What are SSRIs and do they work?

May 30, 2019

WRITTEN BY

Patrick Carey

Patrick joined our team to help people get better information about mental health. He drinks coffee and wishes he had a dog.

There's a very good chance you've heard of the selective serotonin reuptake inhibitors, or SSRIs: Prozac, Zoloft, Paxil, Lexapro, and so on. These drugs, most commonly used for major depressive disorder, have been gradually introduced since the late 1980s. Existing drugs—like the MAOIs and tricyclics—required close attention to diet or had more severe side effects, respectively. So SSRIs quickly became the most commonly prescribed antidepressant medications, as total antidepressant use rose by 64% in the US from 1999-2014. As of 2017, 12.7% of Americans over age 12 were taking antidepressants.

Although most of these prescriptions are still written for depression, a significant portion of the rapid increase comes from a much broader application of SSRIs. They're now prescribed for obsessive-compulsive disorder, generalized anxiety, panic disorder, phobias, PTSD, and a number of other mental health conditions. It's important to note that many experts say they're being too prescribed too often—especially by primary care physicians without any kind of detailed assessment. But SSRIs are helpful for many people with anxiety-related disorders.

For OCD, about 40-60% of people experience partial symptom reduction on an SSRI. They can be used as a standalone treatment, a complement to behavioral therapies (like exposure and response prevention), or along with adjunctive medications like an atypical antipsychotic. SSRIs are roughly as effective for OCD as exposure and response prevention (ERP), according to research, and the value of combining the two has been documented in a number of studies.

So how do SSRIs work?

For about fifty years, depression was seen as a simple imbalance of serotonin in the brain. In the past decade, though, it became clear that things are much more complicated.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

Harvard Health, Harvard Medical School. Published April 11, 2017.

A similar situation exists for all mental health conditions, OCD included: we have some ideas about what's involved, but we just don't know what causes them. And when we don't know the cause of an illness, we can't know exactly why the corresponding medication works for some people. In fact, things are often reversed. Because SSRIs can help people, the quest to link depression and anxiety-related conditions to serotonin continues. The success of an intervention comes to dictate theories about the cause of the illness.

What we know is that brain chemicals like serotonin are somehow involved in OCD, and that SSRIs can affect the brain in multiple ways. Beyond that, nobody is sure.

Is it worth trying an SSRI?

If you're working with a medical professional who recommends an SSRI and you feel comfortable with possible side effects, it may be worth trying one out. Considering the fairly high success rates and a growing body of research, they may alleviate some symptoms of depression, OCD, and other conditions.

At the same time, behavioral therapies like exposure and response prevention (ERP) have equally high success rates without the side effects. If you're able to find an OCD-trained therapist and try ERP with or without medication, that's another great option.

If you're not working with an OCD-trained therapist but you'd like to start, learn more about our team of therapists now: