SSRIs (selective serotonin reuptake inhibitors) - Cautions  

Things to consider 

Selective serotonin reuptake inhibitors (SSRIs) can react unpredictably with other medicines, including over-the-counter medications such as ibuprofen.

Always read the patient information leaflet that comes with your medication to see other medicines you should avoid.

If in doubt your pharmacist or GP will be able to advise you.

Medical conditions

SSRIs may not be suitable for you if have the following conditions:

  • mania – an extremely excitable mood, sometimes with hallucinations
  • bipolar disorder (alternating bouts of depression and mania) and you are in a manic phase
  • a bleeding disorder, or you are taking medicines that make it more likely that you may bleed, for example warfarin
  • diabetes – both type 1 and type 2 diabetes
  • narrow angle glaucoma – increased pressure in the eye 
  • severe kidney disease

Pregnancy

As a precaution, the use of SSRIs is usually not recommended for most pregnant women, especially during the first three months of a pregnancy (the first trimester).

However, exceptions can be made if risks posed by depression (or other mental health conditions) outweigh any potential risks of treatment.

Complications linked to taking SSRIs during pregnancy include:

  • loss of pregnancy
  • birth defects affecting the baby’s heart (congenital heart disease)
  • the baby is born with a rare condition called pulmonary hypertension

However, there is no hard evidence that SSRIs can cause these types of complications.

Most experts think if SSRIs do increase risks of complications in pregnancy then the increase in risk is probably small.

If you are pregnant and are currently depressed you should discuss the pros and cons of treatment with SSRIs with your doctor.

If SSRIs are recommended they will usually be fluoxetinecitalopram or sertraline as these are thought to be relatively safe to use.

Breastfeeding

Again, as a precaution SSRIs are not usually recommended if you are breastfeeding.

But there are circumstances when both benefits of treatment for depression (or other mental health conditions) and benefits of breastfeeding to your baby outweigh the potential risks.

If you are treated with antidepressants when breastfeeding then paroxetine or sertraline are normally recommended.

Children and young people

SSRIs are not usually recommended in children and young people under the age of 18.

This is because there is evidence they can trigger thoughts about suicide and acts of self-harm in this age group.

Concerns have also been raised that use of SSRIs could affect brain development in children and young people.

An exception can usually only be made if the following points are met:

  • the person being treated has failed to respond to talking therapies such as cognitive behavioural therapy, and
  • the person being treated will continue to receive talking therapies in combination with SSRIs, and
  • the treatment is supervised by a psychiatrist (a doctor who specialises in treating mental health conditions)

If an SSRI is recommended then fluoxetine is usually the first choice.

Alcohol

Alcohol is not usually recommended if you are taking an SSRI as it could make the medication less effective and side effects worse.

Dizziness

Some SSRIs may cause you to feel dizzy, particularly when you first start taking them.

If you do experience dizziness avoid driving and using tools and machinery.

Other antidepressants

You should never take two different types of antidepressants, such as an SSRI and a tricyclic antidepressant (TCA), unless advised by your doctor. This is because certain combinations of antidepressants can make you feel very ill.

If a decision is taken to switch you from one type to another, you will normally gradually reduce the dosage of the first antidepressant before switching to the second.

St John’s wort

St John’s wort is a popular herbal remedy promoted for the treatment of depression.

While there is evidence of its effectiveness many experts advise against using it. This is because the amount of active ingredient varies between individual brands and batches, so you can never be sure what sort of effect it will have on you.

Taking St John's wort with other medications, such as anticonvulsants, anticoagulants, SSRIs and the contraceptive pill, can also cause serious health problems.

You shouldn't take St John's wort if you are pregnant or breastfeeding, as it is unclear whether it is safe.

Page last reviewed: 24/04/2012

Next review due: 24/04/2014

Ratings

How helpful is this page?

Average rating

Based on 9 ratings

All ratings

Add your rating

Comments

Making sense of your medicines

Find out about taking prescription medicines and what to discuss with your doctor. Plus, a pharmacist answers common questions