Side Effects of SSRIs and Misconceptions of Antidepressant Drugs

Selective Serotonin Reuptake Inhibitors (SSRIs) are one of the most commonly prescribed medications in psychiatry, yet they remain widely misunderstood. In this blog post, we’ll explore the role of SSRIs in mental health treatment, examine their side effects, and address some common misconceptions.

This blog is for educational purposes only. It does not serve as medical advice. Please consult with a healthcare provider to discuss your unique circumstances and whether medication is right for you.

What Are SSRIs?

SSRIs are a class of medications most commonly used to treat depression, anxiety, and PTSD. Common SSRIs include Escitalopram (Lexapro), Sertraline (Zoloft), and Fluoxetine (Prozac).

These medications work by increasing serotonin levels in the brain, helping regulate mood, emotion, and sleep.

When Are SSRIs Helpful?

Mild vs. Severe Symptoms

Patients with severe depression or anxiety may benefit greatly from SSRIs, sometimes as a life-saving measure. On the other hand, therapy alone may be more appropriate for those with mild symptoms.

SSRIs as a Bridge to Therapy

Often, SSRIs are used to stabilize patients so they can begin engaging in therapy effectively. Many patients eventually taper off medications once their mental health improves.

Over-prescription Concerns

Psychiatrists are doctors who receive specialized training in mental health, and they often prescribe SSRIs to patients who need them. However, many patients receive prescriptions for SSRIs from providers who are not psychiatrists, such as primary care physicians or advanced practice providers like nurse practitioners or physician assistants. The higher rates of mental health diagnoses and prescriptions of SSRIs may be related to more patients seeing these providers instead of a psychiatrist who can complete a more accurate and comprehensive psychiatric evaluation.

Side Effects of SSRI Drugs

It's important to note that some side effects of SSRI drugs are more common than others but that many patients on SSRIs do not experience any side effects at all (or just the short-term side effects without long-term effects). It's difficult to predict which side effects you'd have, which is way some patients just need to trial an SSRI and consider switching to another if severe side effects that outweigh the benefits of the medication occur.

Short-Term Side Effects

What to Expect in the First Few Weeks

• Gastrointestinal issues (nausea, diarrhea, or constipation)

• Headaches

• Sleep disturbances

• Increased anxiety or agitation

These side effects typically fade within a few weeks as your body adjusts.

Suicide Risk and the Black Box Warning

While SSRIs carry a black box warning for potential increased suicidal ideation (especially in youth), further research has shown no increased risk compared to placebo. Nonetheless, it’s crucial to monitor any changes in mood or behavior when starting treatment because cases have been reported.

Long-Term Side Effects

Emotional Blunting

Some patients may feel emotionally numb or disconnected. This may be related to dopamine suppression caused by elevated serotonin levels.

Sexual Dysfunction

• Decreased libido

• Delayed ejaculation

• Difficulty achieving orgasm

These effects are dose-related and may require medication adjustments, switching drug classes, or adding a second medication to help mitigate the effects.

Rare But Serious Risks

• Easy bruising or bleeding

• Sodium imbalances

• Mania in those with bipolar disorder

These are uncommon but should be discussed with your physician, especially if you have existing medical conditions.

Debunking Myths About SSRIs: Do SSRIs Cause Violence?

There’s no clear evidence linking SSRIs to increased aggression or violent behavior. While some influencers claim otherwise, this is often based on anecdotes, not science. Correlation does not equal causation, and there should be consideration that many individuals who become violent on SSRIs may have already been at risk for violence prior to taking medication.

Alternatives to SSRIs

Non-Medication Options

• Therapy (CBT, DBT, trauma-focused)

• Lifestyle changes like regular exercise and structured sleep

• Mindfulness and meditation

These approaches are often first-line for mild symptoms and can be used in combination with SSRIs.

Stay Informed

SSRIs can be an essential part of treatment for many patients. But like any medication, they aren’t for everyone. If you're struggling with side effects or wondering whether medication is right for you, the best course of action is to talk to your psychiatrist.

Psychiatrists are trained to assess mental health conditions in-depth and provide individualized treatment plans. Don’t hesitate to ask your primary care provider for a referral or to ask to see a doctor instead of an NP or PA. Whether you’re starting, adjusting, or considering stopping an SSRI, always involve your doctor. Never stop medication suddenly without medical supervision.

Learn More on the Podcast

If you found this blog post helpful, listen to the full episode of First Line where I go into even more detail. Subscribe to stay up-to-date on future discussions about mental health, holistic wellness, and medical education.

Frequently Asked Questions (FAQ) About SSRIs

1. Can I drink alcohol while taking an SSRI?

It’s generally advised to limit or avoid alcohol while on an SSRI. While occasional use may not be harmful for everyone, alcohol can interfere with how the medication works, worsen depression or anxiety, and increase side effects like drowsiness or impaired coordination, so you'll want to always discuss with your provider before combining the two.

2. Do I need to be on SSRIs for life?

Not necessarily since many people take SSRIs short-term during an acute phase of illness and taper off once stable, especially if they’re also doing therapy or making lifestyle changes. Others may need long-term treatment if their symptoms return when stopping medication, but the decision is highly individual and should be made with a doctor.

3. How do I know if my SSRI is working?

SSRIs can take 4–6 weeks to show noticeable effects. Improvement might first be seen in sleep, energy, or appetite before mood improves. If there’s no change after a full trial at a therapeutic dose, your doctor may suggest adjusting the dose or trying a different medication.

4. Can SSRIs change my personality?

SSRIs don’t change your personality, but they may help reduce symptoms like excessive worry, irritability, or sadness associated with clinical depression or anxiety. Some people describe feeling more like themselves once their symptoms are managed while others may start to feel emotionally flat or disconnected, so always talk to your provider to see if you may have a side effect worth addressing.

5. Is genetic testing useful in choosing the right SSRI?

Pharmacogenetic testing (like GeneSight) can sometimes provide insight into how your body might metabolize certain antidepressants but is not usually necessary and doesn’t predict effectiveness. It may be more helpful in treatment-resistant cases or when someone has had multiple side effect issues.