Selective+Serotonin+Reuptake+Inhibitors


 * What are SSRIs?**

According to Drugs, Behaviour and Society (2012, Chapter 8), Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of psychoactive drugs used primarily in the treatment of depressed mood. As a type of antidepressant, SSRIs work at the level of the synapse by preventing the reuptake (or removal) of the neurotransmitter serotonin. This mechanism of action results in serotonin remaining in the synaptic cleft for longer periods which allows for increased activation of serotonin receptor cites on the post synaptic membrane. Essentially, serotonin is associated with positive mood states, and SSRIs work by encouraging its action thereby improving mood.

One of the first major SSRI treatments popularly prescribed was Prozac. Prozac first became available on the market in the 1980s and was soon the most widely prescribed antidepressant ever (Drugs, Behaviour and Society, 2012, Chapter 8). While primarily used for treatment of depression, Prozac was also prescribed for Generalized Anxiety Disorder (Drugs, Behaviour and Society, 2012, Chapter 8). Used for kids and teens as well as adults, Prozac was seen as a safe and effective treatment for mood disorders until the early 2000s when concerns arose regarding suicidal ideation. Of particular significance was a 2008 study which found that the FDA had published disproportionally high numbers of studies where SSRIs were effective (Drugs, Behaviour and Society, 2012, Chapter 8). Indeed significant numbers of studies with negative SSRI results consistently went unpublished (Drugs, Behaviour and Society, 2012, Chapter 8).

**Are They Effective?**
While extremely popular and widely prescribed, there is controversy regarding whether SSRIs are truly an effective means of combating depression. Cuipers et al. (2009) found in their study that SSRI treatments appeared to have a positive effect on depressive symptoms. They compared treatment groups who received psychotherapy alone with groups who recieved the psychotherapy in conjunction with an SSRI treatment. However, these differences were barely statistically significant and even disappeared over longer follow-up periods. Indeed some studies have found that the use of a SSRI does no better than a placebo in improving depressive symptoms (Drugs, Behaviour and Society, 2012, Chapter 8).

Efficacy is certainly a major concern when considering the use of any medication. There are however several other important factors that relate to whether or not a certain medication is really worthwhile. One fascinating study by Teal (2009) examined participants' subjective experience. Teal (2009) conducted a qualitative analysis of four subjects' feelings, thoughts, and experiences regarding their time using SSRI medications for the treatment of their mood disorders. During his interview process he found that the four participants generally felt the effects of the SSRI quite rapidly. Within weeks and even days of beginning the medication, the participants experienced what they described as a distance between themselves and their external world.

According to Teal (2009), the participants quickly began to feel more relaxed, with many explaining that they felt as if things in their daily lives that would normally be upsetting now could barely touch them.

//“I could ‘hear’ the anxiety yelling somewhere inside of me, but it was muffled, as if someone had put up soundproofing glass”//
The drugs (three on Prozac, one on Zoloft) had allowed for the participants to feel less responsible and overwhelmed. Two of the participants even expressed feeling energized and full of vitality.

//“[Since I’ve been on Prozac] I’ve been a happier, more cheerful, more positive person”//
These feelings soon changed however when concerns arose about the general intensity of their emotions. The treatment appeared to work just as intended, by dampening negative mood states. The problem that began to surface was the concurrent dampening of positive mood states. Participants expressed that after the initial breathing room, the distance from their world began to feel ‘off’. The feelings Teal (2009) noted in his study tended to be concerns over the ‘general reduction in emotional intensity’ as well as concerns about being able to engage with one’s external world in a meaningful way.

Unfortunately, Teal (2009)’s subjects began to feel distant from things they had previously enjoyed and even their loved ones. They expressed that they cared less for others and experienced a reduction in sympathy and empathy. Moreover, specific difficulties surfaced in intimate relationships with sexual dysfunction as a significant issue. Participants lamented the loss of colour and texture from their lives.

After a time, each participant had chosen to discontinue their use of the SSRI primarily due to the general dullness and muted quality of their experienced combined with growing fatigue.

 * Effect of SSRIs on Psychotherapy **

As noted, studies tend to differ in how they perceive the effectiveness of SSRIs in the treatment of depression. However, based on the qualitative study conducted by Teal (2009), it seems likely that SSRIs may in fact be useful in a psychotherapeutic setting, provided that the dosage is closely monitored. Specifically, the boost in energy and the perceived distance from stressors could be immensely helpful in that the client would feel less overwhelmed by the challenges of therapy and actually have the drive to attend sessions. However, over time the distance produced by the SSRI could negatively impact the therapeutic alliance. Thus consideration of a client’s dose and need for psychopharmacological intervention should be re-evaluated regularly.