Selective serotonin reuptake inhibitors (SSRIs) for depression
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SSRIs are newer (second-generation) antidepressants that generally have fewer side effects than older (first-generation) antidepressants such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs). Other second-generation antidepressants include bupropion (Wellbutrin, Wellbutrin SR) and duloxetine (Cymbalta).
How It Works
Symptoms of depression result when certain brain chemicals (neurotransmitters) get out of balance. Selective serotonin reuptake inhibitors (SSRIs) help symptoms of depression by increasing the amount of serotonin available.
Why It Is Used
SSRIs work as well for depression as other types of antidepressants, such as tricyclic antidepressants, but they have different and often less severe side effects.
How Well It Works
SSRIs relieve depression in most people who take them. They have become one of the first medicines used for depression because they work and have few side effects.
SSRIs also may help with anxiety and anxiety disorders.
Side effects of selective serotonin reuptake inhibitors include:
- Feeling sick to your stomach, not having an appetite, or having diarrhea.
- Feeling anxious or grouchy.
- Problems sleeping or drowsiness.
- Loss of sexual desire or ability.
- Headaches or dizziness.
- Weight gain.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:
- An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
- A warning about taking triptans, used for headaches, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.
What To Think About
Antidepressant medicines work in different ways. No antidepressant works better than another, but different ones work better or worse for different people. The side effects of antidepressant medicines are different and may lead you to chose one instead of another. Tell your doctor about side effects.
You may have to try different medicines or take more than one to help your symptoms. Most people find a medicine that works within a few tries. Other people take longer to find the right one and may need to take the antidepressant and another type of medicine.
Take your antidepressant as your doctor says. Don't quit taking your medicines without talking to your doctor. If you quit suddenly, it can cause dizziness, anxiety, fatigue, and headache. If you and your doctor decide you can quit using medicine, gradually reduce the dose over several weeks.
You may start to feel better within 1 to 3 weeks of taking SSRIs. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.
SSRIs may be safer than tricyclic antidepressants because they do not cause death if taken in large quantities (overdose).
Sexual problems can be an important side effect. Other antidepressants such as bupropion (Wellbutrin) may be less likely to cause sexual problems and may be used instead of, or in addition to, an SSRI. Using a medicine such as sildenafil (Viagra) may help with sexual problems caused by SSRIs in both men and women.1, 2
SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.4
Taking medicines for depression during pregnancy may make birth defects more likely. If you are pregnant or thinking of becoming pregnant, talk to your doctor. Medicines may need to be continued if your depression is severe. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.
These medicines must be used very carefully in those who have bipolar disorder because they may trigger a manic episode. If you have bipolar disorder, your doctor may prescribe them, along with a mood stabilizer.
Never suddenly stop taking antidepressants. If you decide to stop taking your antidepressant, you will need to lower your dose slowly, with your doctor's help. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse into another depressive episode.
- Nurnberg HG, et al. (2003). Treatment of antidepressant-associated sexual dysfunction with sildenafil. JAMA, 289(1): 56–64.
- Nurnberg GH, et al. (2008). Sildenafil treatment of women with antidepressant-associated sexual dysfunction: A randomized controlled trial. JAMA, 300(4): 395–404.
- Richards JB, et al. (2007). Effect of selective serotonin reuptake inhibitors on the risk of fracture. Archives of Internal Medicine, 167(2): 188–194.
- Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.
Last Updated: March 13, 2009