SSRI Antidepressants

SSRI antidepressants are not just for depression

SSRI stands for 'selective serotonin reuptake inhibitor'. They are a group of antidepressant drugs that are used to treat depression. They are also used to treat some other conditions such as bulimia, panic disorder, and obsessional-compulsive disorder.

Antidepressants alter the balance of some of the chemicals in the brain (neurotransmitters). SSRI antidepressants mainly affect a neurotransmitter called serotonin. An altered balance of serotonin and other neurotransmitters is thought to play a part in causing depression and other conditions.

Sometimes a life problem such as bereavement, redundancy, illness, etc, triggers a depression. Sometimes there is no apparent cause for a depression. However, antidepressants treat the symptoms of depression, whatever the cause.

Symptoms of depression include: low mood, feelings of sadness, sleep problems, poor appetite, irritability, poor concentration, decreased sex drive, loss of energy, guilt feelings, headaches, aches, pains, and palpitations. If symptoms are eased, you not only feel better, but you may also be able to cope better with any problems or difficult circumstances.

About 5-7 in 10 people with depression improve within a few weeks of starting treatment with antidepressants. However, up to 3 in 10 people improve with dummy tablets (placebo) as some people would have improved in this time naturally. So, you are roughly twice as likely to improve with antidepressants compared to taking no treatment. But, they do not work in everybody.

Note: antidepressants do not necessarily make sad people happy. The word depressed is often used when people really mean 'sad', 'fed-up', or 'unhappy'. True depression is different to unhappiness and has persistent symptoms (which often includes persistent sadness).

The success rate of SSRI antidepressants in treating the other conditions listed above (bulimia, etc) varies.

How quickly do SSRI antidepressants work?

An antidepressant takes 2-4 weeks to build up its effect and work fully. Some people stop treatment after a week or so thinking it is not helping. It is best to wait for 3-4 weeks before deciding if treatment with an SSRI is helping or not.

If you find that the treatment is helpful after 3-4 weeks, it is usual to continue. A normal course of antidepressants lasts up to six months or more after symptoms have eased. If you stop the drug too soon, your symptoms may rapidly return. Some people with recurrent depression need longer courses of treatment.

When you are taking SSRI antidepressants

It is important to take the medication each day at the dose prescribed. Do not stop taking them abruptly. The dose is usually gradually reduced before stopping completely at the end of a course of treatment. But dont do this yourself - your doctor will advise on dosage reduction when the time comes. It is best not to stop treatment or change the dose without consulting a doctor.

Are there different types of SSRI antidepressants?

There are several different types. They include: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. Each of these comes in different brand names. There is no 'best buy' that suits everyone. If the one chosen does not suit, it is sometimes necessary to change the dose, or change the preparation. Your doctor will advise. Also, if SSRI antidepressants do not help then another type of antidepressant may be advised.

Most people have either minor, or no, side-effects. Possible side-effects vary between different preparations. The most common ones include: diarrhoea, feeling sick, vomiting, and headaches. Some people develop a feeling of restlessness or anxiety (see below). Sexual problems sometimes occur. It is worth keeping on with treatment if side-effects are mild at first. Minor side-effects may wear off after a week or so.

The leaflet that comes in the drug packet gives a full list of possible side-effects. Tell your doctor if a side-effect persists or is troublesome. A switch to a different drug may then suit you better. Drowsiness is an uncommon side-effect with SSRI antidepressants, but do not drive or operate machinery if you become drowsy whilst taking one.

SSRI antidepressants and suicidal behaviour
In recent years there have been some case reports which claim a link between taking SSRI antidepressants and feeling suicidal. The Committee on Safety of Medicines (CSM) has recently reviewed the evidence on whether there is such a link. They were unable to find any convincing evidence of this link. The CSM has stated that it will continue to monitor this issue.

Because of this possible link, see your doctor promptly if you become restless, anxious or agitated, or if you have any suicidal thoughts. In particular, if these develop in the early stages of treatment or following an increase in dose.

Are SSRI antidepressants addictive?

SSRIs are not tranquillisers, and are not thought to be addictive. (This is disputed by some people, and so this is a controversial issue. If addiction does occur, it is only in a minority of cases.)

Most people can stop an SSRI without any problem. At the end of a course of treatment you should reduce the dose gradually over about four weeks before finally stopping. This is because some people develop 'withdrawal' symptoms if the medication is stopped abruptly.

Withdrawal symptoms that may occur include: dizziness, anxiety and agitation, sleep disturbance, 'flu-like symptoms, diarrhoea, abdominal cramps, pins and needles, mood swings, feeling sick, and low mood. These symptoms are unlikely to occur if you reduce the dose gradually. If withdrawal symptoms do occur, they will usually last less than two weeks. An option if they do occur is to restart the drug and reduce the dose even more slowly.

© EMIS and PIP 2006   Updated: June 2006   PRODIGY Validated