Selective serotonin reuptake inhibitors (SSRIs) are a class of medications that work by decreasing the reuptake or reabsorption of serotonin, increasing the neurotransmitter’s concentration in the brain.1 SSRI medications are first-line treatments for multiple diseases, including depression, anxiety, bulimia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and several others.1
What Are SSRIs?
SSRIs are commonly used as an anxiety medication or medication for depression by increasing the amount of serotonin available in your brain.1 They are often the first option for medication treatment for anxiety, depression, and many other mood disorders. However, patients should always use them as part of a multimodal treatment plan that includes psychotherapy to utilize the benefits of medications more effectively.
What Do SSRIs Treat?
SSRI medications treat various disease processes independently or in conjunction with other medications. Prescribers may use them to treat depression, anxiety, PTSD, OCD, and bulimia. There are other uses for SSRI medications as well as they can affect everyone differently. Therefore, asking your provider if SSRI medications are a good option for you is essential.
Conditions often prescribed SSRIs for treatment include:
Off-Label Uses for SSRIs
Off-label means the FDA does not approve a medication for that specific disorder. However, prescribers may prescribe these outside of their approved indications if they believe that they may help a patient’s condition.
Some off-label uses for SSRIs can include:
How Do SSRIs Work?
SSRI medications work through two main mechanisms. Similar to how other antidepressants make you feel, SSRIs work by increasing serotonin in the brain by stopping its reuptake into cell membranes to bind to receptors continually. However, a proposed symbiotic mechanism is that SSRI medications increase the functioning of the serotonin receptor in certain areas while downregulating it in others. This variance is why SSRI medications can take weeks to months to work for some making it essential to taper dosing as it can be difficult to predict what side effects someone may experience.4
SNRIs vs. SSRIs
SSRIs and SNRIs are two different antidepressant medications that are often confused. Their mechanisms of action are similar, but they act on different neurotransmitters, giving them unique effects on our cognition. While SNRI medication increases the amount of serotonin in the brain, similar to SSRI medications, they also increase the amount of norepinephrine in the brain.5 Because they increase the amount of norepinephrine, prescribers should use them with caution with patients with increased blood pressure and heart rate.5 It is essential to discuss with your provider which antidepressant is a better option for you.
How Long Does It Take for SSRIs to Work?
As your brain adjusts to the effects of SSRI medications and the increased supply of serotonin in the brain, some patients may not feel the impact of their SSRI medications for at least six weeks. Similar to how long other antidepressants and anxiety medications take to work, it may take a few months to see the medication effects, and they will need to stay consistent with their medication regimen.2
However, patients can also expect common side effects such as nausea/vomiting earlier in treatment. If patients can tolerate their SSRI medications for six weeks, their dosage can potentially be increased if there is no decrease in mood disorder symptoms.2 It is advised that patients seek consistent treatment with a therapist while starting SSRI medications.
Common SSRI Drugs
SSRI medications come in many different types. While they are all in the same class of drugs, some providers may choose one over the other. Prozac is the oldest and most well-researched SSRI medication.4 There are many reasons providers may choose one SSRI over another. It can be helpful to understand why a doctor may choose one SSRI over another and why it is a better option for you.
Here is a list of the most commonly prescribed SSRI medications:4
- sertraline (Zoloft)*
- citalopram (Celexa)*
- paroxetine (Paxil)*
- escitalopram (Lexapro)*
- fluoxetine (Prozac)*
*These medications have a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.
SSRI Side Effects
Disclaimer: Taking certain medications, herbs, or supplements alongside SSRIs can change how SSRIs work in your body or increase the risk for serious side effects. This article does not consider all the possible side effects and interactions. Let your doctor, psychiatrists, and pharmacists know about your current products, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval, as you may experience antidepressant discontinuation syndrome if you do not taper your dosages appropriately.
SSRI medications are generally well-tolerated compared to other antidepressants. Still, patients that start SSRI medications may experience nausea and vomiting in the beginning weeks.3 SSRI users list sexual dysfunction as one of the biggest concerns of SSRI side effects.3 Patients must discuss any history of arrhythmias or heart disease with their provider before starting medications due to SSRI’s impact on the heart.3
Side effects of SSRIs may include:
- QT prolongation (arrhythmias)
- Sexual dysfunction
Warnings & Associated Risks of Taking SSRIs
Medications belonging to the SSRI drug class have a black box warning, the most severe kind of warning from the FDA, for the risk of suicidal thoughts and behaviors in certain people. All patients taking SSRIs under 25 for their depression, anxiety, or other mood disorders should know their increased risk of suicidal ideation. Young patients taking SSRIs should seek careful monitoring from medical professionals when experiencing suicidal thoughts.2 It is also recommended that patients with a cardiac history be monitored closely for arrhythmias while taking SSRI medications.
While rare, serotonin syndrome is a potentially severe condition associated with SSRIs. Serotonin syndrome happens when there’s too much serotonin in the brain. The risk for serotonin syndrome is low if patients use SSRI medications alone. However, they are at increased risk if they take other medications that also increase serotonin. It is essential to discuss your medical history and current medications to decide if SSRI medications are a good option for you.
Symptoms of serotonin syndrome include:2
- Increased agitation
- Abnormal heart rate
- High blood pressure
Risks In Children
Children may be prescribed SSRI medications for similar reasons to adults. SSRIs can be used as medications for OCD, anxiety, and depression in children. All SSRI medications come with a black box of increased suicidal ideation when starting SSRI medications. Children, teenagers, and young adults must be closely monitored when they begin taking SSRI medication as they have a higher risk of suicide while taking SSRIs.
Risks In Pregnant & Breastfeeding Women
Breastfeeding patients can take SSRIs as antidepressants and anxiety medication without the risk of passing the active chemicals to their babies. The preferred SSRIs for breastfeeding women for not affecting the child’s development are sertraline and paroxetine.6
Risks of Alcohol & SSRIs
Patients with Major Depressive Disorder have a higher rate of alcoholism and substance use disorder. While drinking alcohol while taking SSRI medications is okay in moderation, patients should be monitored for risk of drowsiness or further development of addiction. It may be helpful to understand similar interaction effects of anti-anxiety medication like Xanax and alcohol together. Discuss with your provider if you are concerned about your alcohol use while taking SSRIs
How to Know Which SSRI Medication Is Right For You
Providers have multiple options when deciding which SSRI may be best for a patient. If you have had a favorable response to a previous SSRI, it may be beneficial to try the same SSRI again if restarting treatment. Similarly, if you have had unfavorable side effects from the prior SSRI, you must tell your provider. Patients may start one SSRI, decide it is not beneficial to them, and switch to another. It is essential to have shared decision-making with your provider about which SSRI may be best for you.
Questions to Ask Your Health Team About Taking SSRIs
Starting a medication can seem frightening, and you should have all the information you need before initiation. You must know the dosage and frequency of the drug that you are taking. Similarly, you should know common side effects and how to manage them if you face them. Ask your provider what signs of toxicity to watch for and who to contact if the need arises.
Questions to ask your care team before taking SSRIs include:
- Will using an SSRI make my depression go away?
- What dosage of medication should I take for my age, size, and gender?
- What common side effects can I expect to experience taking this SSRI?
- What are signs of toxicity, and who should I contact if they arise?
- How can I use SSRIs as part of my already established anxiety treatment?
- How soon should I expect results?
- Are there SSRIs that might be helpful with treatment-resistant depression?
- What are the best online psychiatry groups to help me get prescription SSRIs?
- How often should I see you for checkups while taking SSRIs as part of my treatment?
What are some online therapy options with my insurance that I can pair with my SSRI medication treatment?
SSRIs can be extremely helpful in reducing symptoms of depression and anxiety. Still, with any antidepressant or psychopharmaceutical, discussing potential side effects with your care team and whether it’s the proper medication for you is essential. If used correctly, SSRIs are an excellent treatment combination with additional psychotherapy. Remember to take your medication consistently and as prescribed and to speak with your doctor before you stop taking your medication.
For Further Reading
- NIMH » Depression (nih.gov)
- Depression | MentalHealth.gov
- Selective Serotonin Reuptake Inhibitors (SSRIs) Information | FDA
- Cerebral Review 2022
- Hers Mental Health Review 2022
- 10 Best Depression Podcasts
- 10 Eye-Opening & Inspiring Movies About Depression
- 15 Best Depression Blogs
- 21 Books on Depression: Helpful Resources for When You Feel Depressed
- 14 Best Anxiety Podcasts
- 14 Best Books for Social Anxiety
- 15 Best Anxiety Blogs
- 15 YouTube Channels for Anxiety
- How to Get Antidepressants: Everything You Need to Know
- How to Get Anxiety Medication: Everything You Need to Know