They’re also more accessible and cost-effective than other treatment options for depression, says James Rachal, MD, a psychiatrist and senior academic chairman of the department of psychiatry at Atrium Health in Charlotte, North Carolina.
The other FDA-approved SSRIs are:
Citalopram (Celexa)Escitalopram (Lexapro)Paroxetine (Paxil)Sertraline (Zoloft)
That said, not all weight gain is necessarily caused by the SSRI itself. For example, some people with severe depression may have lost weight before treatment due to loss of appetite, a common symptom of depression, Carroll explains. But once the treatment helps their appetite return to normal, they may gain that weight back later on.
Rare Side Effects of SSRIs
SSRI Withdrawal and Discontinuation Syndrome
Symptoms include:
AnxietyDizzinessFlu-like symptomsHeadacheIrritabilityLethargyNauseaReturn of depressive symptomsSensations resembling electric shocksVivid dreams or insomnia
Antidepressant discontinuation syndrome can usually be avoided by reducing your dose gradually (also known as tapering) to allow your body to adjust. For instance, Carroll says that when he prescribes SSRIs to patients experiencing their first episode of depression, he periodically checks to see how they’re adjusting to the medication and whether they’re experiencing any uncomfortable side effects. Once the patient is stabilized — meaning their depressive symptoms have receded — he generally advises they continue taking the SSRI for at least another six months. If someone’s depressive symptoms return after their first round of treatment ended, both Carroll and Rachal recommend their patients take an SSRI daily for at least one year. In general, says Carroll, people who can function normally and don’t have suicidal thoughts or behaviors can eventually taper off SSRIs, or gradually stop taking them under the supervision of their doctor. However, Rachal adds, “There are some people who will experience multiple episodes of depression or persistent symptoms without remission, and for them, we recommend staying on the SSRI indefinitely.” Thus, the effectiveness of SSRIs is most often measured on an individual basis based on improvements in one’s depression compared with any side effects one experiences, Carroll explains. This helps you and your doctor determine whether an SSRI is the best treatment option for you.
Aspirin, warfarin, blood thinners, and other medications that increase risk of bleeding, because SSRIs have been linked to an increased risk of bleeding.Medications or supplements that contain serotonin, such as St. John’s wort. If you take too many substances containing serotonin, you may develop a rare but serious medical emergency called serotonin syndrome, evidenced by symptoms like fast heartbeat, significant changes in blood pressure, high fever, sweating, and confusion, among others. This can occur in people taking more than one antidepressant or certain headache or pain medications such as triptans.
As always, if you are prescribed an SSRI, be sure to tell your doctor about any other supplements or medications you’re taking and before taking any new ones. In some cases, SSRIs can also be prescribed off-label to treat premature ejaculation, say Rachal and Carroll. The decision to continue or discontinue an SSRI while pregnant largely depend on one’s functioning, says Carroll. For instance, he explains, if one of his patients is taking a low-dose SSRI for mild depression and considering becoming pregnant, he says he’d likely help that patient safely taper off the medication. “If you’re not suicidal and you are functional, less substances in your system throughout pregnancy is better,” Carroll says. But for someone with moderate to severe depression, it may be safer to continue taking an antidepressant. “Some studies have shown untreated depression and anxiety during pregnancy can also have effects on the development of the baby while in the womb, as well as effects on mother-baby bonding after the child is born,” explains Rachal. “So, it is important to weigh the risk and benefit of any medication with your healthcare provider.”
