Selective Serotonin Reuptake Inhibitors- The Good, The Bad and The Funny. From People Who Have Taken These Crazy Meds...and SCIENCE!

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Selective Serotonin Reuptake Inhibitors.

Medications discussed on this site include:

Celexa / Cipramil (citalopram oxalate)
Lexapro / Cipralex (escitalopram oxalate)
Luvox / Floxyfral / Faverin (fluvoxamine maleate)
Paxil / Aropax / Paroxat / Paxetin / Seroxat (paroxetine)
Prozac / Erocap / Lorien / Lovan / Zactin (fluoxetine)
Zoloft / Lustral (sertraline)

These drugs don't make you produce more serotonin, rather they make your neurons soak for a longer period of time in the serotonin you already produce.

But is that the same thing?

That depends on the person and the sensitivity of your 5HT receptors. Sometimes it's the same effect, sometimes not. When not it could be sub-par (to the point of being useless) or too much.

These days serotonin is the first line of attack in conquering depression, and the most likely neurotransmitter to really mess you up if your problem is actually bipolar and not unipolar depression. While these are not happy pills, for unipolar depression they are often quite effective at keeping depression at bay. In addition to depression, SSRIs are frequently good for panic/anxiety disorders and some are good for OCD as well. SSRIs are sometimes good for the more common forms of premenstrual dysphoric disorder (PMDD).

It states in the PI sheets for all SSRIs that you should use these medications for depression only if you're presenting symptoms of Major Depressive Disorder. Granted my experience of depression, as expressed in the FAQ for alt.depressed.as.fuck and Whale Shit at the Bottom of the Ocean, may not be the same as your experience. But that's the sort of thinking and doing where someone who tells a shrink over and over about a previous bipolar diagnosis and various crazy-manic actions and thoughts gets prescriptions for antidepressants with no concurrent mood stabilizers. That is the sort of thinking and doing that gets you labeled with Major Depressive Disorder. That is about how depressed you should be, for no good reason, to consider taking antidepressants. If your depression isn't approaching that level of despair, day in and day out for weeks at a time, then all you really need is talk therapy that may or may not be combined with various non-drug treatments. The non-drug treatments I think are especially helpful are amino acids (particularly 5-HTP/l-tryptophan, l-tyrosine, GABA), exercise (especially Yoga), dietary changes that are specific to your type of depression and your own dietary needs (there is no one-size-fits all solution), and vitamin and mineral supplements. I will be covering these non-drug treatments in greater detail in the future. They were barely effective for me alone, they work great in concert with my meds, but for some people and some of the mild-to-moderate forms of depression, those are really all you need in addition to some kind of therapy.

Really!

That's 'just' depression. OCD, panic/anxiety, GAD, and the off-label uses of the meds are entirely different issues. However the anxiety issue would follow a similar map. For a goddamn year I couldn't leave my house without a careful balance of additional lorazepam to counter the crippling agoraphobia from which I suffer. Too much and I was too zonked out to leave, too little and I was still too anxious. Sometimes I would not see another human being in the flesh for two weeks at a time as I lived off of frozen and canned foods, being just too agoraphobic to leave and too freaked out to even deal with delivery groceries. That is the sort of anxiety where you had better be evaluating Lexapro (escitalopram oxalate). If you're not so anxious that you keep going over every little detail of every little screw-up in your life and how one little change could have completely made your life better (over-focused anxiety) or you're sweating and you're heart's racing at the very thought of stepping over the threshold of the doorway to the big, scary outside world - you may very well be able to use the same sort of alternate treatments as mentioned above.

Is it worth going down the "alternative therapy" path before trying pharmaceuticals? Sure! It's your life. It's not stupid to try less harsh, and less expensive methods. Dr. Amen has plenty of recommendations for dietary changes and supplements to try first if meds are too big of a step to make right away. And a lot of those methods you can keep with the meds, so it's not that big of a loss if they don't work completely.

You have to make the call between what sucks less, side effects or the ailment. They can work for some people, they can fail utterly, or they can work in concert with the meds. Mileage always varies!

If you've tried the alternate routes and still have a problem with moderate depression, look into the TCAs. While the side effects of TCAs tend to suck more, those side effects are generally more problematic at the higher dosages. Usually. A low dosage of a TCA might work better than a more potent SSRI.

To help you decide if it's bad enough to require an antidepressant, you should be seeing a talk therapist and you should belong to a support group. A psychiatrist is basically going to figure out the right meds for you and that's going to be about it. Sometimes they'll do therapy, but often not. For more information on, and reasons why you should be seeing a talk therapist and belong to a support group, take a look at my page on support groups. Both will help you determine if you really do need antidepressants. And if you do, the services of both therapist and support group are vital to complete what the antidepressants do. Meds alone are not going to fix your problems!

While some people can notice vast differences between each of these meds, they are really very much alike in important generic factors. There's not much we can write about them individually, even though you may notice remarkable variations between any two of them! That's all a question of individual metabolism. For some people, though, they're all alike. For the main contributors to this site they are all alike in that they all suck, but this is a group of people who just happen to be extremely sensitive to any changes in our serotonin reuptake or levels. Everyone just had to find that out the hard way. It's not the fault of the drugs, it's our problem. I can't even eat turkey without having a panic attack later that day because the excessive amount of tryptophan in the meat converts to serotonin and it freaks me out. I've often wondered if that has been a contributing factor to Thanksgiving dysfunctionality. I mean, sure, it's waaaaay down on the list after booze and issues, but for some few people I bet it does contribute to that infamous holiday spirit that drives people apart for years. Enough about yet another of my wacky hypotheses, back to the crazy meds.

There are a few things common to all of them that you need to be aware of:

SSRIs are notorious for killing your libido, which in turn can be counterproductive in dealing with depression. Especially if you're in a relationship. Most especially if you're in a relationship with someone with bipolar hypersexuality, but no point in opening up some of our old issues. Of course the only thing I liked about SSRIs was that they dealt with my bipolar hypersexuality by eliminating my libido. Sometimes they'll leave your libido alone but interfere with you in other ways, like render you impotent or unable to have an orgasm.
Paxil (paroxetine hydrochloride) and Prozac (fluoxetine hydrochloride) are the worst offenders when it comes to this and Lexapro (escitalopram oxalate) seems to have the least problem with it. I plan on writing an article about what you might be able to do about this side effect. Dr. Amen discusses methods of dealing with it in his book Healing Anxiety & Depression. (Referenced below).
Just to prove that anything is possible with these crazy meds, these case studies show how some SSRIs, including Paxil (paroxetine hydrochloride) and Prozac (fluoxetine hydrochloride), can be aphrodisiacs.

Weight gain is a frequent side effect of the SSRIs. Sometimes it's a coin-toss with Prozac (fluoxetine hydrochloride) if you're going to gain or lose weight, but all the others tend to make you put on the pounds. Meridia (sibutramine hydrochloride monohydrate) is the one exception, it caused many people to lose weight in the clinical trials. Naturally it failed utterly as an antidepressant. However it messes with your neurotransmitters just enough that you can't take it if you're bipolar or on other psychiatric meds without your risking screwing up everything royally.

Other common side effects when starting SSRIs are headache, nausea, sweating, dry mouth, sleepiness or insomnia, and diarrhea or constipation. Sometimes it's a coin-toss on the last sets, as you might get to alternate. These are generally transitory effects and pass within a couple weeks. These are incorrectly known as anticholinergic, the term actually applies to another class of meds that affects other neurotransmitters. But you get the exact same side effects, so what the hell. It's like calling someone who breaks into a computer a hacker.
Once again Lexapro (escitalopram oxalate) seems to have the least problems with these common effects. It may not work better than any of the others but the consensus is that it sucks less that all of them!
To help cope with the weight gain, the loss of libido and other common side effects, please see the side effects page.

SSRIs can take up to a month to work, Prozac (fluoxetine hydrochloride) can take up to two months. Sure, you get the side effects right away, but you may not feel the positive benefits for a month. That may be because SSRIs cause new neurons to grow. However, the study that backs that hypothesis was done on rats. When I have some proof of that in humans I'll buy it. I don't deny that is what's happening, and you have to start your hypothesis with rats, it's just drugs do different things in rats, too. So I'll wait until they run MRIs on humans comparing before and after images before I jump on the "SSRIs grow new neurons" bandwagon. However, it's as good an explanation as any as to why nothing happens for a month or more in some people, but they work in a matter of days in others. The serotonin reuptake may not be the answer, the growth of new neurons may be.

SSRI poop-out is starting to become common knowledge in the psychiatric community. For most people SSRI poop-out is not an issue, but for some any SSRI will work great for a few months to a couple years or more and then suddenly stop working. Fortunately you can just move on to the next one until the poop-out happens again. What happens when you run out of SSRIs? By then the drug companies will have come out with at least one new one, but guess what? Most people who experience poop-out can go back to their first SSRI and start all over again! Some people are actually on a one or two-year rotation schedule to avoid experiencing the failure. You literally can rotate SSRIs like tires. Just be advised on point - Paxil (paroxetine hydrochloride) may work for you only once. Or at least work as well as it did for you only the first time. So if Paxil (paroxetine hydrochloride) is your favorite, life is going to suck if it pooped out on you.

If you do have to switch SSRIs because of either poop-out or adverse effects, keep in mind that mileage may vary considerably. For some people they are extremely interchangeable, while other people experience vastly different reactions not just from one SSRI to another but between sustained and immediate release versions and between brand and generic versions. So while they all have the same set of side effects in common and many are good for ailments besides depression, Zoloft (sertraline hydrochloride) may work for you when Prozac (fluoxetine hydrochloride) didn't or you couldn't stand it, or vice versa.

If you need to switch, here are the equivalents: 20mg Celexa (citalopram hydrobromide) = 5mg Lexapro (escitalopram oxalate) = 50mg Luvox (fluvoxamine maleate) = 20mg Paxil (paroxetine hydrochloride) = 20mg Prozac (fluoxetine hydrochloride) = 50mg Zoloft (sertraline hydrochloride) = 75mg of Effexor (venlafaxine hydrochloride). One study has shown that Celexa is the best intermediary drug when rotating SSRIs. Although Effexor is not an SSRI, it's listed here because it is frequently confused for one, its discontinuation syndrome sucks worse than that of the SSRIs', and at 75mg it affects only serotonin anyway.

These work only for the starting dosages. These things aren't exactly linear, therefore at the higher dosages they don't exactly map out. So if you're switching from a high dosage of one to another your doctor is probably writing you a prescription that makes a lot a sense. If you want to try to do the math yourself, see Sheldon Preskorn's Applied Clinical Psychopharmacology and the NIMH Psychoactive Drug Screening Program. If you ask me how to use those sites, you're not qualified to use them.

SSRI discontinuation syndrome. Read the article to learn more about it. SSRIs are some of the most physically addictive drugs in existence. Addictive isn't really the right word, you develop an intense physical and psychological dependency without a craving and urge to abuse them (unless you're bipolar, then you may abuse them), but addictive is close enough. To suddenly stop taking them is to feel so very much worse than you were feeling before you ever considered taking meds. There's a term, "brain shivers." You'll know it if you ever experience it. Mouse and I have kicked opiates and we have kicked SSRIs cold turkey. We'll take the opiate kick. If you're taking an atypical antipsychotic along with an SSRI, the discontinuation is often not nearly as bad, so if you have some Seroquel (quetiapine) on hand for insomnia, you'll want to take some for your SSRI discontinuation. Not everyone experiences SSRI discontinuation syndrome, and for those who do the effects range from mild to extreme. Not all doctors recognize this as an issue, so that sucks even more. Be sure to read the section about how long it takes for a med to clear out of your system and wait that long to taper down to the next stage in your dosage. And, as Paula writes in her article, invest in a pill splitter. Another option is to switch to the liquid form that many of the meds have available, that way you can reduce your dosage by as much as you damn well please and take as long as you can afford to discontinue to med. If it's really bad you may want to switch to liquid Prozac (fluoxetine hydrochloride) for the final discontinuation. That can take a very long time, but because of Prozac's 9.3 day half-life it usually has the mildest discontinuation syndrome effects of all the SSRIs. The long half-life is a double-edged sword. If you're on a high dosage and especially sensitive to the discontinuation syndrome, it will take forever to get off of Prozac, but at least it won't be as bad as the other meds. If you're not as sensitive to the discontinuation syndrome, Prozac's long half-life makes it easier to discontinue than any of the other SSRIs.

Extreme caution should be used if bipolar disorder is suspected or diagnosed and SSRIs are being considered. Although any antidepressant can trigger a mania, the odds are just better with SSRIs. Not just fun, fun, FUN euphoric manias where you max out all your credit cards and start but never finish half a dozen creative projects, but nasty, dysphoric manias where you rage at everyone and everything in sight and cause physical harm to yourself and others. Even if you aren't bipolar you might bring about a quasi-manic state by taking your meds inconsistently and upping the dose by accident or design. There's just no telling if you'll get happy mania or nasty mania.

Care should also be taken if you're epileptic. Although the SSRIs aren't that bad when it comes to causing seizures, they are worse than SNRIs. You always have to be cautious when mixing antidepressants and epilepsy. Make sure that your neurologist is consulted before you start taking any antidepressant. You may have to increase your intake of anticonvulsants, which, in turn, make you more depressed, and round and round it goes.
Is it any wonder that epileptics have higher suicide and murder rates than the general population?

Booze usually isn't that big a deal with SSRIs. Except maybe for Zoloft (sertraline hydrochloride), but the data are contradictory. I'll cover that more in a future article on booze, tobacco, caffeine and recreational drugs. You shouldn't drink as much as you used to, nor as often. But if you're taking only one or two SSRIs and you don't have a problem with booze, you can still have a few drinks now and then. Or your glass of wine or bottle of beer, sake or soju with dinner. Cheers! However, if you're mixing in an atypical antipsychotic with an antidepressant, as is getting very popular, you'll have to cut out the booze all together. Alcohol and antipsychotics don't mix!

Don't mix l-tryptophan / 5-HTP / Tryptan with SSRIs, multiple reuptake inhibitors or Remeron (mirtazapine). Just don't. Unless your doctor tells you to, of course. That's your doctor and not anyone else. Otherwise you're seriously screwing with your serotonin levels and wildly unpredictable results may occur, including the potentially fatal serotonin syndrome. That's right, you could die from the advice some hippie at Ye Olde Vitamin Shoppe gives you about taking 5-HTP along with your Prozac. Amino acids are powerful things, so long as what's in the capsule is what was promised on the label. Anyway, l-tryptophan converts to 5-HTP, which converts to serotonin. So when you take these supplements you wind up getting more serotonin, which is why they are sold as antidepressants, amongst other things. You just don't know how much more you're going to get. I'll cover them in detail in an article specifically on supplements. I'm not against them, I take amino acids myself, with the advice and consent of my doctor. I'm just against taking them stupidly. Do one or the other, not both!
The same goes for valerian and cough syrups containing dextromethorphan. Don't mix these with SSRIs.

While this site is for adults taking meds and not really for the parents of kids taking meds, I feel I must address the issue of SSRIs and children, as more and more information and misinformation is coming out about medicating kids for psychiatric issues.
Dr. Andrew Mosholder, an epidemiologist in the FDA's Office of Drug Safety, analyzed 22 clinical trials of nine antidepressants and concluded that the drugs appeared to double the risk of suicidal behavior among children.
See the story at the San Francisco Chronicle's online site

Some salient points from that article and my comments:

As reported by The Chronicle at the time, Mosholder's presentation to an FDA advisory committee in February was removed from the agenda by his superiors at the agency

This is consistent with the pattern of secrecy in the Cheney-Bush regime.

The agency also contracted with a group of doctors at Columbia University to reanalyze the clinical trial data provided by drug companies, the same data Mosholder reviewed, to see whether suicidal events were correctly classified. Agency officials have argued that the data from those trials are sometimes vague and that some behaviors -- such as a child slapping herself in the head -- may have been labeled wrongly as suicidal events by researchers conducting the drug company-funded studies.

In all fairness, these are valid points. The head-slapping is probably an extreme example. But I can see various forms of self-injury, mostly cutting, getting lumped into suicidal behavior. Cutting isn't always a suicide attempt. Cutting is cutting. And uniformed fear-mongers will latch onto "suicidal behavior" to make it more difficult for anyone, including adolescents, to get the medications they need.

Still, if the meds are increasing self-injury there is a still a problem!

Mosholder's report found that 74 children out of 2,298 who took antidepressants engaged in a "suicide-related event," compared to 34 of the 1, 952 patients who took placebos, or fake pills. The drugs presenting the highest risk were Effexor and Paxil, which nearly tripled the risk of a suicidal event, and Zoloft, which more than doubled the risk, his research showed.

Well, well, well. Just as I've always written. The two meds with the worst discontinuation syndrome have the most problems. It's often a question of med compliance.

Look at this scenario - you start a kid on meds because he feels like crap. Being a teenager he's not very good about doing what he's told, so he often skips doses. That leads to sporadic symptoms of SSRI discontinuation and generally feeling worse. Plus with Paxil (paroxetine hydrochloride) it decreases the efficacy of the med if you aren't 100% compliant 100% of the time. So the meds wind up making the kid feel worse! Not because the meds are necessarily bad (although they might not be appropriate), but because they aren't being taken properly.

As well as potency. Paxil (paroxetine hydrochloride) and Zoloft (sertraline hydrochloride) are just too damn potent for most adults, let alone kids. You're risking serotonin syndrome because they're so strong. Not the fatal version, just the suck-ass version where you feel like shit all the time. No wonder the kids want to harm themselves, if they're forced to take meds that are supposed to make them feel better and those meds just make them feel worse! And everyone says the meds are going to make them feel better, and who is going to get believed, the kid or the doctor?

Being a teenager just sucks. The propaganda was wrong. Those were never the best years of anyone's life. Except for the pathologically happy who may have been delusional in some way.

Prozac, which is now available in generic form, had the lowest risk among the major drugs, and is the only new-generation antidepressant specifically approved by the FDA for treating depressed children. For that reason, Mosholder recommended that Prozac alone continue to be prescribed to children.

I've written the same thing. Prozac (fluoxetine hydrochloride) is the first and often only med that should be used for the majority of adolescents with serotonin issues. Its long half-life makes it perfect for compliance issues and it's the weakest of all the SSRIs.

If anyone needs more information about meds and kids, get over to http://www.whatmeds.com - they are way more up on the issues than I am.

OK, so what's so good about SSRIs anyway? Face it, they work. Not for everyone, because serotonin isn't the answer for everyone. But it is the answer for a lot of people for a lot of different things - depression, OCD, panic & anxiety, PMDD, dealing with some of the nastier aspects of autism, and they're even used for non-psychiatric conditions like MS, arthritis and fibromyalgia. I'm somewhat concerned that they're overprescribed for some forms of depression and anxiety when just therapy would be the answer, but the same could be said for any class of medication. Like any medication they have their good points and bad points. You just need to be fully informed about any medication you're going to take. Try to find out if serotonin is the right neurotransmitter you need to be tweaking, which I'm covering in another article. But if it's just try this med or try that med, have some patience and give an SSRI a good four to six weeks to work at a low dosage before raising the dosage too high or switching to something else if the side effects aren't all that bad.

People are constantly asking me what the equivalents are for different classes of antidepressants. And it literally is an apples and oranges comparison. But since apples and oranges are both types of fruits, there are commonalities. Loren Regier and Brent Jensen of Queen's University School of Medicine, Kingston Ontario have put together a handy Antidepressant Comparison Chart. Of course it applies only for meds available in Canada, eh. But it does cover SSRIs, TCAs, MAOIs, Multiple Reuptake Inhibitors and whatever else they have in the Great White North.

Thanks to groovyone for finding these charts for me.

You'll also want to check Nom de Plum's Summary of Psychotropic Medications for lots of information on the old-school meds like TCAs and MAOIs.

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Crazy Meds Home Crazy Meds Talk About Antidepressants About SSRIs About Anticonvulsants / Mood Stabilizers About Atypical Antipsychotics About Benzodiazepines About Stimulants Finding a Doctor Sites with More Information Support Group Sites About Crazy Meds Crazy Meds: The Blog

Take care, and keep taking your crazy meds!

Jerod

If you still have unanswered questions about this or other medications, including which one is, or combination of meds are the best for you, your best bet is to ask on Crazy Meds Talk. Better yet, if you want to let the world know how they worked out for you and want to help out others in their quest for the correct meds, join the party.
If you want to discuss your issues, I suggest checking out one of the various support groups online.
Otherwise, if you're letting me know about how much you like or hate the site, or need to let me know about medication effects in private, then just drop a note to jerod23 at gmail dot com Honestly, I usually don't have a lot of time to answer e-mail these days. The snide autoresponse message that may or may not hit your mailbox is going to tell you the same thing.
Another problem is that you may not get a response even if I wanted to send you one. You see, so many dickweeds with malicious intents and too much time on their hands have appropriated the crazymeds.org domain name to use for their spam, viruses and the like. Subsequently some lazy-ass e-mail protection software authors just go by the domain name, and not the IP address. So I've been blacklisted because of the actions of others. Or the software just doesn't like the domain name because of the "crazy" and/or "meds." Or your question about a particular medication will set off spam flags. So the e-mail just wouldn't go through regardless. Sorry.

Hey, did you find this page all by itself through Google or some other search engine? Great! But to really appreciate the entire site, you need to start here.

Dead tree references:

End of books used for this article.

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Hey, did you find this page all by itself through Google or some other search engine? Great! But to really appreciate the entire site, you need to start here.

Created Saturday November 8, 2003

Last updated Saturday, May 15, 2010

Almost all of the material on this site is Copyright © 2003 - 2010 Jerod Poore Except, of course, the PI sheets, those are the property of the drug companies who developed the drugs the sheets are about. And any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That's usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that's OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I'm cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won't necessarily happen to you. Nobody on this site is a doctor, therapist, or a pharmacist. We don't portray them either here or on TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don't be a cyberchondriac, thinking you have every disease you see a website about, or that you'll get every side effect from every medication. Self-prescribing is just as dangerous. All information on this site has been obtained through personal experience, the experiences of my friends, the experiences of people reported on online support groups, and from sources that are referenced throughout the site. Know your sources! As such the information presented here is not a substitute for real medical advice from your real doctor, just a compliment to it. No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. All brand names of the drugs listed in this site are the trademarks of the companies listed after them in the pages about the drugs, even though those companies may or may not have been acquired by other companies who may or may not be listed in this site by the time you read this. Always read the PI sheet that comes with your medications and never ever throw them away. If you didn't get a PI sheet, demand one. Loudly. Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they're paid advertisements, or they're something you should read to make an informed decision about a particular med. Sometimes they're more than one of those things. But what's on those sites is their business, not ours. Very little information about visitors to this site is collected or saved. And from time to time I do look at search terms used to find it in an effort to make the information I present more relevant. Use only as directed. Void where prohibited.

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