SSRIs: Uses, most common brand names, and safety information
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In 2017, the World Health Organization estimated that more than 260 million people of all ages suffer from depression worldwide. It is the most common mood disorder in the United States with a lifetime prevalence of 14.4%.
It has been almost years since the first pharmacological treatment for depression was discovered. In the 1960s evidence suggested that serotonin played a significant role in major depressive disorder (MDD). As a result, researchers began developing what would become the earliest antidepressants. These were effective but they also caused significant side effects.
Because of this, pharmaceutical companies started looking to find a treatment for depression that would selectively target the reuptake of serotonin to increase the levels of serotonin in the brain. By 1987, Eli Lilly had gained approval from the U.S. Food and Drug Administration (FDA) for Prozac (fluoxetine). The introduction of Prozac as a selective serotonin reuptake inhibitor (SSRI) transformed the way depression was treated. It also lead the way for the new classes of antidepressants available today.
The list below includes the best SSRIs approved by the U.S. Food and Drug Administration (FDA) and their pricing:
List of SSRIs
Celexa is indicated to treat depression, binge-eating disorder, GAD, OCD, and panic disorder.
Lexapro is indicated to treat major depressive disorder, GAD, and OCD.
Prozac is indicated to treat resistant depression, major depressive disorder, GAD, OCD, and panic disorder.
Luvox is indicated to treat OCD and panic disorder.
Paxil is indicated to treat depression, binge-eating disorder, GAD, OCD, social phobia, and panic disorder.
Zoloft is indicated to treat major depressive disorder, OCD, panic disorder, PTSD, and premenstrual dysphoric disorder.
What are SSRIs?
Selective serotonin reuptake inhibitors (SSRIs) are a class of medications often used as first-line therapy for depression and other mental health conditions due to their effectiveness and incidence of fewer side effects. They are the most commonly prescribed antidepressants.
Like other types of antidepressants, SSRIs typically need up to 4 weeks before you see the full benefit. Side effects may occur when you first start an SSRI, but it is important to keep taking it. They will usually go away within a few days. If you have taken an SSRI for over 4 weeks without any improvement in your symptoms, contact your doctor. They may need to increase your dose or switch to another antidepressant.
How do SSRIs work?
Depression is thought to be caused by low levels of neurotransmitters such as serotonin, dopamine, and norepinephrine in your brain. Serotonin is typically reabsorbed after carrying a signal between nerve cells (neurons) in the brain. SSRIs work by inhibiting this reabsorption, increasing the concentration of serotonin available. Increased serotonin levels are thought to elevate your mood and focus as well as relieve other symptoms of depression. SSRIs also have a relatively weak affinity for norepinephrine. They minimally affect histamine and muscarinic acetylcholine receptors which reduces the incidence of side effects.
What conditions are SSRIs used to treat?
SSRIs are a class of medications used in the treatment of depression and other conditions such as:
- Major depressive disorder
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder
- Generalized anxiety disorder (GAD)
- Premenstrual dysphoric disorder (PMDD)
- Panic disorder
- Social anxiety disorder (SAD)
- Eating disorders (bulimia nervosa)
Are SSRIs safe?
The use of SSRIs is relatively safe and effective when taken as prescribed. Your prescribing physician should be aware of your medical conditions, including:
- Bleeding disorder
- Bipolar disorder
- Kidney disease
- Liver disease
- Are pregnant or plan on becoming pregnant as they may cause fetal harm and/or death
You should also make sure they are aware of all the medications you take, including prescription drugs, over-the-counter medications, and supplements, as they may cause drug interactions:
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine) and Effexor XR (venlafaxine)
- Monoamine oxidase inhibitors (MAOI) such as Emsam (selegiline)
- Tricyclic antidepressants (TCAs) such as Elavil (amitriptyline) and Pamelor (nortriptyline)
- St. John’s wort, antipsychotics, and any other antidepressant medications that increase serotonin
- Blood thinners or any medication that affects coagulation such as aspirin and Coumadin (warfarin)
- Medications that increase the QT interval
Can you take SSRIs while you are pregnant or breastfeeding?
Studies have not established an increased risk of major birth defects or miscarriage with the majority of SSRIs when used during pregnancy. However, Paxil (paroxetine) is contraindicated due to its risk of cardiovascular defects, especially during the first trimester.
Most SSRIs are excreted in breast milk. Because this puts the infant at risk of exposure and adverse reactions. If you have to take an SSRI during lactation, the infant should be monitored for irritability, restlessness, excessive somnolence, decreased feeding, and weight loss.
You should always discuss the risks and benefits of any medication you need with your healthcare provider if you are pregnant, plan on becoming pregnant, or are breastfeeding.
What are the common side effects of SSRIs?
Some common adverse effects of SSRIs include:
- Dry mouth
- Blurred vision
- Weight gain
- Weight loss
- Sexual dysfunction including erectile dysfunction
SSRIs can rarely cause serious side effects, including:
- Serotonin syndrome, which can be life-threatening
- Increased risk of suicidal thoughts or behavior, especially in adolescents and young adults under the age of 24
- Prolongs the QT interval
- Increased risk of seizures
- Mixed/manic episodes in patients with bipolar disorder
- Low sodium levels (hyponatremia)
- Angle-closure glaucoma
This is not a complete list of side effects and we encourage you to consult with your healthcare professional for medical advice about any possible side effects.
How much do SSRIs cost?
SSRIs are very expensive with an average cost of around $2,000 per year for brand-name medications. There are lower-cost generic alternatives available as well.
You can purchase SSRIs for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.
Related resources for SSRIs