Selective Serotonin Reuptake Inhibitors (SSRIs) for Depression

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).

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.

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.

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.

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

• Usually the benefits of the medicine are more important than any minor side effects.
• Side effects may go away after you take the medicine for a while.
• If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call or other emergency services right away if you have:

• Trouble breathing.
• Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

• Hives.
• Thoughts of suicide.
• Agitation and restlessness.
• Seizures.
• Fast heartbeat.
• Nausea and vomiting.

Common side effects of this medicine include:

• Loss of sexual desire or ability.
• Irritability.
• Trouble sleeping or drowsiness.
• Headache.
• Changes in appetite.

FDA advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. Talk with your doctor about these possible side effects and the warning signs of suicide.
• 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.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Never suddenly stop taking antidepressants. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicine can cause negative side effects or a relapse into depression.

SSRIs can be safer than tricyclic or tetracyclic antidepressants, because they do not cause death if taken in large quantities (overdose). SSRIs usually are well tolerated and effective. SSRIs also may be safer for older adults, because the side effects are more tolerable.

People with liver disease usually require lower doses of SSRIs.

Studies have found daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Talk to your doctor about this risk before taking an SSRI.

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.¹

SSRIs are also used to treat depression. SSRIs alone are not commonly used if you have episodes of mania, such as in bipolar disorder.

Sexual dysfunction can be a significant problem for some people while taking an SSRI. A medicine such as sildenafil (Viagra) may help both men and women who have sexual problems caused by SSRIs.^{2, 3}

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant, you and your doctor must weigh the risks of taking an SSRI against the risks of not treating your depression.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. 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.

2. Nurnberg HG, et al. (2003). Treatment of antidepressant-associated sexual dysfunction with sildenafil. JAMA, 289(1): 56-64.

3. Nurnberg GH, et al. (2008). Sildenafil treatment of women with antidepressant-associated sexual dysfunction: A randomized controlled trial. JAMA, 300(4): 395-404.