SSRIs and mental health – frequently asked questions
As psychological therapists, we’re frequently asked about the role of medication in the treatment of mental health issues. We’re not medically qualified and cannot prescribe medication – but we can help answer the initial questions you might have about it and dispel the myth that you “should” always be able to get better without medication.
Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat depression, anxiety, OCD, panic disorder, severe phobias, bulimia, and PTSD. This article aims to answer some common questions asked about them.
How do SSRIs work?
The aim of SSRIs is to help restore the brain’s chemistry back to optimal functioning – much as iron tablets are used for anaemia to restore haemoglobin levels. SSRIs include fluoxetine, sertraline, citalopram and paroxetine, amongst others. There are other medications that impact both serotonin and noradrenaline, such as venlafaxine and duloxetine.
So, here’s the science. For those reading this article, rather than listening, the diagram at the top of the page might help here. Neurons are nerve cells that send messages via neurotransmitters in your brain, allowing you to do everything from breathing to talking, walking, and thinking. Serotonin is thought to be a key neurotransmitter in regulating mood. It gets released into the synapse - the gap between neurons - and acts as a messenger, transmitting signals from one neuron to another. After delivering its message, serotonin is re-absorbed - a process known as reuptake - so it can be reused.
In mental health conditions, this process is disrupted, with serotonin not staying in the synapse long enough to deliver signals between neurons effectively. So, SSRIs selectively inhibit the reuptake of serotonin, allowing it to remain in the synapse for longer and deliver the message properly.
How do I get a prescription for an SSRI?
The best route for being prescribed medication would be through seeing your GP or a psychiatrist. Clinical psychologists and psychological therapists are not qualified to prescribe medication. The doctor you see will likely ask about your symptoms before discussing treatment options, depending on various factors such as your health history, other medication you may be taking, and your current priorities. If medication is decided as a good option, it will often be prescribed in a low dose for a trial period, to minimise side effects, before adjusting the dose or type of medication, if necessary.
What about side effects?
SSRIs generally take 2 weeks to start working and, like all medications, they can have side effects – annoyingly these generally start before you get to see any benefit on your mood! It’s helpful at times to think of the side effects as like building work going on – noisy and dusty in the short-term but helpful in the long-term.
Side effects will vary, depending on the individual and type of medication, but are usually mild and reduce over the first 10 days, as your body adjusts to the medication. Most commonly, side effects include agitation, nausea, gastric problems, loss of appetite, headaches, and dry mouth. If you suffer side effects, always check with a pharmacist or GP. Indeed, your doctor will likely discuss possible side effects with you when discussing potential medication options.
How can medication work alongside therapy?
Research has shown that psychological therapy and medication can be an extremely effective combination, with medication helping restore healthy brain function while psychological therapy helps build long term coping strategies.
What else can help regulate brain chemistry?
There is increasing evidence that regular exercise, a balanced diet, and consistent good quality sleep can help brain function, by increasing levels of neurotransmitters, including serotonin.
Unfortunately, common symptoms associated with mental health difficulties, such as a loss of motivation, can make these changes hard to achieve. Therefore, medication can act as a mechanism to help kickstart the process, improving motivation and giving us the energy to help build these habits.
Will I need to take it forever?
Medication may only be needed in the short term, most commonly for 6-12 months and can be viewed as being similar to how, after experiencing a knee injury, you may be given crutches while your injury heals, before gradually reducing use. In other cases, you may be prone to needing medication intermittently throughout your life or, in more rare cases, may need to take it continually.
How will I know when I’m ready to stop taking it?
Deciding to stop taking medication can be a tricky decision and it is important to discuss with your GP and therapist. This usually comes after a significant improvement in symptoms, period of stable mood, and when you feel that you have effective coping strategies in place to help prevent relapse. These include regular use of psychological techniques learnt in therapy and ensuring that you have optimal emotional support. Alternatively, you may not require medication once trauma has been processed, when panic has been mastered, or once your fears have been overcome.
If you decide it’s time to stop medication, your GP will encourage you to gradually reduce the dose, to reduce the likelihood of withdrawal symptoms.
What about the stigma?
Unfortunately, there’s still some stigma surrounding the use of medication for mental health. Some people worry that taking medication is a sign of weakness or that it means they’ve "failed" to manage their mental health on their own.
In reality, taking medication is a proactive step toward managing your wellbeing. Just as someone with anaemia takes iron tablets to help restore haemoglobin, medication for mental health helps regulate imbalance in brain chemistry. It’s helpful to see the brain as simply another organ in your body, like your heart or pancreas: what matters most is finding what works best for you.
Conclusion
Medication can be a key tool in the biopsychosocial approach to managing mental health conditions. Not everyone will require medication to get better, it’s just one part of treatment along with therapy, living a healthy lifestyle, and building supportive relationships.