SSRIs: Uses, common brands, and safety info

In December 1987, Prozac (fluoxetine) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression. Within three years a picture of the Prozac capsule appeared on the cover of Newsweek magazine, which hailed it as “a breakthrough drug for depression.” Prozac was the first of a new class of drugs to treat depression called selective serotonin reuptake inhibitors, or SSRIs.

These new antidepressants quickly overtook older antidepressants—such as Pamelor (nortriptyline) and Elavil (amitriptyline), known as tricyclics, and Nardil (phenelzine) and Parnate (tranylcypromine), known as monoamine oxidase inhibitors (MAOIs)—as the most commonly prescribed drugs for depression. Healthcare providers believed the SSRIs were safer and avoided the weight gain common with the tricyclics and the hypertension issues with MAOIs.

Today, SSRI antidepressants remain the most commonly prescribed drugs for depression as well as for certain anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder. Continue reading to learn more about SSRIs including common brand names, uses, safety information, and costs. The table below lists the most common SSRIs currently available.

Other SSRI

Symbyax (olanzapine/fluoxetine): a combination antipsychotic drug and SSRI used to treat depressive episodes in bipolar disorder (manic-depressive illness) as well as severe depression that does not respond to other medications.

What are SSRIs?

The development of SSRIs in the 1970s was based on the theory that low serotonin levels played a role in patients who were clinically depressed. Prozac, as well as the other SSRIs that followed, were designed specifically to increase serotonin levels in the brain. This selective activity was a much different mechanism of action from the older antidepressants available at that time. 

How do SSRIs work?

Serotonin is a neurotransmitter, or chemical messenger, that carries signals between nerve cells, or neurons, in the brain. When the brain sends a message, serotonin is released from one neuron and then picked up and reabsorbed by a receptor on the receiving neuron. SSRIs work by blocking the reabsorption, or reuptake, of serotonin at the receptor of the receiving neuron. This allows for more serotonin, thought to have a positive influence on mood, emotion, and sleep, to be available to improve the transmission of messages between neurons. SSRIs are called selective because their main effect is on serotonin and not on other neurotransmitters.

What are SSRIs used for?

• Major depressive disorder (MDD) 

• Obsessive-compulsive disorder (OCD)

• Social anxiety disorder (SAD)

• Panic disorder (PD)

• Post-traumatic stress disorder (PTSD)

• Premenstrual dysphoric disorder (PMDD)

• Bulimia nervosa

Who can take SSRIs?

Children and adolescents

Antidepressants, including all SSRI medications, have an FDA-mandated “boxed warning,” also called a black box warning, due to increased risk of suicidality in children, adolescents, and young adults (up to 24 years of age). The FDA has approved the following antidepressants for use in children and adolescents for different types of diagnoses: 

• Prozac for depression and OCD

• Zoloft for OCD

• Fluvoxamine for OCD

• Lexapro for depression

Adults

SSRIs are generally considered safe and effective for use in adults unless they have a known hypersensitivity to any of the ingredients.

Seniors 

SSRIs are generally considered safe and effective for use in the elderly unless they have a known hypersensitivity to any of the ingredients. Elderly patients may be at greater risk for hyponatremia, or low sodium levels, when taking SSRIs—this may be addressed by changing to a lower dose or less frequent dosing.

Because they have shown the least potential for drug-drug interactions, the SSRIs considered to have the best safety profile in the elderly are Celexa, Lexapro, and Zoloft. 

Are SSRIs safe?

SSRIs carry a boxed warning regarding a risk of increased suicidal thinking and behavior in some younger patients. Patients of all ages who are started on SSRIs should be monitored for signs of suicidal thoughts and behaviors. 

Because SSRIs are thought to work in a similar way they share many of the same warnings:

• Serotonin syndrome is a serious and potentially life-threatening condition in which there is too much serotonin in the body. SSRIs work by increasing the levels of serotonin which may lead to excess levels, especially when taken with other drugs that increase serotonin such as triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, dextromethorphan, amphetamines, St. John’s Wort, and monoamine oxidase inhibitors (MAOIs). Symptoms of serotonin syndrome may include high fever, seizures, uneven heartbeat, or passing out. Emergency medical care may be needed if any of these symptoms occur.

• When discontinuing an SSRI, withdrawal symptoms, such as agitation, may occur if stopped abruptly. Patients should follow the advice of their healthcare provider on the best way to taper off the drug. 

• SSRIs may cause a mixed/manic episode in patients with bipolar disorder.

• SSRIs should be used cautiously in patients with a history of seizures.

• SSRIs may increase the risk of bleeding particularly if used with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen, or with anticoagulant drugs such as warfarin.

• Angle-closure glaucoma has occurred in patients taking SSRIs with untreated anatomically narrow angles.

• Hyponatremia, a condition where the level of sodium in the blood is too low, has been reported with SSRI usage. Symptoms may include nausea, headache, confusion, and fatigue.

• Patients on SSRIs may experience significant weight loss, particularly those already underweight.

• Some SSRIs may trigger a heart rhythm disturbance and should be used cautiously in patients with risk factors for QT prolongation.

• SSRIs have the potential to impair judgment and motor skills and patients should use caution when operating machinery.

SSRI restrictions

SSRIs may increase the chance of causing serious side effects and should be used with caution, or not at all, for those with the following conditions: 

• During the manic phase of bipolar disorder

• A bleeding disorder 

• Type 1 or Type 2 diabetes

• Epilepsy (unless the epilepsy is well controlled)

• Narrow-angle glaucoma

• Serious kidney, liver, or heart problems

SSRI interactions

When combined with some drugs, SSRIs can interfere with their effectiveness and potentially have dangerous reactions. Individual drug-drug interactions for each specific SSRI may be found in the product details links in the List of SSRIs above. Important interactions common to all SSRIs are the following: 

• SSRIs should not be taken with MAOIs or within two weeks of taking MAOIs to avoid the risk of serotonin syndrome.

• SSRIs should not be taken with other serotonergic, or serotonin increasing, drugs such as serotonin-norepinephrine reuptake inhibitors (SNRIs), triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, or St. John’s Wort.

• SSRIs may increase the risk of bleeding when taken with other medications that increase the risk of bleeding, such as NSAIDs (e.g., aspirin or ibuprofen) or blood thinners (e.g., warfarin).

Can you take SSRIs while pregnant or breastfeeding?

A decision to use SSRIs during pregnancy or while breastfeeding is based on the balance between risk and benefit. The risk of birth defects for babies of mothers who take SSRIs during pregnancy is low, although paroxetine (Paxil, Pexeva) is associated with a small risk of birth defects and its use is discouraged. A woman’s healthcare provider is the best source of information when managing antidepressant treatment when pregnant or breastfeeding.

Stopping SSRIs

Although SSRIs are not addictive, missing several doses of any antidepressant in a row or stopping treatment abruptly may cause withdrawal-like symptoms. This is sometimes called discontinuation syndrome and may include the following symptoms:

• General feeling of uneasiness

• Nausea

• Dizziness

• Lethargy

• Flu-like symptoms

Patients should be monitored for these symptoms when discontinuing treatment with an SSRI. A gradual reduction in the dose rather than abruptly stopping is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. The healthcare provider may continue decreasing the dose but at a more gradual rate.

Are SSRIs controlled substances?

No, SSRIs are not controlled substances.

Common SSRI side effects

The following are potential common side effects when taking SSRIs. This is not an exhaustive list and you should always consult a healthcare professional before taking SSRIs.

• Insomnia

• Nausea

• Headache

• Asthenia (

  abnormal weakness or lack of energy)

• Diarrhea

• Loss of appetite

• Drowsiness

• Anxiety

• Nervousness

• Dry mouth

• Decreased libido (loss of sex drive)

• Yawning

• Tremor

• Indigestion

• Flu syndrome

• Dizziness

• Excess sweating

• Ejaculatory dysfunction

• Impotence

• Abnormal dreams

• Constipation

• Rash

• Vomiting

• Visual disturbance

• Weight loss

How much do SSRIs cost?

SSRIs have a wide price range depending on the specific drug, quantity, and dosage. Since several SSRIs are available in generic form, they are much less than the brand name counterpart. For example, generic fluoxetine 20 mg a day costs about $16 a month. The brand name version, Prozac, would cost about $534 a month. Generic citalopram 20 mg a day costs about $14 a month. The brand version, Celexa, would cost about $305 a month. A SingleCare card could reduce certain prescription costs up to 80% at participating pharmacies. 

Also read:

• Lexapro vs. Prozac: Differences, similarities, and which is better for you

• Zoloft vs. Prozac: Differences, similarities, and which is better for you

• Paxil vs. Zoloft: Differences, similarities, and which is better for you

• Celexa vs. Prozac: Differences, similarities, and which is better for you 

• Viibryd vs. Lexapro: Differences, similarities, and which is better for you

• Trintellix vs. Viibryd: Differences, similarities, and which is better for you

• Sex on antidepressants: Exploring the sexual side effects of SSRIs

• What you should know before switching antidepressants