What are SSRIs?
SSRIs are drugs that affect brain chemistry with the aim of relieving specific mental health symptoms. The mechanism of action is unknown according to section 12 of the drug’s label.1
The longstanding theory proposes that these drugs cause serotonin (a natural and very complex chemical) to be blocked from reuptake. Thus it can build up in brain and other tissues, theorized to lead to an enhanced effect on mood regulation. What is known about serotonin is that it is responsible for thousands of regulatory effects throughout the body. Some effects are excitatory, as in overstimulation in the digestive tract which can lead to diarrhea. Predominantly however, serotonin acts as an inhibitory neurotransmitter. For example, serotonin can have a dampening effect on outside sources of stimulation, similar to how earplugs dampen bothersome noise.
Serotonin also regulates body temperature, neural activity, appetite, the immune system, cell growth, sleep, energy metabolism, cardiac health, and countless other tasks.5,6
Why is Gut Health Key to Mental Wellness?
The promotion of antidepressant drugs has been tightly associated with the manipulation of certain natural hormones and neurotransmitters in the human body. The aim has been to chemically correct “errors” in neurotransmission. This treatment method has undergone scrutiny, leading to new horizons of treatment that don’t involve prescription medications, but more holistic ways forward.
Very little serotonin is produced inside the brain tissue, about 5-10%. The remaining 90-95% is produced in the gut. Therefore it is a fundamental of great importance to maintain a healthy gut so the natural neurochemical “factory” that is inbuilt can actually function as it was intended to do.
For more information on the importance of diet, and methods of healing and supporting a healthy gut microbiome, please review these articles:
• The Microbiome and Mental Health
• Your Microbiome Matters for Mental Wellness
• Holistic Detox and Diet: Reliable Foundations of Recovery
What are SSRIs Prescribed to Treat?
SSRIs are prescribed to alleviate depression, but this is not described as an instant fix. It takes between 4 and 6 weeks for SSRIs to “kick in”. Accordingly, clinical trials on antidepressants would have to last longer than 4-6 weeks to show direct causation for such improvements. Interestingly, 88% of clinical pre-marketing trials lasted no longer than 8 weeks.7
SSRIs commonly prescribed to treat depression include these:
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Escitalopram (Lexapro)
- Sertraline (Zoloft)
- Citalopram (Celexa)
The SSRIs above are also prescribed for other issues, some FDA-approved, and some off-label uses. Some examples of FDA-approved use include to alleviate social and general anxiety disorders, eating disorders, obsessive compulsive disorders, post-traumatic stress disorders, premenstrual dysphoria disorders, menopausal symptoms such as hot flashes and night sweats, premature ejaculation, and panic attacks.
Off-label Uses of SSRIs
Off-label uses of SSRIs include to prevent or lessen migraine headaches, body dysphoria, diabetic neuropathy, frequent fainting (syncope), to limit inappropriate sexual behaviors in psychiatric or geriatric settings, and fibromyalgia.2
A physician can prescribe a medication without FDA approval or conclusive evidence from clinical research, for many conditions, as in the off-label uses discussed above. For example, the prescribing of SSRIs to quash inappropriate sexual behaviors or to address premature ejaculation comes not from clinical trials, but from observing a common SSRI side effect called PSSD. PSSD means post-SSRI-sexual dysfunction where the sexual organs become unresponsive. PSSD can linger even after discontinuation. Research from Cambridge University warns that serious risks to patients can occur in off-label prescribing.3,4
What are the Concerns with Overprescribing Psychiatric Medications?
Both on-label and off-label prescribed SSRIs are associated with a very long list of side effects, which are listed out in detail by going to, for example, “Zoloft Side Effects”. Adverse events after SSRI use was tabulated at 80% or higher in a large clinical research trial.9 Research shows that for some, these risks can outweigh the benefits, causing a person to decide to stop taking the drug. However, cessation can be a difficult goal as SSRI withdrawal is a complex and sometimes arduous task especially without medical assistance.
Overprescribing SSRIs or other psychiatric medications can stem from various reasons. One drug is prescribed and causes side effects, so another drug is prescribed to suppress those reactions. Another common scenario is lack of efficacy, where additional drugs are prescribed to raise the level of effect. Also a drug may interfere with another prescribed drug causing interactions that complicate matters. And often, these treatment pathways cross over one another, causing a potential cascade of unintended drug side effects.
There can be many reasons why overprescribing can occur, as in the following examples:
To limit side effect profiles- Polypharmacy
- Drug-drug interactions
- No or waning efficacy
- Developed tolerance
- Acquired dependence
- Liabilities in long-term use
- Difficulties in SSRI withdrawal being misdiagnosed as relapse, leading to more prescription drugs being administered 10
