What are SSRIs and how do they work. Who can benefit from SSRI antidepressants. What are the common side effects of SSRIs. How long do SSRIs take to work. What should you know about stopping SSRI treatment.

What Are SSRIs and How Do They Function in the Brain?

Selective Serotonin Reuptake Inhibitors (SSRIs) are a widely prescribed class of antidepressant medications. These drugs work by increasing the levels of serotonin, a neurotransmitter associated with mood regulation, in the brain.

SSRIs function by blocking the reabsorption (reuptake) of serotonin into neurons. This process leaves more serotonin available in the synaptic space between neurons, allowing for improved communication between brain cells. The increased serotonin activity is believed to alleviate symptoms of depression and anxiety.

While the exact relationship between serotonin levels and mood disorders is complex, SSRIs have proven effective for many patients in managing symptoms and improving overall mental health. These medications are often used in conjunction with psychotherapy, such as cognitive-behavioral therapy (CBT), for optimal results.

Key Mechanisms of SSRI Action:

• Inhibition of serotonin reuptake
• Increased serotonin availability in synapses
• Enhanced communication between neurons
• Gradual improvement in mood and emotional regulation

Common Uses of SSRI Medications: Beyond Depression

While SSRIs are primarily known for treating depression, their applications extend to various other mental health conditions. Healthcare providers often prescribe these medications for a range of disorders that may benefit from serotonin modulation.

Are SSRIs only used for depression? No, these versatile medications have shown efficacy in treating multiple mental health and even some physical conditions.

Conditions Commonly Treated with SSRIs:

1. Major Depressive Disorder (MDD)
2. Generalized Anxiety Disorder (GAD)
3. Obsessive-Compulsive Disorder (OCD)
4. Panic Disorder
5. Social Anxiety Disorder
6. Post-Traumatic Stress Disorder (PTSD)
7. Bulimia Nervosa
8. Premenstrual Dysphoric Disorder (PMDD)

In some cases, SSRIs may also be prescribed off-label for conditions such as fibromyalgia, irritable bowel syndrome (IBS), and certain types of chronic pain. The versatility of these medications makes them a valuable tool in managing a wide array of mental health and related disorders.

Types of SSRIs: A Comprehensive List of Medications

The SSRI class encompasses several medications, each with its own unique properties and potential benefits. While all SSRIs share the same basic mechanism of action, individual drugs may have slight differences in their effects and side effect profiles.

Currently Prescribed SSRIs in the UK:

• Citalopram (Cipramil)
• Dapoxetine (Priligy)
• Escitalopram (Cipralex)
• Fluoxetine (Prozac or Oxactin)
• Fluvoxamine (Faverin)
• Paroxetine (Seroxat)
• Sertraline (Lustral)
• Vortioxetine (Brintellix)

Can different SSRIs have varying effects on individuals? Indeed, patients may respond differently to various SSRIs. Factors such as individual brain chemistry, genetics, and the specific symptoms being treated can influence how a person responds to a particular SSRI.

Healthcare providers often start with one SSRI and may switch to another if the initial medication is not effective or causes intolerable side effects. This process of finding the right medication and dosage is often referred to as “medication management” and requires close collaboration between the patient and their healthcare provider.

Side Effects of SSRIs: What to Expect and How to Manage

Like all medications, SSRIs can cause side effects. While many people tolerate these drugs well, it’s important to be aware of potential adverse reactions. Most side effects are mild and often improve as the body adjusts to the medication.

Common Side Effects of SSRIs:

• Nausea and gastrointestinal disturbances
• Headache
• Sleep disturbances (insomnia or excessive sleepiness)
• Dry mouth
• Dizziness
• Sexual dysfunction (decreased libido, difficulty achieving orgasm)
• Weight changes
• Increased anxiety or agitation (especially in the initial weeks of treatment)

How can patients manage SSRI side effects? Many side effects can be mitigated through strategies such as taking the medication with food to reduce nausea, adjusting the timing of doses to minimize sleep disturbances, or gradually increasing the dose to allow the body to adapt more easily.

It’s crucial for patients to communicate openly with their healthcare provider about any side effects they experience. In some cases, the dosage may need to be adjusted, or a different SSRI may be prescribed to find the best balance between symptom relief and side effect management.

The Timeline of SSRI Effectiveness: When to Expect Results

One of the most common questions patients have when starting SSRI treatment is how long it will take to see improvements in their symptoms. Unlike some medications that provide immediate relief, SSRIs typically require several weeks to reach their full therapeutic effect.

How quickly do SSRIs start working? While some patients may notice subtle improvements in the first week or two, it generally takes 4-6 weeks for SSRIs to produce significant changes in mood and anxiety levels.

Typical Timeline of SSRI Effects:

1. 1-2 weeks: Some patients may experience initial side effects as the body adjusts to the medication.
2. 2-4 weeks: Subtle improvements in mood or anxiety may begin to emerge.
3. 4-6 weeks: More noticeable improvements in symptoms are typically observed.
4. 6-8 weeks: Full therapeutic effects are usually achieved.

It’s important for patients to continue taking their medication as prescribed, even if they don’t feel immediate improvements. Premature discontinuation can lead to a return of symptoms and potential withdrawal effects.

Regular follow-ups with a healthcare provider during the initial weeks of treatment are crucial. This allows for monitoring of progress, adjusting dosages if necessary, and addressing any concerns or side effects that may arise.

SSRI Treatment Duration and Discontinuation: Important Considerations

The duration of SSRI treatment can vary significantly depending on the individual’s condition, response to the medication, and overall treatment plan. For many patients, SSRIs are not intended as a short-term solution but rather as part of a longer-term management strategy for mental health.

How long should patients stay on SSRIs? The recommended duration of treatment often depends on the specific condition being treated and the patient’s history of symptoms. For a first episode of depression, doctors typically recommend continuing the medication for at least 6-12 months after symptoms have improved.

Factors Influencing Treatment Duration:

• Severity and duration of symptoms prior to treatment
• Number of previous depressive episodes
• Presence of other mental health conditions
• Overall response to the medication
• Individual risk factors for relapse

When the time comes to discontinue SSRI treatment, it’s crucial to do so under medical supervision. Abrupt discontinuation can lead to withdrawal symptoms, often referred to as “discontinuation syndrome.”

SSRI Discontinuation Syndrome Symptoms:

• Flu-like symptoms (nausea, vomiting, diarrhea)
• Sleep disturbances
• Sensory disturbances (electric shock sensations, dizziness)
• Mood swings or increased anxiety
• Cognitive difficulties

To minimize the risk of discontinuation syndrome, healthcare providers typically recommend a gradual tapering of the medication over several weeks or even months. This allows the brain to adjust to decreasing levels of serotonin and reduces the likelihood of experiencing withdrawal effects.

Special Considerations: SSRIs in Specific Populations

While SSRIs are generally considered safe and effective for many adults, there are special considerations for certain populations. Healthcare providers must carefully weigh the potential benefits against the risks when prescribing SSRIs to these groups.

SSRIs in Pregnancy and Breastfeeding:

The use of SSRIs during pregnancy and breastfeeding is a complex issue that requires careful consideration. While some SSRIs have been associated with a slightly increased risk of certain birth defects, untreated depression during pregnancy can also pose significant risks to both mother and baby.

Are SSRIs safe during pregnancy? The safety of SSRIs during pregnancy is not absolute, and decisions should be made on a case-by-case basis. Some SSRIs, such as sertraline and citalopram, are generally considered to have a better safety profile during pregnancy compared to others.

For breastfeeding mothers, most SSRIs are considered compatible with breastfeeding, as the amount of medication that passes into breast milk is usually very low. However, close monitoring of the infant is recommended.

SSRIs in Children and Adolescents:

The use of SSRIs in children and adolescents requires special attention due to concerns about potential increased risk of suicidal thoughts or behaviors, particularly in the early stages of treatment.

In the UK, fluoxetine is the only SSRI licensed for use in children and young people with moderate to severe depression. Other SSRIs may be used off-label in certain circumstances, but this requires careful consideration and close monitoring.

SSRIs in Older Adults:

Older adults may be more sensitive to the effects of SSRIs and may be at higher risk for certain side effects, such as falls, bleeding, or hyponatremia (low sodium levels). However, SSRIs are often preferred over other classes of antidepressants in this population due to their generally favorable side effect profile.

When prescribing SSRIs to older adults, healthcare providers typically start with lower doses and increase gradually as needed, while closely monitoring for any adverse effects.

Combining SSRIs with Other Treatments: A Holistic Approach to Mental Health

While SSRIs can be effective on their own, they are often most beneficial when used as part of a comprehensive treatment plan. Combining medication with psychotherapy and lifestyle changes can lead to better outcomes and long-term mental health management.

SSRIs and Psychotherapy:

Cognitive Behavioral Therapy (CBT) is often recommended alongside SSRI treatment, particularly for conditions like depression and anxiety disorders. CBT can help patients develop coping strategies, change negative thought patterns, and improve problem-solving skills.

How do SSRIs enhance the effectiveness of therapy? SSRIs can help alleviate symptoms that might otherwise interfere with a patient’s ability to engage fully in therapy. As mood improves, patients may be better equipped to implement the strategies learned in therapy sessions.

Lifestyle Modifications:

In addition to medication and therapy, certain lifestyle changes can complement SSRI treatment and contribute to overall mental health improvement:

• Regular exercise
• Healthy sleep habits
• Balanced nutrition
• Stress reduction techniques (e.g., mindfulness, meditation)
• Social support and connection

These lifestyle factors can help enhance the effects of SSRIs and contribute to overall well-being. Healthcare providers often encourage patients to incorporate these elements into their treatment plan for a more holistic approach to mental health management.

Potential Interactions:

When combining SSRIs with other treatments, it’s crucial to be aware of potential interactions. Some supplements, such as St. John’s Wort, can interact with SSRIs and should be avoided. Additionally, certain medications, including some over-the-counter pain relievers, can increase the risk of bleeding when taken with SSRIs.

Patients should always inform their healthcare providers about all medications, supplements, and treatments they are using to ensure safe and effective management of their mental health condition.

In conclusion, SSRIs represent a valuable tool in the treatment of depression and various other mental health conditions. While they are not without risks and side effects, for many patients, the benefits of SSRI treatment significantly outweigh the potential drawbacks. As with any medical treatment, the key to success lies in open communication with healthcare providers, careful monitoring, and a comprehensive approach that addresses all aspects of mental health and well-being.

Overview – SSRI antidepressants – NHS

Selective serotonin reuptake inhibitors (SSRIs) are a widely used type of antidepressant.

They’re mainly prescribed to treat depression, particularly persistent or severe cases, and are often used in combination with a talking therapy such as cognitive behavioural therapy (CBT).

SSRIs are usually the first choice medicine for depression because they generally have fewer side effects than most other types of antidepressant.

As well as depression, SSRIs can be used to treat a number of other mental health conditions, including:

• generalised anxiety disorder (GAD)
• obsessive compulsive disorder (OCD)
• panic disorder
• severe phobias, such as agoraphobia and social phobia
• bulimia
• post-traumatic stress disorder (PTSD)

SSRIs can sometimes be used to treat other conditions, such as premenstrual syndrome (PMS), fibromyalgia and irritable bowel syndrome (IBS). Occasionally, they may also be prescribed to treat pain.

How SSRIs work

It’s thought that SSRIs work by increasing serotonin levels in the brain.

Serotonin is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain). It’s thought to have a good influence on mood, emotion and sleep.

After carrying a message, serotonin is usually reabsorbed by the nerve cells (known as “reuptake”). SSRIs work by blocking (“inhibiting”) reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells.

It would be too simplistic to say that depression and related mental health conditions are caused by low serotonin levels, but a rise in serotonin levels can improve symptoms and make people more responsive to other types of treatment, such as CBT.

Doses and duration of treatment

SSRIs are usually taken in tablet form. When they’re prescribed, you’ll start on the lowest possible dose thought necessary to improve your symptoms.

SSRIs usually need to be taken for 2 to 4 weeks before the benefit is felt. You may experience mild side effects early on, but it’s important that you don’t stop taking the medicine. These effects will usually wear off quickly.

If you take an SSRI for 4 to 6 weeks without feeling any benefit, speak to your GP or mental health specialist. They may recommend increasing your dose or trying an alternative antidepressant.

A course of treatment usually continues for at least 6 months after you feel better, although longer courses are sometimes recommended and some people with recurrent problems may be advised to take them indefinitely.

Things to consider

SSRIs aren’t suitable for everyone. They’re not usually recommended if you’re pregnant, breastfeeding or under 18, because there’s an increased risk of serious side effects. However, exceptions can be made if the benefits of treatment are thought to outweigh the risks.

SSRIs also need to be used with caution if you have certain underlying health problems, including diabetes, epilepsy and kidney disease.

Some SSRIs can react unpredictably with other medicines, including some over-the-counter painkillers and herbal remedies, such as St John’s wort. Always read the information leaflet that comes with your SSRI medicine to check if there are any medicines you need to avoid.

Side effects

Most people will only experience a few mild side effects when taking SSRIs. These can be troublesome at first, but they’ll generally improve with time.

Common side effects of SSRIs can include:

• feeling agitated, shaky or anxious
• diarrhoea and feeling or being sick
• dizziness
• blurred vision
• loss of libido (reduced sex drive)
• difficulty achieving orgasm during sex or masturbation
• in men, difficulty obtaining or maintaining an erection (erectile dysfunction)

You’ll usually need to see your doctor every few weeks when you first start taking SSRIs to discuss how well the medicine is working. You can also contact your doctor at any point if you experience any troublesome or persistent side effects.

Types of SSRIs

There are currently 8 SSRIs prescribed in the UK:

• citalopram (Cipramil)
• dapoxetine (Priligy)
• escitalopram (Cipralex)
• fluoxetine (Prozac or Oxactin)
• fluvoxamine (Faverin)
• paroxetine (Seroxat)
• sertraline (Lustral)
• vortioxetine (Brintellix)

Page last reviewed: 8 December 2021

Next review due: 8 December 2024

SSRIs: Uses, Side-Effects, and Cessation

Written by Matthew Hoffman, MD

Medically Reviewed by Jennifer Robinson, MD on May 02, 2023

• How Do SSRIs Work?
• Types of SSRIs
• Side Effects
• How Long Do They Take to Work?
• Stopping Treatment

Everyone feels down from time to time. But for people with depression, the feelings of sadness can be so severe that they interfere with everyday life. It can become hard to function at home or at work, and the feelings can lead to a variety of physical and emotional problems.

However, depression is one of the most treatable mental disorders. Between 80% and 90%of people who have it benefit from treatment. The kind of management you need depends on your specific situation, but for some people, medication can be very helpful.

That’s because brain chemistry may contribute to the condition, so taking antidepressants can actually change your brain chemistry and help you feel better.

The most common antidepressants are called selective serotonin reuptake inhibitors (SSRIs). They’re considered relatively safe and cause fewer side effects than other kinds of medications used to treat depression.

SSRIs work by enhancing the function of nerve cells in the brain that regulate emotion. Information is communicated between your brain cells with signals. The chemical messengers that deliver these signals are called neurotransmitters. Serotonin is one type of neurotransmitter.

When these brain cells (called neurons) send signals to one another, they release a little bit of a neurotransmitter so that the message can be delivered. They then have to take back the neurotransmitter they released so they can send the next message. This process of replacing the neurotransmitter is called “reuptake.”

If you’re struggling with depression, the areas of your brain that regulate mood and send messages using serotonin might not function properly. SSRIs help make more serotonin available by blocking the reuptake process. This allows serotonin to build up between neurons so messages can be sent correctly. They’re called “selective” serotonin reuptake inhibitors because they specifically target serotonin.

The FDA is in charge of deciding which medications are safe and effective for which reasons. The following SSRIs are approved to treat depression, anxiety, and other mood disorders:

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

Most people who use SSRI antidepressants don’t have major problems, but every kind of medical treatment carries some risk. The possible side effects of these antidepressants include:

• Insomnia
• Headaches
• Rash
• Blurred vision
• Drowsiness
• Dry mouth
• Agitation or nervousness
• Feeling dizzy
• Pain in the joints or muscles
• Upset stomach, nausea, or diarrhea
• Reduced sexual desire
• Problems with erection or ejaculation

Some people, especially children and young adults, may be more likely to have suicidal thoughts when they take SSRIs. Studies show that when compared to results from taking a placebo, chances of having suicidal thoughts doubled — from between 1% and 2% to between 2% and 4% — when taking any kind of antidepressant, including an SSRI. If you have thoughts of hurting yourself while taking an SSRI, call 911.

There are also important safety issues to consider about SSRIs. Although it’s rare, if too much serotonin accumulates in your system, you can develop a condition called serotonin syndrome. This happens most often if two different medications that increase serotonin are combined.

SSRIs can also have dangerous interactions with some medicines, both prescription and over-the-counter, including herbs and supplements. Before starting on an SSRI, make sure to tell your doctor all the different kinds of medications and supplements you’re taking.

Since all SSRIs work in a similar way, the side effects tend to be similar no matter what kind you take. But each SSRI has a different chemical makeup, so it’s possible that if you’re having side effects from one, you may not experience as many or any at all if you switch to another.

While some people do have side effects, others do not, and in many cases, the side effects disappear after a few weeks of treatment. It’s important to work with your doctor to find a medication that’s right for you.

Everyone is different when it comes to seeing improvements on SSRIs. But people typically start noticing positive changes after about 4 to 6 weeks of treatment. It can take several months to feel the full effect of the medication.

But if you’re not feeling any improvements after about 6 to 8 weeks, talk to your doctor about trying another treatment or adjusting your dosage.

Even though SSRIs aren’t habit-forming, it can be dangerous to stop them suddenly or miss several doses in a row. Doing this can lead to a condition called discontinuation syndrome that causes withdrawal-like symptoms.

If you do experience discontinuation syndrome, you might start to feel like you have the flu and/or notice symptoms like:

• Nausea
• Dizziness
• Uneasiness
• Fatigue or lethargy

That’s why it’s important to work up to your prescribed dosage slowly with the help of your doctor, and to step down gradually if you agree it’s time to stop.

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Antidepressants: pharmacological group

Drugs specifically for depression appeared in the late 1950s. In 1957, iproniazid was discovered, which became the ancestor of the group of antidepressants – MAO inhibitors, and imipramine, on the basis of which tricyclic antidepressants were obtained.

According to modern concepts, in depressive states, there is a decrease in serotonergic and noradrenergic synaptic transmission. Therefore, the accumulation of serotonin and norepinephrine in the brain caused by them is considered an important link in the mechanism of action of antidepressants. MAO inhibitors block monoamine oxidase, an enzyme that causes oxidative deamination and inactivation of monoamines. Currently, two forms of MAO are known – type A and type B, which differ in the substrates exposed to them. Type A MAO causes mainly the deamination of noradrenaline, adrenaline, dopamine, serotonin, tyramine, and type B MAO causes the deamination of phenylethylamine and some other amines. Allocate inhibition competitive and non-competitive, reversible and irreversible. Substrate specificity can be observed: a predominant effect on the deamination of various monoamines. All this significantly affects the pharmacological and therapeutic properties of various MAO inhibitors. So, iproniazid, nialamide, phenelzine, tranylcypromine irreversibly block MAO type A, and pirlindol, tetrindole, metralindol, eprobemide, moclobemide, etc. have a selective and reversible effect on it.

Tricyclic antidepressants are named because of their characteristic tricyclic structure. The mechanism of their action is associated with inhibition of the reuptake of neurotransmitter monoamines by presynaptic nerve endings, resulting in the accumulation of mediators in the synaptic cleft and activation of synaptic transmission. Tricyclic antidepressants, as a rule, simultaneously reduce the capture of various neurotransmitter amines (norepinephrine, serotonin, dopamine). Recently, antidepressants have been created that block predominantly (selectively) the reuptake of serotonin (fluoxetine, sertraline, paroxetine, citalopram, escitalopram, etc.).

There are also so-called “atypical” antidepressants, which differ from the “typical” ones both in structure and mechanism of action. Preparations of a bi- and four-cyclic structure appeared, in which no pronounced effect was found either on the capture of neurotransmitters or on the activity of MAO (mianserin, etc.).

A common property of all antidepressants is their thymoleptic effect, that is, a positive effect on the affective sphere of the patient, accompanied by an improvement in mood and general mental state. Different antidepressants differ, however, in the amount of pharmacological properties. So, in imipramine and some other antidepressants, the thymoleptic effect is combined with a stimulating one, while in amitriptyline, pipofezin, fluacizine, clomipramine, trimipramine, doxepin, a sedative component is more pronounced. In maprotiline, the antidepressant effect is combined with anxiolytic and sedative. MAO inhibitors (nialamide, eprobemide) have stimulating properties. Pirlindol, removing the symptoms of depression, exhibits nootropic activity, improves “cognitive” (“cognitive”) functions of the central nervous system.

Antidepressants have found application not only in psychiatric practice, but also for the treatment of a number of neurovegetative and somatic diseases, chronic pain syndromes, etc.

The therapeutic effect of antidepressants, both oral and parenteral, develops gradually and usually manifests itself after 3–10 or more days after the start of treatment. This is explained by the fact that the development of the antidepressant effect is associated both with the accumulation of neurotransmitters in the region of nerve endings, and with slowly appearing adaptive changes in the circulation of neurotransmitters and in the sensitivity of brain receptors to them.

From Mania to Depression: Understanding Bipolar Disorder

A certain role in the occurrence of the disease is played by heredity, stressful events. A side effect of some medications can also appear as a similar condition.