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 shouldn't be the first choice you make with your anxiety nor should you only use a medicine, since medicine alone can't cure anxiety. But if you are going to take some type of medication, SSRIs are one of the most common options.
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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 of course medications affect the brain. Make sure you take my anxiety test before reading onward.
How SSRIs Work
Medicines known as reuptake inhibitors increase the amount of particular neurotransmitters in the brain by preventing unused neurotransmitters from moving back into the pre-synaptic neuron. Selective serotonin reuptake inhibitors, or serotonin-specific reuptake inhibitors - as they are also known - increase the amount of the neurotransmitter serotonin in the brain.
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 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 between 17-41% of SSRI users (3, 4). 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 problems such as autism in developing bodies. However, some SSRIs, such as Sertraline and Paroxetine, may be safer, at least for breastfeeding.
- Increased Bleeding Tendencies Taking SSRIs has been shown to increase platelet dysfunction and maycauseexcessive 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 anti-depressants, 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 meds.
Even though low serotonin can contribute to anxiety, raising serotonin will not necessarily improve it. Any time you change your brain chemistry, your mind's reaction is not always certain. That's why SSRIs should also 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 meds to function. Three common NSAIDs are listed below:
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
- 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 also includes markedly overactive reflexes. Moderate serotonin syndrome involves agitation, high bodily temperatures of up to 104 degrees F. and increased bowel sounds in addition to the above symptoms. Severe serotonin syndrome can cause high enough heart rates and body temperatures (up to 106 degrees F.) to result in 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 meds or recreational substances to have the safest experience possible.
If you're interested in a non-medicinal treatment, I strongly suggest you consider my free 7 minute anxiety test now.
Arroll B, Elley CR, Fishman T, et al. (2009). Antidepressants versus placebo for depression in primary care. Cochrane Database Syst Rev (3): CD007954.
Kapczinski F, Lima MS, Souza JS, Schmitt R (2003). Antidepressants for generalized anxiety disorder. Cochrane Database Syst Rev (2): CD003592.
Hu XH, Bull SA, Hunkeler EM, et al. (July 2004). Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. The Journal of Clinical Psychiatry 65 (7): 959–65.
Landén M, Högberg P, Thase ME (January 2005). Incidence of sexual side effects in refractory depression during treatment with citalopram or paroxetine. The Journal of Clinical Psychiatry 66 (1): 100–6.
Gentile S, Rossi A, Bellantuono C (2007). SSRIs during breastfeeding: spotlight on milk-to-plasma ratio. Archives of Women's Mental Health 10 (2): 39–51.
Author: Micah Abraham, BSc Psychology, last updated Sep 28, 2017.