Understanding SSRIs: 7 Questions You Didn’t Think to Ask Your Provider

Over the last decade, the prescription of Selective Serotonin Reuptake Inhibitors (SSRIs),  colloquially known as antidepressants—has risen dramatically, up 35% since 2015. Before the pandemic, more than one in eight Americans over the age of 18 had recently taken SSRIs, according to a survey from the Centers for Disease Control and Prevention.

That number has almost certainly gone up, given that the World Health Organization (WHO) attributes a 25% increase in the prevalence of anxiety and depression worldwide to the pandemic.

But the steady growth of SSRIs has happened over time. It is a trend that has benefited from greater awareness of their efficacy, the destigmatization of mental health concerns, and compensation for a lack of talk therapy, especially for underresourced communities.

For all their prevalence, SSRIs are still widely misunderstood. If you’re considering whether an SSRI might be right for you, here are seven answers to questions that you should be asking yourself and your healthcare provider:

1. How Do SSRIs Work?

SSRIs work by altering the levels of serotonin in the brain, a neurotransmitter involved in regulating mood and emotions. SSRIs prevent serotonin from being reabsorbed, increasing its concentration in the synaptic gap between two neurons, which can positively impact mood regulation and other brain functions.

2. Aren’t SSRIs the Same Thing as Antidepressants? Can They Still Help Me if I’m Not Depressed?

SSRIs are not only for treating depression. While the term “antidepressants” is often used, it is a misnomer. SSRIs can effectively treat a range of mental health conditions, including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, severe phobias, bulimia, and post-traumatic stress disorder (PTSD).

3. Are SSRIs Effective or Over-Prescribed?

The question of whether SSRIs are being overprescribed is a complex and debated topic, but the conversation should start with efficacy. A meta-analysis of several dozen trials found that adults are about 25 percent more likely to see symptoms improve with an SSRI versus a placebo.

This doesn’t mean SSRIs are for everyone. It’s important to approach the question of whether we’re overprescribing SSRIs with nuance and consider multiple factors that contribute to prescribing patterns. Here are some key points to consider:

• Increased Awareness and Recognition of Mental Health Concerns: As awareness of mental health issues has risen, it has led more people to seek help for their mental health concerns and increased demand for treatment options, including medication.
• Expanded Indications for SSRIs: As mentioned above, SSRIs are used to treat far more conditions than just depression. As a result, the range of diagnoses for which SSRIs are prescribed has expanded, leading to more prescriptions.
• Access to Mental Healthcare: Limited access to mental healthcare, including long wait times, shortage of mental health professionals, and lack of insurance coverage, can influence prescribing patterns. In fact, a study in the UK found that “young people living in deprived areas were more likely to be prescribed antidepressants than those from affluent areas.” This may indicate that such areas lack access to alternative treatments like cognitive behavioral therapy, leading more teens to seek medication.

So, in some sense, yes, SSRIs are overprescribed. But this is due to limited access to other viable treatments such as talk therapy. As Doctor Ronald W. Pies says in his comprehensive essay about the over-prescription of antidepressants, “and there-in lies the real failing of American mental health care: not the over-prescription of antidepressants—though it happens—but the under-availability of optimal treatment.”

4. Is Taking an SSRI the Only Thing I Need to Do to Get Better?

Taking an SSRI is not the sole solution for mental well-being. Alternative treatments may include talk therapy, dietary and exercise modifications, socialization, journaling, maintaining a consistent sleep schedule, and reducing screen time. Combining these strategies with medication can lead to improved outcomes and overall well-being.

In fact, a major meta-analysis of over 50 different studies showed that a combined treatment of antidepressants with psychotherapy was about twice as effective as antidepressants alone.

5. Is Telehealth a Good Option for Diagnosing My Mental Illness?

With the rise of online services that streamline the prescription process through online assessments, there is a risk of overlooking the critical human component of diagnosing and prescribing medications.

While online video visits can provide valuable insights, questionnaire-based prescribing that lacks human contact may lead to misdiagnosis. Physical cues, such as appearance, personal hygiene, and verbal indicators of distress, can be missed without a video-based or in-person examination.

6. Who Can Prescribe SSRIs?

Contrary to popular belief, the ability to prescribe is not solely limited to psychiatrists. Various medical professionals, including primary care physicians, psychologists, nurse practitioners, physician assistants, and gynecologists, depending on state regulations, can prescribe SSRIs.

This wide range of healthcare providers ensures that access to these medications is not limited to a single specialty.

7. What Are the Next Steps if the SSRIs Don’t Work? 

It is essential to communicate openly with your healthcare provider if you are not experiencing the desired results. Alternative options may involve adjusting the dosage, trying a different brand of medication, or exploring alternative medications altogether.

It is crucial to note that weaning off SSRIs should be monitored by a healthcare professional, and discontinuation may require a gradual tapering process, as it can lead to withdrawal-like symptoms. Additionally, financial considerations, such as copays, medication costs, and talk therapy expenses, should be discussed with your provider, as they can impact your overall treatment plan.

Find What Works for You

Good healthcare outcomes require deeply personalized care. While effective, SSRIs are often just a first step in treating mental health conditions, and when combined with other treatments such as talk therapy, it unlocks another level of efficacy.

Engaging in open and honest conversations with your healthcare provider to get this kind of personalized and effective care is essential. The comprehensive evaluation provided by a healthcare professional in person can help ensure you are on the best treatment plan for your individual needs.