From the Guidelines
The most common side effects of SSRIs include dry mouth, nausea, diarrhea, heartburn, headache, somnolence, insomnia, dizziness, vivid dreams, changes in appetite, weight loss or gain, fatigue, nervousness, tremor, bruxism, and diaphoresis, rather than anorexia or orthostatic hypotension. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1, most adverse effects of SSRIs emerge within the first few weeks of treatment. While SSRIs can sometimes cause changes in appetite, true anorexia is not a typical side effect. Orthostatic hypotension is more commonly associated with other types of antidepressants rather than SSRIs. The guideline highlights that SSRIs are generally well tolerated by children and adolescents, but close monitoring is recommended for potentially serious adverse effects such as suicidal thinking and behavior, behavioral activation/agitation, and serotonin syndrome.
Some key points to consider when prescribing SSRIs include:
- Most SSRIs have sufficiently long elimination half-lives to permit single daily dosing, but some may require twice-daily dosing 1
- Slow up-titration is recommended to avoid unintentionally exceeding the optimal medication dose 1
- Close monitoring is recommended for suicidality, especially in the first months of treatment and following dosage adjustments 1
- Behavioral activation/agitation may occur early in SSRI treatment, with dose increases, or with concomitant administration of drugs that inhibit the metabolism of SSRIs 1
It is essential to educate patients and their families about the potential side effects of SSRIs and to monitor them closely for any adverse reactions. If a patient experiences significant appetite loss or dizziness upon standing while taking an SSRI, they should consult their healthcare provider, as these could indicate either unusual reactions to the medication or possibly another underlying condition.
From the FDA Drug Label
The most common treatment-emergent adverse events associated with the use of sertraline (incidence of at least 5% for sertraline and at least twice that for placebo within at least one of the indications)
Gastrointestinal Disorders Anorexia 6-8%
Autonomic Nervous System Disorders Orthostatic hypotension is not listed, however, Dizziness 10-14%
The most common side effects of SSRI anorexia is 6-8% and orthostatic hypotension is not listed, however, dizziness is 10-14% 2
From the Research
Common Side Effects of SSRIs
- Anorexia: Studies have shown that SSRIs may be used to aid in relapse prevention and improvement of psychiatric symptomatology in weight-restored anorexic patients 3, 4, 5.
- Orthostatic Hypotension: SSRIs have been associated with an increased risk of orthostatic hypotension, particularly when discontinued or tapered 6, 7.
SSRI-Induced Side Effects
- The use of SSRIs during acute treatment of anorexia nervosa lacks efficacy, but they may be useful as adjunctive treatment to psychotherapy for relapse prevention and improvement of depressive and anxiety symptoms 3.
- Orthostatic hypotension induced by sertraline withdrawal has been reported, highlighting the need for careful management when discontinuing the medication 6.