Examples
|
| citalopram | Celexa |
| fluoxetine | Prozac |
| fluvoxamine | Luvox |
| paroxetine | Paxil |
| sertraline | Zoloft |
How It Works
SSRIs improve your mood by increasing
your brain's use of a chemical messenger (neurotransmitter) called serotonin.
You may start to feel better within 1 to 3 weeks of taking antidepressant
medicine. But it can take as many as 6 to 8 weeks to see more improvement. If
you have questions or concerns about your medicines, or if you do not notice
any improvement by 3 weeks, talk to your doctor.
Why It Is Used
SSRIs are usually the first-choice
medicine for treating
postpartum depression (PPD). Sertraline and paroxetine
are most often recommended for breast-feeding women.3
SSRIs are also used to relieve severe
anxiety and depression during pregnancy and to prevent
PPD in high-risk women.
How Well It Works
SSRIs have become the first line of
treatment for depression, because they have proved effective for most people and
have few side effects.6
Side Effects
Maternal side effects of SSRIs, which tend to improve over time, can include:
- Nausea, appetite changes, weight
loss.
- Nervousness.
- Headache.
- Insomnia,
fatigue.
- Loss of sexual desire or
ability.
- Dizziness.
- Tremors.
- Rash
(rare).
- Weight gain (rare) with long-term use.
SSRI treatment is not recommended if you have a seizure
disorder or a history of
mania (including
bipolar disorder). These conditions can be made worse
by an SSRI.
Breast-feeding infant side effects
Breast-feeding babies whose mothers take an
antidepressant often do not have side effects. But they may. If you are taking an
antidepressant while you are breast-feeding, talk to your doctor and your baby's doctor
about what types of side effects to look for.
Experts cannot yet
say that a mother's antidepressant treatment is completely safe for the
breast-fed baby. But research does show which SSRIs seem most safe. Sertraline
(Zoloft) is typically the first choice for a breast-feeding mother. Side
effects have only been seen in some breast-feeding babies exposed to fluoxetine
(Prozac, Sarafem), paroxetine (Paxil), or citalopram (Celexa).5, 3 Side effects include poor feeding
and more crying and irritability.3
Some
SSRIs, such as fluoxetine and citalopram, are passed on to the breast-fed baby
more than others. Also, every woman uses (metabolizes) and passes on medicine
in different amounts. The level of medicine in your breast milk depends in part
on when you take your daily dose. Talk to your doctor about when the level of
medicine in your breast milk is lowest.
Researchers are studying
children who breast-fed while their mothers took SSRIs. So far, they have seen
no signs of problems in these children into their preschool years.4
See Drug Reference for a full list of side
effects. (Drug Reference is not available in all systems.)
FDA Advisories. The U.S. Food and Drug Administration (FDA)
has issued:
- An
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines.
Instead, a person taking antidepressants should be watched for
warning signs of suicide. This is especially important
at the beginning of treatment or when doses are changed.
- A warning about taking triptans, used for headaches, with SSRIs
(selective serotonin reuptake inhibitors) or SNRIs (selective
serotonin/norepinephrine reuptake inhibitors). Taking these medicines together
can cause a very rare but serious condition called serotonin syndrome.
What To Think About
SSRIs are effective for treatment
of PPD. Some experts recommend using an SSRI to prevent PPD in high-risk women.
But studies have not yet proved that this works.5
Talk to your doctor about your postpartum depression symptoms, and
decide on what type of treatment is right for you. Counseling and
support are considered a first-line treatment for mild to severe PPD. Women
with mild PPD are likely to benefit from counseling alone. And those with
moderate to severe PPD are advised to combine counseling with antidepressant
medicine.
SSRIs make
bleeding more likely in the upper gastrointestinal tract (stomach and
esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding
even more likely. Taking medicines that control acid in the stomach may
help.2
Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects. But not treating depression can also cause problems during pregnancy and birth. If you become pregnant, you and your doctor must weigh the risks of taking an SSRI against the risks of not treating depression.
Do not suddenly stop taking an SSRI. Abruptly stopping an SSRI medicine can
cause headaches, nervousness, anxiety, or insomnia. An SSRI must be gradually
tapered off with supervision from your doctor.
SSRIs and breast-feeding
Treating postpartum
depression is very important for both you and your baby. Untreated postpartum
depression can have bad effects on your baby's development.1
Breast-feeding is also proved to be
good for babies and mothers. This is why
breast-feeding is recommended for the first year after childbirth.
- If your doctor thinks that you need an antidepressant to treat
postpartum depression, you do not have to stop breast-feeding. Some SSRIs are
barely detectable in breast milk.
- If you are breast-feeding and
need treatment for postpartum depression, talk to your doctor. You can use an
SSRI that is known to occur in low levels in breast milk. Also let your baby's
doctor know about what medicine you're taking while breast-feeding.
- If the antidepressant that works best for you is one that has
higher levels in breast milk, talk to your baby's doctor about whether formula
feeding would be a good choice.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
References
Citations
- O'Hara MW, Segre LS (2008). Psychologic disorders of pregnancy and the postpartum period. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 504–514. Philadelphia: Lippincott Williams and Wilkins.
- Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper
gastrointestinal tract bleeding associated with selective serotonin reuptake
inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.
- Weissman AM, et al. (2004). Pooled analysis of
antidepressant levels in lactating mothers, breast milk, and nursing infants.
American Journal of Psychiatry, 161:
1066–1078.
- Yonkers KA (2009). Management of depression and psychoses during pregnancy and the puerperium. In RK Creasy et al., eds., Creasy and Resnik's Maternal Fetal Medicine, 6th ed., pp. 1113–1122. Philadelphia: Saunders.
- Brockingham I (2004). Postpartum psychiatric
disorders. Lancet, 363(9405): 303–310.
- Barbui C, et al. (2007). Depression in adults (drug
and other physical treatments), search date April 2006. Online version of
Clinical Evidence:
http://www.clinicalevidence.com.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Lisa S. Weinstock, MD - Psychiatry |
|---|
| Last Revised | June 14, 2010 |
|---|
O'Hara MW, Segre LS (2008). Psychologic disorders of pregnancy and the postpartum period. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 504–514. Philadelphia: Lippincott Williams and Wilkins.
Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper
gastrointestinal tract bleeding associated with selective serotonin reuptake
inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.
Weissman AM, et al. (2004). Pooled analysis of
antidepressant levels in lactating mothers, breast milk, and nursing infants.
American Journal of Psychiatry, 161:
1066–1078.
Yonkers KA (2009). Management of depression and psychoses during pregnancy and the puerperium. In RK Creasy et al., eds., Creasy and Resnik's Maternal Fetal Medicine, 6th ed., pp. 1113–1122. Philadelphia: Saunders.
Brockingham I (2004). Postpartum psychiatric
disorders. Lancet, 363(9405): 303–310.
Barbui C, et al. (2007). Depression in adults (drug
and other physical treatments), search date April 2006. Online version of
Clinical Evidence:
http://www.clinicalevidence.com.
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