Can Selective Serotonin Reuptake Inhibitors (SSRIs) cause sun sensitivity?

SSRIs and Sun Sensitivity

Yes, SSRIs can cause photosensitivity reactions, making patients more sensitive to sun exposure, though this is considered a relatively rare side effect of these medications. 1

Mechanism and Presentation

Photosensitivity reactions associated with SSRIs typically manifest as:

• Photoallergic reactions (more common with SSRIs)
• Exaggerated sunburn-like responses
• Eczematous or urticarial eruptions
• Abnormal skin pigmentation

These reactions occur when the medication interacts with ultraviolet (UV) radiation, causing excessive or abnormal skin reactions in sun-exposed areas 2. The exact mechanism may involve methylation metabolism, which could explain cross-reactivity between different SSRI molecules 1.

Evidence and Prevalence

The evidence for SSRI-induced photosensitivity comes from case reports rather than large-scale studies:

• Documented cases involve fluvoxamine and paroxetine specifically 1
• Cross-reactivity between different SSRIs has been observed
• Despite widespread SSRI prescribing, photosensitivity reactions remain relatively uncommon

This contrasts with medications known to have high photosensitizing potential, such as:

• Tetracyclines
• Amiodarone
• Quinolones
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Phenothiazines 3, 4

Management Recommendations

For patients taking SSRIs who experience or are concerned about photosensitivity:

1. Sun protection measures should be implemented:

   • Apply broad-spectrum sunscreen (SPF 30+) daily to exposed skin areas
   • Wear protective clothing, hats, and sunglasses
   • Avoid peak sun hours (10 AM to 4 PM)
   • Seek shade when outdoors 5

2. If photosensitivity reaction occurs:

   • Consider topical corticosteroids for symptomatic relief
   • In severe cases, discuss with prescriber about possibly switching to an alternative antidepressant
   • Document the reaction to avoid re-exposure 4

Clinical Considerations

• Photosensitivity reactions may be confused with other conditions like sunburn, eczema, or other drug eruptions
• The diagnosis is primarily based on history of drug intake and clinical appearance affecting sun-exposed areas
• Phototesting and photopatch testing can help confirm the diagnosis in unclear cases 6

Important Caveats

• Patients should be informed about this potential side effect when starting SSRI therapy
• Discontinuation of the medication should be considered only if reactions are severe and after consultation with the prescribing physician
• The benefit of SSRI therapy for mental health often outweighs this relatively uncommon side effect
• Patients planning phototherapy treatments should inform their dermatologist about SSRI use 1

While SSRIs can cause photosensitivity, with proper sun protection measures, most patients can continue their medication without significant problems.