SSRIs, full form selective serotonin reuptake inhibitors, are the most commonly prescribed antidepressant medications for depression to overcome its symptoms.
Depression can be a terrible thing to have. It causes you to feel extremely sad and miserable most of the day and for weeks to come. It can prevent you from carrying on your daily routine.
If not treated, depression can have some pretty serious consequences. The good news is that depression can be treated and 80 to 90 percent of the people with depressive disorder benefit from its treatment with drugs and management measures. SSRIs changed their life and brought it back to normal.
SSRI or selective serotonin reuptake inhibitor is the best medication (antidepressant) for moderate to severe depression and anxiety that most doctors use to start antidepressant therapy.
SSRIs are effective, work very well, are safer to use and its side effects are few as compared to other types of antidepressants. They make you feel elated.
SSRI is the most common first line of antidepressants used for the treatment of depression.
Uses of SSRIs in Psychiatry
- Clinical depression forms the main indication for selective serotonin reuptake inhibitors.
Other indications include
- Anxiety disorders
- Panic disorders
- Eating disorders such as anorexia and bulimia
- Chronic pain of unknown etiology
- Irritable bowel syndrome
- Premature ejaculation
How do SSRIs Work? Mechanism of Action
Inadequate amount of neurotransmitters, which are naturally occurring brain chemicals, is one of the possible causes of depression.
Neurotransmitters, as the name suggests, are responsible for transmission of nerve or brain signals between the nerve cells. When the brain cells have to send a signal they release a bit of this neurotransmitter, which then carries the signal forward.
When the transmitting is done, they take back the neurotransmitter for the next transmission. This process of taking back the neurotransmitter is called “reuptake”.
Serotonin, also called 5-HT, is one such neurotransmitter. As its name “Selective Serotonin Reuptake Inhibitors” suggests, it inhibits the selective uptake of serotonin by the nerve cells.
Depression seems to be linked to disturbances in the neurotransmission in neural pathways that convey signals, due to low levels of these neurotransmitters.
By inhibiting their uptake by the nerve cells, SSRIs allow more serotonin to be available between the neurons, so that nerve signals can be sent efficiently. This brings about a “good mood” effect.
Fall of serotonin levels in the brain due to serotonin uptake results in a depressive state of mind.
Adequate levels of the neurotransmitters like serotonin, help the brain cells to receive and send chemical signals, which helps to boost the mood of the person.
This is brought about by the SSRIs by preventing the reuptake or reabsorption of serotonin by the nerve cells thereby maintaining adequate levels. Since they act selectively on serotonin and inhibit its uptake, they are called selective serotonin reuptake inhibitors or SSRIs.
List of SSRIs
The following is the list of SSRIs with generic names and brand names in brackets, which are approved by the Food Drug Administration to treat depression and other mood disorders like anxiety.
The first and most famous SSRI was fluoxetine hydrochloride first introduced and marketed in 1987 under the trade name Prozac.
- Fluoxetine (Prozac)
- Paroxetine (Paxil, Seroxat)
- Fluvoxamine (Luvox, Faverin)
- Sertraline (Zoloft)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Vibryd – recently approved in early 2011.
Some of these SSRIs are available as time release form and are designated as XR or CR. They are given in single dose and provide controlled release of the medication throughout the day or week. Their advantage is that less nausea is experienced with these time release SSRIs.
Indalpine (Upstene) and zimelidine (Normud, Zelmid) antidepressants, were also formerly prescribed but were withdrawn from the market.
- Indalpine (Upstene) was banned because it was found to cause neutropenia.
- Zimelidine has been banned worldwide of its serious, and sometimes fatal, side effects of central and/or peripheral neuropathy known as Guillain-Barré syndrome and due to a hypersensitivity reaction involving body organs including skin exanthema, flu-like symptoms, arthralgias, and eosinophilia.
How Long Should You Continue Treatment With SSRIs?
Any person with depression on an antidepressant would want to take the medication for as short a time as possible.
This is a dangerous attitude to have because stopping the antidepressant drug without its full prescribed length of duration can lead to a relapse of depression.
A relapse, for most people, can lead to depression becoming a chronic or lifelong illness, with several recurrences.
You have to give time for the antidepressant to work. It can be up to a few weeks to a couple of months for therapeutic action to come into effect. And even then, you still have to continue taking the medication.
If the depression medication does not work and improve your symptoms, you should consult your psychiatrist, who will put you on another type of antidepressant
Most doctors rightly advise patients to continue taking antidepressants for six months to a year after their depression symptoms have resolved.
A study conducted by the National Institute of Mental Health found that people with depression who did not respond to the first medication fared better when they were put on the second type or a new medication was added to their treatment.
Withdrawal Symptoms with SSRIs
Though SSRIs are not addictive and don’t give you a “high”, abruptly stopping them can give you discontinuation syndrome accompanied by withdrawal symptoms.
They include a headache, nausea, dizziness, lethargy, fever, and bodyache. That is why they are discontinued by gradually tapering off the dose t prevent withdrawal syndrome.
Discontinuation syndrome is more common with SSRIs namely paroxetine, sertraline, and fluvoxamine with paroxetine showing the highest incidence.