Cautions and interactions of SSRIs

Selective serotonin reuptake inhibitors (SSRIs) aren't suitable for everyone. They can cause problems if you have other health conditions or if they're taken alongside other medications.

Some of theissues you and your doctor will need to bear in mind when taking SSRIs, or when considering using them, are described below.

Medical conditions

SSRIs may not be suitable if you have any of the following conditions:

• Bipolar disorder and you're in a manic phase (a period of extremely excitable mood), although they can be useful for depressive phases
• a bleeding disorder, such as haemophilia
• type 1diabetes or type 2 diabetes
• epilepsy SSRIs should only be taken if your epilepsy is well controlled, and they should be stopped if your epilepsy gets worse
• narrow angle glaucoma
• serious kidney, liver or heart problems

SSRIs may need to be used with caution or not at all if you have one of these conditions, because the medication could increase your chance of experiencing serious side effects.

Pregnancy

As a precaution,SSRIsaren'tusually recommendedduring pregnancy, particularly during the first three months (the first trimester). This is because there may be a risk to the baby.

However, exceptions can be made if the risk posed by depression (or another mental health condition) outweighsthe potential risks of treatment.

Possible risks of taking SSRIs during pregnancy include:

• loss of the pregnancy
• birth defects affecting the babys heart ( congenital heart disease )
• the babybeing born with a rare condition called persistent pulmonary hypertension in the newborn (PPHN),which causes breathing and circulation problems

However, it isn't clear whether SSRIs definitely cause these complications. Most experts think that ifSSRIs do increase the risks of complications during pregnancy,the increase is probably small.

If you're pregnant and think you may be depressed, you should discuss the risks and benefits ofusingSSRIs with yourdoctor. IfSSRIs are recommended, you'll usually be prescribed fluoxetine, citalopram or sertralinebecause these are thought to be relatively safe to use.

You should also speak to your doctor for advice if you become pregnant while you're taking SSRIs.

Breastfeeding

As a precaution, SSRIs aren't usually recommendedif you're breastfeeding. This is because the medication may be passed to your baby in your breast milk.

However, SSRIs may be usedif it's thought that the benefits of treatment and benefits of breastfeeding your baby outweigh thepotential risks.

If you're prescribed SSRIs when breastfeeding, paroxetine orsertraline are usually recommended.

Children and young people

SSRIsaren't usually recommended for children and young people under the age of 18. This is because there's evidence of an increased riskof self-harm and thoughts about suicide in this age group.

There are also concerns that the use of SSRIs could affect brain developmentin children and young people.

However,children and young people under the age of 18 maybe offered an SSRI iftalking therapies, such as cognitive behavioural therapy (CBT) , alone haven't helped.In such cases, an SSRI will only be prescribed in addition to a talking therapyand treatment must besupervised by a psychiatrist (a doctor who specialises in treating mental health conditions).

If an SSRI is recommended,fluoxetine is usually the first choice.

Driving and operating machinery

Some SSRIs can cause dizziness , drowsiness and blurred vision, particularly when you first start taking them.

If you experience these problems, you should avoid driving or using heavy tools and machinery.

Interactions with other medications

SSRIscan react unpredictably with certain other medications (known as "interacting"), potentially increasing the risk of side effects such as bleeding or a problem known as "serotonin syndrome".

If in doubt, your pharmacist or GP should be able to advise you.

Interactions with food and drink

Alcohol isn't usually recommended if you're taking an SSRI, because it can increase any drowsiness you may experience and can make feelings of depression worse.

The SSRI, fluvoxamine, is also known to enhance the effects of caffeine, so people who drink large amounts of caffeine may experience unpleasant symptoms such as palpitations , feeling sick, restlessness and insomnia .

You should therefore avoid drinking large amounts of caffeinated drinks, such as tea, coffee, energy drinks and cola, while taking fluvoxamine.

St Johns wort

St Johns wort is a popular herbal remedy promoted for the treatment of depression.

While there's some evidence that St John's wort may help mild to moderate depression, many experts advise against using it because the amount of active ingredient can vary significantly and you can never be sure what sort of effect it will have on you.

Taking St John's wort alongside SSRIs can also potentially cause serious health problems.