Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant medication prescribed for treatment of a range of psychiatric disorders. They are most often used for depression but are also widely prescribed to help manage symptoms of anxiety and anxiety -related disorders, including generalized anxiety, social anxiety , obsessive-compulsive disorder and post- traumatic stress disorder ( PTSD ). The prototype drug in this group is fluoxetine, best known by its trade name, Prozac.
How Effective Are SSRIs?
Depression is an extraordinarily complex condition involving multiple brain and body functions and basic appetite for life itself. Due to changes in the activity level of various emotional signaling centers, the brain becomes extremely biased toward negative thoughts and feelings and easily overwhelmed by them. The ability to enjoy life vanishes. Motivation flees with it. Physical movement becomes difficult. Sleep is disturbed. It is a notoriously difficult illness to treat. Talk therapy not only provides symptomatic relief but improves brain function as well. Yet it is not always enough—or fast enough.
From the beginning, there have been questions about the effectiveness of SSRIs. A large meta-analysis recently published in The Lancet found that, overall, all SSRIs and SNRIs were more effective than placebo in treating adults with major depression. However, many well-known SSRIs are ineffective for as many as 30 percent of people who try them.
The successful treatment of depression is important. The longer that depression episodes last and the more episodes that occur, the more that depression changes the brain and becomes a chronic condition and a source of psychic pain. Patients who are prescribed an SSRI that doesn’t manage their symptoms well often feel discouraged or unwilling to try another option, further complicating their treatment prospects.
According to a six-year meta-analysis , SSRIs were more efficacious than placebos in adults with depression when judged by two criteria: efficacy (response rate) and acceptability (measured by whether treatment was discontinued for any reason). The efficacy of a given SSRI across thousands of studies varies significantly, ranging anywhere from about one-third as effective to twice as effective as a placebo , but the effect sizes were generally modest. Studies consistently show that antidepressants work best in conjunction with therapies like cognitive-behavioral therapy (CBT).
Risks and Side Effects
Although the class of drugs was developed in the hopes of eliminating some of the unpleasant (and dangerous) side effects of earlier types of antidepressants, side effects nevertheless accompany SSRI usage. Some, like an increased risk of suicidal ideation in children and adolescents or cardiac arrest in adults, are very serious, while others, like dry mouth or sexual dysfunction, can be troublesome but not life-threatening. Because of their side effects, however—as well as their inconsistent results in treating depression—they continue to generate controversy. Like most antidepressants, SSRIs appear to be most effective when used in combination with cognitive-behavioral therapy or other forms of therapy.
When used correctly, SSRIs can help relieve depression and anxiety, but don’t cause massive personality shifts. If someone feels emotionally flat or not like themselves on an antidepressant, this is considered an adverse side effect, and they may want to consult their physician about switching medications. When SSRIs work properly, patients report a decrease in negative rumination and better overall functioning. Patients might experience temporary withdrawal symptoms , such as increased depression, anxiety, and anger , when stopping an SSRI that should be discussed with their overseeing physician.
Approximately 70 percent of people taking SSRIs experience some form of sexual dysfunction, including the loss of orgasm . Even as SSRIs increase serotonin levels, they have a dampening effect on the neurotransmitter dopamine , which is associated with the elation of falling in love. Patients should be aware of the potential for some SSRIs to cause problems with sexual desire and performance . In some cases, these issues can be addressed by changing antidepressants, lowering the dosage, or taking a brief, physician-directed medication hiatus
Taking antidepressants has been linked to significant weight gain. Individuals who are already overweight are more likely to experience this generally undesirable side effect. Paxil and Lexapro are especially known to contribute to weight gain. Switching medications to avoid or reduce unwanted weight gain may be an option for some patients.
Controversies About SSRIs
Despite their popularity, SSRIs have been the subject of controversy from the beginning. Many people are skeptical about how effective they truly are and how much they cost. Concerns have arisen about serious side effects, like an increase in suicidal thoughts or the potential for causing harm to the fetus during pregnancy .
When all the results of drug trials are examined in aggregate, SSRIs prove to be modestly more effective than a placebo for approximately one-third of the individuals who try them. Plus, it often takes experimenting with a few different types of SSRIs before finding the one that alleviates symptoms.
Despite the rapid rise in use of SSRIs, their use in young people has raised many questions. After examining the results of a 2004 study, the FDA mandated that drug manufacturers include a black box warning that the antidepressants can increase suicidal thoughts and behavior in children and teens . Critics of the black box warning argue that it scares parents and youths away from potentially helpful treatments. In fact, not enough is known about the way the drugs affect children’s bodies versus adults’ to make them a first-choice treatment. Some experts also worry about the overprescribing of SSRIs when normal sadness gets mistaken for depression.
SSRIs have long been controversial because they reflect a theory of depression causation that is a longstanding source of debate. While the chemical imbalance theory has been largely superseded, serotonin levels may still play a role in increasing a person’s risk for depression. Low serotonin levels have been linked to increased inflammation. High levels of inflammatory biomarkers are commonly found in depressed patients, suggestion a relationship between serotonin, inflammation, and depressive symptoms, even if the exact details remain unclear.
Explore More About SSRIs
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