Prescriptions for mental health medications are on the rise. According to the CDC, depression in adolescents and adults has increased over 60% in the last decade. And findings from the National Health Interview Survey show that more than 1 in 10 U.S. adults took prescription medication for depression in 2023.
Among these medications are selective serotonin reuptake inhibitors, also known as SSRIs. A class of antidepressant medications, SSRIs are commonly prescribed as a first line of treatment when symptoms of depression, anxiety, or other mental health conditions interfere with daily activities, relationships, work, or overall quality of life. They may be prescribed alone or alongside psychotherapy, such as cognitive behavioral therapy (CBT).
Seo Young Esther Park, PharmD, clinical pharmacy specialist in the Behavioral Health Department of Pharmacy Services at Montefiore Nyack Hospital, shares information you need to know about these lifechanging prescriptions.
Q: How does an SSRI work?
Dr. Park: Serotonin is a chemical messenger in the brain that helps regulate mood, sleep, appetite, and anxiety. Normally, after serotonin is released between nerve cells, it is reabsorbed through a process called reuptake. SSRIs block this process, allowing serotonin to remain available between nerve cells for longer.
Although SSRIs begin affecting serotonin levels within hours of the first dose, most patients need approximately 4-8 weeks to experience their full therapeutic benefits. This is because the brain needs time to gradually adapt to changes in serotonin signaling
Q: What are the different kinds of SSRI’s?
Dr. Park: The commonly used SSRIs, with their brand names, are: Sertraline (Zoloft), Escitalopram (Lexapro), Citalopram (Celexa), Fluoxetine (Prozac), Paroxetine (Paxil), and Fluvoxamine (Luvox).
Q: What are the top 3 SSRIs and what are they prescribed for?
Dr. Park: Sertraline (Zoloft): Commonly prescribed for major depressive disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social anxiety disorder. It is also frequently prescribed off-label for generalized anxiety disorder and certain eating disorders, such as binge eating disorder and bulimia nervosa.
Escitalopram (Lexapro): Commonly prescribed for depression and generalized anxiety disorder, particularly in individuals experiencing persistent sadness, excessive worry, or anxiety that interferes with daily life.
Fluoxetine (Prozac): Commonly prescribed for depression, OCD, panic disorder, and bulimia nervosa. Because it remains in the body longer than other SSRIs, it generally has a lower risk of discontinuation symptoms.
Although these medications work similarly, the choice of medication depends on the individual’s symptoms, medical history, potential side effects, and response to previous treatments.
Q: What are side effects of taking an SSRI?
Dr. Park: Common side effects include nausea, diarrhea, headache, dizziness, changes in appetite, sleep disturbances, increased sweating, and sexual side effects, such as decreased libido. Many of these begin improving within the first 1-2 weeks, are mild and improve as the body adjusts to the medication. If some last longer, patients should contact their healthcare provider.
SSRIs can also increase the risk of bleeding or bruising, particularly when combined with NSAID pain relievers (such as ibuprofen or naproxen), aspirin, or blood thinners, and occasionally lower sodium levels in the blood, particularly in older adults.
Q: How can you manage side effects?
Dr. Park: Taking the medication with food may help reduce nausea, while staying hydrated and getting up slowly can help manage dizziness. If the medication causes difficulty sleeping, taking it in the morning may help. If it causes drowsiness, taking it in the evening may be more appropriate.
Patients should consult their pharmacist or prescriber before changing how they take their medication. If side effects persist, adjusting the dose or switching medications may help. Patients should also be aware that antidepressants carry an FDA warning about an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults (through age 24), particularly when starting treatment or changing doses. Any new or worsening suicidal thoughts or significant behavioral changes should be addressed immediately.
Q: Are there any foods, drinks, or recreational substances that should be avoided when taking an SSRI?
Dr. Park: Most SSRIs do not require major dietary restrictions; however, alcohol and recreational substances such as marijuana should generally be avoided because they can worsen dizziness and drowsiness. Alcohol can worsen depression and anxiety symptoms and increase these side effects as well as impact mood and sleep. Marijuana may also increase dizziness and sedation and can worsen anxiety or other psychiatric symptoms in some individuals.
Patients should also be cautious with certain medications and supplements that increase serotonin activity, because combining them with SSRIs may increase the risk of serotonin syndrome which is a potentially life-threatening reaction caused by excessive serotonin activity. Patients should consult their healthcare provider or pharmacist before combining them with an SSRI.
Q: On the flip side, what are side effects when someone is tapering off an SSRI?
Dr. Park: Discontinuation symptoms typically begin within a few days of reducing or stopping an SSRI and often resolve within 1-2 weeks. Reducing or stopping an SSRI, particularly abruptly, may cause antidepressant discontinuation syndrome. Common symptoms include dizziness, nausea, headaches, fatigue, irritability, anxiety, sleep disturbances, and flu-like symptoms. Some individuals may also experience brain zaps,
which are brief electrical shock-like sensations in the head. The likelihood of experiencing these symptoms depends on the medication, dose, duration of treatment, and how quickly it is discontinued.
SSRIs that leave the body more quickly are generally associated with a higher risk of discontinuation symptoms. The medication should be gradually reduced through an individualized tapering plan. Maintaining adequate hydration, following a consistent sleep schedule, and monitoring changes in mood may help manage symptoms.
A note on pregnancy: Anyone who is pregnant, planning pregnancy, or breastfeeding should discuss SSRIs with their provider. These medications are used in pregnancy when needed, but the risks and benefits should be reviewed individually.
