Psychopharmacology and Psychiatry Updates Do SSRI Side Effects Improve Over Time?
Nov 27, 2025
Dr. Paul Zarkowski, a psychiatrist and researcher known for his analysis of the STAR*D trial data, dives into the controversial belief surrounding SSRI side effects. He discusses whether these effects truly diminish over time, revealing that some patients may actually face worsening symptoms. Zarkowski explains concepts like survivor bias and presents data showing distinct side-effect trajectories. He also highlights persistent problems such as sexual and sleep-related side effects and stresses the importance of early assessments for effective patient counseling.
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Patient Case Framing The Question
- Sarah, a 34-year-old started citalopram and reported insomnia, dry mouth, and loss of libido at two weeks.
- Her question about whether side effects improve framed the episode's investigation into SSRI tolerability over time.
STAR*D Provides Temporal Side-Effect Data
- STAR*D provided structured side-effect ratings at weeks 2,4,6,9,12 using PRISE and FISER scales.
- The study design allows temporal tracking of side effects across a large, real-world sample starting citalopram.
Apparent Decline Masks Survivor Bias
- Raw percentages of side-effect endorsement fell from week 2 to week 12, e.g., insomnia from 57% to 38%.
- However, this simple decline risks survivor bias because patients with worse side effects drop out early.