14 Common SSRI Side Effects
Selective serotonin reuptake inhibitors (SSRIs) belong to a class of medications often prescribed to manage the symptoms of depression and other mental health disorders, including obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders, and anxiety. These medications work by decreasing serotonin reuptake in the brain, though the relationship between serotonin levels and mental health conditions is complex.
SSRIs are often widely utilized because their side effects are typically believed to be less severe than those associated with other types of antidepressants. However, SSRIs can still produce a range of potential side effects for some people. Side effects can include weight changes, mood changes, sexual dysfunction, drowsiness, tremors, mania, and others.
If you are taking or considering taking medication, discuss all questions regarding the medication with your doctor. Never start, change, or stop any form of medication without the guidance of a licensed medical professional. As medication can be highly effective when combined with therapy, you may also connect with a therapist in person or online. Therapy can also be supportive on its own for those who do not take medication for any reason. BetterHelp now offers psychiatry services through UpLift as an additional care option alongside therapy. Psychiatry services may include medication management when clinically appropriate and based on a licensed psychiatric provider’s evaluation.
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Potential SSRI side effects
SSRIs may cause side effects for some people. However, not everyone who takes SSRIs will experience any of these side effects.
Awareness can be a step toward preparedness to monitor for potential side effects of SSRIs. Below are common side effects to discuss with your doctor.
Sexual dysfunction
One of the more common SSRI side effects can be sexual dysfunction, which can take many forms. Some individuals may report erectile dysfunction and difficulty ejaculating. Decreased libido is also common. In some cases, sexual dysfunction can lead to tension in relationships and discomfort for the individual taking the medication, and it may be necessary to adjust the treatment plan to mitigate this risk. In patients who experience sexual dysfunction as a side effect of SSRIs, it usually resolves after stopping the medication. However, in some cases, post-SSRI sexual dysfunction can occur, with the effects persisting for a period of time after discontinuation of the medication.
Weight changes
Fluctuations in weight can be another common side effect of SSRIs. Some people report initial weight loss after starting SSRIs, followed by weight gain within six months of starting the medication, with additional weight gain sometimes following. Others may exclusively experience weight loss or weight gain, and oftentimes, the weight changes differ between SSRIs, and between individuals.
Still, other lifestyle factors contribute to weight changes during SSRI treatment. Changes in appetite may often be a factor. For some, gaining weight can lead to additional physical health concerns, such as heart disease, high blood pressure, and diabetes. However, weight is not a direct indicator of health problems, so talk to your doctor if you are concerned about eating or body changes.
Insomnia
Sleep disruptions are a potential SSRI side effect that can seriously impact an individual’s mental and physical health. Some people who take SSRIs experience trouble falling or staying asleep.
Emotional detachment
Some people struggle to experience emotions as strongly as usual when taking SSRIs. This side effect, commonly called emotional blunting or SSRI-induced indifference, is thought to be related to higher medication doses, though it can occur regardless of the amount taken.
Emotional blunting can be concerning for many people, as they may not experience emotions (like happiness or excitement) in the way they normally do. Emotional detachment may also make it difficult to have an outlet for anxiety, sadness, or anger. While these feelings in the extreme may not be desirable, not feeling them at all can cause conflicts in relationships and may decrease overall quality of life.
Drowsiness
Fatigue and brain fog can be common side effects of SSRIs, and they often make it hard to concentrate and get as much done throughout the day. This drowsiness may be related to changes in sleep-wake regulation. To alleviate drowsiness that can be caused by SSRIs, professionals may recommend sticking to a consistent sleep schedule, exercising regularly, and eating nutritious foods.
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Anxiety
Some people have reported increased anxiety with the use of SSRIs. Though these medications are sometimes prescribed to manage anxiety, individuals may still begin to experience extreme feelings of worry or fear. These feelings are typically situational. The anxiety may also be related to emotional detachment, with anxiety heightening because other feelings may not feel the same as they usually do.
There may be several lifestyle changes you can make to manage feelings of anxiety. Regularly practicing mindfulness, meditation, and deep breathing can reduce these symptoms. You may also consider reducing alcohol and caffeine consumption, as both substances can increase anxiety levels.
Restlessness
One of the more common SSRI side effects can be an increase in energy levels that may make it hard to sit still and relax, leading to restlessness. Without an outlet to expend this energy, an individual may become restless while sitting for long periods, such as at work or school. They may also find themselves fidgeting more or frequently pacing when they are not engaged with the task at hand.
Finding healthy outlets for your energy may reduce restlessness, and remaining engaged in active pursuits may help you utilize your excess energy constructively. You might also consider starting a new hobby or volunteering with a local organization.
Agitation
Some people who take SSRIs find that they become more irritable and agitated than usual. Because SSRIs can affect serotonin levels in the brain, an individual may become agitated easily, have little patience, or experience angry outbursts. Medication adjustments may be warrented. For those with persistent anger issues, anger management techniques, such as deep breathing and grounding exercises, as well as support groups, can be helpful.
Tremor
Some people who take SSRIs can develop involuntary muscle movements. Tremors may show up in any part of the body, but they are most often experienced in the hands. Rarely, some people develop a tremor so severe that it can become difficult to write with a pen or type on a computer.
Mania
When used for the treatment of depression in people with bipolar disorder, SSRI medications can be associated with manic episodes. Manic episodes can be defined as periods in which an individual experiences an increase in energy, an elevated mood, and a decreased need for sleep. Manic episodes can lead them to engage in risky behavior and experience potentially harmful physical symptoms. Starting an SSRI medication during a depressive episode in an individual with bipolar disorder can also be associated with a manic or a mixed episode, which can be dangerous. Please contact your doctor immediately if you experience this side effect.
Other physical side effects of SSRIs
Several other physical SSRI side effects can potentially occur. These side effects are frequently mild and tend to resolve themselves after treatment is continued for several days to weeks. However, these SSRI side effects can be common when starting treatment.
- Nausea
- Dry mouth
- Diarrhea
- Headache
The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional. BetterHelp now offers psychiatry services through UpLift for people who may benefit from psychiatric support as part of their care. Medication availability and coverage may vary by member location, clinical appropriateness, and individual pharmacy/insurance benefits. Prescribing decisions are made by the treating clinicians. We do not guarantee that any specific medication will be prescribed or covered by a member’s insurance plan.
Managing mental health conditions with therapy
Research shows that the most effective treatment for depression is often a combination of therapy and medication. However, these methods can also be beneficial for other conditions, including anxiety. Online or in-person therapy can be a helpful alternative to medication or used in conjunction. Psychiatric treatment can also be part of a holistic mental health care experience when clinically appropriate.
With an online therapy platform like BetterHelp, you can participate in sessions remotely, which can be helpful if you’re struggling to leave home due to mental health disorder symptoms or medication side effects. In addition, you can schedule sessions that fit into your life, as there are often timeslots available outside of typical office hours. If you’re interested in psychiatric support, BetterHelp now offers psychiatry services through UpLift.
Getting started with BetterHelp is simple:
- Take a short questionnaire. Answer a few quick questions about your goals, preferences, and the type of therapist you’d like to work with.
- Get matched quickly. In most cases, you can be matched with a licensed provider in as little as 48 hours.
- Start therapy on your terms. Schedule sessions by video, phone, or live chat, and join from anywhere you have an internet connection.
Finding the right therapist isn’t just important – it’s everything.
Find your matchA growing body of evidence suggests that online therapy can help individuals manage symptoms of mental health disorders that are commonly treated with SSRIs. For example, in one study, researchers concluded that online cognitive-behavioral therapy could produce “sustained and clinically meaningful improvements in depression and anxiety” for those experiencing moderate to severe symptoms. Cognitive-behavioral therapy can be a common treatment method to help an individual identify and replace negative thought patterns that may be underlying maladaptive behaviors and emotions, such as those related to depression.
Takeaway
Does BetterHelp offer psychiatry and medication management?
Yes. BetterHelp now offers psychiatry services through UpLift. BetterHelp psychiatry and medication management services provide virtual mental health care for individuals ages 18 and older who are experiencing mild to severe behavioral health symptoms, including anxiety, depression, and other conditions that may benefit from psychiatric consultation, prescriptions, and ongoing medication management. Psychiatry is an additional care option available alongside therapy and can be part of a holistic mental health care experience. Psychiatry services may include medication management when clinically appropriate. All treatment decisions are made by a licensed psychiatric provider.
Are psychiatry and medication management covered by insurance on BetterHelp?
Yes. BetterHelp now offers psychiatry services that may be covered by insurance through UpLift. Many UpLift providers are in-network with most major insurance carriers (for eligible members the average copay is only $20). The cost of your medication will depend on your insurance plan. We recommend speaking with your insurance to learn how much your medication will cost. Try asking about your copay, deductible, and whether they cover your prescribed medication.
How long does it take for your body to get used to SSRIs?
The time it takes for your body to adjust to an SSRI (selective serotonin reuptake inhibitor) medication can vary from person to person. However, the following general timeline may offer insight into what you might expect:
- Initial weeks: In the first few days to weeks after starting an SSRI, you may experience some side effects, which can include nausea, dizziness, insomnia, and increased anxiety. These side effects can be temporary and often improve within the first two weeks.
- Therapeutic effects: The therapeutic effects of SSRIs, such as a reduction in symptoms of depression or anxiety, often emerge within a few weeks to a couple of months. However, the full benefit may not be realized until several weeks or a few months of consistent use, and potential dose adjustment.
- Stabilization: Once the medication has reached its full therapeutic effect, you may experience more stable moods and reduced symptoms. This stabilization phase can vary but often occurs within the first two to three months.
- Long-term use: SSRIs may be prescribed for longer-term use, especially for individuals with chronic or recurrent conditions like depression or anxiety. Continued use of the medication may help reduce the risk of symptom recurrence for some people.
Individual responses to SSRIs can differ, and your healthcare provider may adjust your medication dose or switch to a different SSRI if you do not respond well to the initial treatment. Older adults may respond differently to SSRIs compared with younger individuals.
Do antidepressant side effects go away?
When asking, “How long do SSRI side effects last?” individuals may consider that antidepressant side effects can vary widely from person to person. For some, side effects may diminish or disappear over time as the body adjusts to the medication. Below are potential side effects that may occur:
- Early side effects: In the first few days to weeks after starting an antidepressant, research shows common side effects like nausea, dizziness, sleep disturbances, increased anxiety, or gastrointestinal discomfort. These side effects may be temporary and gradually improve as your body adapts to the medication.
- Short-term side effects: Some side effects, such as sleep disturbances or increased anxiety, may persist for a few weeks but tend to subside as your body adjusts to the medication. In some cases, your healthcare provider may recommend treatment changes or strategies to help manage these side effects.
- Long-term side effects: Long-term side effects can vary depending on the specific antidepressant and the individual. Some people may experience side effects related to sexual desire, weight changes, or other ongoing challenges while taking the medication. Discuss any persistent or bothersome side effects with your healthcare provider, as they may be able to adjust the medication or suggest alternative treatments.
- Individual variability: Individual responses to antidepressants can differ. What works well for one person may not be as effective or may cause different side effects in another. It may take some adjustments to find the right antidepressant and dosage that works best for you.
Can SSRIs make you feel worse at first?
Yes, it's possible for SSRIs (selective serotonin reuptake inhibitors) to make you feel worse or cause initial side effects when you first start taking them. This period is often referred to as the "adjustment phase," and it can last for the first few days to a few weeks after beginning treatment.
Do you go back to normal after SSRIs?
The experience of going back to "normal" after taking SSRIs for a period of time can vary from person to person and depends on several factors, including the individual's condition, treatment response, and the reasons for taking the medication. Below are several considerations:
- Treatment goals: The term "normal" can have different meanings for different people. In the context of antidepressant treatment, the goal of medication may be to alleviate or manage the symptoms of depression or anxiety and improve overall well-being. Successful treatment with SSRIs often means achieving a state of reduced or manageable symptoms and an improved quality of life.
- Duration of treatment: The duration of SSRI treatment varies based on the individual's response and the clinical judgment of the healthcare provider. Some individuals may take SSRIs for several months or years to maintain symptom control and help reduce the risk of relapse.
- Tapering and discontinuation: When a person or their doctor decides to discontinue SSRIs, medical advice and monitoring are often recommended. Abruptly stopping these medications can lead to withdrawal symptoms. Tapering (gradually reducing the dose) is often recommended to minimize withdrawal effects.
- Recovery and relapse: Some individuals may experience a full recovery from depression or anxiety while taking SSRIs and may eventually discontinue the medication successfully. Others may find that discontinuing the medication leads to a return of symptoms, in which case they may choose to resume treatment.
- Lifestyle and coping strategies: While SSRIs can be highly effective in managing symptoms, they are not the sole solution to mental health challenges. Individuals may also benefit from learning and practicing coping strategies, lifestyle changes, and therapy to maintain mental health.
- Regular follow-up: After discontinuing SSRIs or reaching a stable treatment phase, individuals should have periodic follow-up appointments with their healthcare provider to monitor their mental health and make adjustments to treatment as needed.
How do I know if my SSRI is working?
You can gauge whether your SSRI (selective serotonin reuptake inhibitor) is working by paying attention to changes in your mood, thoughts, and daily functioning. Below are some indicators that your SSRI may be effective:
- Mood improvement: If you notice a positive shift in your mood, such as feeling less persistently sad, anxious, or irritable, it may be a sign that the medication is working.
- Better functioning: An effective SSRI can help you function better in daily life. You may notice yourself being more able to concentrate, complete tasks, maintain relationships, and engage in activities you enjoy.
- Reduction in physical symptoms: If you were experiencing physical symptoms related to your mental health condition, such as changes in sleep patterns or appetite, you may observe improvements in these areas.
- Overall quality of life: Consider whether your overall quality of life has improved since starting the SSRI. Quality of life can include your ability to enjoy activities, connect with others, and experience a sense of hope and optimism.
The response to an SSRI can be gradual, and not everyone will experience immediate changes. Additionally, the effectiveness of the medication can vary from person to person. Regular communication with your healthcare provider is crucial throughout the treatment process.
Why do I still feel bad on antidepressants?
Feeling bad or not experiencing the expected improvement in mood while taking antidepressants can be frustrating and disheartening, but it's not uncommon. There are several potential reasons why you may still feel bad while taking antidepressants, including treatment timing.
Antidepressants may take several weeks to reach their full therapeutic effect. During this adjustment period, you might not see immediate improvements, and you may experience side effects. In addition, not all antidepressants work the same way, and individual responses can vary. If one antidepressant doesn't provide the desired results, your healthcare provider may consider trying a different medication or adjusting the dosage to attempt to reduce side effects.
In addition, depression and anxiety can have various underlying causes, including biological, psychological, and environmental factors. Antidepressants primarily target certain biological pathways, so they may not fully alleviate symptoms if other factors are at play. In some cases, individuals may have treatment-resistant depression, meaning they do not respond well to multiple antidepressant medications. In such situations, alternative treatments, such as therapy, lifestyle changes, medical interventions, or different types of medications, may be explored.
How do I know if my SSRI is too strong?
Determining if your SSRI (selective serotonin reuptake inhibitor) dosage is too strong or not suitable for you is a decision that can be made in consultation with your healthcare provider. Your doctor can assess your symptoms, monitor your response to the medication, and consider potential side effects. However, there are some signs and symptoms to watch for that may suggest your SSRI dosage is too strong for your individual needs:
- Excessive side effects: If you are experiencing severe or intolerable side effects, such as extreme drowsiness, dizziness, nausea, or increased anxiety, it could be an indication that your SSRI dosage is too high.
- Exaggerated emotional blunting: While SSRI medications are designed to manage symptoms of depression and anxiety, in some cases, they can lead to emotional blunting, where an individual becomes numb or disconnected from their emotions. If you notice a significant loss of emotional depth or a sense of being flat or indifferent, it may be a sign that the dosage is too strong.
- Agitation or restlessness: Some individuals may experience heightened agitation, restlessness, or jitteriness when their SSRI dosage is too high. This symptom can manifest as increased anxiety or difficulty sitting still.
- Insomnia or sleep disturbances: An excessively strong SSRI dosage may lead to severe sleep disturbances, making it difficult to fall asleep or stay asleep.
- Gastrointestinal issues: Excessively high doses of an SSRI can cause or exacerbate gastrointestinal side effects, such as nausea, diarrhea, or stomach discomfort.
- Hyponatremia: Certain SSRIs can lead to a condition called hyponatremia, characterized by dangerously low sodium levels in the blood. Symptoms may include confusion, headache, muscle twitching, and, in severe cases, seizures. If you experience any of these symptoms, seek immediate medical attention.
If you believe that your SSRI is too strong, it may be beneficial to consult with your doctor. It is also important to inform your doctor of all of your medications as interactions leading to too much serotonin can lead to serotonin syndrome, which is a potentially life-threatening condition. Follow all directions on the product labeling, especially when starting or changing antidepressants, to reduce the risk of serotonin reaching dangerous levels.
Why do I feel worse on SSRIs?
Experiencing a worsening of symptoms or feeling worse when starting SSRIs (selective serotonin reuptake inhibitors) is not uncommon. Several factors contribute to feeling worse, including:
- The adjustment period: SSRIs typically take several weeks to show their full therapeutic effects. During this time, you may not see immediate improvements and may experience side effects. Patience and allowing time for the medication to work may offer clarity. If you don’t notice effects after a month or more, talk to your doctor.
- Initial side effects: SSRIs can cause side effects when you begin taking them, such as nausea, dizziness, insomnia, increased anxiety, and irritability. These side effects are often temporary and tend to lessen as your body adapts to the medication.
- Individual differences: Responses to SSRIs vary, and what works for one person may not be suitable for another. Your specific SSRI may not be the best fit for your needs, and your healthcare provider may consider alternative medications or dosage adjustments.
- Co-occurring conditions: Individuals with other conditions, like anxiety or bipolar disorder, may experience exacerbated symptoms when starting an SSRI. Be transparent about your mental health and any co-occurring conditions when talking to your doctor about medication.
- Psychological factors: Concerns about side effects or anxiety related to taking medication can contribute to negative feelings. Addressing these concerns with your healthcare provider or therapist can lead to solutions.
Open communication with your healthcare provider can help you address adverse effects or changes in your symptoms. They can guide you, monitor your progress, and adjust your treatment plan. Some individuals who initially feel worse on SSRIs find that their symptoms improve as they continue treatment and the medication takes full effect.
When should you stop SSRIs?
Deciding when to stop SSRIs (selective serotonin reuptake inhibitors) is often a carefully considered decision made in consultation with your healthcare provider. However, a doctor may decide to discontinue your medication in the following scenarios:
- Symptom improvement: If you initially started taking SSRIs for the treatment of depression, anxiety, or another mental health condition, the decision to stop the medication may come when your symptoms are significantly improved and you have experienced a sustained period of stability. Your healthcare provider can assess your progress and symptoms to determine if discontinuation is appropriate.
- Stable remission: In some cases, individuals may achieve a state of remission, where they are free of symptoms for an extended period while taking SSRIs. Your healthcare provider may consider discontinuation if you have maintained this stable remission for a sufficient duration.
- Side effects or intolerance: If you experience intolerable side effects from SSRIs or if the medication is not well-tolerated, your healthcare provider may consider discontinuation or a switch from one SSRI to another. They may also try a different class of medication, such as tricyclic antidepressants or monoamine oxidase inhibitors.
- Treatment plan assessment: Your treatment plan may be periodically assessed. Your healthcare provider can review your progress and the benefits versus risks of continued SSRI use. If you and your provider believe that you have met your treatment goals or that alternative treatments may be more appropriate, discontinuation may be discussed.
- Decision-making: The decision to stop SSRIs involves decision-making between you and your healthcare provider. The provider can discuss the potential benefits and risks with you, as well as any concerns you have about discontinuing the medication.
- Tapering off: If you and your healthcare provider decide to discontinue SSRIs, they may recommend you do so gradually and under medical supervision. Abruptly stopping these medications can lead to withdrawal symptoms or SSRI discontinuation syndrome. Tapering involves gradually reducing the dose over time to minimize withdrawal effects.
- Maintenance and follow-up: Even after discontinuation, ongoing monitoring of your mental health and any potential relapse or recurrence of symptoms may be recommended. Your healthcare provider can establish a plan for follow-up and continued support as needed.
Why do SSRIs cause anxiety at first?
SSRIs (selective serotonin reuptake inhibitors) can initially lead to increased anxiety or worsened anxiety symptoms for some individuals. This paradoxical effect occurs due to several factors. When SSRIs are first introduced, they affect serotonin signaling in the brain, which can contribute to an initial increase in restlessness, agitation, and anxiety for some people. Additionally, it can take several weeks for the therapeutic effects of SSRIs to develop, during which time temporary side effects may be more noticeable. However, as the body gradually adjusts to the medication, some individuals find that their anxiety symptoms begin to improve, and the overall therapeutic benefits of SSRIs may become more apparent.
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