What Is a Selective Serotonin Reuptake Inhibitor (SSRI)?
An SSRI is a selective serotonin reuptake inhibitor and is an antidepressant medication that is used to treat many mental health conditions. These medications are frequently used to lessen the symptoms of depression and are generally prescribed to patients to treat severe or constant depression. SSRIs are commonly thought to cause fewer side effects than other types of antidepressants. Since Prozac, the first SSRI to be released in the US, was released in 1988, antidepressants have become extremely popular. They are typically the first medication prescribed to a patient to treat their depression.
What Is Depression?
Depression, or major depressive disorder, is a serious medical condition that is both common and treatable. Depression can have negative effects on how a person feels, thinks, and acts. A person with depression may experience sadness and/or a decline in interest in once-enjoyable activities. It can cause both physical and emotional complications, making it difficult for someone to function at home or work.
Depression is characterized by many symptoms ranging from moderate to serious.
Moderate symptoms may include:
- Feelings of sadness
- Experiencing a depressed mood
- A decline in interest in activities once enjoyed
- Appetite changes
- Changes in weight
- Difficulty sleeping
- Excessive sleeping
- Loss of energy
- Excessive or increased fatigue
- Abnormal excessive purposeless physical activity
Severe symptoms of depression may include:
- Feelings of worthlessness
- Feelings of guilt
- Trouble thinking
- Difficulty concentrating
- Trouble making decisions
- Thinking about death or suicide
What Other Conditions Are SSRIs Used To Treat?
Although SSRIs are most commonly used to treat depression, they can also be used to treat other mental health conditions.
- Bipolar disorder
- Obsessive-compulsive disorder (OCD)
- Panic disorder
- Eating disorders
- Post-traumatic stress disorder (PTSD)
In some cases, SSRIs may be used to treat other disorders that are not related to mental health.
- Premenstrual syndrome (PMS)
- Irritable bowel syndrome (IBS)
SSRIs may sometimes be used to treat pain.
What Is Bipolar Disorder?
Bipolar disorder is a brain disorder category that includes three different disorders: Bipolar I, Bipolar II, and Cyclothymic Disorder. In general, these disorders cause changes in mood, energy, and ability to function. A person who has bipolar disorder goes through extreme changes in emotional state. These “mood episodes” usually take place over distinct periods of days or weeks.
Mood episodes are characterized as manic/hypomanic or depressive. A manic/hypomanic mood episode includes strikingly happy or irritable moods while a depressive mood episode involves a sad mood. These changes in mood are accompanied by drastic changes in a person’s behavior. A person experiencing a mood episode may also have trouble completing daily tasks or routines and interacting socially. Relationships with close friends and family may be impacted by bipolar disorder.
What Is Anxiety?
Anxiety is a natural response to stress. It may cause feelings of nervousness or anxiousness. Anxiety can be helpful in some situations, and it may alert to danger or help a person pay attention.
Anxiety disorders are characterized by excessive worry, fear, or anxiety which are not proportionate to the situation and affect a person’s ability to function normally. These are the most common mental disorders, affecting almost 30% of adults. Anxiety, when used to describe anxiety disorders, indicates the anticipation of an impending concern. When someone has an anxiety disorder, they may try to dodge situations that generate or exacerbate their symptoms. This may affect numerous areas of the person’s life, including work, school, or personal life.
What Is OCD?
Obsessive-compulsive disorder (OCD) causes people to have persistent, unwanted obsessions that cause them to feel compelled to do something repeatedly. These obsessions may present in the form of thoughts, ideas, or sensations. The repeated actions can be a variety of behaviors, such as handwashing, and may considerably affect a person’s day-to-day life.
What Is Panic Disorder?
Panic disorder is one type of anxiety disorder. People with panic disorder experience unanticipated and recurrent episodes of heightened fear that are coupled with physical symptoms such as chest pain, shortness of breath, dizziness, heart palpitations, or abdominal discomfort or distress. Episodes caused by panic disorder are not induced by an obvious stressor.
Eating disorders are dangerous illnesses characterized by dangerous disruptions in a person’s eating habits or behaviors coupled with linked thoughts and emotions. They frequently occur with separate mental disorders, usually OCD, anxiety disorders, mood disorders, and substance use disorders. The three most common eating disorders are anorexia nervosa, bulimia, and binge eating disorder.
Posttraumatic stress disorder (PTSD) refers to a psychiatric disorder that can occur in a person who was exposed to a traumatic event. Exposure can be by having experienced the event, by having witnessed the traumatic event, or by having secondhand experience such as learning about a loved one’s violent death or hearing details of someone else’s trauma. Examples of traumatic events include war, combat, natural disaster, major accident, terrorist attack, or rape. Threats of serious injury, death, or sexual assault are also considered to be traumatic events.
SSRI antidepressants work to increase levels of serotonin in certain areas of the brain. Serotonin is a naturally occurring chemical that is produced in the body and brain. It is a chemical messenger, or neurotransmitter, associated with regulating mood, learning, and sleep. Selective serotonin reuptake inhibitors or SSRI medications block the brain from reabsorbing serotonin after it is produced. This increases serotonin levels to higher than normal.
The term “selective” in the name of this class of drugs refers to the fact that the main neurotransmitter they affect is serotonin. Older antidepressants were not “selective” and may have worked on a wider variety of neurotransmitter types.
Not all patients respond to SSRIs the same way, and the length of time a person takes this medication will vary depending on many factors. However, there are some general timelines for how long someone may stay on these medications.
When a person starts taking an SSRI, it is expected that it will take anywhere from two to four weeks before they start seeing or feeling any improvements in their depression. During this time, it is important that the person not stop taking the medication simply because they are not feeling better. Once that initial period has passed, it may take three to six months for the patient to feel better and no longer depressed. In general, the shortest length of time a person may take this medication is about one year. Those who experience more severe depression may take the medications even longer.
There are many different types of SSRIs and antidepressants on the market.
Some of the most popularly prescribed SSRIs are:
- Celexa (Citalopram hydrobromide)
- Effexor (Venlafaxine)
- Lexapro (Escitalopram)
- Paxil (Paroxetine)
- Prozac (Fluoxetine)
- Zoloft (Sertraline)
Are These SSRIs FDA-Approved?
Yes, all of the above-listed medications are approved by the FDA.
Can SSRIs Cause Side Effects?
SSRIs were designed to have fewer side effects, but side effects are extremely common in patients who take SSRI antidepressants. These side effects range from minor to severe and life-threatening.
What Are Common Side Effects Caused by SSRIs?
SSRI antidepressants may cause side effects that are mild to moderate and will go away with time.
Common side effects from SSRI antidepressants may include:
- Dry mouth
- Increased sweating
- Weight gain or loss
- Decreased sexual desire
- Sexual dysfunction
What Are Severe Side Effects Caused by SSRIs?
Because SSRIs are “selective” to serotonin, they have been considered safer and have fewer side effects than older medications. Despite their improved safety profile, SSRIs may still cause severe side effects, some of which may be serious or life-threatening. These more severe side effects may include birth defects, suicide, withdrawal, and serotonin syndrome.
Severe or sudden side effects should be reported to a medical professional and may require emergency treatment.
Pregnant women taking SSRI antidepressants may be at increased risk of birth defects in their developing fetus.
The FDA uses pregnancy categories to warn doctors and patients of pregnancy risks associated with medication use. Prescription medications are categorized by the U.S. Food and Drug Administration (FDA) as A through D and pregnancy category X.
- Category A medications have been tested in animals and pregnant women and have shown no adverse effects.
- Category B medications have not shown any risk in animal studies but there are no adequate studies done on pregnant women.
- Category C medications have shown birth defect risk in animals and there are no adequate studies in humans, but the potential benefits of the medication may outweigh potential risks.
- Category D medications have shown fetal injury in both animals and humans, but the potential benefits may still outweigh a significant risk.
- Category X medications are known to be highly teratogenic or will cause fetal harm to both animals and humans as shown in drug studies or adverse event reports. These risks outweigh any potential benefits and should not be used on pregnant women.
Though most SSRIs were initially considered to be Category B pregnancy medications, most of the drugs were upgraded and are now considered to be Category C. Paxil is considered to be Category D. These medications should only be taken if the benefits clearly outweigh the risks.
Some birth defects associated with SSRI medications have included:
- Persistent Pulmonary Hypertension in Newborns (PPHN)
- Hypoplastic Left/Right Heart Syndrome (HLHS, HRHS),
- Anencephaly (born without part of the brain, skull, and scalp)
- Spina Bifida (underdeveloped vertebrae which leave the spinal cord exposed)
- Cleft Palate or Lip (a missing portion of the roof of the mouth or upper front jaw)
- Omphalocele (abdominal organs on the outside of the body)
- Scoliosis (curved spine)
- Club feet (feet curl inwards)
- Autism Spectrum Disorder (ASD) or Delayed Development Disorder (DDD)
- Withdrawal symptoms or Serotonin Syndrome in infants
In some cases, birth defects require surgery to correct skeletal deformities but in other cases, malformations may be fatal.
Consideration should also be taken if a pregnant woman intends to nurse her baby. These medications can be secreted through the mother’s breast milk and may pose risks to the baby.
In 2004, the U.S. Food and Drug Administration (FDA) issued a “black box warning” regarding SSRI antidepressants and suicide risk. A black box warning is required to be printed at the top of all prescribing information, enclosed in a thick, black border, and is the most severe safety warning that is issued by the FDA.
SSRI medications have been shown to increase the risk of suicide in patients who are depressed. Patients who are under the age of 25, have bipolar disorder, or have a history of suicidal behaviors or thoughts may be at increased risk.
The increased risk may be worse when a medication is first started or when the dosage is altered. Healthcare providers should closely monitor patients who could be at risk, and those taking the medication should notify their healthcare providers if they experience changes in behavior, suicidal thoughts or ideation, or the desire to self-harm.
While SSRIs are not considered chemically addictive, many patients suffer withdrawal because they become dependent on them during treatment. During dependency, the patient comes to need the drug to maintain normal mental and physical functioning. Patients who have been taking an SSRI for longer than six weeks and who abruptly stop taking their medication may be more likely to experience withdrawal symptoms.
These symptoms will usually develop within one to two days and include:
- Depression symptoms
Approximately 20 percent of patients will develop a condition referred to as SSRI Discontinuation Syndrome and may experience symptoms including:
- Chills and shivers
- Brain “zaps”
- Electrical-type skin sensations
SSRI Discontinuation Syndrome can be quickly stopped by restarting the medication. Tapering off medication over a period of time rather than suddenly stopping the medication may decrease withdrawal effects. However, some patients will continue to experience symptoms.
SSRI medications may cause “serotonin syndrome” due to excess serotonin concentration in the brain. Serotonin Syndrome syndrome generally occurs when a person takes a new medication or an increased dosage of a medication intended to increase the level of serotonin in the body. Serotonin syndrome may be more likely if SSRIs are taken with other medications that also affect serotonin such as treatments for migraine, cough suppressants, and certain herbal remedies. People who take any type of medication or supplement or other drugs that alter serotonin levels may be at risk for developing serotonin syndrome.
Serotonin syndrome symptoms can range in severity and may differ from person to person.
Less severe symptoms include:
- Dilated pupils
Moderately severe symptoms include:
- Muscle twitching or spasms
- Irregular eye movements
Severe symptoms include:
- High blood pressure
- Excessively high fever
- Increased heart rate
- Changes in heart rhythm
- Loss of balance or coordination
In some cases, serotonin syndrome may be life-threatening. All medications should be discussed with a physician to avoid drug interactions and sudden or severe symptoms should be reported to a health care practitioner right away.
Almost everyone who experiences symptoms of serotonin syndrome will experience those symptoms within twenty-four hours of beginning a medication or adding or increasing the dosage of a medication that affects the body’s serotonin levels.
Antidepressant manufacturers have been accused of failing to warn the public about the harmful effects of their medications. Thousands of product liability lawsuits have been filed against major SSRI manufacturers including Forest Laboratories, Eli Lilly, Pfizer, and other drug companies by people or loved ones of those who were harmed by the medications. These lawsuits were filed in connection with the severe side effects linked to the medications.
There are two main claims in these lawsuits:
- The medication caused unreasonably serious side effects.
- The manufacturer of the medication neglected to provide sufficient warnings about the potentially serious side effects.
Most lawsuits involving SSRIs have been settled, and the amounts of those settlements have not been disclosed. If you or someone you know experienced any severe side effects, such as birth defects in newborns, after taking an SSRI, consider contacting an attorney specializing in these lawsuits.
Notwithstanding claims relating to this product, the drug/medical device remains approved by the U.S. FDA.