SSRI Side Effects—From Weight Gain to Insomnia—and How Long They Really Last
Starting an antidepressant can feel scary, but many side effects improve as your body adapts
Key Takeaways
- Nausea, sleep changes, weight gain and sexual side effects are among the most common reactions.
- Most SSRI side effects occur early in treatment and often improve within several weeks.
- Experts say the brain needs time to adapt before SSRIs deliver their full benefits.
You’ve tried everything to feel like yourself again. You’ve done talk therapy, made time to get outside every day, listened to your granddaughter’s advice to spend less time on Facebook and surrounded yourself with a community of people who love you. But you still wake up every morning with a racing heart and a sense of dread about the day ahead. You think an SSRI might help, but want to know what side effects you should expect and how long they’ll last. We spoke with two experts to find out.
What are SSRIs?
Selective serotonin reuptake inhibitors (SRRIs) are medications often considered antidepressants but are used to treat many different psychiatric conditions, says Guy Maytal, MD, chief medical officer at Forge Health and assistant clinical professor of psychiatry at Weill Cornell Medicine.
Dr. Maytal says the FDA-approved uses for SSRIs include:
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- Anxiety disorders (generalized anxiety disorder, social anxiety disorder and panic disorder)
- Post-traumatic stress disorder (PTSD)
- Eating disorders (bulimia nervosa)
- Obsessive-compulsive disorder (OCD)
- Major depressive disorder
Dr. Maytal adds that menopausal symptoms such as hot flashes and night sweats can also be treated with SSRIs. However, low-dose paroxetine (Paxil) is currently the only FDA-approved SSRI for these symptoms, while use of other SSRIs for hot flashes and night sweats would be considered off-label. Other off-label uses of SSRIs include irritable bowel syndrome (IBS) and premature ejaculation.
SSRI side effects to watch for
SSRIs are effective for many people, but some still avoid them for fear of side effects. Here’s are some of the more common potential side effects to be aware of:
Nausea and GI upset
Nearly 90 percent of the serotonin in our bodies is found in cells along the GI tract. Because SSRIs affect the GI tract, they raise serotonin levels there, which can trigger nausea and vomiting, explains Dr. Maytal.
Sleep changes
Dr. Maytal says SSRIs can cause excessive sleepiness or insomnia because they affect serotonin receptors involved in the body’s sleep-wake cycle. “Whether a patient experiences insomnia or [excessive sleeping] depends partly on the specific SSRI and individual’s receptor sensitivity.”
Weight gain
The relationship between SSRIs and weight gain is still being understood by doctors. If patients do experience weight gain on an SSRI, Dr. Maytal says it may be due to serotonin’s role in impacting appetite and changes in carb craving and metabolism after starting them.
Sexual dysfunction
Changes in sexual functioning due to SSRIs can take different forms including inability to orgasm, low libido and erectile dysfunction, says Dr. Maytal. He explains that increased serotonin activity due to SSRIs can suppress the activity of neurotransmitters in the brain, including dopamine and norepinephrine, which can then impact sexual desire.
Note: Not everyone will experience side effects from SSRIs, and Dr. Maytal says differences in genetic makeup can help explain why. Factors such as how a person’s body metabolizes medications, baseline serotonin activity and differences in serotonin transporters and receptors can all influence how someone responds to SSRIs and whether they experience side effects.
How long do SSRI side effects last?
“Some SSRI side effects, especially nausea, mild headache, jitteriness and early sleep changes, often improve within the first one to four weeks as the body adjusts,” says Rab Nawaz, MD, a board-certified neurologist. “Weight gain and sexual dysfunction are different because they may persist, appear later or last as long as the medication is continued in some patients. I always tell patients not to stop an SSRI suddenly, but to speak with their prescriber if side effects are affecting sleep, intimacy, weight or quality of life.”
And if you find the weight is sticking while you’re on an SSRI, Dr. Nawaz recommends tracking your weight, focusing on fiber and protein, walking and strength training. He adds that you can also speak to your doctor about whether dose adjustment or switching to another SSRI make sense.
Note: If you ever experience rare side effects such as suicidal thoughts, seek immediate medical care.
What to remember about SSRI side effects
We get it. After reading these side effects, you may be tempted to cancel your CVS pickup appointment. But new research provides some encouraging news.
An animal study published in Molecular Psychiatry found that the SSRI fluoxetine increases serotonin signaling in the brain, which temporarily causes serotonin neurons to not fire properly as the brain adjusts to the medication. But after 22 days of treatment, the mice showed widespread changes in serotonin signaling and brain-cell pathways, suggesting the brain had adapted to the medication over time.
“This research reinforces what clinicians and clinical researchers have long observed: An adjustment period of several weeks is expected and normal when starting an SSRI,” says Dr. Maytal. “The brain must undergo a series of neurochemical adaptations before the full therapeutic benefit of the medication is experienced.”
The bottom line on SSRI side effects
Just as your body adjusts to new exercise routines, dietary changes or other health plans, it needs time to adjust to an SSRI. Those first few weeks of side effects don’t mean the medication isn’t working or that it never will. Your brain is recalibrating and finding its new balance. If side effects feel overwhelming or last beyond the adjustment period, that’s valuable information to share with your doctor. Together, you can adjust your treatment plan to figure out what’s best for you.
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