Clarifying the Truth About SSRIs and Antidepressants: A Mental Health Therapist’s Insight into Their Benefits and Misconceptions
There has been a lot of talk about antidepressants and SSRIs in the media today, as well as a lot of misinformation about the medications. It can be hard to determine what information is accurate with scientific backing. Therapists like me must understand antidepressants and other mental health medications to be able to fully understand how medications might impact a person and their symptoms, if any side effects are worsening symptoms, or if being on a specific medication might be beneficial for the therapeutic process and a client’s treatment plan. Here is a quick guide for SSRIs and antidepressants on how they work, their side effects, and their benefits. The information in this article is not meant to substitute for any medical professional’s assessment of you and your individual needs.
What are SSRIs?
SSRIs are used to treat several mental health concerns, such as depression, anxiety, phobias, bulimia, and post-traumatic stress disorder, among others. SSRI stands for selective serotonin reuptake inhibitor. Serotonin is one of the primary neurotransmitter, or chemical messenger, that plays a role in depression. An SSRI inhibits serotonin reuptake; this means that the serotonin will remain active in the brain longer, increasing its activity in turn, decreasing symptoms of depression and anxiety. Some examples of SSRIs are Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), and Sertraline (Zoloft).
These medications typically take two to six weeks to have their full therapeutic effect. SSRIs do have side effects that can impact some individuals, such as decreased libido, digestive issues, decreased appetite, insomnia, and agitation. Some of these side effects are temporary, while others last longer. It is essential to discuss your side effects with your doctor to monitor how they change to ensure you are on the best medication and dose.
What is Serotonin Syndrome?
Serotonin syndrome is a possible side effect of taking an SSRI, which occurs when there is too much serotonin activity. Symptoms include disorientation, confusion, blurriness, agitation, mania, high blood pressure, elevated body temperature, cold sweats, and diarrhea. The syndrome is most likely to occur when another medication is taken alongside SSRIs, increasing its effects, or when taking too much of an SSRI. If you believe this is something you are experiencing, please contact your provider.
What is a “Black Box Warning” or a “Boxed Warning?”
A boxed warning is assigned to a medication by the Food and Drug Administration (FDA). The purpose is to inform consumers of any significant risks of a medication. SSRIs have a boxed warning stating that antidepressant use for children, adolescents, and young adults may increase the risk of suicidality. The use of a boxed warning on antidepressants has caused controversy. According to the American Psychological Association, suicidality is defined as “the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan.” The studies used to determine the label saw a four percent suicidality rate in patients receiving the medicine and a two percent rate in those receiving the placebo. There were no deaths in the studies. Following the boxed warning was a decrease in antidepressant use in youth and an increase in youth suicide. It is unclear what the causal factor may be in this case. It is uncommon to see an increase in suicidality when taking antidepressants, but it is important to pay attention to any symptoms that might lead to it. Make sure to communicate with your doctor about the symptoms you experience while on medication to ensure you are on the correct medication and dosage. If you experience suicidal thoughts, it is important to seek help, whether from a doctor, therapist, or loved one.
Other Antidepressants
Tricyclic Antidepressants: These antidepressants also deal with Serotonin as well as Norepinephrine by keeping them active in the brain longer to decrease depressive symptoms. These medications do have side effects such as drowsiness, fatigue, dry mouth, dizziness, low blood pressure, constipation, blurred vision, and difficulty concentrating. Overdosing on tricyclic antidepressants can lead to such things as seizures, cardiac arrhythmias, and extremely low blood pressure.
Monoamine Oxidase Inhibitors (MAOIs): Monoamine Oxidase is an enzyme that removes neurotransmitters such as norepinephrine and serotonin in the brain. By inhibiting the enzyme, there are more of the neurotransmitters available in the brain, combating depressive symptoms. However, this antidepressant has serious side effects such as sedation, fatigue, dizziness, tremors, blurred vision, decreased libido, dry mouth, and weight gain. This medicine has increased side effects when taken with foods containing tyramine, like dairy, bread, and wine, among others, resulting in headaches, sweating, nausea, and possibly stroke.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs act similarly to SSRIs but address serotonin and norepinephrine, another transmitter impacted by depression, precisely symptoms like fatigue and combatting side effects. SNRI’s side effects can include decreased libido, nausea, upset stomach, high blood pressure, and sedation.
Atypical Antidepressants: These medications do not act on serotonin or norepinephrine but other possible pathways that can lead to depression. For example, Bupropion (Wellbutrin) focuses on the neurotransmitter dopamine with side effects of restlessness and decreased appetite, among others, and is not recommended to be used as an anxiety medication.
Common Questions
Are SSRIs addictive?
Research proves that antidepressants are not addictive. It is extremely rare for people using SSRIs to exhibit features of addiction like cravings and not being able to control their use of the medication. However, if you stop taking antidepressants without consulting your doctor and tapering down your dose, you can experience adverse effects, which can be misconstrued as a symptom of addiction to antidepressants.
What happens if I stop taking antidepressants?
If you stop taking antidepressants abruptly without consulting your doctor, it is possible to experience withdrawal symptoms or “antidepressant discontinuation syndrome.” These symptoms include anxiety, insomnia, headaches, dizziness, tiredness, irritability, muscle aches, chills, nausea, “brain zaps,” and depressive symptoms. These symptoms occur because your brain is used to the added help the antidepressant provides in regulating the chemicals in your brain. By abruptly taking away this help from your brain, you will experience difficulty adapting to this loss, resulting in withdrawal symptoms. When you taper off the medicine or slowly decrease your dose, with the direction of your provider, you allow your brain the time and ability to adapt to the change, avoiding adverse effects.
Will I lose my personality if I take an antidepressant?
Antidepressants should not change your personality or cause you to “lose your spark.” The medication should help your functioning and return to or find a healthier way of living. If you feel like you are losing your personality, this might be a sign you are not on the correct dose or medication and should seek the assistance of your prescriber to modify your prescription as needed.
Will I have to be on an antidepressant for the rest of my life?
Nope! Each person starts a medication for their own reasons, and they may change over time. You can start an antidepressant because you are experiencing an exceptionally difficult period of life or experiencing chronic depression that is not just a one-time episode. It is okay if you feel like you would like to continue taking medication for longer because it helps or if you want to stop because you are at a point where you feel ready. At the end of the day, it is up to you to determine what is best for you; however, make sure to communicate with your doctor so you remain healthy and safe.
Ultimately, antidepressants are a form of medication meant to help people function in their daily lives and are not something to fear or be ashamed of taking. It is essential to communicate any concerns regarding medication and side effects to your doctor; they will work with you to help find the correct medicine and dosage to help you best. Many times, antidepressants work really well alongside therapy as well. SSRIs can make symptoms more manageable to make space for deeper and more meaningful work in therapy. Medications and therapy look different for every person but act as a way to help everyone in the ways they need. When looking for information about antidepressants, it is important to be aware of where you are getting your information; as time moves on, research develops, and we learn more. Make sure to use sources from reputable sites and that the information or articles are not more than five years old to ensure you are getting the most accurate information. Please reach out if you have any questions or want to explore therapy!
Again, please seek professional help for your personal physical and/or mental health needs. You deserve proper care.
References:
American Psychological Association. (n.d.). Apa Dictionary of Psychology. American Psychological Association. https://dictionary.apa.org/suicidality
Balon, R. (2022). Black-box warnings: Their consequences and how we should approach them. Annals of Clinical Psychiatry, 34(4). https://doi.org/10.12788/acp.0084
Daniel K. Hall-Flavin, M. D. (2019, January 29). Abruptly quitting an antidepressant may cause symptoms. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressant-withdrawal/faq-20058133
Ettinger, R. H. (2023). Psychopharmacology. ROUTLEDGE.
Ho, D. (2012, June 1). Antidepressants and the FDA’s black-box warning: Determining a rational public policy in the absence of sufficient evidence. Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/antidepressants-and-fdas-black-box-warning-determining-rational-public-policy-absence-sufficient/2012-06#:~:text=The%20black%20box%20is%20the,increase%20the%20risk%20of%20suicidality.
Mayo Foundation for Medical Education and Research. (2024, September 11). The type of antidepressant prescribed most often. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
NHS. (n.d.). NHS choices. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/overview/
WebMD. (n.d.). Myths & Facts about antidepressant side-effects. WebMD. https://www.webmd.com/depression/fears-and-facts-about-antidepressants
