Selective Serotonin Reuptake ... Health Article

Special conditions

People with certain medical conditions or who are taking certain other medicines can have problems if they take SSRIs. Before taking these drugs, a patient should let the doctor know about any of these conditions:

ALLERGIES. Anyone who has had unusual reactions to SSRIs in the past should let his or her doctor know before taking the drugs again. The doctor should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY. In studies of laboratory animals, some SSRIs have caused miscarriage and other problems in pregnant females and their offspring. However, at least two studies in humans (by Pastuszak in 1993 and Kuhlin in 1998) have shown SSRIs to be safe during pregnancy. Still, women who are pregnant or who may become pregnant should check with their doctors before using SSRIs.

BREASTFEEDING. SSRIs pass into breast milk and some may occasionally cause unwanted side effects in nursing babies whose mothers take the drugs. These effects include vomiting, watery stools, crying, and sleep problems. Women who are breastfeeding should talk to their doctors about the use of SSRIs. They may need to switch to a different medicine while breastfeeding. If SSRIs must be taken, it may be necessary to stop breast-feeding while being treated with these drugs. However, several studies in people (for example, Yoshida in 1998) have indicated that SSRIs in breast milk have no effect on infant development.

DIABETES. SSRIs may affect blood sugar levels. People with diabetes who notice changes in their blood or urine tests while taking this medicine should check with their doctors.

OTHER MEDICAL CONDITIONS. Before using SSRIs, people with any of these medical problems should make sure their doctors are aware of their conditions: diabetes, kidney disease, liver disease, seizure disorders, current or past drug abuse or dependence, or diseases or conditions that affect the metabolism or blood circulation.

Side effects

The most common side effects are anxiety and nervousness (reported by 5–13% of people taking various SSRIs), tremor (5–14%), trouble sleeping (2–8%), tiredness or weakness (4–15%), nausea (11–26%), diarrhea (11–26%), constipation (1–8%), loss of appetite (3–18%), weight loss (1–13%), dry mouth (10–22%), headache (1–5%), sweating (5–9%), trouble urinating (1–2%), and decreased sexual ability (8–15%). Many of these problems diminish or disappear as the body adjusts to the drug and do not require medical treatment unless they interfere with normal activities. Persistent problems, such as sexual dysfunction, should be discussed with the doctor.

More serious side effects are possible, but extremely rare. People taking SSRIs who notice unusual joint or muscle pain; breathing problems; chills or fever; excessive excitement, fast talking, or actions that are out of control; or mood swings should contact their doctors. People who develop skin rashes or hives after taking an SSRI should stop taking the medication and contact their doctors as soon as possible. Other rare side effects may occur. Anyone who has unusual symptoms after taking an SSRI should get in touch with his or her doctor.

Side effects may continue for some time after treatment with this medicine ends. How long the effects continue depends on how long the drug was taken and how much of it was used. In most cases, doctors recommend that patients taper off SSRIs rather than abruptly discontinuing them, which usually prevents any withdrawal symptoms. People who experience agitation, confusion, or restlessness; dizziness or lightheadedness; vision problems; tremor; sleep problems; unusual tiredness or weakness; nausea and vomiting or diarrhea; headache; excessive sweating; runny nose; or muscle pain for more than a few days after stopping or tapering an SSRI should consult their doctors.

Drug interactions

SSRIs may interact with other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes SSRIs should let the doctor know about all other medicines he or she is taking. Among the drugs that may interact with SSRIs are:

• Central nervous system (CNS) depressants such as medicine for allergies, colds, hay fever, and asthma; sedatives; tranquilizers; prescription pain medicine; muscle relaxants; medicine for seizures; sleep aids; barbiturates; and anesthetics.
• blood thinners
• monoamine oxidase inhibitors (MAOIs) such as Nardil or Parnate, used to treat conditions including depression and Parkinson's disease
• the antiseizure drug phenytoin (Dilantin)
• the food supplement (and sleep aid) tryptophan, which has been withdrawn from the United States market, but may be found in some herbal preparations
• digitalis and other heart medicines

The list above does not include every drug that may interact with SSRIs. Patients should be sure to check with a doctor or pharmacist before combining SSRIs with any other prescription or nonprescription (over-the-counter) medicine.