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SSRI Antidepressant Medications: Adverse Effects and Tolerability PMC

Previous studies provide conflicting evidence about potential links between the use of SSRIs during pregnancy and certain birth defects. Serotonin syndrome is a life-threatening consequence of increased serotonergic activity. It can result from overdosing on SSRIs or from combining multiple medications that increase serotonin levels. Serotonin syndrome is characterized by mental status changes, autonomic dysfunction, and dystonias. Findings may include agitation, tachycardia, hypertension, hyperthermia, hyperreflexia, tremor, nausea, vomiting, and clonus.Serotonin syndrome may present similarly to neuroleptic malignant syndrome and malignant hyperthermia. This is especially important to keep in mind since commonly prescribed psychiatric medications can cause both serotonin syndrome and neuroleptic malignant syndrome.

Taking monoamine oxidase inhibitors in combination with SSRIs can be fatal, since MAOIs disrupt monoamine oxidase, an enzyme which is needed to break down serotonin and other neurotransmitters. Without monoamine oxidase, the body is unable to eliminate excess neurotransmitters, allowing them to build up to dangerous levels. The prognosis for recovery in a hospital setting is generally good if serotonin syndrome is correctly identified. Treatment consists of discontinuing any serotonergic drugs and providing supportive care to manage agitation and hyperthermia, usually with benzodiazepines.

What are the differences between SSRIs and SNRIs?

Peripheral inflammation can induce an inflammatory response in microglia and can cause neuroinflammation. SSRIs inhibit proinflammatory cytokine production which leads to less activation of microglia and peripheral macrophages. SSRIs not only inhibit the production of these proinflammatory cytokines, they also have been shown to upregulate anti-inflammatory cytokines such as IL-10.

What is the most commonly used SSRI?

Sertraline hydrochloride, used for multiple mental health and mood disorders, is the most prescribed antidepressant on the list with more than 18 million prescriptions in 2021.

Easily compare tier status for drugs in the same class when considering an alternative drug for your patient. Topics are richly illustrated with more than 40,000 clinical photos, videos, diagrams, and radiographic images. Medscape’s clinical reference is the most authoritative and accessible point-of-care medical reference for physicians and healthcare professionals, available online and via all major mobile devices.


Getting Plenty of Sleep Sleep affects our mood, especially those suffering from severe depression. Unfortunately, depression can make getting sleep more difficult, but things like avoiding distractions in the bedroom — TV, computer, phone, etc. — along with eating healthy and exercising regularly can improve sleep patterns. samhsas national helpline Eating Healthy Some studies show that a diet rich in “superfoods” such as tomatoes , seafood (salmon and tuna contain omega-3 fatty acids) and spinach and avocados can naturally ease symptoms of depression. The most common alternative is therapy, which helps a person cope with feelings of hopelessness or anxiety.

ssri drugs

Craniosynostosis, where one or more fibrous joints in an infant’s skull fuse together, has been linked to Prozac. In severe cases, patients will have a collection of symptoms called SSRI Discontinuation syndrome, which can last up to several weeks. The goal is to ease or eliminate the symptoms within the first few weeks to months. Treatment duration depends on several factors, including the severity of the symptoms and how well each individual responds to treatments. SSRIs work by increasing the levels of a brain chemical called serotonin, which plays a key role in mood. The body naturally produces serotonin and keeps it at a certain level, but SSRIs can increase that level by blocking the re-absorption of serotonin.

Weight Gain

Effective treatment options are available that can help dramatically improve your quality of life. Selective serotonin reuptake inhibitors can affect patients in different ways. Some people put on weight while taking their medication; some lose their appetite or lose weight instead.

The National Institute for Health and Care Excellence places the excess risk in the “early stages of treatment”. A 2014 Cochrane review found that at six to nine months, suicidal ideation remained higher in children treated with antidepressants compared to those treated with psychological therapy. In 2004, the FDA issued a black box warning for SSRIs and other antidepressant medications due to a possible increased risk of suicidality among pediatric and young adult populations. The risk and benefits of initiating SSRI therapy on acutely suicidal patients must be weighed, keeping in mind that depression itself is a large risk factor for suicidality and requires treatment. Common side effects from SSRIs include sexual dysfunction, sleep disturbances, weight changes, anxiety, dizziness, xerostomia, headache, and gastrointestinal distress. Selective serotonin reuptake inhibitors are a class of medications most commonly prescribed to treat depression.

What happens the first week of SSRI?

Signs and symptoms such as nausea, weight gain or sleep problems can be common initially. For many people, these improve within weeks of starting an antidepressant. In some cases, however, antidepressants cause side effects that don't go away.

SSRIs may increase the risk of certain fetal developmental issues, especially heart and lung problems. 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.

This switch might happen even with no prior manic episodes and might therefore not be foreseen by the psychiatrist. A 2006 meta-analysis of random controlled trials suggests that SSRIs increase suicide ideation compared with placebo. However, the observational studies suggest that SSRIs did not increase suicide risk more than older antidepressants. The researchers stated that if SSRIs increase suicide risk in some patients, the number of additional deaths is very small because ecological studies have generally found that suicide mortality has declined as SSRI use has increased.

Prescribing SSRIs: What they help treat

Other SSRIs were soon introduced in the United States and elsewhere . The most common antidepressants are called selective serotonin reuptake inhibitors . They’re considered relatively safe and cause fewer side effects than other kinds of medications used to treat depression. Another study found no increase in cardiovascular birth defects and a 27% increased risk of major malformations in SSRI exposed pregnancies. Many women need to take medication during pregnancy to appropriately manage their symptoms. If you are pregnant or thinking about becoming pregnant, talk with your doctor about any medications you are taking or thinking about taking.

  • We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles.
  • SSRIs not only inhibit the production of these proinflammatory cytokines, they also have been shown to upregulate anti-inflammatory cytokines such as IL-10.
  • Efficacy has been demonstrated both in short-term treatment trials of 6 to 24 weeks and in discontinuation trials of 28 to 52 weeks duration.
  • They are among the most commonly prescribed psychiatric drugs in the country, with nearly 13% of adults in the United States taking at least one dose in the last 30 days.
  • In overdose, fluoxetine has been reported to cause sinus tachycardia, myocardial infarction, junctional rhythms and trigeminy.

Avoiding alcohol and caffeine can be beneficial, as can seeking out psychotherapy or psychiatric support groups. Paroxetine is contraindicated in pregnancy and is classified as category D/X due to its teratogenic effects in causing cardiovascular defects, specifically cardiac malformations if prescribed in the first trimester. The popularity and widespread use of SSRIs is due in part to their relatively fewer side effects than prior commonly used antidepressants such as TCAs and MAOIs. SSRIs have little or no effect on dopamine, norepinephrine, histamine, or acetylcholine . This characteristic leads to fewer complaints of side effects such as xerostomia, sedation, constipation, urinary retention, and cognitive impairments. If your doctor prescribes Lexapro for your depression or anxiety, the drug may cause side effects.

Taken together, this reduces the overall inflammatory immune response. There are a number of potential pharmacokinetic interactions between the various individual SSRIs and other medications. Most of these arise from the fact that every SSRI has the ability to inhibit certain P450 cytochromes. Poisoning is also can i drink alcohol with diabetes known in animals, and some toxicity information is available for veterinary treatment. While trazodone is a notorious cause of priapism, cases of priapism have also been reported with certain SSRIs (e.g. fluoxetine, citalopram). Several studies have suggested that SSRIs may adversely affect semen quality.

Neurons, which are cells in the brain, send messages to one another using neurotransmitters. Keep people safe from potentially harmful drugs, medical devices and procedures by informing them of medical conditions, severe side effects and ways to take action. Tricyclic antidepressants are an older class of antidepressants, having been available for more than 50 years.

Neurotransmitters are chemicals brain cells use to communicate with each other. The CDC notes that regular physical activity can reduce a person’s risk of depression. People may wish to try three exercise sessions per week for 12–24 weeks.

ssri drugs

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.

However, they are less likely to cause sexual dysfunction, according to 2010 research. For example, if a person combined an MAOI with an SSRI, it could lead to serotonin syndrome. Serotonin syndrome is a serious condition in which a person has too much serotonin in their can i drink alcohol during pregnancy body. Due to their adverse side effects and drug-drug interactions, doctors do not typically suggest MAOIs as a first-line treatment option for depression. Doctors may also use these drugs on an off-label basis to treat other conditions, such as sleep disorders.

Selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors are two different types of antidepressants. SSRIs increase serotonin levels in the brain, while SNRIs increase both serotonin and norepinephrine levels. SSRIs are usually the first choice for doctors treating depression or anxiety with prescription medications, but they’re not for everyone. It is normal to feel sad or “down” in the wake of stressful life events such as the death of a loved one, a job loss or a divorce. Patients may be candidates for antidepressants if they aren’t functioning well, if the symptoms last for several weeks without getting better, or if there is no apparent reason for the symptoms.

How can I increase serotonin naturally?

  1. Adjust your diet.
  2. Get more exercise.
  3. Bring in the bright light.
  4. Take certain supplements.
  5. Try massage therapy.
  6. Try mood induction.
  7. Manage emotions and stress levels.
  8. Think about sleep deprivation.

Also, observed side effects reported for a single drug may vary considerably depending on the psychiatric condition studied. These adverse events may, in turn, be summarized without addressing which side effects are condition specific. The calculated rate of occurrence for drug-related side effects could be inappropriate for a specific disorder. For example, headache is reported more often with SSRI therapy in patients receiving treatment for obsessive-compulsive disorder than for depression. However, this must be interpreted with the knowledge that the baseline prevalence of headache is higher in patients with obsessive-compulsive disorder than in those with depression.

Another serious concern for SSRI patients is whether they will suffer withdrawal symptoms when they stop taking the antidepressants. This condition is a drop in a person’s sodium levels, which can lead to the accumulation of fluid in cells and is dangerous. Elderly people especially should be monitored for this condition from the beginning of treatment. K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.