Many women with PCOS suffer from depression and are prescribed anti-depressants like SSRIs, or Selective Serotonin Reuptake Inhibitors. SSRIs come with certain side effects. It is advisable to address the root cause of PCOS rather than relying on anti-depressants, which provide only short-term relief.
Irregular periods, inability to get pregnant, losing hair at a feverish rate, gaining weight around the abdomen, facial hair as well as hair on the abdomen and thighs — these PCOS symptoms can really take a toll on the emotional health of women. It really is no wonder that a majority of women with PCOS suffer from depression at least once, if not more, during their lives.
If depression continues for long, doctors may prescribe anti-depressants, the most common of which are selective serotonin reuptake inhibitors or SSRIs. However, any drug that messes with the fine working of the brain comes with its own share of side effects. Let’s find out more about PCOS and antidepressants – how they work and what are their side effects.
How Do SSRIs Work AS PCOS Antidepressants?
Your brain controls every function within your body. It does so by exchanging messages with other cells using chemical messengers called neurotransmitters. Serotonin is a type of neurotransmitter. Now, when signals are passed between brain cells, a bit of neurotransmitter is released by the cell passing the message. The neurotransmitter molecules travel the short distance between the two cells and bind to specific receptors on the other cell. The message is passed once the neurotransmitter molecules bind. The remaining neurotransmitter (that has not bound to the receptors) has to be taken back by the nerve cell. This process is called “reuptake.”
When you are depressed, the areas in your brain that regulate mood aren’t functioning properly. This is because messages aren’t being passed effectively by brain cells in that area. SSRIs inhibit the reuptake of serotonin and make more serotonin available for an efficient passing of messages between cells. Since they are “selective” they will only act on serotonin and not on any other chemical in the brain.
Types of SSRIs and the Most Commonly Prescribed Names
While there are many drugs that fall under the broad category of SSRIs, the US FDA has approved the following SSRIs for treating depression. The name in the brackets is the most popularly used brand name.
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Paroxetine (Paxil, Pexeva)
- Escitalopram (Lexapro)
- Vilazodone (Viibryd)
- Sertraline (Zoloft)
- Fluvoxamine (Luvox, Luvox CR)
How and When to Take SSRIs As PCOS Antidepressants?
SSRIs are available either as a tablet, a capsule or a liquid and have to be taken once or twice a day. There are weekly preparations that have to be taken once a week. Dosages will be decided by your doctor.
If you decide to stop taking these medicines, do not stop taking them abruptly. Taper off gradually by reducing the dosage so as not to experience withdrawal symptoms like agitation, anxiety, confusion, and insomnia.
What Are the Side Effects of SSRIs?
You can well imagine the effects of any drug that acts on the brain. The brain is an extremely complex organ. Anything that inhibits a single step in its functioning may have a profound effect on many other bodily functions.
Common Side Effects of SSRIs
- Dryness in mouth
- Nervousness or agitation
- Restlessness and anxiety
- Blurred vision
- Diarrhea or constipation
- Loss of appetite and weight loss
- Sexual problems like reduced desire and difficulty reaching orgasm
- Tendency to bruise or bleed easily (this may include vomiting blood or finding blood in the stools)
- Problems with movement (stiffness or shakiness)
- Mental confusion
- Unable to urinate, even though the feeling is there
You should call your doctor if you vomit blood or experience any of the above.
Rare Side Effects of SSRIs
This is a pretty nasty condition that affects a very few people who are on SSRIs. This syndrome is caused when serotonin accumulates in the brain and its levels are way higher than normal. Since the drug is an inhibitor of serotonin reuptake, its activity can raise serotonin to alarming levels. Usually, this condition affects people who are also taking another medication (such as other antidepressants) that has effects similar to SSRIs. The combined effect of the two medications raises serotonin levels much faster than normal.
Symptoms of serotonin syndrome include
- Twitching of muscles
- Shivering and sweating
Severe serotonin syndrome tends to cause these symptoms
- Irregular heartbeat
- Very high fever
- Loss of consciousness
If you happen to experience these symptoms, you should immediately stop taking SSRIs and call your doctor.
This is a condition in which sodium levels in the body drop to dangerous levels. This results in a buildup of fluid inside the cells of the body. This condition occurs commonly in the older folk.
Mild hyponatremia causes symptoms like
- Reduced appetite
- Muscle pain
More severe hyponatremia causes symptoms like
- Feeling tired
If this condition isn’t diagnosed and corrected on time, it may result in the person going into coma. It can also lead to stopped breathing and, eventually, death.
Now, this is pretty scary. Young people below 25 years are at a greater risk of having such thoughts. Thoughts of self-harm occur when you first start taking SSRIs. If any such thoughts come to mind, do talk to a close friend or a relative or better still, call your doctor.
Do SSRIs Cause Long-Term Health Problems?
Antidepressants like SSRIs are among the most widely used medications in the US, next only to painkillers and cholesterol-reducing drugs (statins). One in every 10 Americans are being prescribed antidepressants for a variety of psychiatric disorders, including PCOS depression. Many are taking these drugs even for unrelated conditions like migraines and irritable bowel syndrome.
Anything that changes brain chemistry has to have side effects when used for a long-term. These side effects need to be factored in by doctors while prescribing antidepressants for PCOS. The patient is too psychologically imbalanced to think about these side effects.
A study published in the Journal of Clinical Psychiatry has shown that long-term use of SSRIs increases the risk of type 2 diabetes in patients. Weight gain is another problem associated with SSRIs. Excessive weight can increase the risk of various health ailments, including heart disease.
Once you are off SSRIs, you can have trouble sleeping since your regular sleep patterns have been disrupted. You may experience tremors and have trouble with digestion for weeks or sometimes even months after stopping SSRIs.
People who are on antidepressants like SSRIs are 15 times more likely to commit suicide. In a study published in the journal The BMJ, Peter C GØtzsche, a Danish Professor contends that actual figures are way more than those claimed by the FDA. If this is true, there cannot be anything more ironic, can there? A depressed person is more likely to have suicidal thoughts. And if a drug that is used to treat depression is leading to such thoughts, it’s a serious concern. Suicidal thoughts can persist for up to 12 weeks after the person has gone off the medication.
Also, antidepressants like SSRIs can decrease your sex drive. Women have complained of loss of sexual drive for up to six months (or even more) after they have stopped taking the drugs. The clitoris isn’t as easily stimulated as it should and vaginal lubrication is severely reduced. This means less pleasant and more painful sex.
How Safe Are SSRIs As PCOS Antidepressants?
A study on mice has also shown that these drugs play havoc with the fetal brain by permanently increasing the levels of serotonin. During adulthood, these mice showed more anxiety. So if you are pregnant, you shouldn’t be taking antidepressants as they can put your child’s mental health at risk.
You should inform your doctor if you are allergic to SSRIs or have been taking any other antidepressants, any prescription medicine, or herbal preparations and supplements.
Do SSRIs Interact With Other Drugs?
SSRIs interact with drugs like sumatriptan and zolmitriptan (also called 5-HT1 agonists) and may cause (rarely) weakness and incoordination.
SSRIs have also been found to increase the toxicity of drugs like
- Warfarin and digoxin
- Propafenone or flecainide (both antiarrhytmic medicines)
- Beta blockers (like propranolol or metaprolol)
- Tricyclic antidepressants (like amitriptyline)
- Benzodiazepenes (like alprazolam, diazepam, midazolam or triazolam)
Substances that are found to increase the toxicity of SSRIs include
- Alcohol or other CNS depressants
- Diuretics (water pills)
- MAOIs (monoamine oxidase inhibitors, another class of antidepressants)
- John’s Wort
- Decongestants like pseuodoephedrine
- Zolpidem or other medicines for insomnia
Who Should Not Take SSRIs?
There are certain conditions in which you shouldn’t be taking these drugs. These include:
- If you are allergic to SSRIs
- If you are just recovering from a heart attack
- If you have glaucoma
- If you have a kidney problem (urine retention)
- If you are taking other antidepressants or have recently stopped (within two weeks) taking them
- If you are taking medication that alters heart rhythm
SSRIs As Antidepressants For PCOS Depression: The Final Verdict
A metareview that analyzed multiple studies found “no evidence on the effectiveness and safety of antidepressants in treating depression and other symptoms in women with PCOS.”
Depression in women with PCOS should not be treated as a singular unrelated disorder. To tackle PCOS-related depression, you need to address the underlying symptoms of PCOS by making holistic changes to your diet and lifestyle.