MVIIIHealth The MVIII app
← Back

Research · Medication

SSRIs

Meta-analyses of placebo-controlled trials found SSRIs lowered depression scores about 2 Hamilton points more than placebo, with about 7 people treated for one extra response, and raised response in anxiety disorders, OCD and PTSD. Sexual side effects, nausea, sleep changes and stopping symptoms were common. FDA labels carry a boxed warning on suicidal thoughts under age 25.

Add to Bio HackChecked 2026-11-13
Status
Prescription drugs in the US. FDA-approved uses differ by drug: major depressive disorder (all five), obsessive-compulsive disorder, panic disorder, PTSD, social anxiety disorder and premenstrual dysphoric disorder (sertraline), generalized anxiety disorder (escitalopram, paroxetine), bulimia nervosa (fluoxetine), and menopausal hot flashes (paroxetine 7.5 mg). No label cited here lists premature ejaculation.
Also called
selective serotonin reuptake inhibitors, sertraline, Zoloft, escitalopram, Lexapro, fluoxetine, Prozac, citalopram, Celexa, paroxetine, Paxil, Paxil CR, Brisdelle
Taken for
depression, anxiety, panic attacks, OCD, PTSD, social anxiety, PMS and PMDD, premature ejaculation, hot flashes, bulimia

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help11

Reported risks20

What people take it for, and what was found

Shown to help11

StrongVery common

Depression in adults

Shown to reduce depression symptoms more than placebo in adults, by about 2 points on the Hamilton scale, with about 7 treated for one extra response.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Across 522 trials of 21 antidepressants, every drug had a higher response rate than placebo, with odds ratios from 1.37 to 2.13 and a summary standardized mean difference of 0.30 (95% CrI 0.26 to 0.34) [1]. In 131 placebo-controlled SSRI trials, SSRIs lowered Hamilton depression scores 1.94 points more than placebo (95% CI 1.37 to 2.50) and lowered the risk of no remission (RR 0.88, 95% CI 0.84 to 0.91) [2]. In primary care trials, response was more likely on an SSRI than placebo (RR 1.28, 95% CI 1.15 to 1.43), with a number needed to treat of 7 to 8 [3]. In individual data from trials submitted to FDA, the difference between drug and placebo was 1.75 Hamilton points (95% CI 1.63 to 1.86). A large response occurred in 24.5% on a drug and 9.6% on placebo, which the authors read as about 15% of participants having a substantial drug effect beyond placebo [4].
Population
116,477 adults in 522 trials [1]; 27,422 adults in 131 trials [2]; 14 primary care studies, 4 of them testing SSRIs, mostly 6 to 8 weeks long [3]; 73,388 adults and children in 232 trials of antidepressant monotherapy [4].
Sources
[1], [2], [3], [4]
Caveats
[1] and [4] cover all antidepressant classes, not SSRIs alone. [2] rated every trial at high risk of bias and set 3 Hamilton points as its threshold for clinical significance, which the pooled effect did not reach. The gap between drug and placebo widened with greater baseline severity [4]. Most trials lasted weeks.
Strong

Obsessive-compulsive disorder

Shown to reduce OCD symptoms by about 3 points more than placebo on the Yale-Brown scale in adults, with response about 1.8 times as likely.

The numbers and sources
Effect
SSRIs as a group lowered Yale-Brown Obsessive Compulsive Scale scores more than placebo over 6 to 13 weeks (WMD -3.21, 95% CI -3.84 to -2.57) and raised clinical response (RR 1.84, 95% CI 1.56 to 2.17). Results for individual SSRIs were similar [5]. A network meta-analysis found a class effect of -3.49 points against drug placebo (95% CrI -5.12 to -1.81). Behavioral therapy (-14.48) and cognitive therapy (-13.36) had larger effects against placebo than SSRIs did [6].
Population
3,097 adults in 17 trials [5]; 6,652 adults in 54 trials, 37 of them of SSRIs with 3,158 patients [6].
Sources
[5], [6]
Caveats
Short-term trials. Most psychotherapy trials in [6] included people already taking stable doses of antidepressants, which limits the comparison between therapy and drugs.
StrongVery common

Generalized anxiety disorder

Shown to raise response in generalized anxiety disorder, with about 7 treated for one extra response across antidepressants. Escitalopram lowered anxiety scores 2.45 points more than placebo.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Antidepressants raised the rate of a 50% or greater drop on the Hamilton Anxiety scale against placebo (RR 1.41, 95% CI 1.29 to 1.55), a number needed to treat of 7 (95% CI 5 to 9), with similar findings when classes were compared separately. Dropouts for adverse effects were more frequent on antidepressants (RR 2.18, 95% CI 1.81 to 2.61), a number needed to harm of 17 [7]. In a network meta-analysis, escitalopram lowered Hamilton Anxiety scores more than placebo (MD -2.45, 95% CrI -3.27 to -1.63). Sertraline and fluoxetine also beat placebo, in small samples. Paroxetine beat placebo and had more dropouts than placebo [8]. Across anxiety, obsessive-compulsive and stress disorders, SSRIs and SNRIs lowered symptoms against placebo (SMD -0.56, 95% CI -0.62 to -0.51) [9].
Population
12,226 adults with moderate to severe generalized anxiety disorder in 37 RCTs of 4 to 28 weeks [7]; 25,441 adult outpatients in 89 trials [8]; 30,245 adults and children in 135 studies [9].
Sources
[7], [8], [9]
Caveats
[7] pooled SSRIs with other antidepressants and enrolled few people with other psychiatric conditions. The clearest single-drug estimate is for escitalopram [8]. Most trials in [9] had moderate risk of bias.
ModerateVery common

Panic disorder

Shown to raise response in panic disorder in adults, with about 7 treated with an antidepressant for one extra response.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Antidepressants as a group lowered the risk of failing to respond against placebo (RR 0.72, 95% CI 0.66 to 0.79), a number needed to treat of 7 (95% CI 6 to 9), and the same finding held when classes were compared with placebo. SSRIs produced more dropouts for adverse effects than placebo [10].
Population
8,252 adults with panic disorder in the placebo-controlled arms of 41 RCTs [10].
Sources
[10]
Caveats
The review rated the response evidence low quality. Some trials were funded by drug companies, and only short-term outcomes were assessed [10].
Moderate

Social anxiety disorder

Shown to raise response in social anxiety disorder in adults, about 1.65 times as likely as on placebo, in evidence a Cochrane review rated very low quality.

The numbers and sources
Effect
Treatment response was more likely on an SSRI than placebo (RR 1.65, 95% CI 1.48 to 1.85, 24 studies). SSRIs were the only class shown to reduce relapse and to reduce disability across several domains. Withdrawal from treatment was more frequent on SSRIs than placebo (RR 2.59, 95% CI 1.97 to 3.39), with low absolute rates [11].
Population
4,984 adults in 24 SSRI trials, within a review of 66 RCTs and 11,597 participants [11].
Sources
[11]
Caveats
The response evidence was rated very low quality and the relapse evidence moderate quality [11].
ModerateVery common

PTSD

Shown to improve PTSD symptoms in adults, with 58% responding on an SSRI against 35% on placebo.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
SSRIs lowered the risk of not responding against placebo (RR 0.66, 95% CI 0.59 to 0.74), with PTSD symptoms improving in 58% on an SSRI and 35% on placebo. Withdrawal from treatment was more frequent on SSRIs (RR 1.41, 95% CI 1.07 to 1.87), and 9% of people on SSRIs dropped out for adverse events [12].
Population
1,078 adults in 8 SSRI trials for the response outcome, within a review of 66 RCTs and 7,442 participants lasting 13 days to 28 weeks [12].
Sources
[12]
Caveats
Moderate-certainty evidence. Withdrawals were higher on paroxetine than placebo when that drug was analyzed alone (RR 1.55) [12].
ModerateVery common

Staying well after symptoms improve

Shown to lower relapse in people who had improved: about 22 fewer relapses per 100 on a continued SSRI than after a switch to placebo.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Across 40 studies in depression, relapse was 20.9% on a continued antidepressant and 39.7% after a switch to placebo (OR 0.38, 95% CI 0.33 to 0.43). For SSRIs the difference was 21.8 percentage points (OR 0.33, 95% CI 0.28 to 0.38) [13]. In UK primary care, relapse by 52 weeks occurred in 39% of people who stayed on their antidepressant and 56% of those who tapered to placebo (HR 2.06, 95% CI 1.56 to 2.70) [14]. In anxiety disorders, OCD and PTSD, relapse was 16.4% on a continued antidepressant and 36.4% on placebo (OR for relapse after discontinuation 3.11, 95% CI 2.48 to 3.89) [15].
Population
8,890 people with depression in remission in 40 studies [13]; 478 adults who felt well enough to stop, mean age 54 [14]; 5,233 responders in 28 studies followed up to one year [15].
Sources
[13], [14], [15]
Caveats
These trials enrolled only people who had already improved on the drug. The discontinuation group in [14] also reported more withdrawal symptoms, and adherence to the assigned arm was 70% and 52%. [15] has no data beyond one year. Antidepressant classes were pooled in [14] and [15].
ModerateStudied in women

Premenstrual syndrome and PMDD

Shown to reduce premenstrual symptoms in women with PMS or PMDD by a moderate amount, more with daily dosing than with dosing in the luteal phase only.

The numbers and sources
Effect
SSRIs lowered overall self-rated premenstrual symptoms against placebo (SMD -0.57, 95% CI -0.72 to -0.42). The effect was larger with continuous dosing (SMD -0.69) than with luteal phase dosing (SMD -0.39). Nausea (OR 3.30), insomnia (OR 1.99) and sexual dysfunction or decreased libido (OR 2.32) were more frequent than on placebo [16]. The 2013 version of the same review reported numbers needed to harm of 7 for nausea and 14 for decreased libido at moderate doses [17].
Population
1,742 women in 12 studies for the symptom outcome, within 34 RCTs of fluoxetine, paroxetine, sertraline, escitalopram and citalopram [16]; 31 RCTs [17].
Sources
[16], [17]
Caveats
Both sources are versions of one Cochrane review. 68% of the included studies were funded by drug companies, and the authors suspected publication bias in the response analysis [16].
ModerateStudied in menVery common

Premature ejaculation

Shown to improve self-rated premature ejaculation in men, about 202 more per 1,000 than placebo, in a use no label cited here lists.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Men on an SSRI were more likely to rate their symptoms better or much better than men on placebo (RR 1.92, 95% CI 1.66 to 2.23), 202 more per 1,000 against 220 per 1,000 on placebo. Satisfaction with intercourse rose (RR 1.63, 95% CI 1.42 to 1.87). Time to ejaculation was 3.09 minutes longer (95% CI 1.94 to 4.25). Stopping treatment for adverse events was more frequent (RR 3.80, 95% CI 2.61 to 5.51), 30 more per 1,000 against 11 per 1,000 on placebo [18].
Population
8,254 men with premature ejaculation in 31 randomized trials [18].
Sources
[18]
Caveats
Certainty was moderate for symptom ratings and low for time to ejaculation and for withdrawals. The abstract does not break results down by drug [18].
ModerateStudied in women

Menopausal hot flashes

Shown to reduce hot flash frequency and severity modestly in menopausal women. Paroxetine 7.5 mg is the one SSRI product approved for this use.

The numbers and sources
Effect
Against placebo, SSRIs lowered hot flash frequency (difference in means -0.93, 95% CI -1.46 to -0.37) and severity (standardized difference -0.34, 95% CI -0.59 to -0.10) [19]. The label for paroxetine 7.5 mg reports two placebo-controlled trials in which the frequency of moderate to severe hot flashes fell more than on placebo at weeks 4 and 12 [20].
Population
2,069 menopausal and postmenopausal women in 11 RCTs followed 1 to 9 months [19]; 1,174 postmenopausal women with at least 7 to 8 moderate to severe hot flashes a day in two trials of 12 and 24 weeks [20].
Sources
[19], [20]
Caveats
The pooled analysis ranked escitalopram ahead of other SSRIs by indirect comparison [19]. In one of the two label trials, severity did not differ from placebo at week 12 [20].
ModerateVery common

Bulimia nervosa

Shown to raise remission from binge eating in bulimia nervosa across antidepressants, with about 9 treated for one extra remission. The SSRI trials were all of fluoxetine.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Across antidepressant classes, the risk of not reaching remission from binge episodes was lower than on placebo (RR 0.88, 95% CI 0.83 to 0.93), a number needed to treat of 9 (95% CI 6 to 16) over a mean 8 weeks. A 50% or greater drop in binge episodes was also more likely (RR for no improvement 0.63, 95% CI 0.55 to 0.74), a number needed to treat of 4. Fewer people dropped out on fluoxetine than on placebo [21].
Population
People with bulimia nervosa in 16 placebo-controlled trials, 3 of them of fluoxetine [21].
Sources
[21]
Caveats
The evidence within this class is for fluoxetine only, and the pooled numbers include tricyclics and MAOIs. The review dates from 2003, and 92% of the placebo group did not reach remission [21].

Mixed results2

ModerateStudied in children

Depression in children and teenagers

Mixed results: fluoxetine alone separated from placebo in one network meta-analysis, and a Cochrane review called the symptom reductions small and unimportant.

The numbers and sources
Effect
Among 14 antidepressants, only fluoxetine reduced depression symptoms more than placebo (SMD -0.51, 95% CrI -0.99 to -0.03) [22]. On a scale running from 17 to 113, a Cochrane network meta-analysis found reductions against placebo of 2.84 points for fluoxetine (95% CI 1.56 to 4.12) and 3.51 for sertraline (95% CI 0.04 to 6.99). Escitalopram (-2.62, 95% CI -5.29 to 0.04) and paroxetine (-1.43, 95% CI -3.90 to 1.04) did not clearly differ from placebo. The review described these reductions as small and unimportant [23].
Population
5,260 children and adolescents in 34 trials [22]; 26 studies in children and adolescents [23].
Sources
[22], [23]
Caveats
Evidence quality was very low for most comparisons [22]. Most trials excluded young people at risk of self-harm, and intervals for suicide-related outcomes were wide [23]. See the boxed warning under Risks.
Moderate

Differences between SSRIs

Mixed results: head-to-head depression trials placed escitalopram and paroxetine among the higher response rates and fluoxetine among the lower, with small gaps once all trials were pooled.

The numbers and sources
Effect
In head-to-head depression trials, escitalopram and paroxetine were among the drugs with higher response rates than other antidepressants (odds ratios 1.19 to 1.96), and fluoxetine was among those with lower rates (0.51 to 0.84). Citalopram, escitalopram, fluoxetine and sertraline had fewer dropouts than other antidepressants (odds ratios 0.43 to 0.77). When placebo-controlled trials were added, the differences between drugs shrank [1]. In OCD, the effects of individual SSRIs were similar and did not differ statistically [5]. Across anxiety, obsessive-compulsive and stress disorders, pairwise comparisons showed only small differences between drugs [9].
Population
116,477 adults with depression in 522 trials [1]; 3,097 adults with OCD [5]; 30,245 participants in 135 studies [9].
Sources
[1], [5], [9]
Caveats
Credible intervals were wide on most comparisons between drugs, and the certainty of evidence ranged from moderate to very low [1].

Doses studied

The sertraline label describes trials that mostly used 50 to 200 mg a day, and for PMDD either 50 to 150 mg daily or 50 to 100 mg in the luteal phase only [24]. The escitalopram label lists 10 mg once daily for depression and generalized anxiety, with 20 mg as the maximum [25]. The fluoxetine label lists 20 mg a day as the starting dose for depression and OCD, 60 mg a day for bulimia nervosa and 10 mg a day to start for panic disorder [26]. The citalopram label lists 20 mg once daily to start and 40 mg as the maximum, with 20 mg as the maximum for people over 60, because QT prolongation rises with dose [27]. The paroxetine label describes a starting dose raised in 10 mg steps at weekly intervals [28], and the hot flash product is 7.5 mg once daily [20].

The premenstrual trials compared daily dosing with dosing in the two weeks before menstruation [16]. The Cochrane review of premature ejaculation does not report doses in its abstract [18].

Risks

Reported risks19

ModerateVery common

Sexual side effects

Shown to raise sexual side effects against placebo: ejaculation problems in 8% to 14% of men against 1% to 2%, and lower desire in both sexes.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In pooled sertraline trials, men reported ejaculation failure (8% vs 1% on placebo), decreased libido (7% vs 2%) and erectile dysfunction (4% vs 1%), and women reported decreased libido (4% vs 2%) [24]. In escitalopram anxiety trials, ejaculation disorder occurred in 14% of men vs 2%, decreased libido in 7% vs 2% and anorgasmia in 6% of women vs under 1% [25]. A meta-analysis that included studies asking about sexual function directly found sexual dysfunction in 25.8% to 80.3% of patients on the drugs that differed from placebo, which included sertraline, citalopram, paroxetine, fluoxetine and escitalopram [31].
Population
3,066 adults on sertraline and 2,293 on placebo in trials of 8 to 12 weeks [24]; 429 adults with generalized anxiety disorder on escitalopram and 427 on placebo [25]; patients in antidepressant studies pooled by drug [31].
Sources
[24], [25], [31]
Caveats
The labels state that rates from spontaneous reports in trials may underestimate the true incidence [24]. The meta-analysis included open-label studies and differing scales, which its authors say could weaken the findings [31]. Sexual symptoms can also come from the condition being treated.
ModerateVery common

Nausea, diarrhea and other common side effects

Shown to raise nausea, diarrhea, tremor and sweating against placebo, with nausea in 26% on sertraline against 12% on placebo.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In pooled sertraline trials: nausea 26% vs 12% on placebo, diarrhea or loose stools 20% vs 10%, dry mouth 14% vs 9%, fatigue 12% vs 8%, dizziness 12% vs 8%, tremor 9% vs 2%, decreased appetite 7% vs 2% and sweating 7% vs 3%. 12% stopped sertraline for an adverse reaction against 4% on placebo [24]. In fluoxetine depression trials, nausea occurred in 21% vs 9% and anxiety in 12% vs 7% [26]. A meta-analysis of 131 SSRI trials found more serious and non-serious adverse events on SSRIs than placebo [2].
Population
3,066 adults on sertraline and 2,293 on placebo [24]; 1,728 adults on fluoxetine and 975 on placebo in depression trials [26]; 27,422 adults in 131 trials [2].
Sources
[24], [26], [2]
Caveats
Rates come from trials of 8 to 12 weeks and differ by drug and by condition treated [24].
StrongVery common

Insomnia and drowsiness

Shown to raise both insomnia and drowsiness against placebo, with insomnia in 20% on sertraline against 13% and drowsiness in 11% against 6%.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In pooled sertraline trials, insomnia occurred in 20% vs 13% on placebo and somnolence in 11% vs 6% [24]. In fluoxetine depression trials, insomnia occurred in 16% vs 9% and somnolence in 13% vs 6% [26]. In escitalopram anxiety trials, somnolence occurred in 13% vs 7% and insomnia in 12% vs 6% [25]. A network meta-analysis of 216 trials found 13 of 21 antidepressants had higher odds of somnolence than placebo and 11 had higher odds of insomnia [33]. An earlier meta-analysis found 10 second-generation antidepressants with more insomnia than placebo and 11 with more somnolence [34].
Population
Adults in placebo-controlled label trials [24][26][25]; 64,696 patients with depression in 216 trials [33]; trials of second-generation antidepressants in depression [34].
Sources
[24], [26], [25], [33], [34]
Caveats
The two meta-analyses cover all newer antidepressants, and the highest somnolence odds were for fluvoxamine, which is outside this page [33][34]. Evidence quality was rated very low to moderate [33].
StrongVery common

Symptoms after stopping

Shown to cause discontinuation symptoms in about 31% of people stopping an antidepressant against 17% stopping placebo, with severe symptoms in about 3%.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
At least one discontinuation symptom occurred in 31% (95% CI 27 to 35) after stopping an antidepressant and 17% (95% CI 14 to 21) after stopping placebo. Within randomized trials the difference was 8 percentage points (95% CI 4 to 12). Severe symptoms occurred in 2.8% vs 0.6%. Escitalopram was among the drugs with higher frequency, and paroxetine among those with higher severity [37]. A second meta-analysis found about one more symptom on a discontinuation symptom checklist in the first week after stopping (SMD 0.31, 95% CI 0.23 to 0.39), with higher odds of dizziness (OR 5.52, risk difference 6.24%), nausea (OR 3.16) and nervousness (OR 3.15) than after stopping placebo [38]. The label lists nausea, sweating, dizziness, electric shock sensations, irritability, anxiety, insomnia and tinnitus among the symptoms [24].
Population
21,002 patients in 44 RCTs and 35 observational studies, 16,532 stopping an antidepressant [37]; 17,828 participants in 50 studies followed 1 day to 52 weeks [38].
Sources
[37], [38], [24], [39]
Caveats
Estimates vary widely. An earlier review that included surveys reported a weighted average of 56% (range 27% to 86%), with 46% of those affected choosing the most severe rating, and symptoms lasting weeks to months in some studies [39]. Heterogeneity was substantial [37]. Both meta-analyses pooled SSRIs with other antidepressants.
ModerateCommon

FDA boxed warning: suicidal thoughts and behaviors in young people

FDA states antidepressants raised suicidal thoughts and behaviors in pediatric and young adult patients in short-term trials, 14 more cases per 1,000 under age 18.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
Every SSRI label carries this boxed warning. In FDA's pooled analyses of placebo-controlled trials, the difference between drug and placebo in cases of suicidal thoughts or behaviors per 1,000 patients treated was 14 more under age 18, 5 more at ages 18 to 24, 1 fewer at ages 25 to 64 and 6 fewer at 65 and older. No suicides occurred in the pediatric trials [24]. In the pediatric analysis, the risk ratio was 1.66 (95% CI 1.02 to 2.68) for SSRIs in depression trials and 1.95 (95% CI 1.28 to 2.98) for all drugs across all indications, a risk difference of 0.02 [29]. In adults with psychiatric indications, the odds ratio for suicidal behavior or ideation was 1.62 (95% CI 0.97 to 2.71) under age 25, 0.79 (95% CI 0.64 to 0.98) at 25 to 64 and 0.37 (95% CI 0.18 to 0.76) at 65 and older [30].
Population
About 77,000 adults and over 4,400 pediatric patients in placebo-controlled trials of SSRIs and other antidepressants [24][29][30].
Sources
[24], [29], [30]
Caveats
The label reports differences from placebo, not absolute rates, so the band above is the excess under age 18. The trials were short, and the label states it is unknown whether the risk extends beyond four months. The outcome was thoughts and behaviors. The number of suicides in adult trials was too small for any conclusion [24].
ModerateCommon

Low sodium

Linked to low blood sodium in about 6% of users in observational studies, at about twice the odds of non-users, more often in older adults.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
Across 38 observational studies, hyponatremia occurred in 5.98% of people on SSRIs, with an odds ratio of 2.158 against comparison groups. Among individual drugs, fluoxetine ranked highest and sertraline lower [45]. An earlier review found incidence figures from 0.06% to 40% for SSRIs depending on design and cutoff, and named older age (OR 6.3) and thiazide diuretics (OR 11.2 to 13.5) as risk factors [46]. The label reports cases with sodium below 110 mmol/L and states that older people and people on diuretics may be at greater risk [24].
Population
30 cohort and 8 case-control studies [45]; 21 effect studies and more than 100 case reports [46].
Sources
[45], [46], [24]
Caveats
Observational, with rates that swing widely by population and by the sodium cutoff used [46]. The abstract of [45] gives no confidence intervals.
ModerateUncommon

Pregnancy and newborns

Linked to persistent pulmonary hypertension in about 2.9 per 1,000 exposed newborns, and to a small rise in birth defects that disappeared among women with a psychiatric diagnosis.

The numbers and sources
How common
Uncommon: between 1 in 1,000 and 1 in 100 people.
Effect
Among 156,978 pregnancies exposed to an SSRI or SNRI, persistent pulmonary hypertension of the newborn occurred in 2.9 per 1,000 live births (OR 1.82, 95% CI 1.31 to 2.54), a number needed to harm of 1,000 [48]. The label gives a background rate of 1 to 2 per 1,000 [24]. Across 29 cohort studies, first-trimester SSRI use was associated with major congenital anomalies (RR 1.11, 95% CI 1.03 to 1.19) and congenital heart defects (RR 1.24, 95% CI 1.11 to 1.37). Neither association was significant when the comparison was limited to women with a psychiatric diagnosis (RR 1.04 and 1.06) [49]. The paroxetine label states that first-trimester exposure is associated with a less than 2-fold increase in cardiovascular malformations [28]. The labels also describe newborns exposed late in pregnancy who needed prolonged hospital stays, breathing support and tube feeding, and a less than 2-fold increase in postpartum hemorrhage with use in the month before delivery [24].
Population
11 studies of prenatal exposure [48]; 9,085,954 births in 29 cohort studies [49].
Sources
[48], [24], [49], [28]
Caveats
Observational, with high heterogeneity for the pulmonary hypertension estimate (I² 72%) [48]. The label also cites a study in which women who stopped antidepressants in pregnancy relapsed more often than women who continued [24].
LimitedUncommon

Mania or hypomania

The label warns that an antidepressant can trigger a manic episode in people with bipolar disorder. Mania or hypomania was reported in 0.4% in sertraline trials.

The numbers and sources
How common
Uncommon: between 1 in 1,000 and 1 in 100 people.
Effect
In controlled sertraline trials, which generally excluded people with bipolar disorder, symptoms of mania or hypomania were reported in 0.4% of patients on sertraline. The label gives no placebo rate [24].
Population
Adults in controlled sertraline trials [24].
Sources
[24]
Caveats
No comparator rate is given, and the trials mostly left out the people the warning is about.
LimitedUncommon

Seizures

The label reports seizures in 0.1% of people on paroxetine in clinical studies, which excluded people with a history of seizures.

The numbers and sources
How common
Uncommon: between 1 in 1,000 and 1 in 100 people.
Effect
During clinical studies, seizures occurred in 0.1% of patients treated with paroxetine. The label gives no placebo rate [28]. The sertraline label states the drug has not been studied in people with seizure disorders [24].
Population
Adults in paroxetine clinical studies [28].
Sources
[28], [24]
Caveats
No comparator rate. People with a history of seizures were excluded from the studies.
StrongRare

Bleeding

Linked to about 40% higher odds of serious bleeding in observational studies, roughly one extra upper gut bleed per 3,177 low-risk people treated.

The numbers and sources
How common
Rare: fewer than 1 in 1,000 people.
Effect
Across 42 observational studies, SSRI use was associated with severe bleeding at any site (OR 1.41, 95% CI 1.27 to 1.57) [40]. For upper gastrointestinal bleeding, the odds ratio was 1.66 (95% CI 1.44 to 1.92) in case-control studies and 1.68 (95% CI 1.13 to 2.50) in cohort studies. The number needed to harm was 3,177 in a low-risk population and 881 in a high-risk population [41]. The label states that drugs interfering with serotonin reuptake increase the risk of bleeding events, from bruising and nosebleeds to life-threatening hemorrhage [24].
Population
31 case-control studies with 1,255,073 patients and 11 cohort studies with 187,956 [40]; 15 case-control studies with 393,268 participants and 4 cohort studies [41].
Sources
[40], [41], [24]
Caveats
Observational studies, which cannot rule out confounding by the conditions SSRIs are prescribed for. The band above is the excess in low-risk people, since the sources give no absolute rate.
LimitedRare

Use with triptans

Linked to serotonin syndrome rarely: 2 definite cases in 30,928 person-years of triptans taken with an SSRI or SNRI in one health system.

The numbers and sources
How common
Rare: fewer than 1 in 1,000 people.
Effect
Among 19,017 people prescribed a triptan together with an SSRI or SNRI, serotonin syndrome was suspected in 17 and classed as definite in 2, an incidence of 0.6 cases per 10,000 person-years (95% CI 0.0 to 1.5). Counting 5 possible cases as well, the rate was 2.3 per 10,000 person-years [44]. The label names triptans among the drugs that increase the risk [24].
Population
19,017 patients in one US health system over 14 years, 30,928 person-years of combined exposure [44].
Sources
[44], [24]
Caveats
One records-based study, which depends on cases being recognized and coded. Its authors concluded the risk was low and questioned FDA's 2006 advisory [44].
LimitedHow often is not known

Sexual symptoms that continue after stopping

Limited evidence: a literature review describes sexual symptoms persisting after SSRIs are stopped, including genital numbness and low desire, with no prevalence established.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
A review of the published literature lists the reported symptoms as genital anesthesia, weak or pleasureless orgasm, decreased sex drive, erectile dysfunction and premature ejaculation. It found no established prevalence, cause or treatment [32].
Population
Published reports of people with sexual symptoms after stopping an SSRI [32].
Sources
[32]
Caveats
No denominator, so no rate. The diagnosis is made by excluding other causes [32].
ModerateHow often is not known

Bleeding with NSAIDs, aspirin and blood thinners

Linked to more bleeding when combined: about 4 times the odds of an upper gut bleed with an NSAID, and about a third more major bleeds with anticoagulants.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Taking an SSRI together with an NSAID was associated with upper gastrointestinal bleeding at an odds ratio of 4.25 (95% CI 2.82 to 6.42) [41]. With oral anticoagulants, the pooled hazard ratio for major bleeding was 1.35 (95% CI 1.14 to 1.58) against anticoagulants alone [42]. In people with atrial fibrillation, the rate ratio was 1.33 (95% CI 1.24 to 1.42), highest in the first 30 days (1.74), and present with both direct anticoagulants (1.25) and warfarin-type drugs (1.36) [43]. The label states that aspirin, NSAIDs, other antiplatelet drugs, warfarin and other anticoagulants may add to the bleeding risk [24].
Population
Case-control and cohort studies [41]; 98,070 patients in 8 studies [42]; 42,190 people with major bleeding and 1,156,641 matched controls, mean age 74 [43].
Sources
[41], [42], [43], [24]
Caveats
Observational. The sources give relative figures and no absolute rate for the combination.
LimitedHow often is not known

Serotonin syndrome

The label warns that SSRIs can cause serotonin syndrome, alone or more often with other serotonergic drugs. It gives no rate.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The label describes serotonin syndrome as potentially life-threatening, with agitation, hallucinations, fast heart rate, unstable blood pressure, sweating, fever, tremor, rigidity, seizures, nausea, vomiting and diarrhea. It states the risk is increased with triptans, tricyclic antidepressants, other SSRIs and SNRIs, fentanyl, tramadol, meperidine, methadone, lithium, tryptophan, buspirone, amphetamines and St. John's Wort, and that it can also occur on an SSRI alone [24].
Population
Postmarketing reports summarized in labeling [24].
Sources
[24]
Caveats
A label warning based on reports, with no denominator.
LimitedHow often is not known

Use with MAOIs

The label lists MAOIs as a contraindication, within 14 days in either direction, because the combination raises the risk of serotonin syndrome.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The label states that taking an SSRI with a monoamine oxidase inhibitor increases the risk of serotonin syndrome and lists the combination, or use within 14 days of stopping an MAOI, as a contraindication. Its examples are selegiline, tranylcypromine, isocarboxazid, phenelzine, the antibiotic linezolid and intravenous methylene blue [24].
Population
Labeling statement [24].
Sources
[24]
Caveats
The label gives no rate.
ModerateHow often is not known

Heart rhythm and QT interval

Shown to lengthen the QT interval by about 6 milliseconds on average, more with citalopram and more at higher doses.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Across 16 articles, SSRIs lengthened the corrected QT interval against placebo by 6.10 milliseconds (95% CI 3.47 to 8.73), in a dose-dependent way, and citalopram lengthened it more than sertraline, paroxetine or fluvoxamine [47]. In a QT study in healthy volunteers, the maximum mean difference from placebo was 8.5 milliseconds at citalopram 20 mg and 18.5 milliseconds at 60 mg. The citalopram label reports torsade de pointes, ventricular tachycardia and sudden death in postmarketing use and limits the dose to 40 mg a day [27]. The sertraline label reports postmarketing cases of QT prolongation and torsade de pointes, most with other risk factors [24]. The labels name other QT-prolonging drugs as adding to the risk, including some antipsychotics, antiarrhythmics and the antibiotics erythromycin, gatifloxacin and moxifloxacin [24][27].
Population
4,292 patients in 16 articles [47]; 119 healthy subjects in a crossover QT study [27].
Sources
[47], [27], [24]
Caveats
The pooled figure is an average change on an ECG, not a rate of arrhythmia. The sources give no rate for arrhythmia itself.
StrongHow often is not known

Fractures

Linked to about 1.6 times the fracture risk in observational studies, a figure that fell to about 1.4 in studies adjusting for more risk factors.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Across 37 observational studies, SSRI use was associated with fracture (RR 1.62, 95% CI 1.52 to 1.73) [50]. An earlier meta-analysis of 12 studies found an odds ratio of 1.69 (95% CI 1.51 to 1.90), which was 1.38 (95% CI 1.27 to 1.49) in studies adjusting for four or more fracture risk factors, and 2.06 for hip or femur fracture [51].
Population
14 case-control and 23 cohort studies [50]; 7 case-control and 5 cohort studies [51].
Sources
[50], [51]
Caveats
Observational with very high heterogeneity (I² about 90%). Depression itself is tied to falls and fracture, and studies adjusting for bone density showed a smaller association [50]. The sources give no absolute rate.
LimitedHow often is not known

Angle-closure glaucoma

The label warns that pupil widening on antidepressants can trigger an angle-closure attack in people with untreated narrow angles. It gives no rate.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The label states that the pupillary dilation that follows use of many antidepressants, including sertraline, may trigger an angle-closure attack in a person with anatomically narrow angles who has not had an iridectomy [24].
Population
Labeling statement [24].
Sources
[24]
Caveats
No rate and no trial data are given.
LimitedHow often is not known

Raised levels of other drugs, and tamoxifen

The labels state that sertraline and paroxetine slow a liver enzyme and can raise levels of drugs it clears. The paroxetine label warns of reduced tamoxifen benefit.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The sertraline label states that it inhibits the enzyme CYP2D6 and may raise exposure to drugs cleared by it. Its examples include the antidepressants desipramine and venlafaxine, the beta blockers metoprolol and nebivolol, the heart rhythm drugs propafenone and flecainide, atomoxetine and dextromethorphan. It also states sertraline may raise phenytoin levels [24]. The paroxetine label states that some studies found tamoxifen less able to prevent breast cancer relapse and death when taken with paroxetine, and that other studies did not find this [28].
Population
Labeling statements drawn from drug interaction studies [24][28].
Sources
[24], [28]
Caveats
The strength of enzyme inhibition differs between SSRIs. The labels describe changes in drug levels and give no rate of harm.

Mixed results1

ModerateCommon

Weight change

Mixed results: paroxetine was linked to weight gain and fluoxetine to short-term weight loss, and six-month differences between SSRIs were under half a kilogram.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
A meta-analysis found paroxetine associated with a greater risk of weight gain, and some weight loss with fluoxetine that was limited to the acute phase of treatment [35]. In fluoxetine depression trials, decreased appetite was reported by 11% vs 2% on placebo and weight loss by 1.4% vs 0.5% [26]. The escitalopram label states that weight change did not differ from placebo in controlled trials [25]. In health records, estimated 6-month weight gain was higher than on sertraline for escitalopram (0.41 kg, 95% CI 0.31 to 0.52), paroxetine (0.37 kg) and citalopram (0.12 kg), and similar for fluoxetine. Escitalopram and paroxetine were linked to a 10% to 15% higher risk of gaining 5% of baseline weight [36].
Population
Antidepressant trials reporting weight [35]; adults in label trials [26][25]; adults starting one of 8 antidepressants in US health systems, compared by target trial emulation [36].
Sources
[35], [26], [25], [36]
Caveats
The band above is the fluoxetine label's rate for weight loss. [36] is observational, compared drugs with each other and not with no treatment, and adherence at 6 months was 28% to 41%. The meta-analysis notes effects grew more evident with longer treatment [35].

Checked, no increase found1

Limited

Alcohol

One trial found escitalopram did not add to the mental and motor impairment caused by alcohol, according to its label.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The escitalopram label states that the drug did not potentiate the cognitive and motor effects of alcohol in a clinical trial. The same label states that alcohol use by people taking it is not advised [25].
Population
Volunteers in a clinical trial described in labeling, with no head count given [25].
Sources
[25]
Caveats
One trial, summarized in a sentence. The experiments were in people without depression [25].

Claims tested and not found

  1. That antidepressants raise suicidal thoughts or behavior in adults of every age. In FDA's analysis of adult trials, the odds of suicidal behavior or ideation were lower on antidepressants than placebo at ages 25 to 64 (OR 0.79, 95% CI 0.64 to 0.98) and at 65 and older (OR 0.37, 95% CI 0.18 to 0.76). The rise was limited to people under 25 [30].
  2. That low mood after stopping an antidepressant is a withdrawal symptom. In a meta-analysis of 50 studies, stopping an antidepressant was not associated with depression symptoms in the 5 studies that measured them, while dizziness, nausea and nervousness rose [38].
  3. That depression has been shown to come from low serotonin. An umbrella review of 17 reviews and large studies found that two meta-analyses of the serotonin metabolite 5-HIAA and one of plasma serotonin showed no association with depression [52]. This is a separate question from whether SSRIs reduce symptoms, which is covered under Outcomes.
  4. That taking a triptan with an SSRI commonly causes serotonin syndrome. In 30,928 person-years of combined use, 2 definite cases were found [44].

Sources

  1. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet. 2018. https://doi.org/10.1016/S0140-6736(17)32802-7
  2. Jakobsen JC, Katakam KK, Schou A, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry. 2017. https://doi.org/10.1186/s12888-016-1173-2
  3. Arroll B, Elley CR, Fishman T, et al. Antidepressants versus placebo for depression in primary care. Cochrane Database of Systematic Reviews. 2009. https://doi.org/10.1002/14651858.CD007954
  4. Stone MB, Yaseen ZS, Miller BJ, et al. Response to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis. BMJ. 2022. https://doi.org/10.1136/bmj-2021-067606
  5. Soomro GM, Altman DG, Rajagopal S, et al. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database of Systematic Reviews. 2008. https://doi.org/10.1002/14651858.CD001765.pub3
  6. Skapinakis P, Caldwell DM, Hollingworth W, et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry. 2016. https://doi.org/10.1016/S2215-0366(16)30069-4
  7. Kopcalic K, Arcaro J, Pinto A, et al. Antidepressants versus placebo for generalised anxiety disorder (GAD). Cochrane Database of Systematic Reviews. 2025. https://doi.org/10.1002/14651858.CD012942.pub2
  8. Slee A, Nazareth I, Bondaronek P, et al. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. The Lancet. 2019. https://doi.org/10.1016/S0140-6736(18)31793-8
  9. Gosmann NP, Costa MdA, Jaeger MdB, et al. Selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress disorders: A 3-level network meta-analysis. PLOS Medicine. 2021. https://doi.org/10.1371/journal.pmed.1003664
  10. Bighelli I, Castellazzi M, Cipriani A, et al. Antidepressants versus placebo for panic disorder in adults. Cochrane Database of Systematic Reviews. 2018. https://doi.org/10.1002/14651858.CD010676.pub2
  11. Williams T, Hattingh CJ, Kariuki CM, et al. Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Database of Systematic Reviews. 2017. https://doi.org/10.1002/14651858.CD001206.pub3
  12. Williams T, Phillips NJ, Stein DJ, et al. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews. 2022. https://doi.org/10.1002/14651858.CD002795.pub3
  13. Kato M, Hori H, Inoue T, et al. Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis. Molecular Psychiatry. 2021. https://doi.org/10.1038/s41380-020-0843-0
  14. Lewis G, Marston L, Duffy L, et al. Maintenance or Discontinuation of Antidepressants in Primary Care. New England Journal of Medicine. 2021. https://doi.org/10.1056/NEJMoa2106356
  15. Batelaan NM, Bosman RC, Muntingh A, et al. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ. 2017. https://doi.org/10.1136/bmj.j3927
  16. Jespersen C, Lauritsen MP, Frokjaer VG, et al. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database of Systematic Reviews. 2024. https://doi.org/10.1002/14651858.CD001396.pub4
  17. Marjoribanks J, Brown J, O'Brien PMS, et al. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database of Systematic Reviews. 2013. https://doi.org/10.1002/14651858.CD001396.pub3
  18. Sathianathen NJ, Hwang EC, Mian R, et al. Selective serotonin re-uptake inhibitors for premature ejaculation in adult men. Cochrane Database of Systematic Reviews. 2021. https://doi.org/10.1002/14651858.CD012799.pub2
  19. Shams T, Firwana B, Habib F, et al. SSRIs for Hot Flashes: A Systematic Review and Meta-Analysis of Randomized Trials. Journal of General Internal Medicine. 2014. https://doi.org/10.1007/s11606-013-2535-9
  20. U.S. Food and Drug Administration. BRISDELLE (paroxetine) capsules, prescribing information. 2025. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=502311b3-b617-4cbd-a3ab-a60f2c62880a
  21. Bacaltchuk J, Hay PP. Antidepressants versus placebo for people with bulimia nervosa. Cochrane Database of Systematic Reviews. 2003. https://doi.org/10.1002/14651858.CD003391
  22. Cipriani A, Zhou X, Del Giovane C, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. The Lancet. 2016. https://doi.org/10.1016/S0140-6736(16)30385-3
  23. Hetrick SE, McKenzie JE, Bailey AP, et al. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database of Systematic Reviews. 2021. https://doi.org/10.1002/14651858.CD013674.pub2
  24. U.S. Food and Drug Administration. ZOLOFT (sertraline hydrochloride) tablets and oral solution, prescribing information. 2023. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fda754f6-d0f3-4dce-a17a-927d64f912f7
  25. U.S. Food and Drug Administration. LEXAPRO (escitalopram) tablets and oral solution, prescribing information. 2023. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a
  26. U.S. Food and Drug Administration. PROZAC (fluoxetine hydrochloride) capsules, prescribing information. 2026. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c88f33ed-6dfb-4c5e-bc01-d8e36dd97299
  27. U.S. Food and Drug Administration. CELEXA (citalopram) tablets, prescribing information. 2023. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4259d9b1-de34-43a4-85a8-41dd214e9177
  28. U.S. Food and Drug Administration. PAXIL (paroxetine hydrochloride) tablets, prescribing information. 2026. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ef3b5cbe-f9e1-c1ac-79da-cfe14e3a7e7e
  29. Hammad TA, Laughren T, Racoosin J. Suicidality in Pediatric Patients Treated With Antidepressant Drugs. Archives of General Psychiatry. 2006. https://doi.org/10.1001/archpsyc.63.3.332
  30. Stone M, Laughren T, Jones ML, et al. Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ. 2009. https://doi.org/10.1136/bmj.b2880
  31. Serretti A, Chiesa A. Treatment-Emergent Sexual Dysfunction Related to Antidepressants: a meta-analysis. Journal of Clinical Psychopharmacology. 2009. https://doi.org/10.1097/JCP.0b013e3181a5233f
  32. Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI Sexual Dysfunction: A Literature Review. Sexual Medicine Reviews. 2018. https://doi.org/10.1016/j.sxmr.2017.07.002
  33. Zhou S, Li P, Lv X, et al. Adverse effects of 21 antidepressants on sleep during acute-phase treatment in major depressive disorder: a systemic review and dose-effect network meta-analysis. Sleep. 2023. https://doi.org/10.1093/sleep/zsad177
  34. Alberti S, Chiesa A, Andrisano C, et al. Insomnia and Somnolence Associated With Second-Generation Antidepressants During the Treatment of Major Depression: a meta-analysis. Journal of Clinical Psychopharmacology. 2015. https://doi.org/10.1097/JCP.0000000000000329
  35. Serretti A, Mandelli L. Antidepressants and Body Weight: a comprehensive review and meta-analysis. The Journal of Clinical Psychiatry. 2010. https://doi.org/10.4088/JCP.09r05346blu
  36. Petimar J, Young JG, Yu H, et al. Medication-Induced Weight Change Across Common Antidepressant Treatments: A Target Trial Emulation Study. Annals of Internal Medicine. 2024. https://doi.org/10.7326/M23-2742
  37. Henssler J, Schmidt Y, Schmidt U, et al. Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. The Lancet Psychiatry. 2024. https://doi.org/10.1016/S2215-0366(24)00133-0
  38. Kalfas M, Tsapekos D, Butler M, et al. Incidence and Nature of Antidepressant Discontinuation Symptoms: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2025. https://doi.org/10.1001/jamapsychiatry.2025.1362
  39. Davies J, Read J. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors. 2019. https://doi.org/10.1016/j.addbeh.2018.08.027
  40. Laporte S, Chapelle C, Caillet P, et al. Bleeding risk under selective serotonin reuptake inhibitor (SSRI) antidepressants: A meta-analysis of observational studies. Pharmacological Research. 2017. https://doi.org/10.1016/j.phrs.2016.08.017
  41. Anglin R, Yuan Y, Moayyedi P, et al. Risk of Upper Gastrointestinal Bleeding With Selective Serotonin Reuptake Inhibitors With or Without Concurrent NonSteroidal Anti-Inflammatory Use: A Systematic Review and Meta-Analysis. American Journal of Gastroenterology. 2014. https://doi.org/10.1038/ajg.2014.82
  42. Rahman AA, He N, Rej S, et al. Concomitant Use of Selective Serotonin Reuptake Inhibitors and Oral Anticoagulants and Risk of Major Bleeding: A Systematic Review and Meta-analysis. Thrombosis and Haemostasis. 2023. https://doi.org/10.1055/a-1932-8976
  43. Rahman AA, Platt RW, Beradid S, et al. Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding. JAMA Network Open. 2024. https://doi.org/10.1001/jamanetworkopen.2024.3208
  44. Orlova Y, Rizzoli P, Loder E. Association of Coprescription of Triptan Antimigraine Drugs and Selective Serotonin Reuptake Inhibitor or Selective Norepinephrine Reuptake Inhibitor Antidepressants With Serotonin Syndrome. JAMA Neurology. 2018. https://doi.org/10.1001/jamaneurol.2017.5144
  45. Li Y, Du X, Wu H. The risk of hyponatremia induced by SSRIs and SNRIs antidepressants: a systematic review and meta-analysis. BMC Pharmacology and Toxicology. 2025. https://doi.org/10.1186/s40360-025-00977-1
  46. De Picker L, Van Den Eede F, Dumont G, et al. Antidepressants and the Risk of Hyponatremia: A Class-by-Class Review of Literature. Psychosomatics. 2014. https://doi.org/10.1016/j.psym.2014.01.010
  47. Beach SR, Kostis WJ, Celano CM, et al. Meta-Analysis of Selective Serotonin Reuptake Inhibitor-Associated QTc Prolongation. The Journal of Clinical Psychiatry. 2014. https://doi.org/10.4088/JCP.13r08672
  48. Masarwa R, Bar-Oz B, Gorelik E, et al. Prenatal exposure to selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors and risk for persistent pulmonary hypertension of the newborn: a systematic review, meta-analysis, and network meta-analysis. American Journal of Obstetrics and Gynecology. 2019. https://doi.org/10.1016/j.ajog.2018.08.030
  49. Gao SY, Wu QJ, Sun C, et al. Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births. BMC Medicine. 2018. https://doi.org/10.1186/s12916-018-1193-5
  50. Kumar M, Bajpai R, Shaik AR, et al. Alliance between selective serotonin reuptake inhibitors and fracture risk: an updated systematic review and meta-analysis. European Journal of Clinical Pharmacology. 2020. https://doi.org/10.1007/s00228-020-02893-1
  51. Eom CS, Lee HK, Ye S, et al. Use of selective serotonin reuptake inhibitors and risk of fracture: A systematic review and meta-analysis. Journal of Bone and Mineral Research. 2012. https://doi.org/10.1002/jbmr.1554
  52. Moncrieff J, Cooper RE, Stockmann T, et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry. 2023. https://doi.org/10.1038/s41380-022-01661-0

Everything in the library