What are SSRI's? The mainstay of antidepressant treatments

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What are SSRI’s? The mainstay of antidepressant treatments.‍

Selective Serotonin Re-Uptake Inhibitors (SSRI) are currently used to treat moderate to severe depression and generalized anxiety disorder more safely, and with less side effects. 

At Cognito our main objective is to help our patients feel like themselves again, and an important first step towards this is education. So, what are SSRI’s? How do SSRI’s work? What are the different types of SSRI’s - How do they differ? Understanding how SSRI’s work will empower you with the knowledge to work together with your clinician team more effectively and have agency in your journey towards mental health management.‍

How do SSRI’s work? Paving the road on the “feel-good-hormone” highway‍

SSRI’s increase the level of serotonin in the brain -what is serotonin? Serotonin is a neurotransmitter that communicates signals between brain cells (neurons) and other cells in the body. These neurons communicate in ways that regulate mood, cognition, learning, memory and even helps regulate sleeping and digestion. With such important responsibilities, it’s easy to see how low or irregular serotonin levels can have massive impacts on mental health, and why SSRI’s are beneficial to manage depression and anxiety symptoms. 

Counterintuitively, SSRI’s actually work by selectively BLOCKING the re-uptake of serotonin into the neurons that it uses to travel throughout the brain and body. By blocking the reabsorption of serotonin back into neurons, more free flowing serotonin becomes available to transmit messages. ‍

When will you start to feel better after taking SSRI’s?  Endure the first month‍

After starting SSRI therapy the serotonin in your synapses increases almost right away, however, it can take 4-6 weeks for SSRIs to improve your mood or alleviate depression and anxiety symptoms.

Frustratingly, the side effects of SSRIs are felt almost right away. The good news is that the side effects decrease over a 4 week period as the positive effect starts to take hold.  Understanding how your SSRI treatment will play out allows you to manage expectations and understand that the side effects are part of the journey to an improving situation. Patience and self compassion during this period can help make the journey more manageable.‍

What are common side effects of SSRI’s?

• Nausea, vomiting, or diarrhea
• Vertigo/dizziness
• Insomnia
• Dry mouth
• Nervousness, agitation and restlessness (anxiety symptoms)
• Sexual problems such as reduced libido, difficulty reaching orgasm and erectile dysfunction.
  

*It’s important to remember, most side effects subside after the first few months and others can be managed with dosage adjustments or adjunct therapies.‍

Which antidepressant (SSRI) is best? The biggest improvements, with the least side effects.‍

At Cognito Health, we use empirical evidence and real time patient feedback combined with scientific peer reviewed studies to shape our collective opinion with our patients best interests at heart.  Our patients are looking for more information and guidance about medication and other mental health treatment plans which is why we are sharing our preferences here.

• This is our preferred SSRI medication: Escitalopram (Cipralex)
• Our second preferred SSRI treatment option: Citalopram
  

What is the difference between Escitalopram VS Citalopram? Two sides of a coin

The best way to explain the difference between these two medications is drawing a parallel between the differences of your two hands. Our hands can’t be superimposed on each other and they aren’t exactly the same, but they ARE mirrored images of each other. Think of Citalopram as a bunch of left and right hands mixed together in a pill, whereas Escitalopram is just the right hands. In this case the right hands are the active medication and the left hands are passive, less selective components that can cause side effects. 

More specifically, these hands are isomers. Isomers are compounds with the same formula but a different arrangement of atoms in the molecule which results in different properties. Citalopram has two isomers: R-citalopram and S-citalopram, with the S- isomer being responsible for blocking the re-uptake of serotonin into neurons. The R-isomer functions to stabilize the S- isomer, but through this interferes with the S-citalopram ability to transport itself throughout the brain and body. The interference from the R-isomer reduces the treatment effectiveness alongside bringing additional side effects.

Escitalopram has been scientifically engineered to only contain S-citalopram - the free flowing and serotonin re-uptake blocking isomer. Because of this, Escitalopram yields much more positive results when studied. These superior effects are replicated in our patient feedback.‍

Which SSRI treatments are less recommended? Become informed.‍

Often, doctors and pharmacists will avoid saying “this drug is the best” or “this drug is the worst” but through our empirical patient reviews and recovery, and experience of our expert physician team we can provide information to help our patients work with us to make the best decision together.

SSRIs with more side effects or drug interactions

● Fluoxetine

● Fluvoxamine

● Paroxetine

● Sertraline

If you’re stable on one of the above medications this isn’t a reason to stop taking it, but if one of the above medications was recommended without a compelling reason, this is grounds to do more research. Some of the above drugs do have specific indications like in pediatrics, in which case these specific patient requirements would justify one of the above options being prescribed. 

How to choose an SSRI? Weigh out of all the variables.‍

As you can see, there are a number of factors that should be considered when choosing the best medication for specific individual needs.

At Cognito our best advice is to do your research before you see your doctor about depression or anxiety medication. Knowing your own personal priorities for your mental health recovery, and knowing what is important to you as an individual will help guide physician prescribing. Are finances an issue? Maybe a less expensive medication would be better. Is depression more of an issue than your anxiety? There are medications that are optimized for that. Do you worry about weight gain? There are some antidepressants that can actually help you lose weight. Our clinician team has the ability to prescribe medication based on individual patient tolerance of various side effects.

Once you understand what you’re hoping to get out of SSRI treatment, and what your side effect deal breakers might be, speak with a physician to get all of the information and make an informed decision together. ‍

What to expect during the first days of SSRI treatment? ‍

The side effects from SSRI’s come first and can hit you HARD, making continuing treatment difficult. However, after working together with your physician or Cognito care team and you’ve settled on the SSRI with the best likelihood to meet your individual needs, it's important to stick with treatment beyond the initial two months. It’s also important to remember that the side effects typically wear off as the medication starts to work. Take your pills at the same time each day - If they make you tired, take them at night or If they keep you awake, take them in the morning. If the medication upsets your stomach, then make sure to take it with food.

After giving the prescribed treatment a fair try, if the side effects are too much or your mental health symptoms aren’t improving the way you hoped, you can always STOP that specific medication and pivot. There are always other SSRI’s to try and even medications in different classes that work differently and have different side effect profiles. Keep adherent, and remember with Cognito you can chat with your doctor, pharmacist or any member of our team on a regular basis. This is an evolving and collaborative process between patient and physician. At Cognito, we’re here to help.