There is one place where we as high schoolers find antidepressants most discussed: social media. Whether it be through an honest chat or a funny meme, representation of antidepressants is prevalent on TikTok and Instagram. Many users share their positive experiences with antidepressants and how they have changed their lives. Others say that the drugs fail to help or cause too many challenging side-effects. Although we see antidepressants so much in the media, many do not know exactly what they are or how they work.
SSRIs, or selective serotonin reuptake inhibitors, are a class of medications commonly prescribed to treat mental health conditions including depression and anxiety. They work by selectively inhibiting the absorption of serotonin, a neurotransmitter involved in regulating mood and emotions. By blocking the absorption process, SSRIs increase the concentration of serotonin in the brain, leading to improved neurotransmission and mood regulation.
There are several types of SSRIs available, including fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram, and vilazodone. Each SSRI has its own specific characteristics and may vary in terms of dosing, duration of action, and potential side effects. SSRIs are widely used for the treatment of major depressive disorder, providing relief from symptoms such as persistent sadness, loss of interest, and changes in appetite and sleep patterns. They are also prescribed for generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, post-traumatic stress disorder, and premenstrual dysphoric disorder.
SSRIs can also be helpful in managing conditions such as bulimia nervosa, bipolar disorder, and treatment-resistant depression. These medications may offer effective and relatively safe options for individuals experiencing a range of psychological distress. This is why SSRIs have become a first-line option for many patients. They have minimal sedative effects compared to older antidepressant classes, making them suitable for individuals who need to maintain their daily routines. SSRIs also have a lower risk of causing cardiac disturbances and dizziness, which is particularly advantageous for older adults. Furthermore, these medications are less likely to induce weight gain and have a reduced potential for overdose compared to other antidepressants.
While SSRI’s offer benefits, they can also have side effects that range from mild to more significant concerns. Temporary side effects may include insomnia, skin rashes, headaches, joint and muscle pain, stomach upset, nausea, or diarrhea. Another potential side effect is a reduced blood clotting capacity, as SSRIs decrease serotonin concentration in platelets, increasing the risk of internal bleeding, particularly when combined with medications that impair blood clotting.
SSRIs also interact with other drugs as they are metabolized in the liver, which can lead to changes in blood levels of both drugs, necessitating dose adjustments or avoidance of certain combinations. Combining SSRIs with medications that enhance serotonin activity can result in serotonin syndrome, a rare condition characterized by symptoms like racing heart, sweating, high fever, high blood pressure, and delirium.
In older individuals, SSRI’s are generally safer than other types of antidepressants due to fewer cardiac disturbances and less dizziness that can lead to falls. Older individuals often respond well to rapidly metabolized SSRIs like sertraline. One aspect to consider is the potential loss of antidepressant effectiveness over time, which may be due to tolerance. This can be solved by increasing the dose or switching to an antidepressant with a different mechanism of action.
Discontinuation of SSRIs can lead to discontinuation symptoms, such as dizziness, loss of coordination, fatigue, tingling, blurred vision, insomnia, nausea, diarrhea, irritability, and anxiety. Paroxetine tends to produce more intense discontinuation symptoms, so switching to fluoxetine before gradually reducing the dose can be beneficial.
During pregnancy, the potential risks of SSRI use to the fetus, such as premature delivery and lower birth weight, need to be weighed against the risks of untreated depression for both the mother and child. Women with more severe depression may require antidepressant medication during pregnancy, though caution is also advised for nursing mothers. Paroxetine and sertraline are preferred options due to their lower levels present in breast milk.
Finally, the risk of SSRIs inciting violent or self-destructive actions is a subject of ongoing controversy. In 2004, the FDA issued a Black Box Warning on SSRIs, highlighting the risk of suicidal thoughts, hostility, and agitation in children, teens, and young adults. Close monitoring and regular follow-up are crucial to prevent adverse outcomes. Patients should be informed about the possibility of initially feeling worse or developing new symptoms after changing medication or dosage.
Great overview of SSRIs and their role in mental health treatment!