SSRIs and Stomach Discomfort

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SSRIs and Stomach Discomfort

Question:

I have an extremely sensitive stomach and could not tolerate the heartburn and nausea from my first attempt at using an SSRI. Is there an SSRI that has a reputation for being easier on the stomach?

Answer:

There is not much convincing evidence that one of these medications to treat depression is easier on the stomach than another. Antidepressants in this group — called Selective Serotonin Reuptake Inhibitors or SSRIs — all work in roughly the same way, but their chemical structures vary. Therefore, having stomach distress with one does not mean you'll have it with another.

The stomach discomfort from SSRIs can be very distressing, but the good news is that there are a lot of options.

When a person develops stomach distress after starting a new drug, a psychiatrist may recommend waiting it out. That's because stomach distress in the early days of treatment often goes away.

That approach is always easier for a doctor to recommend than it is for a patient to tolerate. Nausea and heartburn may sound like a small problem in the abstract, but anything more than mild distress is pretty hard to deal with.

Another way to go: Start with a VERY low dose of the medication. Sometimes by increasing the dose gradually, you can avoid the discomfort.

In most situations, the simplest strategy is to try another drug.

You may tolerate a different SSRI just fine. But you don't have to stay within that class at all. All antidepressants are equally effective, so you can try a non-SSRI antidepressant.

Remember, however, that all antidepressants (like every other medical treatment) can cause adverse effects. Be alert to that possibility, but I recommend you keep trying until you find a medicine that works best for you. Ideally you'll find one that gives you benefit while causing minimal or no distress.

If this sounds like a trial and error process, that's because it is. But it's worth going through it so you can get relief.

Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

Last updated:	July 20, 2009