HOW DO SSRIs EVEN WORK?
That’s a wonderful question. The truth is that- they (as in researchers) are not 100% sure on all the in’s and out’s of how this class of medications works, but one way they help is by blocking the “reuptake of serotonin.”
The simplest and most fun way I can think of to explain it is this.
Imagine that there are Pacman in your brain and the little dots they like to eat are serotonin. As soon as the serotonin gets into your brain they start munching it up before anyone else can do anything with it. The SSRI medication comes in and blocks Pacman from eating the dots so that serotonin hangs out in your brain longer which can improve depression and anxiety.
SSRIs are the short way of saying Selective Serotonin Reuptake Inhibitors.
The most common ones used are:
BRAND NAME: Lexapro GENERIC: escitalopram
BRAND NAME: Zoloft GENERIC: sertraline
BRAND NAME: Celexa GENERIC: citalopram
BRAND NAME: Prozac GENERIC: fluoxetine
WHAT IS A BLACK BOX WARNING?
The FDA started to require Black Box Warning on antidepressant medications (like the SSRIs listed above) in 2004 to warn people that it can increase suicidal tendencies in children and teens. In 2006, they changed the warning to include children, teens, and adults up to age 25.
Your provider should be telling you about this Black Box Warning and how to respond if the person taking it does have any suicidal thoughts. There is some controversy about the Black Box Warning, which I have read a lot about the research and results, but at the end of the day- it doesn’t matter because providers should always be reminding their patients of any age that if your mood tanks and you feel depressed and/or suicidal you need to let them know immediately.
WHAT ARE THE SIDE EFFECTS FROM SSRIs?
Side effects are tricky for a few reasons. 1. You can have a side effect that is really rare and uncommon and maybe not listed in a lot of medication resources, 2. Any side effect that someone maybe experienced during a drug trial has to be included in the side effects listed- therefore some people will feel really nervous about trying a medication because a side effect is listed. In my experience though- here are the most common side effects I see when someone starts taking SSRIs.
Some side effects are transient which means they go away after some time as the body has a chance to get use to the medication.
The most common side effects are: nausea, sweating, heat intolerance, insomnia, tiredness, sexual side effects, and headache.
WHAT TO DO IF YOU HAVE SIDE EFFECTS FROM SSRIs.
First and foremost you should be comfortable talking about any side effects with your provider. Some people will keep a log of their possible side effects:
Nausea: try taking it at night with food, if it persists talk to your provider about starting a lower dose and titrating up slowly. Some providers might consider anti-nausea medications for short-term use like Zofran.
Sweating: some people have minimal sweating and some will wake up drenched in sweat. Some options are to talk to your provider about Vitamin E or other small doses of medications to help.
Heat intolerance: be mindful of your limits when you are exposed to heat and activity.
Insomnia: if Lexapro gives you some oompf and energy, you might consider taking it at night time.
Tiredness: if Lexapro makes you sleepy or drowsy, you might consider taking it at night time.
Headaches: can be treated for a few days with Tylenol, but most people report this side effect is temporary.
Low libido: talk with your doctor if this is happening. Up to 50% of people experience sexual problems due to depression, so sometimes the culprit can be hard to identify at first. If the medication is helping with depression and anxiety, it can sometimes be worth waiting a little bit longer to see if this improves. If it does not, you should talk to your doctor about different options. Some options could be lowering the dose, scheduling sex around times when low libido is less annoying, take a medication holiday, switch to a different medication, add a medication used to treat, or see a therapist.
I want to stress that before you do anything with medications on your own, please consult your prescribing provider!
CAN AN SSRI CAUSE HYPOMANIA OR MANIA?
Short answer: Yes. Medications that mess with serotonin have the potential to trigger hypomania and mania symptoms. If you know of any bipolar history in your family, you should tell your provider. If you suspect a family member maybe had bipolar, please tell your provider. Sometimes people will refer to it as “manic depression” or “severe mood swings.” Bipolar II can be hard to detect at times- check out my blog posts about bipolar- so sometimes people do not even know they have bipolar lying under the surface until the hypomania appears after starting an SSRI.
WHAT IS SEROTONIN SYNDROME?
Serotonin syndrome is a super rare condition but is important to mention because if it does happen it can be really dangerous. I have only seen it one time in my career. Some symptoms are: agitation, hallucinations, other mental status changes, hyperthermia, fast heart rate, unstable BP, twitching/jerking of muscles, overactive reflexes, incoordination, nausea, vomiting, and diarrhea has been reported when serotonergic antidepressants are used with other serotonergic agents.
This syndrome could potentially happen when you take more than one drug that increases serotonin or if you have a unique genetic makeup that affects how your body processes medications that affect serotonin. I’d like to stress again that this is a really rare condition.
CAN I DO DRUGS WITH SSRIs?
If you are taking an SSRI medication and you want to use drugs you need to do so carefully. Any drugs that flood your brain with serotonin can increase your risk of serotonin syndrome. It can also set you up for a pretty crappy depressed mood afterward too. Professionally, your provider is likely to advise you to stay away from drugs like MDMA, Cocaine, LSD, and meth due to this risk. A few tips though:
– don’t stop your SSRI to try and get a better drug high
– PLEASE talk to your provider if you are/plan to use any drugs- they might change how they dose the medication.
– if you take your usual dose of drugs and they don’t get you high like they did before, it’s likely from the SSRI. Don’t take more drugs please, because although you might not be flying high, your blood pressure and heart rate could be which is not ideal.
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