SSRIs (Selective Serotonin Reuptake Inhibitors)

SSRIs (selective serotonin reuptake inhibitors) are a common type of antidepressant. They work by changing the activity of serotonin, a chemical that affects your mood, as well as many other bodily and mental functions.

These medications are often used to treat mental health conditions, like depression, anxiety, PTSD and OCD. They can also help manage other conditions and symptoms.

There are several types of antidepressants, but SSRIs are usually the first choice by healthcare providers. That’s because they tend to cause fewer and milder side effects compared to other options.

Types of SSRI drugs

Selective serotonin reuptake inhibitors that providers currently prescribe in the United States include:

• Citalopram (Celexa®)
• Escitalopram (Lexapro®)
• Fluoxetine (Prozac®, Sarafem™)
• Fluvoxamine (Luvox®)
• Paroxetine (Brisdelle™, Paxil™, Pexeva®)
• Sertraline (Zoloft®)
• Vilazodone (Viibryd®)
• Vortioxetine (Trintillex®)

What are SSRIs approved for?

The U.S. Food and Drug Administration (FDA) has approved SSRIs to treat the following conditions:

• Major depressive disorder (MDD)
• Generalized anxiety disorder (GAD)
• Bulimia nervosa
• Menopause
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Premenstrual dysphoric disorder (PMDD)
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder (social phobia)

Healthcare providers sometimes use SSRIs to help with other conditions, too. This is an off-label use. Examples may include:

• Binge eating disorder
• Body dysmorphic disorder
• Chronic pelvic pain syndrome
• Fibromyalgia
• Premature ejaculation

How do SSRI antidepressants work?

Serotonin is a type of neurotransmitter, or chemical messenger. Neurotransmitters are molecules that dictate how different regions of your brain communicate with each other. Normally, after serotonin delivers its message, your brain cells reabsorb it. This is a process called reuptake. SSRIs block this reabsorption, allowing serotonin to remain active in your brain for a longer period of time. Serotonin plays a role in the regulation of:

• Appetite
• Memory
• Mood
• Libido
• Sleep
• Social behavior

What are the potential benefits of SSRIs?

These medications help manage symptoms of depression and anxiety, as well as many other conditions. These medications often work well when paired with talk therapy, like cognitive behavioral therapy (CBT). SSRIs are generally well tolerated, with mild or minimal side effects.

SSRI side effects

Common side effects may include:

• Dizziness
• Dry mouth
• Headache
• Gastrointestinal distress
• Sexual dysfunction
• Sleep disturbances
• Weight gain

Each medication has different side effects. Ask your provider or pharmacist for more information.

Risks and complications of SSRIs

While these medications are generally safe, they may cause rare but serious complications in some cases, such as:

• Antidepressant discontinuation syndrome: Stopping your medication suddenly may lead to symptoms like dizziness, flu-like aches or anxiety. Always talk to your provider before making changes to your dose.
• QT prolongation: A problem with your heart’s electrical system causes it to take too long to reset between beats. When untreated, a prolonged QT interval could be life-threatening.
• Serotonin syndrome: This is when too much serotonin builds up in your body. Warning signs include confusion, a fast heart rate, fever and/or stiff muscles. Contact your doctor or go to the nearest emergency room if you have these symptoms.
• Suicidal thoughts: People under 25 may be at higher risk of developing or having worsening suicidal thoughts.

If you’re thinking about suicide, you can reach out for help. Contact your provider. You can also call or text 988 (U.S.) to reach the Suicide and Crisis Lifeline. Someone is available to talk to you 24/7.

What interacts with SSRIs?

Some medications may interact with SSRIs, including:

• Blood clot-preventing medication (low-dose aspirin, clopidogrel)
• Herbal supplements (St. John’s wort)
• Certain migraine medicines (triptans)
• NSAIDs (ibuprofen, diclofenac, naproxen)
• Over-the-counter cough suppressants (like dextromethorphan)
• Other antidepressants

This isn’t a complete list. Talk to your healthcare provider about all the medications and supplements you currently take. They’ll let you know if an SSRI is the safest option to manage your symptoms.

Can I drink alcohol while on an SSRI?

It’s best to avoid alcohol while taking antidepressants, including SSRIs. Alcohol is a depressant and might interfere with how well the medication works. It can sometimes make depression symptoms worse. If you have concerns about drinking, talk to your provider.

Can I take SSRIs if I’m pregnant or thinking of becoming pregnant?

SSRIs have been shown to cause some negative effects in a developing fetus. However, stopping these medications during pregnancy also carries risks. Your depression symptoms may worsen without treatment. If you’re pregnant or planning to become pregnant, talk to your provider. They can explain the risks and benefits in detail and help you decide what’s best.

Stopping treatment with SSRIs

If you need or want to stop taking an SSRI, your provider will help you gradually reduce your dose. Quitting abruptly can lead to a group of symptoms known as antidepressant discontinuation syndrome. These symptoms typically happen if you’ve been on the medication for six weeks or longer.

How long does it take for an SSRI to work?

Selective serotonin reuptake inhibitors take time to work, usually between four and six weeks after reaching a therapeutic dose. But they can take even longer (between nine and 12 weeks) in certain individuals. If you’re not feeling better by then, check in with your provider, who may recommend an adjustment to your treatment plan.