Antidepressant Side Effects

SSRIs (selective serotonin re-uptake inhibitors) are currently the most commonly prescribed class of antidepressant drugs in the United States. SSRIs are believed to work by increasing the amount of serotonin in the brain by inhibiting its reabsorption into neural receptors. Serotonin is a naturally occurring chemical in the brain that is generally considered to be responsible for feelings of well-being and happiness.

SSRIs are prescribed not only to treat clinical depression, but also anxiety disorders, including panic disorders, social anxiety, obsessive-compulsive disorder (OCD), eating disorders, and post-traumatic stress disorder. Some of the more serious side effects include suicidal thoughts and behavior and birth defects (including heart defects) in children of mothers who took SSRI antidepressants during pregnancy.

Popular SSRI drugs include:

• Prozac (fluoxetine)
• Celexa (citalopram)
• Luvox (fluvoxamine)
• Zoloft (sertraline)
• Paxil (paroxetine)
• Lexapro (escitalopram)
• Effexor (venlafaxine)
• Viibryd (vilazodone)

SSRIs are not considered addictive, though patients should never stop taking the medication “cold turkey.” Instead, doctors recommend that patients slowly reduce the frequency and dosage so that the brain can adjust to the new neurochemical levels.

Different medications affect patients in various ways, and in many cases doctors will prescribe several to a patient before determining which has the most positive impact. Multiple SSRIs are never prescribed simultaneously, and patients should be carefully monitored for antidepressant side effects. One of the perceived advantages of this class of drugs is that they generally do not interact detrimentally with other medications. A rare exception of a contraindication is with MAO (Monoamine oxidase) inhibitors, which may lead to hypertension in some patients.

Some SSRIs are prescribed in controlled-release or extended-release forms (known as CR or XR), in which case a single dose incrementally releases the drug into the body over an extended period of time, such as a day or week.

SSRI side effects

Mild and/or temporary antidepressant side effects include, but are not limited to:

• Vomiting
• Nausea
• Dry mouth
• Headache
• Diarrhea
• Nervousness, agitation or restlessness
• Reduced sexual desire or difficulty reaching orgasm
• Inability to maintain an erection (erectile dysfunction)
• Vivid or unusual dreams
• Photosensitivity
• Rash
• Joint and muscle pain
• Excessive sweating
• Tremors or jaw clenching
• Weight gain or weight loss
• Drowsiness
• Insomnia

More serious or even life-threatening antidepressant side effects include:

• Hemorrhaging: Decreased capacity for blood clotting, particularly in the stomach or uterus. The internal bleeding risk increases significantly when SSRIs are combined with aspirin, ibuprofen, or other NSAIDs.
• Serotonin syndrome: In a very small percentage of cases, SSRI use (sometimes in conjunction with the herbal supplement St. John’s wort) can cause dangerously high levels of serotonin leading to confusion, vertigo, irregular heart rate, dilated pupils, and raised body temperature.
• Sexual side effects: SSRIs have long been associated with sexual dysfunction in both men and women, including decreased libido, difficulty in reaching orgasm, diminished sexual satisfaction, and erectile dysfunction. For some men, the problem has been counteracted through use of Viagra (sildenafil) or similar libido-enhancing drugs.
• Suicide: Numerous studies have shown that SSRI antidepressants may increase the risk of suicidal thoughts and behavior, as well as increased aggressiveness and violence, particularly in children and adolescents. In 2007, the FDA required all antidepressants (including but not limited to SSRIs) to carry a “black box” warning about the increased risk of suicide ideation in young adults.
• Miscarriage: A 2006 study on pregnancy outcomes in women taking SSRIs found an increased risk for miscarriage and spontaneous abortion.
• Birth defects: SSRIs have been linked to an increased incidence of birth defects in children whose mothers used the drugs as prescribed during their pregnancies. According to at least one study cited by the FDA in 2006, children whose mothers took SSRIs after the 20th week of pregnancy were six times more likely to develop the heart and lung condition known as persistent pulmonary hypertension of the newborn (PPHN). Paxil has specifically been linked by the FDA to a two-fold increased risk of heart defects when taken in the first trimester; while a 2007 study in the New England Journal of Medicine found that Zoloft users are twice as likely to give birth to a child with abdominal birth defects such as omphalocele.

Prozac, Paxil and Zoloft birth defects

Scientific research on SSRI side effects has pointed to an increased risk for birth defects, particularly heart defects, due to prenatal fetal exposure to the drugs.

Reported Prozac, Paxil, and Zoloft birth defects include:

• Persistent pulmonary hypertension of the newborn (PPHN)
• Hypoplastic left heart syndrome
• Ventricular septal defects
• Atrial septal defects
• Coarctation of the aorta
• Tetralogy of Fallot
• Omphalocele
• Anal atresia
• Craniosynostosis
• Clubfoot
• Limb-reduction defects
• Cleft lip and palate
• Spina bifida

Persistent pulmonary hypertension of the newborn (PPHN)

Persistent pulmonary hypertension of the newborn (PPHN) occurs when normal blood flow to the infant’s lungs at and after birth fails to initiate. PPHN can be life-threatening, and may lead to shock, heart failure, brain hemorrhage, seizures, kidney damage, multiple organ failure, and even death. Chronic lung disease, hearing problems, the need for feeding tubes, developmental delay, and long-term neurological defects may also result. Symptoms of PPHN include rapid or difficult breathing, increased heart rate (tachycardia), or a bluish tint to the skin.

Treatment of PPHN generally involves using artificial means to increase the child’s oxygen levels. Oxygen may be delivered through a plastic mask, assisted ventilation via a tube, or high frequency oscillatory ventilation. Nearly 20% of infants with PPHN die, though that number has significantly decreased from a few decades ago.

Heart defects

Heart defects are the most frequently reported of potential Prozac, Paxil, and Zoloft birth defects. Two of the most commonly cited are atrial septal defects (ASD) and ventricular septal defects (VSD), or “holes in the heart.” Babies with ASD or VSD are born with holes in the chambers of their hearts, which in most children naturally seal after birth. These abnormal openings can lead to increased blood pressure in the lungs and a lack of oxygen delivered to the child’s organs. ASD and VSD range in severity, but in extreme cases may require heart surgery to repair the defect.

Clubfoot

SSRI side effects in newborns may also include clubfoot, a congenital deformity in which the child’s foot bends inward and downward. Orthopedic therapy may be able to straighten the foot, though in some cases surgical repair is required.

Omphalocele

A type of hernia, omphalocele is a birth defect in which the infant’s intestines or other abdominal organs—including the liver or spleen—protrude from the naval in a transparent sac. In most cases, surgery can return the protruding organs back inside the abdomen with no long-term health consequences.

Craniosynostosis

Craniosynostosis is a birth defect affecting the brain, where the bones of the skull -called cranial sutures – close prematurely before the brain can fully develop. The condition results in an abnormally shaped skull and in many cases impaires development of the brain. Symptoms include developmental delays, seizures, and blindness.

Weighing the risk of antidepressant side effects

Women who are pregnant or planning to conceive are strongly advised to consult a physician to discuss the benefits and risks of taking SSRI medications during pregnancy. Some doctors believe that the pregnancy risks associated with maternal depression outweigh the statistically low risk of prenatal SSRI side effects.

Thousands of women whose children were born with birth defects after prenatal SSRI use have filed lawsuits across the country, claiming that they were not adequately warned by the drug manufacturers about the risks for SSRI birth defects.