By Lily Kangas
Published 11:21 PM EST, Tues June 15, 2021
SSRIs are antidepressants that work to correct serotonin deficits for patients with various mental health problems. These drugs, however, have many downsides that are often not acknowledged including more minor side effects like headaches and nausea, to much more concerning long-term implications such as weight gain and sleep disturbances. Fortunately, alternatives do exist.
What Are They?
Selective Serotonin Reuptake Inhibitors, more commonly called SSRIs, are the most common form of antidepressant. They work by enhancing the nerve cells that are responsible for regulating emotion and increase serotonin levels within the brain. Serotonin is a key hormone that works to stabilize mood and promote feelings of happiness and well-being. When one is in a serotonin deficit, these positive emotions and feelings are often lost or minimized, leading to psychiatric symptoms associated with anxiety, depression, and OCD. To combat this deficit, psychiatrists prescribe SSRIs in hopes that it will restore the hormone to its natural levels. What many patients are not prepared for, however, are the many harmful side effects and long term implications these drugs pose (Sharma, 1).
SSRIs Used to Treat Depression
The list of SSRIs that have been officially approved by the FDA to treat clinical depression include:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil, Pexeva)
- Sertraline (Zoloft)
These drugs each differ in potency when it comes to blocking serotonin reuptake, and most patients metabolize (eliminate) each drug at a different rate, but they all have the same general function.
Most people who take SSRIs experience one or several short-term side effects. Because all SSRIs work in generally the same way, these side effects are typically similar in symptoms and severity. It is common for these side effects to fade once a patient’s body has adjusted to the drug, however if they persist, some patients may opt to try a different SSRI or discontinue antidepressants entirely (Mayo Clinic). The most commonly reported side effects include:
- Nausea and vomiting/upset stomach
- Dry mouth
- Nervousness, restlessness, and agitation
- Reproductive difficulties
- Changes in appetite (resulting in weight loss or gain)
Overall, the SSRI with most commonly reported side effects is fluvoxamine, followed by paroxetine and sertraline. As a result, these three drugs have the highest discontinuation rates as well as the highest risk of complications (NCBI).
Long Term Effects
Although the short term effects listed earlier typically go away, SSRIs can also pose much more dangerous long-lasting implications. The most common of these effects include:
- Weight gain: an uncontrolled study found that, in a period of 6-12 months, sertraline has a mean weight gain of 15 pounds, fluoxetine has a mean weight gain of 21 pounds, and paroxetine has a mean weight gain of 24 pounds (NCBI). With any form of weight gain comes increased medical risks. Patients increase their chances of a heart attack by 5-7% with each point added, so with a 24 pound weight gain on paxil, the risk of a heart attack goes up 25% (today.com). Additionally, weight gain leads to an increase in fatty acids and resistance to insulin, increasing risk of type 2 diabetes. Not only that, but people who are overweight have a 2-7% higher chance of developing end stage kidney disease than those in the healthy BMI range (World Kidney Organization).
- Sleep disturbances: SSRIs have been shown to disrupt the normal sleep patterns of depressed patients by delaying the onset of REM sleep and reducing the duration of REM sleep, as well as sleep efficiency, leading to an overall loss in sleep time. Over time, this loss can build up, causing “sleep debt.” The absence or lack of sleep over long periods has been found to cause issues like hormone imbalance, susceptibility to diseases such as diabetes or heart failure, and a greater risk of death.
Other long-term effects include physical and emotional dependency, increased risk of dementia (AADA), and increased likelihood of strokes.
Many alternatives to SSRIs exist and most have lessened likelihoods of adverse effects or complications. The first alternative is switching to a different form of antidepressant such as Wellbutrin, Cymbalta, or Pristiq. These drugs are not commonly associated with long-term effects such as weight gain, in fact, they are more commonly associated with slight weight loss, however, sleep hindrance may still occur.
If SSRIs and alternative antidepressants still prove to have too many adverse effects, doctors may recommend a non-pharmaceutical approach to treatment. Non-pharmaceutical treatments encompass any activity or intervention aimed at improving one’s mental state without the use of medication, so a wide range of options exist. The most commonly recommended medication-free mental health treatments include:
- Cognitive behavioral therapies (CBT)
- Grounding techniques such as yoga, mindfulness, or meditation
- Changes to diet and exercise
- Acupuncture and aromatherapy
Generally speaking, this naturopathic approach to psychotherapy has been proven to be just as effective at restoring serotonin levels as SSRIs. Futhermore, these treatments are free from the possible implications drugs pose, which is why much of the medical world is beginning to move away from pharmaceutical mental-health intervention (Dr. Jessica Black).
Lily Kangas, Youth Medical Journal 2021
Black, Jessica. “3 Reasons Naturopathy Is Good for Emotional and Mental Health.” Jessica Black, 3 Mar. 2016, drjessicablack.com/3-reasons-naturopathy-is-good-for-emotional-and-mental-health.
Carvalho, André. “The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature.” FullText – Psychotherapy and Psychosomatics 2016, Vol. 85, No. 5 – Karger Publishers, 2016, http://www.karger.com/Article/FullText/447034#:%7E:text=Some%20studies%20have%20found%20nausea,GI%20side%20effects%20%5B34%5D.
“SSRI Antidepressant Medications: Adverse Effects and Tolerability”
NCBI, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/#:%7E:text=The%20latter%202%20drugs%20are,side%20effects%20in%20clinical%20trials.&text=During%20long%2Dterm%20SSRI%20therapy%2C%20the%20most%20troubling%20adverse%20effects,weight%20gain%2C%20and%20sleep%20disturbance. Accessed 28 May 2021.
“Selective Serotonin Reuptake Inhibitors (SSRIs).” Mayo Clinic, 17 Sept. 2019, http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825.
Worldkidneyday. “Obesity & Kidney Disease.” World Kidney Day, 7 June 2019, http://www.worldkidneyday.org/facts/topics/obesity-kidney-disease/#:%7E:text=People%20who%20are%20overweight%20or,to%20those%20of%20normal%20weight.