General SSRI side-effects
Recent studies indicate that SSRIs are ideal for people with minor depressive illness -- much better than tricyclics, such as imipramine, or the complication-prone MAOIs. The SSRIs are effective for major depression as well.
Research seems to suggest that you can head off serious full-blown illness by taking an SSRI during the early stages of depression. This doesn't mean that SSRIs are the only worthwhile antidepressant. There is still a place for the older drugs.
Researchers note that the SSRIs don't work for 20 percent to 40 percent of depressed or anxious people who try them -- the same failure rate as for the older antidepressants.
Most experts agree that no single SSRI is better than the rest. Each drug has a certain profile of its own particular side effects; some have markedly similar side effects, while others vary widely.
For example, Zoloft and Paxil don't last as long in the body as Prozac; the half-life of Zoloft is about 26 hours, and the half-life of Paxil is about 21 hours. ("Half-life" is the time it takes for a drug in the blood to decrease by half of its original dose.)
SSRIs are not wonder drugs. They have potential side effects, although these are generally less severe than those of other antidepressants.
One of the biggest problems with these drugs is their cost. All of them are much more expensive than the generic versions of older drugs like MAOIs or tricyclics. Generic versions of the older drugs are available because their patents have expired.
Severe kidney or liver disease could result in higher-than-normal blood levels of the SSRIs. In addition, the SSRIs may not be the best choice in the treatment of patients with mania, or in those with a history of seizures.
The side effects of SSRIs are usually mild and manageable, although sensitive people may get a severe reaction. Like most antidepressants, SSRIs may cause nausea, dizziness, or dry mouth, not to mention a range of sexual-function side effects, including decreased sexual interest (in men), increased sexual interest (in women), ejaculation problems, impotence, or menstrual changes. For other reported side-effects, see the list below.
The most common side effects with Zoloft, launched in 1991, and Paxil, introduced in 1993, are insomnia, diarrhea, tremor, and drowsiness. If you get side effects while taking either of these, your doctor may switch you to Wellbutrin, as long as you don't have any of the conditions that might make you vulnerable to seizures with this drug (such as previous severe head injury or epilepsy). And like Prozac, Zoloft and Paxil can produce mild mania in some people with a genetic tendency in that direction.
More recent additions to the SSRI family include duloxitene (Cymbalta) and escitalopram oxalate (Lexapro).
Thes latter two medicines seem to particularly work well in fibromyalgia, in my opinion.
Luvox (fluvoxamine) is an SSRI recently approved by the FDA for the treatment of obsessive-compulsive disorder but not yet approved for depression in the U.S. (It has been used as an antidepressant for several years in Europe and Canada.)
Given together, tryptophan and any of the SSRIs may cause headache, nausea, sweating, and dizziness. Taking an SSRI within two weeks of an MAOI (such as Marplan or Parnate) may cause serious side effects; you should wait at least two weeks between stopping MAOIs and starting an SSRI, or at least five weeks after stopping an SSRI and starting an MAOI.
Combining SSRIs and warfarin may cause excess bleeding. If you're taking cimetidine, which can cause an increase in the blood levels of SSRI, your dosage of SSRI should be adjusted.
There are potentially severe reactions between nonprescription drugs and SSRIs, so be sure to talk to your doctor about any other drugs you take. The same goes for alcohol and herbal remedies. Combining SSRIs with either digoxin (Lanoxin) or warfarin (Coumadin) may cause unwanted side effects.
Most SSRIs haven't been studied in nursing mothers or pregnant women and should be avoided if possible.
The SSRIs may be an effective treatment for other disorders besides depression. Luvox appears to be as effective as Prozac or clomipramine for obsessive-compulsive disorder. Paxil has been approved by the FDA for obsessive-compulsive disorder and panic disorder. Zoloft has been approved for obsessive-compulsive disorder.
Research with SSRIs has not found that people become dependent on the drug or have withdrawal symptoms when they stop taking it. Nevertheless, you should let your doctor know if you develop any troubling symptoms while taking, or after stopping, an SSRI.
Other side-effects that have been reported by people who have taken SSRIs include:
• Mind racing and unable to control thoughts
• Panic attacks or mood changes
• Hot surges or hot flashes.
• Horrible nightmares.
• Obsessive thoughts.
• Feeling like a zombie, foggy.
• Physically numb.
• Severe dizziness.
• Felt like going to pass out or lose control.
• Feel disconnected.
• Really drugged out most of the time.
• Heart palpitations and tightness in the head.
• Flashes of memories and images from the past.
• Headache.
• More depressed.
• Fatigue
• Nose bleeds
• Nausea and loss of appetite
• Memory loss with apathy
• Nipple discharge
• Loss of sex drive
• Manic/depressive episodes
• Numbness in genitals
• Swelled penis
• Sudden and excessive weight gain
• Tremors, sudden jerky movements of muscles, extreme sensitivity to sound
• Suicidal
• Can't focus, hard to read words
• Worsening of acne
• Lethargy
• Somnolence
• Heavy sweating
• Temperature changes in limbs
• Dramatic weight loss
• Cold intolerance
• Paranoia
• Muscle and joint pains
• Strange and vivid dreams
• Rashes
• Itching
• Abdominal pain
• Self mutilation
• Tongue pain at night
• Ringing in ears
• Shortness of breath
• Palpitations
• Craving for sugar or protein or vitamin C
• Delayed ejaculation and subtle loss of genital sensitivity
• Acceleration of Alzheimer's
• Numbness in limbs
• Constipation
• Abdominal bloating
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