Common Side Effects of Selective Serotonin Reuptake Inhibitors

Like all medications, Selective Serotonin Reuptake Inhibitors can have potential side effects. Common ones include:

• Nausea or upset stomach, especially during the first week or so after starting medication or after a dosage increase.

• Sedation (tiredness or sleepiness) or activation (having more energy) can also occur with these medications. Of the five currently prescribed, fluvoxamine (Luvox) is more often sedating, fluoxetine (Prozac) and paroxetine (Paxil) are more often activating, and sertraline (Zoloft) and citalopram (Celexa) are in between. We use the term "more often" because children and teens vary greatly in their responses, and the same medication may sedate one child and activate another. By having either morning (for activating medication) or evening (for sedating medication) dosing, these problems can often be avoided. Youngsters appear to be somewhat more sensitive to the activating effects of SSRIs than adults are, so the more sedating and "in between" medications have increased in popularity with children recently.

• Headaches are less common side effects, but can occur in children who are predisposed.

• Loss of sexual interest can occur.

• Flu-like symptoms can occur if they are stopped suddenly (ex­cept for Prozac, which leaves the body very gradually). Note, however, that none of these medications are addictive, in the sense that they do not induce a "high," and the body does not develop a need for ever-increasing doses over time (termed "tolerance"). Dosage adjustments are made according to your child's response to the medication, and sometimes in response to physical growth. Teens who grow quickly or gain substantial weight quickly may need more medication.

• Weight change can occur. Weight gain is more common than weight loss, but some of these medications (for example, Prozac) can also curb appetite in some people. With good eating habits, medication-related weight change is usually not great. Remember, though, that appetite changes often accompany depression and remit as depression improves. Thus, a teen whose appetite has been suppressed by depression for several months may appear to gain substantial weight when the depression is medically treated.

Overall, SSRIs are remarkably well tolerated compared to other psychiatric medications. The one exception occurs in people predisposed to bipolar disorder, a condition where elated or irritable mood episodes occur alternating with depressive ones. In these people, SSRIs (or any other antidepressant medications) can sometimes trigger manic episodes. People with close relatives who have bipolar disorder may also be at risk for this reaction.



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