Risks & Dangers Of SSRI Antidepressants

Five selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant medication, have been approved for use in the United States. These include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft). 

These medications all increase the effect of the neurotransmitter serotonin and are generally considered safe. 

However, there are certain risks involved with the routine use of SSRI antidepressants to treat major depressive disorder, panic and anxiety disorders, obsessive-compulsive disorder, eating disorders, post-traumatic stress disorder, and other mental health conditions. 

Short-Term Risks Of SSRIs

Even though SSRIs are safe and well-tolerated by most individuals, many report experiencing certain side effects when they start taking these medications.

Side effects may include:

• feelings of illness
• agitation, restlessness, or shakiness
• indigestion
• digestive issues
• changes in appetite and weight loss or weight gain
• dizziness
• blurred vision
• dry mouth
• excessive sweating
• drowsiness or insomnia
• headaches
• low sex drive
• difficulty achieving orgasm
• erectile dysfunction

These side effects often fade as the body adapts to the medication. If they do not, healthcare providers likely have individuals switch between different SSRI medications or dosages until they find the right combination.

Uncommon Risks & Dangers Of SSRIs

In some cases, individuals do not tolerate the effects of SSRIs. This can lead to more worrying and dangerous side effects, which may also be prompted by risky drug interactions.

These uncommon side effects should be reported to your healthcare provider if you notice them.

Suicidal Thoughts

While the use of antidepressants in the treatment of severe depression likely reduces the risk of suicide, there have been cases where antidepressants have increased the risk of suicidal impulses in children, teenagers, and young adults under 25. 

As a result, the FDA requires that all antidepressants carry black box warnings alerting patients to this potential risk. 

Serotonin Syndrome

A controlled increase in serotonin levels can help boost a person’s mood and mental state. However, if serotonin levels climb too high, it can provoke a very dangerous medical condition known as serotonin syndrome. 

Serotonin syndrome is most common when at least two serotonergic substances are mixed, such as SSRIs and other types of antidepressants (tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors), monoamine oxidase inhibitors, MDMA/ecstasy, St. John’s Wort, and others. 

Serotonin syndrome involves signs and symptoms of agitation, confusion, high blood pressure, fast heart rate, heavy sweating, headache, muscle stiffness or twitching, shivering, and goosebumps. 

Gastrointestinal Bleeding

SSRIs are believed to cause an increased risk of gastrointestinal (GI) and other bleeding issues, especially if taken with certain other medications like nonsteroidal anti-inflammatory drugs, aspirin, warfarin, or blood thinners.

Potential Long-Term Effects Of SSRIs

SSRIs were evaluated for safety through clinical trials before being approved for general prescription use in the United States. 

However, investigations and meta-analyses in the years since have shown that these antidepressant drugs are associated with more long-term side effects than early clinical trials would have suggested. 

In fact, research shows that a majority of those who take SSRIs for an extended period of time likely experience at least one of the following effects.

Sleep Disturbances

Major depression interferes with a person’s sleep quality. 

Unfortunately, SSRIs used for the treatment of depression can also interfere with sleep quality, increasing awakenings and reducing REM sleep, slow-wave sleep, and the overall length of sleep.

Sexual Problems

SSRIs are associated with an increased risk of long-term sexual dysfunction (inability to orgasm, low libido, and erectile dysfunction), even compared to the considerable effect of depression on sexual desire and performance.

Weight Gain

While SSRIs may cause some initial weight loss, this weight is likely regained within six months and may be followed by additional weight gain. However, significant weight gain may also occur over a relatively short period of time depending on the individual.

Physical Dependence & Discontinuation Syndrome

Whenever possible, healthcare providers likely combine antidepressant use with psychotherapy, including cognitive-behavioral therapy. Therapy can help wean individuals off their medication after a proper duration of use.

However, antidepressant discontinuation syndrome is a possible side-effect of giving up SSRIs after a person has become physiologically dependent on them. 

This can cause short-lived withdrawal symptoms including: 

• flu-like illness
• insomnia
• nausea
• imbalance
• sensory disturbances
• hyperarousal

Antidepressants can be tapered off, rather than cut off cold-turkey, to avoid these side effects and monitor for a resurgence of symptoms. 

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