Selective serotonin reuptake inhibitors (SSRIs) are a popular antidepressant option for individuals with depression, anxiety, and other mental disorders. However, side effects and lack of response can impact their efficacy for some individuals. A deeper understanding of how SSRIs can potentially improve your symptoms can help you make well-informed treatment decisions.
Read on to learn about how fast SSRIs work, treating psychiatric disorders with SSRIs, managing side effects, and finally, what to do when your SSRI stops working.
SSRIs have a delayed therapeutic response, with symptom relief typically taking effect after two weeks. Some individuals may notice slight improvement as early as the first week, but the full impact takes several weeks to develop.
Escitalopram is an SSRI under the brand name Lexapro. Individuals taking it may notice therapeutic effects within the first week. It has the fastest known response of an SSRI and the mechanisms behind it are still being studied. Antidepressant use has a known placebo effect, meaning that patients may feel better just by knowing they are taking the treatment, regardless of the drug’s actual efficacy. That said, research findings show that escitalopram’s rapid onset may be a true drug response.
One hypothesis attributes escitalopram’s rapid response to a biochemical action called allosteric binding. Allosteric substances impact how neurotransmitter receptors respond, either increasing or decreasing a receptor’s affinity for them. Increased affinity means that a receptor is more attracted to the neurotransmitter and more likely to stay bound. Allosteric binding may improve how consistently escitalopram stays active as a serotonin reuptake blocker, resulting in a more rapid impact on depressive symptoms.
Studies recognize a positive medication response when an overall decrease in reporting symptom severity is observed. Specific symptom relief is variable among individuals with a positive response, though physical symptoms often show significant improvement over the first four weeks with the effect leveling off in the following weeks.
SSRI treatment may also bring on a beneficial change in the patient’s mood—though more gradually, due to the complex process involved with emotional processing. As the biochemical responses affect the way neurons function, individuals perceive their environment with more positive bias. This shift further influences how they interpret their surroundings, eventually resulting in a more positive mood.
SSRIs are versatile antidepressants that act on serotonin activity patterns to improve the psychiatric symptoms of a number of mental health conditions. They are well regarded for their safety, efficacy, and tolerability, making them first-line treatments for such psychiatric disorders as obsessive-compulsive disorder (OCD), general anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD). That said, SSRIs should be carefully considered under the guidance of a mental health professional or healthcare provider. Adverse effects are possible, and SSRIs may not be the right fit for everyone seeking treatment.
Anxious depression is a common subtype of major depression marked by the presence of anxious distress. SSRIs have both antidepressant and anti-anxiety properties, but individuals with this condition often have more challenges finding adequate symptom relief and may develop treatment-resistant depression. Deep TMS™ is an FDA-cleared, noninvasive treatment shown to provide safe and effective relief for anxious depression. It can be used as a standalone treatment or in conjunction with other treatments, such as antidepressants, to relieve symptoms more completely.
A potential benefit of augmenting SSRIs with aripiprazole (an antipsychotic medication) is its proven efficacy when treating individuals with inadequate treatment response. A newer anxiolytic (anti-anxiety substance) called buspirone may also be used to address anxiety symptoms of anxious depression without the risk of misuse or sedative side effects.
The serotonin reuptake inhibition mechanism of SSRIs is effective at reducing anxiety. Because these effects may not emerge for two weeks or more, short-term augmentation with benzodiazepine can provide rapid symptom relief until the full SSRI response develops.
Both SSRIs and benzodiazepines may cause significant, adverse side effects that lead patients to discontinue taking their medication. For this reason, reducing anxiety symptoms early in treatment may improve adherence.
When treating OCD with SSRIs, healthcare providers recommend a higher dose than what is usually prescribed for depression treatment. While lower doses may have some positive impact, they may not provide enough effect for significant symptom relief.
Unfortunately, using higher doses may also increase the chance of experiencing adverse side effects, which may negatively affect medication adherence. When selecting SSRI medication for OCD, individuals may consider consulting their healthcare provider to understand the risks and benefits of this treatment strategy.
Adverse side effects are a potential factor when considering SSRI antidepressants. They are often more tolerable and safer than older antidepressants, but they may still negatively impact quality of life and lead to treatment stoppage. Effectively managing the most bothersome SSRI side effects may help you benefit more from your antidepressant while minimizing discomforts.
Take SSRIs as prescribed and only make changes such as these suggestions under the careful supervision of your healthcare provider.
Augment an SSRI with bupropion, an atypical antidepressant that does not impact the serotonin activity.
Take a short-term medication break lasting 48-72 hours before sexual activity, then resume taking the usual dose afterward.
Nausea is possible with all antidepressants and typically improves after a week but may persist for some individuals. Taking a larger dose at bedtime, taking medication with food, or considering augmenting it with mirtazapine may help.
Diarrhea occurs for up to 16% of individuals and is more likely with sertraline than other SSRIs. Taking antidiarrheal agents, such as psyllium husks, and switching to a non-serotonergic antidepressant if diarrhea persists can counter this effect.
Drowsiness is a side effect often associated with early medication discontinuation. Short-term insomnia may also occur as individuals adjust to the initial dose or increased dosage, though this is less likely with the SSRI citalopram.
Addressing side effects by considering overall treatment context, through shifting the dosage schedule, dividing doses, and carefully managing sleep hygiene behaviors may prevent their effects.
Some individuals initially experience adequate relief due to taking SSRIs, only to find them less effective over time. Researchers are still learning why this loss of SSRI response at times occurs.
Potential reasons why SSRIs may stop working include:
When SSRIs stop working, individuals may consider abrupt discontinuation. If you want to consider a different treatment, it is imperative to consult with a licensed mental health professional or healthcare provider before stopping your medication.
When stopping one’s SSRI treatment without medical guidance, patients may experience uncomfortable side effects due to antidepressant discontinuation syndrome. For this reason, it is important for patients to continue taking their medication as prescribed until their provider advises them on gradually tapering it off.
Strategies for treatment-resistant depression may be helpful when SSRI efficacy wanes. These may include increasing dosage, augmenting with other antidepressants, changing medication, or using additional treatments proven to improve depression symptoms, such as Deep Transcranial Magnetic Stimulation (or Deep TMS).
For some individuals, antidepressant medications lose some of their therapeutic effect over time. Whether antidepressants become less effective or stop working altogether, Deep TMS can be used as an additional treatment to provide more complete symptom relief. Deep TMS is an FDA-cleared, empirically-based treatment utilizing a cushioned helmet to deliver targeted magnetic pulses to regions of the brain associated with psychiatric symptoms. Its patented technology helps regulate the neural activity in these brain regions, improving symptoms over several treatment sessions, without causing any long-lasting side effects.
SSRI medications play a prominent role in treating many psychiatric disorders, though they may not be suitable for everyone. Understanding how to get the most benefit from SSRIs is essential when choosing an effective treatment.