SSRIs, or selective serotonin reuptake inhibitors, are a type of antidepressant commonly used to treat both depression and anxiety disorders.
Anxiety medications have their place, but they should not be the first choice for treating your anxiety. It is also important to point out that medication alone can't cure anxiety. But if you are going to take some type of medication, SSRIs are one of the most common options.
It should be noted that medications are always a bit risky. In some cases the side effects are worth the risk. In others, it is strongly worth trying alternative treatments that do not use medications, since medications affect the brain and other major organs in the body.
How SSRIs Work
The brain is filled with neurotransmitters which are responsible for sending messages through the brain. Normally when a neurotransmitter has sent a message it is then reabsorbed back into the nerve cell. SSRIs work by preventing the neurotransmitter from being reabsorbed; instead it remains, temporarily, in the gap between nerves (known as the synapse). Selective serotonin reuptake inhibitors (SSRI’s), or serotonin-specific reuptake inhibitors - as they are also known - increase the amount of the neurotransmitter serotonin in the brain. The thought is that by increasing the number of transmitters present in the synapse communication between nerve cells is improved.
Serotonin has many roles in the body, including the regulation of your appetite, your sleeping patterns, your body temperature and your memory. It also plays a primary role in regulating your mood, which is the main reason why supplemental serotonin, the most common form of antidepressant, is prescribed for people experiencing anxiety or depression. People of both the male and female gender with anxiety disorders may exhibit lower levels of serotonin than normal.
Types of Anxiety Approved for Treatment with SSRIs
There are two types of anxiety for which SSRIs are regularly prescribed. The SSRI treatment recommendations for each type of anxiety are as follows.
- Generalized Anxiety Disorder (GAD) For people with generalized anxiety disorder, the National Institute for Health and Clinical Excellence (NICE) recommends SSRIs only as a secondary measure, when self help and therapy fail to produce an adequate response. They are shown to have a modest to moderate effect on GAD, and are equal in effectiveness to other types antidepressants prescribed for this disorder, such as dopamine reuptake inhibitors. GAD is characterized by persistent, excessive and uncontrollable worry about more than one specific issue that lasts for 6 months at minimum.
- Obsessive-Compulsive Disorder (OCD) SSRIs are recommended by NICE as a secondary measure for OCD adults who are only mildly impaired by their disorder, but as a primary measure for OCD adults who are moderately to severely impaired. For children with OCD, SSRIs are recommended only as a secondary measure even if the child is moderately to severely impaired due to the potential risk factors involved, which will be discussed in the following section. If a child is given SSRIs for their OCD, they must be closely monitored by a professional while undergoing treatment to avoid any problematic psychological effects. Obsessive compulsive disorder is characterized by intrusive thoughts that often result in repetitive behaviors, as well as distress when the repetitive behaviors cannot be or are prevented from being carried out.
SSRI Side Effects
Over the course of the 1-4 weeks that it takes for most people to adjust to SSRIs, almost all SSRIs will have one or more temporary side effects. The possible short term side effects of SSRIs during these initial weeks are listed below.
- Vivid dreams
- A roughly 7 lb shift in body weight (either up or down)
- Increased anxiety or depression
- Suicidal thoughts
- Cognitive disorders
If you find that you are experiencing one or more of these side effects and that it further impedes your functionality, your may be able to switch treatment to a different SSRI to avoid that particular effect.
SSRIs also have some long term side effects as well. Possible long term side effects of SSRIs include:
- Sexual Dysfunction Sexual dysfunction occurs in up to 75% of SSRI users, with it affecting men slightly more frequently than women. In some cases, it can continue even after treatment has been terminated. Due to this side effect, SSRIs are sometimes used to treat premature ejaculation.
- Cardiovascular Effects These side effects are rare, but it has been suggested that electroencephalographic monitoring be used as a preventative measure for individuals with pre-existing cardiovascular problems.
- Withdrawal Withdrawal from SSRIs is less severe than withdrawal from antidepressants like benzodiazepines, but can still be difficult to deal with as it often produces symptoms similar to the original anxiety disorder. Requesting SSRIs in liquid form allows for a more gradual reduction of the dosage, which can help to limit the amount and severity of withdrawal effects.
- Developmental Problems When Taken During Pregnancy Taking SSRIs during pregnancy can cause birth defects and possible long term mental health problems in developing bodies. However, some SSRIs, such as Sertraline and Paroxetine, may be safer, at least for breastfeeding. In general however, it is not recommended to take SSRIs while pregnant or breastfeeding.
- Increased Bleeding Tendencies Taking SSRIs has been shown to increase platelet dysfunction and may cause excessive bleeding, including gastrointestinal bleeding, post-operative bleeding and bleeding within the brain.
Because of the potential risk factors involved in taking SSRIs, which are relatively low-risk antidepressants, it is a good idea to engage in self help and to spend time finding a therapist who is a good fit for you before resorting to antidepressant medications.
Even though low serotonin can contribute to anxiety, raising serotonin will not necessarily improve it. Furthermore, high levels of serotonin also contribute to anxiety, which makes finding the correct balance a sometimes difficult and lengthy process. Because of the side effects and impact on your brain chemistry SSRIs should never be taken without a doctor's supervision.
Possible Substance Interactions
Painkillers belonging to the NSAID drug family can reduce the impact of SSRIs and should be avoided in order to allow SSRI medications to function properly. Three common NSAIDs are listed below:
- Naproxen (commonly known as Aleve)
SSRIs can interact negatively with some medications, supplements and recreational substances by increasing their toxicity. Substances commonly used by people with anxiety that should not be combined with SSRIs include:
- Beta blockers
- Tricyclic antidepressants
- Thyroid medications
- St. John’s Wort
Ask your doctor about possible interactions you should be aware of if you are taking any other medication simultaneously, even if it’s just cough medicine, as many other medications including some cough medicines can also interact negatively with SSRIs.
Many of the above substances, as well as overdosing on SSRIs, can result in a condition called serotonin syndrome, in which high levels of serotonin overwhelm the body. Serotonin syndrome can be mild, moderate or severe. Severe serotonin syndrome can be fatal.
Mild serotonin syndrome is marked by many symptoms reminiscent of regular anxiety symptoms, such as sweating, shaking, pupil dilation and increased heart rate, but may also include diarrhea, headaches, goosebumps and loss of muscle coordination. Moderate serotonin syndrome involves agitation, high bodily temperatures of up to 104 degrees F, in addition to the above symptoms. Severe serotonin syndrome can cause irregular heartbeat high body temperatures (up to 106 degrees F), seizures, and unconsciousness which leads to shock and even death.
Overview of SSRI Safety
If you are considering taking SSRIs for your anxiety, it is important to be aware of the risks involved and to use the medication safely. Resort to SSRIs only if therapy and self help do not improve your condition. Ask about SSRIs in liquid form to reduce the likelihood of withdrawal and anxiety recurrence, and avoid combining SSRIs with any other medications or recreational substances to have the safest experience possible.