Health Library Selective Serotonin Reuptake Inhibitors (SSRIs) for PTSDFrom Healthwise

Chemicals in your brain affect the way you feel. When you have post-traumatic stress disorder (PTSD) or depression, you may not have enough of a chemical called serotonin. Selective serotonin reuptake inhibitors (SSRIs) raise the level of serotonin in your brain.

SSRIs often are used to treat all the symptoms of PTSD, as well as other conditions like depression or anxiety. These medicines also treat the sleep problems you may have with PTSD.

Studies have shown that paroxetine, sertraline, and fluoxetine improved symptoms of PTSD when compared with a placebo.^{1, 2, 3, 4} One study found that fluoxetine reduced how often symptoms come back when compared with a placebo.¹

SSRIs can help more types of symptoms than other medicines.

Side effects of SSRIs include:

• Feeling sick to your stomach.
• Not feeling hungry.
• Diarrhea.
• Feeling anxious, cranky, or grumpy.
• Problems sleeping or drowsiness.
• Not being interested in sex or not being able to have sex.
• Headaches or dizziness.

Usually, side effects will get better over time.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.
• A warning about taking triptans, used for headaches, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

SSRIs usually are started at low doses and increased gradually. If you have side effects, your doctor may change your medicine or combine it with another medicine. This often can make your side effects go away. But SSRIs usually have fewer side effects than some other medicines for PTSD.

Your doctor may have to try different medicines to find one that works for you. It is important to keep taking your medicines even after your symptoms get better.

Medicines are often combined with counseling to treat PTSD.

Never suddenly stop taking antidepressants. Stopping antidepressants suddenly can cause bad side effects. Your symptoms may get worse or come back. If you stop taking these medicines, do it gradually. Let your doctor decide how fast you should lower your dose.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. Bisson J (2006). Post-traumatic stress disorder, search date December 2005. Online version of Clinical Evidence (15): 1–18.

2. Brady K, et al. (2006). Efficacy and safety of sertraline treatment of posttraumatic stress disorder. JAMA, 283(14): 1837–1844.

3. Davidson JRT, et al. (2001). Multicenter, double-blind comparison of sertraline and placebo in the treatment of post-traumatic stress disorder. Archives of General Psychiatry, 58(5): 485–492.

4. Marshall RD, et al. (2006). Efficacy and safety of paroxetine treatment for chronic PTSD: A fixed-dose, placebo-controlled study. American Journal of Psychiatry, 158(12): 1982–1988.

Author:	Kate Copsey Paul Lehnert Ryan Powers	Last Updated: February 23, 2007
Medical Review:	Steven L. Schneider, MD - Family Medicine Tina Esther Bronner, MD - Internal Medicine Jessica Hamblen, PhD - Post Traumatic Stress Disorder Mara Kushner, CSW - Mental Health Care
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