Go “Low and Slow” to Avert and Avoid SSRI Side Effects

From a patient’s comorbid conditions and family medical history to the potential appearance of side effects, every little detail matters when prescribing SSRIs, especially in younger patients. A “low and slow” approach to antidepressants is key.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type of antidepressant. But we shouldn’t confuse their popularity with ease of access, as clinicians take great care when initially prescribing these medications and determining their efficacy for individual patients, especially due to their side effects.

“Side effects of these medications are important to consider,” said Nelson Handal, M.D., in a webinar for ADDitude, adding, “You have to look at every little detail before you give an antidepressant.”

A full family history of psychological disorders is considered when clinicians decide whether to prescribe an SSRI. “I have to know from the family history if there is bipolar disorder,” Handal offers as an example. For individuals with bipolar disorder, SSRIs are thought to increase risk for mania.

Increase in suicidal thoughts is another concerning side effect of SSRIs, especially in younger patients. To avert these and other side effects, the gold standard is to adopt a conservative approach when starting a patient on an SSRI and to establish checks along the way.

“There are two goals with treatment: One is efficacy, and the other is tolerance,” said Handal. “I tell every parent… we will go low and slow because of tolerance and possible side effects.”

“Low and slow” helps build a patient’s tolerance to the new medication, and it is an effective method to minimize the more serious side effects of SSRIs. Handal, who encourages clinicians to communicate openly with patients, especially with parents of younger patients, also recommends seeing young patients about three weeks after they start on an SSRI to review their experiences and adjust if necessary.

To learn more about treating depression, watch the full replay of Dr. Handal’s free ADDitude webinar, “New Insights Into and Treatments for Comorbid Depression.”

SSRI Side Effects: Next Steps

Since 1998, ADDitude has worked to provide ADHD education and guidance through webinars, newsletters, community engagement, and its groundbreaking magazine. To support ADDitude’s mission, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.