By Mark Morales
From PHN Issue 32, Spring 2017
Editors’ Note: People in prison have a right to informed consent, according to the Handbook of Correctional Mental Health. For psychiatric medications, this means the healthcare provider who prescribes a drug must explain why they’re giving you the drug, and what the risks and benefits might be. They need to tell you about any other drugs that you could possibly take to treat the condition, because you may have more than one option to choose from. They also need to tell you the risks and benefits of not taking the drug, so that you can make an informed choice. This discussion and your consent to be given the drug should be documented in the medical record. You have a right to refuse treatment.
Selective serotonin reuptake inhibitors, commonly known as SSRIs, are usually the first medicines that doctors will use to treat depression and other mental illnesses. SSRIs are also called “antidepressants,” but they can be used to treat other mental illnesses besides depression. If you suffer from anxiety, post-traumatic stress disorder (PTSD), panic attacks, or obsessive-compulsive disorder (OCD), you may also benefit from taking SSRIs.
Unsure if you are currently taking an SSRI? Here is a list of SSRIs, with brand names in parentheses:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
How do SSRIs work?
These drugs work by raising the level of serotonin in your brain. Serotonin is a chemical that relays signals in the brain. By increasing the amount of serotonin available for signaling, SSRIs can improve symptoms of depression and anxiety.
How do I know if the drug is working? How long will it take?
SSRIs can improve your mood and reduce your symptoms of depression or anxiety. Many people report that they “feel like themselves” again when the medication is working. While your mood may improve during the first two weeks taking the drug, it can take anywhere from 3-8 weeks before you feel the full benefit of the drug. SSRIs must be taken every day, not just when you are feeling sad or anxious.
What if the drug is not working?
If your mood or anxiety level does not feel any better after 4 weeks, your doctor may decide to slowly increase the dose. Your doctor should start you on the lowest effective dose of the drug, then gradually increase the dose as needed. This gives your body and brain time to adjust to the medication, which lessens the chance that you will have negative side effects. If you are still not feeling better on a higher dose of the drug, then the doctor might decide to switch you to a different SSRI. Sometimes you have to try two or even three different SSRIs before finding the one that works for you. It can be a process of trial and error.
Are there negative side effects?
SSRIs are generally safe medications, and they have fewer side effects than other classes of drugs that are used to treat depression and anxiety. Side effects are most common in the first 3 months of treatment. In many cases, the side effects diminish or go away completely as your body adjusts to the drug. But for others, the side effects may last. Here are the most common side effects of SSRIs:
- Decreased sex drive/difficulty reaching orgasm
- Trouble falling asleep at night
- Daytime sleepiness
- Weight gain
- Dry mouth
If you’re having side effects, you can ask your healthcare provider if there are ways to treat the side effect, or if the drug dose can be lowered, or if you can switch to a different SSRI.
What happens if I stop taking the drug abruptly?
It is important to talk to your doctor before stopping your SSRI. If you stop the drug abruptly, you will likely experience symptoms of withdrawal. These can include changes in mood, suicidal feelings, dizziness, fatigue, upset stomach, muscle aches, and chills. You are not “addicted” to the SSRI, but your body needs the right amount of time to adjust. To prevent these symptoms of withdrawal, your doctor should slowly lower your dose of the SSRI over a few weeks before stopping it completely. This is called “tapering” the drug.
If you are having feelings of depression or anxiety, it may help to talk to your doctor. You do not need to suffer in silence! Your mental health is just as important as your physical health, and antidepressant medication may help improve your quality of life.
If you are having thoughts of suicide, or if someone you know is and you want to help, we can send you a free pamphlet on suicide prevention written by and for people in prison.
For those who are having thoughts of suicide and can call a toll-free number, the National Suicide Prevention Lifeline is 1-800-273-TALK (8255), 24 hours a day, 7 days a week. Most cities have a local suicide or crisis hotline number.