General SSRI side-effects

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

SSRIs are ideal for people with minor depression -- much better than the older drugs such as tricyclics or the complication-inducing MAO inhibitors. The SSRIs are effective for major depression as well.

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 older antidepressants.

No single SSRI is better than the others. And their side effect profiles can vary.

Side effects are often dependent on serum half-life of a drug. For example, Zoloft and Paxil have half-lives significantly shorter than Prozac; the half-life of Zoloft is about 26 hours, and the half-life of Paxil is about 21 hours. ("Half-life" is defined as the time it takes for a drug in the blood to decrease by half of its original dose.)

Most SSRIs are available as generic drugs so cosrt has become less of an issue than it once was.

Severe kidney or liver disease can lead to higher than normal blood levels of the SSRIs. In addition, the SSRIs may not be the best choice in the treatment of patients with manic behavior, or in those with a history of seizures.

The side effects of SSRIs are usually mild. Like most antidepressants, SSRIs may cause nausea, dizziness, or dry mouth, sexual-function side effects, including decreased sexual interest (in men), increased sexual interest (in women), ejaculation problems, impotence, or menstrual changes.

More recent additions to the SSRI family include duloxitene (Cymbalta) and escitalopram oxalate (Lexapro). Cymbalta is actually an selective serotonin and nor-epinephrine uptake inhibitor (SNRI).

These latter two medicines seem to particularly work well in fibromyalgia, in my opinion.

Taking an SSRI within two weeks of an MAOI (such as Marplan or Parnate) may cause serious side effects; one 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. H2-antagonists, used for ulcer prophylaxis can cause an increase in the blood levels of SSRI.

There are potentially severe reactions between nonprescription drugs and SSRIs. This can also be seen with 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.

Research with SSRIs has not found that people become dependent on the drug or have withdrawal symptoms when they stop taking it.

Here is a list of side-effects that have been reported by people who have taken SSRIs:

• 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

One final but important side-effect is an increased risk of suicide reported in patients taking these medicines.

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