Additive care options to antidepressants

SSRI: The best-known acronym

It’s hard to find a class of drug that’s had a bigger impact on mental health care than selective serotonin reuptake inhibitors (SSRIs). Yep, that’s a mouthful. We’ll stick with “SSRIs” from here on out. The first SSRI, Prozac, made a huge splash when it hit the market in 1987, promising a treatment for depression with fewer side effects than earlier antidepressants — such as phenelzine, which could be fatal in combination with certain foods or drugs. In the years that followed, Prozac and other SSRIs – like Zoloft, Celexa, and Lexapro – have made good on that promise. They’ve been joined by a similar class of drugs, SNRIs (selective serotonin and norepinephrine reuptake inhibitors, like Cymbalta or Effexor), to become among the most prescribed psychiatric medications in the world.

SSRIs and SNRIs* work by improving how certain brain neurotransmitters, specifically serotonin and norepinephrine, function to help regulate mood and energy. These neurochemicals influence mood and attention in ways that can impact not only depression symptoms but also things like worry, irritability, and obsessive thinking. As a result, SSRIs and SNRIs are now widely used in treating anxiety, including generalized anxiety disorder, panic disorder, and social anxiety. With rates of anxiety and depression on the rise, it’s no surprise that these medications are so widely used.

An all-too-common story: worry on overdrive at work

Jelani is a 45-year-old human resources manager who’s always prided himself on being productive at work. But in recent months, Jelani finds that he can’t stop worrying – about his family, his employees, his finances, and more. He feels like he’s constantly on high alert. And Jelani is in a difficult position: He’s supporting employees through the stress and challenges of their careers, but he has not sought help for himself. As he spends his days problem-solving for others, his worry and anxiety are causing him to procrastinate at work and snap at his kids. He’s also noticed worsening muscle pain in his shoulders, and he often feels he just doesn’t have the energy to meet his daily responsibilities.

When Jelani tells his doctor that his worry is getting in the way of his work and family life, his doctor tells him about the clinical guidelines for treating anxiety. He discovers that SSRIs and SNRIs effectively reduce symptoms of generalized anxiety disorder, like the hard-to-control worry Jelani has been experiencing. Even though these classes of medications are often referred to as “antidepressants,” they are one of the first-line recommended treatments for depression and generalized anxiety — as is cognitive behavioral therapy (CBT).

Even though these classes of medications are often referred to as “antidepressants,” they are one of the first-line recommended treatments for depression and generalized anxiety — as is cognitive behavioral therapy (CBT).

Why do primary care doctors prescribe SSRIs and SNRIs?

SSRIs and SNRIs are so widely used that in a survey of primary care doctors, 100% reported prescribing them. This is for a good reason: SSRIs/SNRIs have many advantages. They are generally safe and have fewer side effects than many psychiatric drugs — so patients find them more tolerable and easier to stay on. In addition to being evidence-backed, they’re affordable in generic form and widely available. As a result, they can scale to meet the growing need for mental health treatment that’s in line with clinical guidelines.

What are the downsides of SSRIs and SNRIs?

Unfortunately, the benefits of SSRIs and SNRIs have to be weighed against their risks and side effects. Despite their advantages over older medications, SSRIs and SNRIs still cause side effects, leading over 50% of patients to stop taking them after four months. For example, many antidepressant users complain of sexual dysfunction, such as reduced drive or enjoyment, which can continue even after stopping the medication. And even though SSRIs and SNRIs present lower risk than older antidepressants, weight gain is still a common concern. In unusual cases, when combined with other drugs, SSRIs and SNRIs can contribute to a rare but potentially life-threatening condition called serotonin syndrome.

Despite their advantages over older medications, SSRIs and SNRIs still cause side effects, leading over 50% of patients to stop taking them after four months.

Like all mental health medications, SSRIs and SNRIs affect everyone differently. And this class of medications can take weeks to start improving symptoms of low mood and anxiety. Further, people may experience withdrawal symptoms — such as anxiety, nausea, and fatigue — when they stop taking SSRIs and SNRIs.

Additive solutions: CBT and digital treatments

Fortunately, for patients who want options, SSRIs and SNRIs are not the only recommended treatment for depression and anxiety. Evidence-based psychotherapy, such as CBT, is also a gold-standard treatment. CBT is one of the most extensively researched and supported forms of psychotherapy and is generally very safe with no severe side effects. Since CBT teaches techniques to address negative thoughts and behavior patterns, patients will learn the skills they need to cope with and manage their mental health conditions — and develop new, healthier patterns for the future.

However, like medication, CBT may not work for everyone. Some limitations of CBT include the need for active participation and dedication from the patient, challenges and discomfort when developing new patterns of thinking, and it may not be suitable for those with severe conditions. Face-to-face psychotherapy may also be challenging to find as waitlists could be months long with many overwhelmed therapists turning clients away.

Evidence-based digital treatments are another type of solution that deliver CBT techniques through a virtual experience, eliminating concerns about finding a therapist. Easy-to-use, tailored treatments that can be accessed 24/7 from a smartphone can help bring necessary care to individuals in need without delay — potentially improving health outcomes.

Easy-to-use, tailored treatments that can be accessed 24/7 from a smartphone can help bring necessary care to individuals in need without delay — potentially improving health outcomes.

Yet, digital treatments have limitations as well. For example, some people may not have access to a smartphone or device. Others may prefer to interact with someone in person or need additional levels of care to address the full extent of their conditions.

That’s why it’s important for patients and their care teams to evaluate all treatment options and choose the appropriate option(s) for them. CBT and digital solutions can be a great additive treatment method for someone on medication and vice versa.

Jelani’s road to recovery

Jelani’s doctor tells him he can try SSRI and SNRI medication, behavioral care, or a combination of both. Jelani considers his choices. He’s excited that antidepressants such as SSRIs and SNRIs can improve workplace functioning, one of the areas where he’s been struggling. But he knows it could take a while to find a medication that’s a good fit, especially if one affects his weight or sexual functioning. So Jelani decides to work on his anxiety using multiple tools at once: He asks his doctor to prescribe an SSRI or SNRI and point him towards behavioral care.

Jelani’s doctor considers referring him to face-to-face psychotherapy but has concerns about waitlists. Fortunately, Jelani’s doctor knows that if in-person therapy is inaccessible, an evidence-based care option is just a click away. He tells Jelani about Daylight, a clinical-grade digital treatment for anxiety available 24/7 that can teach him proven cognitive and behavioral skills to manage his anxiety. Armed with effective care, whenever or wherever the need arises, Jelani has hope that he’ll be feeling less worried and more productive soon.

*SSRIs and SNRIs work the same way: by preventing brain chemicals from being reabsorbed, so they’re circulating at higher levels. The main difference is that SSRIs affect serotonin, whereas SNRIs affect both serotonin and norepinephrine. Both of these chemicals affect mood and anxiety. SSRIs and SNRIs are both effective for treating depression and anxiety.

Daylight is available as an adjunct to usual medical care for generalized anxiety disorder for adults ages 18 and older, without FDA review under their COVID-19 policy.

DOC-1090 Effective 03/2023