SSRIs and Depression

Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that affect serotonin levels in the brain. Serotonin is a chemical neurotransmitter. For many people, SSRIs are the first choice of depression selected by health care professionals for the treatment of depression or anxiety. Specific forms of depression that have been found to be effectively managed by SSRIs include severe major depression, the chronic melancholy of dysthymia, sadness that occurs during specific seasons (seasonal affective disorder), and that which primarily affects women after delivery of a child (postpartum depression). Forms of anxiety that have been found to be successfully addressed by SSRIs include the multiple worries of generalized anxiety disorder, the debilitating attacks of anxiety associated with panic disorder, the intrusive thoughts or compulsive acts of obsessive compulsive disorder, and the anxiety resulting from traumatic experiences (posttraumatic stress disorder).

Statistics indicate that SSRIs and other antidepressants have been prescribed more often over the last several years. In the United Kingdom, the frequency of antidepressant use increased by 10% every year from 1998 through 2010. In the United States, the use of these medications is about three times that in some other Western countries.

SSRIs, which are medications available only by prescription, may be used to treat depression. If a person's symptoms indicate that he or she has depression, a health care professional will strongly recommend treatment. Treatment may include supportive therapy, such as changes in lifestyle and behavior, psychotherapy, and complementary therapies, but it usually includes medication. Without treatment, depression symptoms may become worse or last much longer, making recovery difficult. With treatment, the chances of recovery from depression are very good.

Commonly prescribed SSRIs include the following:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Escitalopram (Lexapro)
• Fluvoxamine (Luvox)
• Citalopram (Celexa)
• Volazodone (Viibrid)
• Vortioxetine (Brintellix)

SSRIs are available as tablets, capsules, or oral solution.

The antidepressant action of SSRIs is not completely understood but is possibly due to the ability of SSRIs to block the uptake of serotonin, thereby providing higher levels of serotonin at the brain receptor site.

• Individuals who are allergic to SSRIs
• Individuals who are currently taking, or have taken within the past two weeks, thioridazine (Mellaril), pimozide (Orap), or monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) and tranylcypromine (Parnate). (Do not take MAOIs or thioridazine for at least five weeks after stopping SSRIs.)

• Individuals with bipolar disorder (manic depression) since SSRIs may induce manic episodes
• Children and adolescents with depression seem to experience the rare potential side effect of experiencing an acute (suddenly and severely) worsening of depression compared to adults. That can potentially result in suicidal or homicidal thoughts, plans, or acts. Despite this rare occurrence, the benefits of using SSRIs to treat child and adolescent depression has been found to outweigh the risks.

Tell the doctor what medications are currently being taken because many medicines interact with SSRIs. Do not take any nonprescription or herbal medications without first consulting a doctor or pharmacist. The following are facts about some examples of interactions between SSRIs and other drugs, but they do not represent a complete list.

• When an SSRI is administered with 5-HT1 agonists, such as sumatriptan or zolmitriptan, weakness and incoordination, although rare, have been reported.
• SSRIs may increase the blood levels and risk of toxicity of certain medications, including the following:
  • Highly protein-bound medicines such as warfarin (Coumadin) and digoxin
  • Antiarrhythmic medicines such as propafenone (Rythmol) or flecainide (Tambocor)
  • Beta-blockers such as propranolol (Inderal) or metoprolol (Lopressor, Toprol XL)
  • Tricyclic antidepressants such as amitriptyline (Elavil) (may increase risk for serotonin syndrome -- symptoms include hypertension, fever, muscle tremor, or confusion)
  • Benzodiazepines such as alprazolam (Xanax), diazepam (Valium), midazolam (Versed), or triazolam (Halcion)
  • Carbamazepine (Tegretol)
  • Cisapride (Propulsid)
  • Clozapine (Clozaril)
  • Cyclosporine (Neoral, Sandimmune)
  • Haloperidol (Haldol)
  • Thioridazine (Mellaril)
  • Phenytoin (Dilantin)
  • Pimozide (Orap)
  • Theophylline (TheoDur, TheoBid)
• The following substances may increase the toxicity of SSRIs:
  • Alcohol or other drugs that depress the central nervous system
  • Diuretics (water pills)
  • MAOIs (may cause serious, and sometimes fatal, reactions)
  • St. John's wort
  • Sympathomimetics such as pseudoephedrine (Sudafed)
  • Lithium
  • Sibutramine (Meridia)
  • Zolpidem (Ambien)
  • Grapefruits

SSRIs may cause the following side effects:

• Withdrawal-like symptoms in newborns (Women who take SSRIs in late pregnancy [third trimester] may have newborns who require prolonged hospitalization due to withdrawal-like symptoms such as shortness of breath, constant crying, feeding difficulty, or low blood sugar levels.)
• Photosensitivity (increased risk of sunburn) (Use protective clothing, such as long sleeves and hats, and sunscreen to decrease the risk of sunburn.)
• Rash
• Low blood sodium levels (in people who are dehydrated or taking diuretics)
• Low blood sugar levels
• Drowsiness (Caution is advised when operating machinery, driving, or performing other tasks requiring alertness.)
• Kidney or liver impairment (A doctor may check to see if any kidney or liver impairment exists before prescribing SSRIs.)

U.S. Food and Drug Administration (FDA)
5600 Fishers Lane
Rockville, MD 20857-0001
888-INFO-FDA (463-6332)

National Institute of Mental Health (NIMH)
Office of Communications
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
866-615-6464