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SSRIs (Selective Serotonin Reuptake Inhibitors)

Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed category of antidepressants. These medications have a strong reputation for both safety and effectiveness. Developed in the past 20 years, SSRIs are typically the first choice for physicians when treatment requires the prescription of antidepressants.

Conditions Treated with SSRIs

SSRIs are commonly prescribed for the following conditions:

This list is not a comprehensive collection of physical or mental health issues that may be treated with SSRIs, but includes many of the conditions commonly treated with this category of drug.

Commonly Prescribed SSRIs

SSRI medications are some of the most widely prescribed and recognized psychotropic medications on the market. The brand name SSRIs include:

History of SSRIs

Fluoxetine was brought into the U.S. market in 1988. It is now one of the most prescribed antidepressants across the globe. The discovery of fluoxetine was the result of a search for compounds that could have an affinity for monoamine receptors. The goal of this search was to find specific compounds that did not affect cholinergic, adrenergic, or histamine receptors.

How Do SSRIs Work?

SSRIs act on the serotonin transporter (SERT or 5-HTT), which is responsible for taking up serotonin from a synaptic cleft back to the presynaptic neuron. These transporters are glycoproteins present in synapses. Their function is to take up extra quantities of neurotransmitters from these synapses and transfer them back to presynaptic nerves for further use.


Serotonin—or 5-HT—has primary functions that include mood regulation. For most people, boosting serotonin results in improved mood and can have beneficial effects for those experiencing depression or anxiety. SSRIs are called "selective" because they have relatively little or no effect on other neurotransmitters present in the body.


Most prescriptions for these medications consist of a once-daily or even a once-weekly dosage. Because the amount of serotonin in the brain increases very slowly, these medications usually require up to four weeks to reach their full strength. It is even possible that a person will feel worse during the first week or two of treatment. As such, people taking any SSRI medication should report any unusual symptoms to their doctor.


It should also be noted that nearly all antidepressant medications work better when paired with some type of psychotherapy. Medications can help with managing the overt symptoms of depression, but do not address the root causes, negative feelings, or help a person develop positive coping strategies should they experience symptoms of depression, anxiety, or panic in the future. If you are prescribed an SSRI or any other prescription antidepressant, please consider finding a qualified therapist you trust to help you better understand your mental health condition.

Side Effects

It is possible to experience unwanted side effects while taking SSRI medications. You should discuss your health history with your doctor before beginning any new medication, and notify your doctor if you experience changes in your health while taking an SSRI. Possible side effects from these medications can include:

  • Cardiovascular Effects: Hypertension and increased heart rate may occur when taking SSRIs, although this side effect is very rare. Hypotension may occur as well. Orthostatic hypotension—the medical term for the dizzy feeling you get when standing up or stretching too quickly—and fainting have also been reported. Palpitations, flushes, and arrhythmias are also possible adverse drug reactions.   
     
  • Gastrointestinal Effects: Constipation, dry mouth, anorexia, weight gain or loss, and nausea are some common adverse effects of SSRIs.
     
  • Nervous System Effects: Most common effects include dizziness, headache (unrelated to blood pressure), drowsiness, sleep disturbances (insomnia, hypersomnia), confusion, and memory loss. At high doses, worsening of anxiety, depression, and suicidal ideation have been noticed. Seizures have been reported as well.  
     
  • Hepatic Effects: Liver damage is likely when a patient is already suffering from chronic liver disease. However, the risk is very low for people using SSRIs. Reduction of dose is recommended, but a pharmacist or physician should be consulted before reaching this decision.
     
  • Adverse Effects on the Urinary and Reproductive Systems: Impotence, delayed and premature ejaculation, and anorgasmia have been reported. Hyponatremia (abnormally low sodium) is a major adverse effect of SSRIs and SNRIs.
     
  • Abnormal Bleeding: Abnormal bleeding must be reported. SSRIs should be used with caution if a person is taking anticoagulants, such as warfarin and aspirin.
     
  • Pregnancy and SSRIs: There is not enough data about these medications and pregnancy to make a definitive recommendation. However, in animals, this category of drugs has demonstrated some teratogenic effects. Fluoxetine, for example, when given to pregnant mice prolonged the gestation period. SSRI use is considered an option for pregnant and nursing mothers, but a physician must balance the benefit to risk ratio before prescribing them.
     
  • Other Side Effects: Visual disturbances, mydriasis, thrombocytopenia, anemia, alopecia, arthralgia, and lupus-like syndrome are reported by some people using SSRI drugs.

Drug Interactions

SSRIs medications should not be used with the following substances:

Withdrawal

A washout period of at least 15 to 20 days is required after the discontinuation of treatment with SSRI drugs. Officially, SSRIs are not addictive, which is why they are usually prescribed over benzodiazepines to treat depression, although that classification has come under fire in recent years. Nevertheless, suddenly discontinuing an SSRI medication may lead to unpleasant withdrawal-like symptoms. These include nausea, headache, lethargy, insomnia, fatigue, depression, anxiety, mania, and even flu-like symptoms. It is recommended to reduce doses at equal intervals so that withdrawal symptoms can be avoided.


References:

  1. Mayo Clinic. (n.d.). Depression (Major Depression). Retrieved from http://www.mayoclinic.com/health/antidepressants/MH00071
  2. National Institute of Mental Health. (n.d.). Antidepressant Medications. Retrieved from http://wwwapps.nimh.nih.gov/health/publications/medications/antidepressant-medications.shtml
  3. Harvard Health Publications. (2005). SSRI Side Effects: Harvard Mental Health Letter Discusses the Real Risks of Antidepressants. Retrieved from http://www.health.harvard.edu/press_releases/ssri_side_effects
  4. Gillman, P.K. (2006). A Review of Serotonin Toxicity Data: Implications for the Mechanisms of Antidepressant Drug Action. Biol Psychiatry, 59(11), 1046.
  5. Gether, U. et al. (2006). Neurotransmitter Transporters: Molecular Function of Important Drug Targets. Trends Pharmacol Sci, 27(7), 375.
  6. Stein, D.J., Kupfer, D.J., and Schatzberg, A.F. (2006). American Psychiatric Publishing Textbook of Mood Disorders. American Psychiatric Publishing, Inc.

 

Last Update: 02-09-2015

 

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