Written and medically reviewed by Dorcas Morak, Pharm.D
Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are commonly prescribed for depression and other mental health disorders. Some commonly prescribed SSRIs include:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil, Pexeva)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
They offer notable advantages. However, it's essential to recognize that, just like any medication, SSRIs can have side effects. While many are familiar with common ones such as nausea, changes in weight, and sexual difficulties, exploring further uncovers lesser-known effects that patients and healthcare providers should consider when assessing the pros and cons of SSRI treatment.
Lesser-Known Side Effects of Antidepressants
Cardiac Side Effects
SSRIs are generally safer for the heart than other antidepressants, but they still come with risks. A key concern is arrhythmias—irregular heartbeats—with citalopram (Celexa) posing a higher risk. Additionally, SSRIs can prolong the QT interval, potentially leading to Torsade de Pointes, a life-threatening arrhythmia. While these side effects are rare and mainly occur at higher doses, they highlight the need for cardiac monitoring in patients with heart diseases or those on higher SSRI doses.
Serotonin Syndrome
Serotonin syndrome is a dangerous, potentially fatal condition caused by excess serotonin in the brain, often triggered by combining SSRIs (such as citalopram) with other serotonergic drugs like MAOIs (such as phenelzine), tricyclic antidepressants (such as amitriptyline), or triptans (such as almotriptan). Symptoms can start mild—headaches or dizziness—but can quickly escalate to severe issues like high fever, seizures, and irregular heartbeat. Because mild symptoms are easy to overlook, early detection is challenging. If you suspect serotonin syndrome, get medical help immediately to treat and resolve the symptoms.
Long-Term SSRI Discontinuation Syndrome
When you abruptly stop taking SSRIs, you risk experiencing discontinuation syndrome, which often includes flu-like symptoms, insomnia, nausea, and sensory disturbances. While most people recover within weeks, some may suffer for a year or longer. This isn't due to physical dependence and remains poorly understood. It's crucial to taper off the medication gradually under medical supervision to minimize these effects.
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
SIADH is a rare but severe side effect of SSRIs, marked by an excessive release of antidiuretic hormone (ADH). ADH controls water and sodium balance in the body. When too much ADH is produced, the body retains water, diluting blood sodium levels. This condition can cause headaches, confusion, and nausea, worsening if untreated. SIADH is more common in adults over 65 and is most often linked to fluoxetine (Prozac) use. Managing SIADH requires careful monitoring of fluid intake, adjusting SSRI dosages, and balancing electrolytes.
Mania Symptoms
Behavior activation in children is a severe concern when starting SSRI therapy. Symptoms like agitation, irritability, and impulsivity affect about 5% of young patients within the first few weeks. In severe cases, SSRIs can trigger mania, causing extreme mood swings, hyperactivity, and inflated self-esteem, especially in those with bipolar disorder. To reduce these risks, start with a low dose and increase it gradually. The treatment plan needs immediate reassessment if any signs of behavior activation or mania appear.
Knowing the rare side effects of antidepressants is crucial for making smart treatment choices. SSRIs can significantly help those with depression and anxiety, but understanding both the common and rare side effects is essential for managing risks. At RxLess, we are dedicated to providing affordable, FDA approved prescription medications at a significantly discounted rate. RxLess can save you up to 88% at pharmacies like CVS, Rite Aid, and Walgreens. Follow our posts for health tips and ways to save money!
