Depression is a disorder that affects globally approximately 270 million persons and it has a consistent impact over quality of life through intense feelings of sadness, apathy, loss of interest, changes in appetite, sleep problems, impaired relationships and decreased work efficiency. Severe cases result in suicide, depression being the second leading cause of suicide among people between 18 and 30 years old.

There are multiple treatment options for depression, the most widely used being psychotherapy and medication.

The best known antidepressants are drugs known as SSRI (Selective-Serotonin Reuptake Inhibitors): fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa, Cipramil), escitalopram (Lexapro). These drugs can be bought only through a medical prescription issued by a psychiatrist, following a medical examination.

They work by increasing the length of time that serotonin, a neurotransmitter involved in regulating well-being and positive emotions, is available to its receptors. These receptors are located not only in the brain, but also in other organs such as the heart, gut, liver, kidneys. Once entered in the body the drug acts on all these receptors, regardless of their location, causing a number of side effects.

Fluoxetine (Prozac) is recommended for major depression, OCD (Obsessive-Compulsive Disorder), panic disorder, bulimia. Among the side effects of fluoxetine we mention: dizziness, headache, anxiety, sleep problems, loss of appetite, fatigue, excessive sweating. Rarely can occur: agitation, suicide thoughts, mild bleedings, loss of weight, tremor, muscle spasms, decreased libido and erectile dysfunctions (prolonged and painful erection).

Sertraline (Zoloft) is prescribed in cases of major depression, OCD, panic disorder, PTSD, dysphoric menstrual disorder, social anxiety. Its side effects include: insomnia, dizziness, drowsiness, fatigue, agitation, nervousness, headache, diarrhea, constipation, vomiting, nausea, dry mouth, sore throat, loss of appetite, increased appetite, excessive sweating, decreased libido, premature ejaculation, bruxism, numbness, tingling, muscle tension, tinnitus, vision problems, palpitations, hot flashes, yawning. Rarely could occur: hallucinations, seizures, involuntary muscle contractions, amnesia, emotional flattening, difficulty breathing, nosebleeds, back pain, difficulties in urination (frequent urination, increased urine volume, inability to urinate), and edema. In case of sudden interruption can occur dizziness, muscle numbness, sleep problems, agitation, anxiety, headaches, nausea, vomiting. People being treated with sertraline have a higher risk of bone fractures.

Paroxetine (Paxil) is prescribed in cases of depression, OCD, anxiety, PTSD. Its side effects are fatigue, headache, dizziness, insomnia, diarrhea, and rarely erectile dysfunction, bleeding, high blood pressure.

Citalopram (Cipramil) is indicated for depression, panic attacks, social anxiety. Among its side effects we mention: dry mouth, intense sweating, insomnia, fatigue, feeling weak, erectile dysfunction, high blood pressure.

Escitalopram (Lexapro) is recommended for depression, panic disorders, social anxiety, generalized anxiety, OCD. It has fewer side effects than other drugs, which decrease in intensity as the body gets used to the new substance: dry mouth, fatigue, headache, insomnia, sweating.

The common risks of SSRIs are: risk of allergic reactions, interaction with other drugs (including the homeopathic ones, as Saint John’s wort) and alcohol, worsening of symptoms in diabetes, glaucoma, kidney disease, cardiovascular disorders, liver disease. It is recommended that persons treated with SSRIs avoid driving or operating complex installations to prevent accidents. When the treatment is stopped abruptly, side effects may be exacerbated, the younger the patient and the longer the duration of treatment. In addition, it takes 2-6 weeks for a full effect (to reach the optimal plasmatic concentration).

In conclusion, SSRI medication is indicated for the relief of depressive symptoms, but it comes with a number of important side effects. Studies show that a combination of psychotherapy and medication has a significantly higher effect in the treatment of depression and increased quality of life than medication alone.

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