Selective Serotonin Reuptake Inhibitors, also known as SSRI’s, are the most popularly prescribed medications to treat depression and anxiety. They include Prozac, Paxil, Celexa, Lexapro, Zoloft, Luvox, and Viibryd. These medications are effective at alleviating many of the symptoms that accompany depressive and anxiety disorders, such as hopelessness, sadness, excessive nervousness, fear, insomnia, inner feelings of restlessness, and obsessive or ruminative thoughts. Doctors might recommend that a patient first address their mood disorder with psychotherapy (talk therapy) or other behavioral modifications such as meditation or exercise. When symptoms are overwhelming or not alleviated with other therapies, physicians are likely to recommend an SSRI. Occasionally, doctors might use SSRI’s as a first line treatment when symptoms are overwhelming, accompanied by thoughts of suicide, and/or negatively impacting everyday functioning.
With the exception of Viibryd, SSRI’s work by blocking a receptor in the brain that absorbs the chemical serotonin. In addition to blocking the reuptake of serotonin, Viibryd also works as a partial agonist, or mimic, at a certain kind of serotonin receptor. Serotonin is produced in neurons, the cells that make up the brain. It functions as a neurotransmitter, a chemical that nerve cells use to communicate with one another. Serotonin is thought to mediate mood balance and feelings of well being. Normally, once serotonin is released by a neuron, it is quickly metabolized and is no longer active. SSRI’s block this process, allowing the brain cells prolonged exposure to the chemical. We believe that when the nerves have greater exposure to serotonin, mood, outlook and even behavior can improve.
Many people worry that if they take an SSRI, the medication will interfere or change their personality. This is not true. The medications are effective at alleviating negative emotions, but they do not transform character. Ideally, SSRI’s help people feel more like themselves, and be less burdened by their severe depression and anxiety. When dosed correctly, patients still experience their normal thoughts and cognitions, as well as a full range of emotion and affect. However, the medication will prevent severe mood swings that reach clinical proportions. If you are prescribed an SSRI and feel “drugged” or not like yourself, it is important to speak to your doctor. This is not the intention of treatment and may mean the medication and/or dosage needs to be adjusted.
Most people wonder when, after starting an SSRI, will they begin to feel better. Unfortunately, there is no exact answer. Improvement time is variable according to each individual, and is dependent on metabolism, genetics, and other uncertain factors. Some will experience positive effects almost immediately. Alternatively, it could take up to six weeks to feel your mood lift. The typical pattern is to feel some improvement over the first couple of weeks, with the full treatment effect realized after six to eight weeks. If you haven’t noticed even a hint of improvement after two to three weeks, your doctor might choose to increase your dosage. It is essential that you have periodic office visits with your doctor to assess the effects of the medication, as further adjustment may be needed over the course of treatment.
Although SSRI’s are generally well tolerated, no medications are without side effects. Some patients might experience adverse effects immediately. These are a harbinger that the medication is being absorbed by your system, and typically wane over the first two weeks. Early side effects include mild stomach upset, mostly characterized by loose bowel movements, headaches, and/or lightheadedness. These symptoms are more of a nuisance and rarely interfere with your usual function. Over time, patients might feel tired after taking SSRI’s, while others experience greater amounts of energy. These side effects are mitigated by taking the medication at bedtime or upon awakening, respectively. If you are having more severe and/or sustained side effects, notify your doctor immediately.
Sexual side effects are a common concern for those prescribed SSRI’s. This is not everyone’s experience. paradoxically, there are some individuals in which depression and anxiety reduce libido, and SSRI’s actually help restore their sex drive. However, studies show that sexual side effects do occur in up to 20-45% of individuals. The most common symptom is difficulty achieving orgasm. If this occurs, make sure to tell your doctor. Often times a second medication can be prescribed to counteract these effects and restore a normal sex life.
An additional concern for those taking SSRIs is weight gain. It is estimated that about 12% of individuals experience some weight gain. The amount of weight gain depends on the specific agent prescribed as well as the duration of treatment. Prozac (Fluoextine) has the lowest rate of weight gain, while Paxil (Paroxetine) may be the most problematic. It is unclear if patients gain weight secondary to improved appetite or some physical effect of the drug. Most will not experience weight gain immediately, but may over a length of time. Rarely do people gain large amounts of weight from the medication alone. If you have any questions or concerns about weight, do discuss these with your doctor Together you can establish a method to monitor and address any changes in your body.
A common misperception about SSRI’s is that they are addictive. Patients do not experience cravings for these drugs, nor do they produce a high or euphoria. They do not produce tolerance. However, if you are taking an SSRI and suddenly discontinue it, some will experience negative physical and emotional symptoms. These symptoms are uncomfortable, but are not physically dangerous. The effects include flu like symptoms, disturbances in sleep, thinking, and mood. If left untreated, symptoms will disappear over time. However, they can be alleviated by restarting the medication. By slowly tapering an SSRI, a discontinuation syndrome can be avoided or greatly reduced.
A final concern that many patients taking SSRI’s have is the fear that they will be on medication forever. This is not the case. In fact, the American Psychiatric Association recommends a six month course after symptoms remit. In patients that have experienced a previous Major Depressive Episode, it is recommended to continue an SSRI for two years. However, these are only guidelines. You and your doctor might decide to treat longer than this period or discontinue earlier according to the specific clinical circumstance. Regardless, it is reassuring to know that these medications have a proven safety and efficacy profile, and can be extremely effective in the treatment of moderate to severe depressive and anxiety conditions.
SSRI’s are medications used to treat moderate to severe depression and anxiety. They can help eliminate feelings of severe anxiety, sadness, obsessive and compulsive thoughts, insomnia, agitation, and hopelessness. This group of medications is very well tolerated, but they are not without side effects. Many adverse effects are manageable and may taper off after the first few weeks of taking the medication. People starting an SSRI often fear it will change their personality, or that they will be taking the medications for the rest of their life. Neither of these statements is true. When taken effectively, SSRI’s help alleviate pathological mood states, but do not alter ones character whatsoever. You and your doctor can decide to stop an SSRI at any time, although the guidelines recommend continuing for several months or even up to two years if one has experienced a previous relapse. When discontinuing the medications, it is important to taper slowly to avoid a discontinuation syndrome.