Of all psychotropic drugs, serotonin reuptake inhibitors (SSRIs) are the most widely prescribed in most industrialized countries.
This type of antidepressant is popular for several reasons: it is indicated for the most prevalent disorders such as major depression or anxiety disorders, it is effective, and its side effects are almost always well tolerable.
If we understand why depression occurs, we can also understand how SSRIs are effective in the treatment and through what mechanism they act.
In this article we are going to answer the question ‘’Does SSRI cause brain damage?’’ We will briefly review how it works, what its properties and adverse effects are, and in which disorders it is most often prescribed.
Does SSRI cause brain damage?
No, SSRI doesn’t cause brain damage. But it does cause long-term side effects.
In recent decades, many studies have shown that there is a series of effective drugs to increase the effectiveness of different interventions by reducing the intensity or frequency of certain symptoms. This is the case with selective serotonin reuptake inhibitors (SSRIs), used mainly in the treatment of depression.
You’ve probably heard of some selective serotonin reuptake inhibitors. These drugs are presented under the name of citalopram, escitalopram, fluoxetine, paroxetine, sertraline, etc. Do any look familiar to you?
Selective serotonin reuptake inhibitors are a label that encompasses a number of drugs with a common goal. Typically they have been used as antidepressants in the treatment of depressive disorders, anxiety disorders and some personality disorders.
What is SSRI?
Although it can be cumbersome, it is necessary to understand how neurons function at the cellular level when they communicate with each other through neurotransmitters in order to understand how serotonin reuptake inhibitors modify neuronal activity.
Serotonin release and reuptake
When neurons communicate with each other, the presynaptic neuron (the emitter of chemicals that the other will receive) releases neurotransmitters into the synaptic space, which are picked up by receptors on the postsynaptic neuron.
In the case of circuits for the neurotransmitter serotonin, neurons use this neurotransmitter to communicate. One neuron releases serotonin into space and the other picks it up, understanding that it must be activated.
What happens is that not all neurotransmitters are received and sometimes they remain floating in the intersynaptic space. There are pumps that are responsible for cleaning this excess neurotransmitter and returning it to the presynaptic neuron.
In depression and other disorders, it is hypothesized that there is very little serotonin in this space so that serotonin-starved postsynaptic neurons create many receptors to receive neurotransmitters but are not activated and do not release anything, as in a state of hibernation.
SSRIs block reuptake pumps and allow more and more serotonin to accumulate in space.
Post-synaptic neurons, as they perceive that the concentration of serotonin in space is higher and there is more neurotransmitter available, begin to decrease the number of receptors because they no longer believe they need so many.
The neuron relaxes its strict norm of not releasing anything and begins to let go of serotonin and activate the rest of the neurons in the circuit.
Types of SSRIs
Not all SSRIs are the same. Each drug uses a different active ingredient that will have a specific therapeutic dose.
Furthermore, as each active ingredient acts on different serotonin receptors, their side effects will also be different. It is this relationship between the efficacy, safety and tolerance of the drug that defines whether it is preferable to use one or the other.
Below you can see a list of the SSRIs marketed. In pharmacies, we will find them under different commercial names depending on the country. For example, fluoxetine is more widely known as Prozac, or escitalopram under the name Cipralex:
Antidepressants alter the brain in a matter of hours
A new study carried out by scientists from the Department of Neurology at the Max Planck Institute in Leipzig (Germany) has concluded that despite the belief that for antidepressants to have an effect it is necessary for the patient to take it for at least 4-6 weeks, a single dose already causes significant changes in the brain in a matter of hours.
The research, which has been published in the journal Current Biology, aimed to investigate how selective serotonin reuptake inhibitors (SSRIs), the most widely prescribed antidepressants in the treatment of anxiety, personality or depression disorders (Prozac, Lexapro or Zoloft, for example), act in the human brain.
For this, they had the participation of 22 healthy subjects. Each of them underwent a 15-minute brain scan that measured oxygenation of the brain’s blood flow. They were then given a dose of Lexapro before undergoing the brain scan again about three hours later.
Comparison of the two brain scans revealed that the drug reduced connectivity levels in most areas of the brain after three hours; however, it also increased the connectivity of two specific regions of the brain: the cerebellum (involved in voluntary movement) and the thalamus (involved in sensory perception and motor function).
That is, the dose of Lexapro altered brain connectivity and increased the production of serotonin, a neurotransmitter believed to play an important role in maintaining a balance of mood.
“We did not expect the SSRI to have such a significant effect in such a short time or to encompass the entire brain,” says Julia Sacher, leader of the study. According to the researchers, these results suggest that SSRIs can reorganize the brain early to reduce symptoms of depression and not as long-term as previously thought.
Safety, tolerance and side effects
In general, SSRI psychotropic drugs are safe. Contrary to what happens with lithium salts, the toxic dose is difficult to reach by mistake when we take SSRIs.
Likewise, they do not produce the same tolerance as other drugs such as benzodiazepines, so it is not necessary to increase the dose due to the properties of the SSRI.
On the other hand, the side effects it produces are minor. They can cause nausea, dry mouth, sweating, anorgasmia, decreased sexual desire and blurred vision, among others much less frequent.
The abrupt cessation of SSRI use, even if it does not generate addiction, can cause a withdrawal condition, as the brain gets used to the presence of the substance. Therefore, the withdrawal of the drug is done gradually.
SSRIs interact with many other medications, so close supervision by the prescribing psychiatrist is necessary. For example, there are some antidepressants that remain in the system for days or weeks after they are stopped.
When someone taking this type of antidepressant switches to SSRIs, it could happen that the effects of the previous medication that has not yet been excreted and that of the SSRIs overlap.
This causes the patient to suffer from serotonin syndrome, an excess of serotonin that causes a confusional state, agitation, headache, nausea, etc. and it must be treated urgently.
What are the side effects of SSRI antidepressants?
All selective serotonin reuptake inhibitors work in a similar way. As with all medicines, there are certain side effects that are common, which does not mean that they necessarily have to appear during treatment.
In fact, some of the side effects may go away after the first few weeks of treatment, while others may cause your doctor to decide to change your treatment. If you cannot tolerate one SSRI, you may be able to tolerate another, as their chemical composition varies.
Since all that glitters is not gold, potential side effects of SSRIs may include, but are not limited to:
- Dry mouth.
- Nervousness, agitation, or restlessness
- Sexual problems, such as decreased sex drive or difficulty reaching orgasm or inability to maintain an erection (erectile dysfunction).
- Blurry vision.
Uses in psychiatry
In the same way as tricyclic antidepressants, SSRIs are used for a wide variety of disorders. Naturally, the main use is in patients with major depressive episodes or depressive symptoms.
The use of SSRIs is very effective in ending the depressive symptoms that can be found in patients with anxiety disorders, personality disorders, gender dysphoria, bulimia nervosa, autism, etc.
Since serotonin is also involved in anxiety, the benefit of SSRIs in anxiety disorders is often twofold. On the one hand, it appeases the negative mood, and on the other, it reduces the experience of anxiety.
Especially in patients experiencing chronic levels of anxiety such as generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, or acute stress reactions, serotonin reuptake inhibitors will be very helpful.
These patients, when taking SSRIs, experience a significant decrease in anxiety levels. This allows them to loosen the worries and restlessness that torments them, recovering much of their quality of life and leading a functional life.
According to most scientists, antidepressants do not cause physical addiction, although they can cause psychological addiction. There are several studies in which a very harmful effect of these pills has been verified, particularly when they are consumed for more than five years.
A responsible psychiatrist assumes drugs as temporary help, not as a condition on which a patient must depend for life.
As we have seen, selective serotonin reuptake inhibitors are drugs specially designed for depression. However, they may have other indications (long-term treatment of anxiety and obsessive-compulsive disorder).
These drugs are not without side effects, although they are less than other antidepressants, such as MAOIs or ADTs. If you think you may need medication, the first thing to do is visit your doctor. Remember that self-medication can be very dangerous.
FAQS: Does SSRI cause brain damage?
Do SSRIs permanently change your brain?
Although SSRIs are the most widely prescribed antidepressants in the world, it is still not entirely clear how they work. They are believed to change connections in the brain in important ways, but these effects were admitted to occur after about six weeks, but not hours.
Can antidepressant cause brain damage?
No, antidepressants can’t cause brain damage.
Do SSRIs cause long term damage?
During long-term SSRI therapy, the most troubling adverse effects are sexual dysfunction, weight gain, and sleep disturbance.
What does SSRI do to the brain?
By enhancing serotonin levels in the brain, selective serotonin reuptake inhibitors (SSRIs) treat depression. One of the chemical messengers that carry signals between the brain’s nerve cells is serotonin.
What is the hardest antidepressant to come off of?
Below is a list of the antidepressants that were included in this systematic review:
In this article we answered the question ‘’Does ssri cause brain damage?’’ We briefly reviewed how it works, what its properties and adverse effects are, and in which disorders it is most often prescribed.
If you have any questions or comments please let us know!
Cascade, E., Kalali, A. H., & Kennedy, S. H. (2009). Real-world data on SSRI antidepressant side effects. Psychiatry (Edgmont), 6(2), 16.
Chu, A., & Roopma Wadhwa. (2020, November 7). Selective Serotonin Reuptake Inhibitors. Retrieved January 22, 2021, from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK554406/