restless, have low blood sugar, sudden changes in body temperature, nervousness, unstable condition, and limb tremors. These symptoms can be caused by the medication itself or by its withdrawal.

If you are planning a pregnancy, or you are already pregnant and suffer from depression, you should always consult a doctor before starting SSRIs to exclude possible risks and negative consequences.

SSRIs during breastfeeding

Doctors do not prohibit taking antidepressants during breastfeeding, as they are considered safe. They do not pose a great danger to the child's health if the mother takes such drugs. At the same time, there is some data on newborns with various problems:

  • Severe irritability.
  • Problems with breastfeeding.
  • Problems with sleep.
  • Nervousness.
  • Constant crying for no reason.

SSRIs vs. SNRIs

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are other antidepressants that are often prescribed by doctors. They work in the same way as SSRIs by changing chemicals in the brain that affect mood. SSRIs help to block the reuptake of both serotonin and norepinephrine, another type of neurotransmitter that also acts as a chemical mediator in the transmission of information between cells.

Serotonin inherently affects appetite, sexual desire, and social relationships. Norepinephrine affects human alertness and even sexual arousal.

The FDA has approved the following types of SSRIs for use:

  • Desvenlafaxine (Hedezla, Pristiq).
  • Duloxetine (Drizalma, Irene, Cymbalta).
  • Levomilnacipram (Fetzima).
  • Milnacipran (Savella).
  • Venlafaxine (Effexor).

Different types of drugs are prescribed for different conditions, but they are mainly intended to treat severe depression. SSRIs are also used for diseases such as:

  • Fibromyalgia (Milnacipran or Duloxetine is prescribed).
  • Generalized anxiety disorder (Duloxetine or Venlafaxine are prescribed).
  • Pain caused by diabetic neuropathy and chronic musculoskeletal problems (Duloxetine is prescribed).
  • Social anxiety and panic attacks (take Vanlafaxine).

Your doctor may also use SSRIs off-label, that is, without FDA approval:

  • For night sweats and hot flashes associated with menopause.
  • In case of involuntary urination (urinary incontinence).
  • In case of neuropathy due to chemotherapy.
  • In obsessive-compulsive disorders.
  • In case of headaches (migraines).
  • In case of attention deficit hyperactivity disorder.

When do SSRIs start working?

Everyone perceives SSRIs differently. In most cases, improvements begin 4-6 weeks after starting the drug. But some patients take several months to feel relief. If there is no improvement after 6-8 weeks, you should talk to your doctor to find another medication of this type or increase the dose. About 9% of patients taking SSRIs switch from one medication to another during the first two months of treatment.

How to choose an SSRI

It may take some time to find a suitable SSRI. To do this, the patient should discuss with the doctor all the symptoms of depression, the likelihood of side effects, and other issues that will help to choose the best antidepressant option. When choosing an SSRI, the following should be taken into account:

  1. Symptoms. Some types of antidepressants are more effective for insomnia and anxiety.
  2. Side effects. All SSRIs differ in the risk of side effects, such as excessive weight gain, nausea, and sexual dysfunction.
  3. Genetic factor. If a close relative had significant improvements after taking the drug, then the patient may have a similar situation.
  4. Combination with medications. It is necessary to find out how SSRIs are combined with other drugs that a person takes. You should tell your doctor about them so that he or she can make the right decision.
  5. Price. The cost of some medications can be quite high, so you should ask your doctor if your health insurance can cover these costs. It may be necessary to purchase more affordable and inexpensive analogs.

How to help SSRIs perform their functions?

There are a number of things a patient can do to improve the effect of SSRIs. The first step is patience. It may take several weeks for the drug to take effect. The doctor may prescribe a small dose and then gradually increase it. Side effects may disappear on their own in a few weeks, and if not, you should consult a doctor.

Taking the drug should be strict and regular, otherwise you will not get the desired result. You should not stop taking SSRIs without consulting a doctor, as abrupt withdrawal from the medication can lead to withdrawal symptoms or worsen depression.

While taking an antidepressant, you should avoid alcohol and drugs that can worsen a person's condition.

What happens when SSRIs are discontinued

In principle, SSRIs are not addictive, but abrupt discontinuation of the drug or frequent omissions can pose a health risk. Withdrawal symptoms can lead to a condition similar to withdrawal symptoms.

Also, during withdrawal, a person may feel sick like the flu or experience:

  • Nausea.
  • Dizziness.
  • Anxiety.
  • Fatigue, loss of energy, and lethargy.

Therefore, it is very important to increase or decrease the dose only under the supervision of a doctor who will monitor your health and well-being.

Some people may experience sexual problems (loss of sex drive and weak orgasms). If you have experienced such problems, it is likely that they will not stop after you stop taking SSRIs. After taking the drug, the following types of sexual dysfunction may occur

  • Premature ejaculation.
  • Weak orgasms or those that do not bring full satisfaction.
  • Decreased sex drive.
  • Erectile dysfunction.
  • Numbness of the genitals.

Conclusion

If you suspect you have depression, anxiety, or other mental disorders, consult a specialist who will help you choose the right treatment and possibly prescribe an SSRI. An important part of therapy in this case is patience, because medications can take effect only 6-8 weeks after starting them. They can also have various side effects. SSRIs are of great importance for people who are prone to severe depression, as they are better able to cope with this illness.

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