Is it safe to go on antidepressant SSRIs?

by | Mar 19, 2023 | Medicine, Mental health

Are SSRI antidepressants safe?

SSRIs have increasingly come into question over recent years due to some opinions about their side effects, safety and efficacy in treating depression. That said, SSRIs are generally considered a safe, well researched and effective treatment for depression and some forms of anxiety, such as OCD and panic attacks.

This article details everything you need to know about SSRIs, including alternative available medicines.

It is always wise to research and understand the potential side effects of any medication before taking it and it’s no different with SSRIs.

What are SSRIs?

Selective serotonin reuptake inhibitors (SSRIs), are a form of antidepressant prescribed to ease symptoms of depression and other mental illnesses. Taking SSRIs can help to positively increase your response to other forms of treatment, such as Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT). Examples of SSRIs include citalopram (Cipramil), fluvoxamine (Faverin) and sertraline (Lustral).

How do SSRIs work?

SSRI’s enhance the function of nerve cells that are responsible for your emotions by targeting the mind’s serotonin reuptake inhibitors. Serotonin is the body’s and mind’s natural mood stabiliser, responsible for sending signals between your nerve cells and regulating your mood and sleep cycle.

These types of antidepressants are often prescribed jointly with Cognitive Behavioural Therapy (CBT) to treat depression, generalised anxiety disorder (GAD) , obsessive-compulsive disorder (OCD), panic disorders and post-traumatic stress disorder (PTSD).

Common SSRIs that your doctor may prescribe are Fluoxetine and Sertraline oral capsules. Other SSRIs include Citalopram, Escitalopram, Fluvoxamine, Paroxetine and Vilazodone. 

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Are SSRIs effective in treating depression

Thousands of clinical trials assessing the effect of SSRIs on depression have been conducted over the years with a meta analysis of these trials concluding that antidepressants are 20-30% more effective than placebo at treating depression.*

Greatest efficacy may be seen with severe depression as opposed to mild depression, studies have also shown.*

Regardless, with thousands of random controlled trials indicating a positive effect on depression of SSRIs and millions of patients indicating they benefit from taking antidepressants, there is sound evidence that they are effective in managing depression.

What about any alternatives to SSRIs

There are a range of effective, evidence based depression treatments, and what works best varies from person to person. Often it may be a case of trying a few different treatment methods to find the best one that works for you.

For cases of mild depression your doctor might suggest lifestyle changes such as diet, alcohol avoidance and regular exercise. For cases of moderate to severe depression, therapy and/or medical treatments are usually recommended.

Some other complementary or alternative therapies are more widely being discussed these days which can include medicinal cannabis, acupuncture, light therapy, St John’s wort and more.

In addition cognitive-behaviour therapy has been well studied and is an effective treatment for mild-moderate depression

Beyond Blue and the Royal Australian and New Zealand College of Psychiatrists has an evidence based review guide which provides a good level of analysis and detail around a range of depression treatment approaches.

The importance of adherence

It can be dangerous to stop taking SSRIs suddenly or to forget several doses when taking them. This can lead to discontinuation syndrome that leaves you suffering from flu-like symptoms as your body withdraws. In addition, there is a risk of relapse of your depression if you stop treatment precipitously.

Your doctor will prescribe a slower dosage when you no longer need the medication, so your body and mind adjust safely.

Patients are required to stick to taking SSRIs for two to four weeks before they start to see benefits and improvements in their mood and symptoms. You’ll usually see your doctor every few weeks when you first start taking SSRIs to discuss how well the medicine is working. However, it is important you contact your doctor at any point if you experience any particularly troublesome or persistent side effects.

Side effects of SSRIs experienced during the initial starting period include:

  • Blurred vision
  • Anxiousness
  • Loss of libido
  • Insomnia
  • Headaches
  • Drowsiness
  • Dry mouth
  • Dizziness
  • Muscular pain
  • Nausea

Your doctor will, of course, consider these side effects and advise you when prescribing the medication. While everyone is different in experiencing the benefits of SSRIs, typically, you will see a change after four to six weeks.

Less common side effects:

  • Confusion
  • Hallucinations (seeing or hearing things that aren’t real)
  • Being unable to pass urine
  • Bruising or bleeding easily, including vomiting blood or bleeding from your bottom.
  • Movement problems such as shaking or feeling stiff.

If you experience any of the above, then call 000 and go to emergency.

Suicidal thoughts

Some people can have suicidal or self harm thoughts when they first start to take SSRIs. This can be more common in people between the ages of 18- 25.*

We recommend telling someone close to you when first starting SSRIs and giving them some medicine information that you would have been given by your GP so that they understand the side effects and can monitor your progress. Ask them to let you know if they notice significant changes in your mood or behaviour.

SSRIs will continue to be prescribed for at least six months after you start experiencing the benefits of the prescription to ensure continual success.

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Who shouldn’t take SSRIs?

SSRIs are not recommended for pregnant women, breastfeeding or anyone under 18 due to the increased risk of side effects that can be quite dangerous. They also must be considered and used cautiously if the patient has diabetes, epilepsy or kidney disease. It is crucial to seek professional advice if you believe you are at risk or if side effects become unmanageable. There are also other medicines that interact with SSRI so it is important your prescribing doctor is aware of your various medicines before he/she prescribes an SSRI. To learn more, we recommend you search myDr for available medicines.

References

https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/side-effects/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736946/
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Medically reviewed by Dr Matt Cullen
MBBS, FRANZCP

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