SSRIs and Depression

Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that affect serotonin levels in the brain. Serotonin is a chemical neurotransmitter. For many people, SSRIs are the first choice of depression treatment selected by health care providers.
 
SSRIs, which are medications available only by prescription, may be used to treat depression. If a person’s symptoms indicate that he or she has depression, a health care provider will strongly recommend treatment. Treatment may include supportive therapy, such as changes in lifestyle and behavior, psychotherapy, and complementary therapies, but it almost always includes medication. Without treatment, depression symptoms may become worse or last much longer, making recovery difficult. With treatment, the chances of recovery from depression are very high.

Commonly prescribed SSRIs include the following:

• Fluoxetine (Prozac)



• Sertraline (Zoloft)



• Paroxetine (Paxil)



• Escitalopram (Lexapro)



• Fluvoxamine (Luvox)



• Citalopram (Celexa)

SSRIs are available as tablets, capsules, or oral solution.

The antidepressant action of SSRIs is not thoroughly understood but is possibly due to the ability of SSRIs to block the uptake of serotonin, thereby providing higher levels of serotonin at the brain receptor site.

• Individuals who are allergic to SSRIs



• Individuals who are currently taking, or have taken within the past 2 weeks, thioridazine (Mellaril), pimozide (Orap), or monoamine oxidase inhibitors (MAOIs) such as Phenelzine (Nardil) and tranylcypromine (Parnate) (Do not take MAOIs or thioridazine for at least 5 weeks after stopping SSRIs.)



• Individuals with bipolar disorder (manic depression) (SSRIs may induce manic episodes.)

Tell the doctor what medications are currently being taken because many medicines interact with SSRIs. Do not take any nonprescription or herbal medications without first consulting a doctor or pharmacist. The following are examples of interactions, but they do not represent a complete list.

• When an SSRI is administered with 5-HT1 agonists, such as sumatriptan or zolmitriptan, weakness and incoordination, although rare, have been reported.



• SSRIs may increase the blood levels and risk of toxicity of certain medications, including the following:
  
  
  • Highly protein-bound medicines such as warfarin (Coumadin) and digoxin
  
  
  
  • Antiarrhythmic medicines such as propafenone (Rythmol) or flecainide (Tambocor)
  
  
  
  • Beta-blockers such as propranolol (Inderal) or metoprolol (Lopressor, Toprol XL)
  
  
  
  • Tricyclic antidepressants such as amitriptyline (Elavil) (may increase risk for serotonin syndrome—symptoms include hypertension, fever, muscle tremor, or confusion)
  
  
  
  • Benzodiazepines such as alprazolam (Xanax), diazepam (Valium), midazolam (Versed), or triazolam (Halcion)
  
  
  
  • Carbamazepine (Tegretol)
  
  
  
  • Cisapride (Propulsid)
  
  
  
  • Clozapine (Clozaril)
  
  
  
  • Cyclosporine (Neoral, Sandimmune)
  
  
  
  • Haloperidol (Haldol)
  
  
  
  • Thioridazine (Mellaril)
  
  
  
  • Phenytoin (Dilantin)
  
  
  
  • Pimozide (Orap)
  
  
  
  • Theophylline (TheoDur, TheoBid)
     
• The following substances may increase toxicity of SSRIs:
  
  
  • Alcohol or other drugs that depress the central nervous system
  
  
  
  • Diuretics (water pills)
  
  
  
  • MAOIs (may cause serious, and sometimes fatal, reactions)
  
  
  
  • St. John’s wort 
  
  
  
  • Sympathomimetics such as pseudoephedrine (Sudafed)
  
  
  
  • Lithium
  
  
  
  • Sibutramine (Meridia)
  
  
  
  • Zolpidem (Ambien)

SSRIs may cause the following side effects:
 

• Withdrawal-like symptoms in newborns (Women who take SSRIs in late pregnancy [third trimester] may have newborns who require prolonged hospitalization due to withdrawal-like symptoms such as shortness of breath, constant crying, feeding difficulty, or low blood sugar levels.)



• Photosensitivity (increased risk of sunburn) (Use protective clothing, such as long sleeves and hats, and sunscreen to decrease the risk of sunburn.)



• Rash



• Low blood sodium levels (in people who are dehydrated or taking diuretics)



• Low blood sugar levels



• Drowsiness (Caution is advised when operating machinery, driving, or performing other tasks requiring alertness.)



• Kidney or liver impairment (A doctor may check to see if any kidney or liver impairment exists before prescribing SSRIs.)

US Food and Drug Administration (FDA)
5600 Fishers Lane
Rockville, MD 20857-0001
(888) INFO-FDA (463-6332)

National Institute of Mental Health (NIMH)
Office of Communications
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
(866) 615-6464

|Web Links|

National Institute of Mental Health, Medications

FDA, Antidepressant Use in Children, Adolescents, and Adults

SSRIs and depression, fluoxetine, Prozac, sertraline, Zoloft, paroxetine, Paxil, escitalopram, Lexapro, fluvoxamine, Luvox, citalopram, Celexa, SSRI, SSRIs, depression, selective serotonin reuptake inhibitors, antidepressants, serotonin, antidepressant medication, treatment of depression, side effects of SSRIs, drug interactions of SSRIs, food interactions of SSRIs

Author: Mary L Windle, Pharm D, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, .com, Inc.

Editors: Cory Franklin, MD, Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science; Director, Division of Critical Care Medicine, Cook County Hospital; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Alan D Schmetzer, MD, Professor and Assistant Chair for Education, Department of Psychiatry, Indiana University School of Medicine.