Psych Medication Management (SSRIs)

By The Fix staff 01/21/15

SSRIs: Newer, Safer Treatment for Depression and Mental Health Issues

Psych Medication Management (SSRIs)

According to the Anxiety and Depression Association of America, 17% of Americans will experience the chronic malaise, persistent sadness, and low-mood of depression at some point in their lives. In order to come up with new medications for the treatment of depression, researchers developed SSRIs, or Selective Serotonin Reuptake Inhibitors. Since the creation of the first SSRI, Prozac, the US has seen an explosion in the number of people taking SSRIs for the treatment of depression. The Centers for Disease Control reports the use of SSRIs has increased 400% since their development.

SSRIs represent a significant advancement in the field of mental health treatment for mood disorders. However, many fail to realize exactly what these medications are, beyond antidepressants. You need to know what mood disorders SSRIs treat; the reasons behind the development of SSRIs; how they improve depression; the possible side effects of the medications; and the FDA warning issued against SSRIs. Furthermore, If you suffer from depression and take SSRIs, you may be at risk for "Serotonin Syndrome." When you have a thorough understanding of SSRIs, you will have a greater confidence in your battle against depression.

Conditions Treated by SSRIs

Currently, the FDA has approved six SSRIs: Celexa (generic--citalopram), Lexapro (generic--escitalopram), Prozac (generic--fluoxetine), Paxil or Pexeva (generic--paroxetine), Luvox (generic--fluvoxamine), and Zoloft (generic--sertraline). These medications may be used to treat a wide range of mental health conditions aside from depression alone. For example, psychiatrists usually prescribe Luvox for the treatment of Obsessive-Compulsive disorder (OCD) and other anxiety disorders as well as depression. Although SSRIs may not be approved by the FDA to treat many other health conditions, a doctor may choose to prescribe SSRIs for the treatment of symptoms of menopause.

Reasons for Development

The two oldest classes of antidepressant medications, MAOIs and Tricyclics, were the driving force behind the development of SSRIs. The National Institute of Mental Health reports that MAOIs required those taking these medications to avoid specific foods and beverages that may interact with the medication. Furthermore, MAOIs may cause serious complications for those suffering from cardiac problems, such as an irregular heart beat or congenital (born with) cardiac defects.

Tricyclics are the strongest class of antidepressant medications available. However, overdose on Tricyclic medications can be fatal, and since those suffering from depression have an increased risk of suicide already, the risk for committing suicide while taking Tricyclics grows exponentially. Tricyclics should not be taken by anyone with a heart condition, and they may cause severe side effects. Imipramine and nortriptyline are two of the most commonly prescribed Tricyclics prior to the development of SSRIs.

Although all antidepressant medications may require up to 6-weeks to have full effect, SSRIs have been shown to improve mood and depression within as little time as one week according to the National Institute on Mental Health. Using the same technique that led to the development of SSRIs, researchers have also created SNRIs, or Serotonin and Norepinephrine Reuptake Inhibitors. SNRIs affect the reabsorption of dopamine as well as serotonin within the brain. Effexor (generic--venlafaxine) and Cymbalta (generic--duloxetine) are the two SNRIs currently approved by the FDA.

Mechanism of Action

Your mood is the result of a complex network of communications in your brain. When your neurons, or brain cells, communicate with one another, neurotransmitters are released into the spaces between adjoining cells. Serotonin is one of the neurotransmitters responsible for enabling the continuation of the communications between cells. In properly functioning brain communications, the neurotransmitters bind to the receptor neuron, which allows the next cell to continue the line of communication. Once the cell has recognized the binding of serotonin, it releases the bound neurotransmitters back into the space between the cells. At this point, the original cell that released the neurotransmitters reabsorbs the neurotransmitters. However, this process may become stalled or malfunction.

On occasion, such as when suffering from depression or other mental illness, the neurotransmitters may not be able to bind to the next neuron in a sufficient quantity to continue the line of communication. Unfortunately, the original cell begins reabsorbing the neurotransmitters and the communication is lost. SSRIs slow down the reabsorption of serotonin and encourage the continuation of the communication. As a result, your brain will be more apt to produce positive, fulfilling thoughts and feelings.

Side Effects

Medication commonly comes with side effects, and SSRIs are no different. Most of the side effects of SSRIs are minor; however, some may experience severe side effects. Aside from common, minor side effects, SSRIs may cause two primary, more intense side effects. According to the Mayo Clinic, most side effects of SSRIs dissipate after a few weeks. These side effects include:

  • Nausea -- Reduce upset stomach by taking medication with food
  • Nervousness, agitation or restlessness -- Your doctor may prescribe additional medication to treat these side effects
  • Dizziness -- Avoid moving from a lying to sitting or sitting to standing position quickly
  • Tiredness -- Take your medication at bedtime if approved by your doctor and if it does not cause problems sleeping
  • Insomnia -- Discuss your treatment options for insomnia with your doctor
  • Weight gain or loss -- Monitor your diet while taking SSRIs. Eat healthy, well-balanced meals
  • Headache -- After consulting your physician, you may be able to take over-the-counter medications or use complementary and alternative medicine to treat headaches. However, some over-the-counter pain medications may increase your risk for bleeding while taking SSRIs
  • Dry mouth -- Several over-the-counter mouthwashes can provide additional oral moisture and prevent dry mouth
  • Vomiting -- Over-the-counter or prescription, anti-nausea medications alleviate this symptom
  • Diarrhea -- Discuss treatment of chronic diarrhea side effects with your doctor; however, over-the-counter medications are most commonly used to treat diarrhea

Sexual Dysfunction

Sexual dysfunction remains one of the most widely reported side effects of SSRIs. For both genders, SSRIs may reduce sexual desires and make achieving an orgasm difficult. In men, SSRIs may cause erectile dysfunction--inability to obtain or maintain an erection. Multiple medications, such as Cialis, Viagra, and Levitra, will counteract potential sexual dysfunction while taking SSRIs.

Serotonin Syndrome

As you take SSRIs, you may develop a high level of serotonin in the blood stream, or Serotonin Syndrome. The Mayo Clinic identifies two primary times that you may be susceptible to developing Serotonin Syndrome: when your dosage has been increased or a new, additional medication has been prescribed for you. If you take MAOIs in addition to SSRIs you have an increased risk for Serotonin Syndrome. Furthermore, drug or alcohol use may impact serotonin levels in the blood, which may cause Serotonin Syndrome.

In most cases, symptoms of Serotonin Syndrome will appear within a few hours of the change in medication. The most common symptoms include

  • Irritability
  • Disorientation
  • Increased heart rate
  • Hypertension, or high blood pressure
  • Dilated pupils
  • Lack of muscle coordination
  • Perspiration
  • Diarrhea
  • Headache
  • Chills or shivering
  • Goose bumps

Although Serotonin Syndrome can be effectively treated when diagnosed early, severe Serotonin Syndrome may be life-threatening. The iconic symptoms of severe Serotonin Syndrome include high fever, seizures, arrhythmias, and a loss of consciousness. If you suspect that you or a loved one may have Serotonin Syndrome, especially when severe symptoms are present, obtain medical treatment immediately.

A Warning from the FDA

Due to the prevalence of worsening severity of depression and likelihood of suicide in children, adolescents, and adults under the age of 25 following widespread use of SSRIs and other antidepressant medications, the FDA issued a prominent notice to the danger of using antidepressant medications. According to the Mayo Clinic, all antidepressants must now carry the easy-to-recognize Black Box Warning, which is the strictest warning for prescription medications issued by the FDA. This warning draws attention to special concerns and considerations for the use of SSRIs in specific populations or in combination with other medications, illicit and legal.

SSRIs stand out as the most commonly prescribed medications for the treatment of depression and mood disorders in the US. SSRIs have shown excellent improvement in those suffering from depression in a relatively-quick time frame and have posed less of a risk than traditional antidepressant medications. Through an understanding of the conditions treated by these medications, reasons for their development, how they function, and the possible side effects, will you be able to make an educated decision regarding your psychiatric medication management. Rather than sitting in the dark waiting on SSRIs to "work," those with depression need to be aware of how SSRIs have impacted the field of mental health and society. You do not have to face a decision between traditional, risky antidepressant medications and feeling better.

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