Some SSRI Warnings and Precautions
Some precautions and warnings with SSRIs
to be aware of include:
- Antidepressants (including SSRIs) may increase the risk of suicidal thoughts or behavior in children, teenagers, and adults (see Depression and Suicide for more information). Therefore, if you notice any changes in symptoms or develop new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include anxiety, hostility, agitation, panic, restlessness, hallucinations, extreme hyperactivity, and suicidal thoughts or behavior (see SSRIs and Suicide for more information).
- Before prescribing SSRIs for depression, your healthcare provider should make sure that you do not have bipolar disorder (instead of depression). Sometimes, the symptoms of bipolar disorder and depression are very similar, and SSRIs can cause problems in people with bipolar disorder.
- Taking SSRIs with other medications that affect serotonin can increase your risk of a dangerous group of symptoms called serotonin syndrome. These other medications include other antidepressants, triptans (migraine medications), and several other medications. Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:
o Seeing or hearing things that are not really there (hallucinations)
o A fast heartbeat (tachycardia)
o Feeling faint
o Muscle spasms
o Difficulty walking
- SSRIs can interact with many other medications. Because some of these interactions can be very serious, be sure to tell your healthcare provider any time you start or stop a new medication. For more information, see the specific SSRI within the eMedTV Web site.
- If you have a seizure disorder, there is a possibility that taking SSRIs may cause seizures. Talk to your healthcare professional before taking SSRIs if you have seizures.
- If you are stopping SSRIs, you should be monitored by a healthcare professional for withdrawal symptoms. If you do develop any symptoms of a SSRI withdrawal, such as irritability, anxiety, confusion, headaches, lethargy, or insomnia, your healthcare provider may slow down the rate at which the SSRI is stopped (see SSRI Withdrawal).
- Some SSRIs can make glaucoma (a condition of the eye) worse. Talk to your healthcare provider before taking an SSRI if you have glaucoma.
- SSRIs may cause bleeding in the stomach or intestines. This risk is increased in those taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Symptoms of gastrointestinal bleeding may include:
o Bright red blood coating the stool
o Dark blood mixed with the stool
o Black or tarry stool
o Bright red blood in vomit
o Vomit that has the appearance of coffee grounds.
If you experience any of these symptoms, call your healthcare provider.
- If you are elderly or taking a diuretic, SSRIs could cause low salt levels in the blood (hyponatremia). This generally returns to "normal" when the SSRI is stopped.
- SSRIs can cause akathisia, an internal feeling of jitteriness or restlessness. Akathisia can be very disturbing, so make sure to tell your healthcare provider if you are experiencing this SSRI side effect.
- If you have liver or kidney problems, you may need a lower SSRI dose, as the liver and kidneys help to remove SSRIs from the blood.
- SSRIs can cause insomnia and anxiety. Talk to your healthcare provider if you are experiencing problems sleeping or develop anxiety while taking an SSRI.
- There is a possibility that SSRIs may cause unwanted weight loss.
- SSRIs may affect your ability to perform complex tasks requiring mental and motor skills. Therefore, it is recommended that you become accustomed to its effect on you before becoming involved in activities requiring mental or motor concentration (such as driving a car or operating machinery).
- All SSRIs, except paroxetine (Paxil®, Paxil CR®), are considered pregnancy Category C medications. This means that SSRIs may not be safe to use during pregnancy. Paroxetine is a pregnancy Category D medication, meaning it should generally not be used during pregnancy (due to concerns of birth defects). Talk to your healthcare provider about the risks and benefits of using an SSRI during pregnancy (see SSRIs and Pregnancy for more information).
- SSRIs pass through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about using an SSRI (see SSRIs and Breastfeeding).