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Medicine for Depression: SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are newer or second generation antidepressants that generally have fewer side effects than older or first generation antidepressants. These include tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs). Other second generation antidepressants include bupropion (Wellbutrin, Wellbutrin SR) and duloxetine (Cymbalta).

Examples

Generic name

Brand name

citalopram

Celexa

escitalopram

Lexapro

fluoxetine

Prozac

fluvoxamine

Luvox

paroxetine

Paxil

sertraline

Zoloft

How they work

Symptoms of depression happen when certain brain chemicals (neurotransmitters) get out of balance. SSRIs help symptoms of depression by increasing the amount of serotonin available.

Why they are used

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.

How well they work

SSRIs relieve depression in many people who take them. They have become one of the first medicines used for depression because they work and have few side effects. SSRIs may also help with anxiety and anxiety disorders.

Side effects

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 healthcare provider. He or she may be able to lower your dose or change your medicine. Do not suddenly stop taking your medicine unless your healthcare provider tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing

  • Hives

  • Swelling of your face, lips, tongue, or throat

Call your healthcare provider if you have:

  • 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 for suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

  • A warning about taking triptans, used for headaches, with SSRIs or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

What to think about

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

SSRIs can be safer than tricyclic or tetracyclic antidepressants, because there is lower risk for death if taken in large quantities (overdose). SSRIs are usually well tolerated and effective. SSRIs may also 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 with your healthcare provider 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.

SSRIs are 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.

Taking medicine

Medicine is one of the many tools your healthcare provider has to treat a health problem. Taking medicine as your healthcare provider 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.

Advice for women

Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects. Untreated depression can also have a negative impact on your baby's health, so medicines may need to be continued if your depression is severe. Talk with your healthcare provider. He or she can help weigh the risks of treatment against the risk of untreated or undertreated 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 healthcare provider 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. 

Do you have thoughts about suicide?

If you or a loved one has thoughts about death or suicide, call 911 or the Veterans Crisis Line at 800-273-TALK (800-273-8255) and press 1, or use other emergency services. Or you can chat with a trained counselor online at www.VeteransCrisisLine.net.

Author: StayWell Custom Communications
Last Annual Review Date: 7/1/2018
Copyright © The StayWell Company, LLC. except where otherwise noted.
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