Concerns are mounting regarding the safety and long-term effects of Selective Serotonin Reuptake Inhibitors (SSRIs), a class of powerful antidepressants. Figures from the Medicines and Healthcare products Regulatory Agency (MHRA) show 1,127 'reports with a fatal outcome' linked to SSRIs since the late 1980s, although the agency clarifies this figure is closer to 1,102 due to some cases listing multiple drugs. While none of these fatalities are definitively proven to have been caused by SSRIs, with existing illnesses potentially being factors, experts caution that this number might only be the 'tip of the iceberg' given the widespread use of these medications.

The MHRA's Yellow Card scheme, a database established after the 1960s thalidomide scandal, allows healthcare professionals and patients to report suspected adverse drug reactions. However, a report to this scheme does not prove causation, and the MHRA notes that some reactions could be coincidental or related to underlying conditions. Despite this, there are longstanding concerns about the scheme's effectiveness, with some estimates suggesting it captures only one in ten serious reactions, largely due to time constraints for doctors and pharmacists and the reliance on patient accounts.

SSRIs, including commonly prescribed drugs like sertraline (Lustral), citalopram (Cipramil), fluoxetine (Prozac), and paroxetine (Seroxat), were prescribed an astonishing 47 million times in 2023 in the UK, equivalent to roughly 1.5 prescriptions every second. Psychiatrists often assert that the benefits of SSRIs, which are also used to treat anxiety, OCD, bulimia, and premature ejaculation, are 'clear' and far outweigh any potential risks, with millions having taken the drugs safely for years.

However, critics highlight numerous severe side effects and question the drugs' fundamental mechanism. The NHS warns against suddenly stopping SSRIs due to crippling withdrawal symptoms. Common side effects include a loss of libido, diarrhoea, and dizziness. More alarmingly, the NHS also states that 'some people have suicidal thoughts and a desire to self-harm' when they first begin taking SSRIs. In rarer instances, patients can experience hallucinations and urinary retention.

A significant area of contention is the drugs' impact on libido. Many users report profound sexual dysfunction, with some feeling like 'sexless zombies' even years after discontinuing the medication. This issue gained prominence when Scottish singer Lewis Capaldi openly discussed his struggles with SSRI-induced sexual dysfunction in a documentary. The potent libido-dampening effects have even led to trials of these drugs on sex offenders to curb urges.

Furthermore, the scientific basis for how SSRIs work has been challenged. The traditional theory that they correct abnormally low serotonin levels – the 'feel-good' chemical – was largely debunked by a major 2022 review, which found 'no convincing evidence' that depression is caused by a chemical imbalance. While this doesn't disprove their effectiveness, it highlights that their exact mechanics remain 'shrouded in mystery.' Some studies have even suggested SSRIs may not be more effective than a placebo.

Leading experts, such as Professor Joanna Moncrieff, a psychiatrist at University College London, strongly caution against their widespread use. She states that the reported figures likely 'underestimate the deaths in which antidepressants play a role,' citing increased risks of cardiovascular disease, falls, and fractures in the elderly that could indirectly lead to death but are not attributed to the drugs. Professor Moncrieff also believes that side effects like persistent sexual dysfunction can drive individuals to despair and suicidal ideation, and that in rare cases, SSRIs can directly induce suicidal thoughts and behavior, particularly in younger individuals, or cause death through overdose.

Dr. Cathy Wield, an emergency medicine specialist, shared her personal experience of developing suicidal thoughts after being prescribed fluoxetine without full awareness of potential side effects. She stressed the importance of the MHRA listening to patients and reviewing data to prevent further loss of life. Dame Clare Gerada, former president of the Royal College of General Practitioners, has also raised concerns that many Britons may be mistaking 'normal stresses of life' for mental health problems, leading to self-diagnosis and potentially unnecessary medication.

In response, the Royal College of Psychiatrists acknowledges that while depression is a serious and treatable condition, antidepressants can significantly benefit those with severe depression. They emphasize that, like all medications, SSRIs carry risks of side effects, which should be thoroughly discussed with patients and regularly reviewed. The MHRA consistently states that it evaluates new evidence and conducts multiple reviews on SSRIs, maintaining that the benefits for treating moderate to severe depression and other conditions generally outweigh the risks for most individuals. They reiterate that a reported fatal outcome does not necessarily mean it was caused by the medicine, but advises anyone with concerns to consult their doctor and report via the Yellow Card scheme.