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What’s in This?: Antidepressants

All 15 ingredients in these SSRIs, explained (yep, even carboxymethylcellulose sodium)

We’re often told that you should never eat anything (or put anything on your body) if you don’t recognize everything on the ingredients list. But since most of us have no idea what xanthan gum or potassium benzoate are — or more importantly, what they’re doing to our bodies — we’re decoding the ingredients in the many things Americans put in (and on, or near) themselves.

This edition: Prozac, which is made from 15 separate ingredients that we’ve broken down in the exact order they appear online.

The Ingredients

1) Fluoxetine Hydrochloride: This is the active ingredient in Prozac, and it works by blocking the absorption of the neurotransmitter serotonin in the brain, hence Prozac being a selective serotonin reuptake inhibitor (or SSRI). While it might seem like prohibiting the intake of serotonin, a chemical that promotes a general sense of happiness, would have the opposite effect of making someone with depression or anxiety feel better, as you can see in the video below, it’s more complicated than that. Basically, when the reuptake of serotonin — a process that normally maintains serotonin levels in the brain — is inhibited, the overall levels of serotonin in the brain actually build up and rise.

Now, while heightened serotonin levels have long been believed to be the main reason behind why SSRIs work, more recent research suggests that there must be more at play. For instance, some studies claim that placebos are almost as effective. As one concludes, “There is a strong therapeutic response to antidepressant medication. But the response to placebo is almost as strong. This presents a therapeutic dilemma. The drug effect of antidepressants is not clinically significant, but the placebo effect is.” All in all, the effects of SSRIs are complicated, and continued research is needed to fully explain how they work.

In terms of the drug itself, while more serotonin might be good for feeling better, too much can have a negative effect on other areas of the brain — namely, the ones that regulate your sex drive. “Pathways of sexual desire involve serotonin, but also chemicals such as dopamine and norepinephrine,” psychiatrist Ash Nadkarni explained to HuffPost. “Dopamine is linked to the intense passion and arousal of romantic love, while norepinephrine is associated with the heightened attention and motivation of desire. Serotonin-enhancing antidepressants blunt sexual desire by reducing the capacity of dopamine and norepinephrine, or excitatory pathways, to be activated.” 

In other words, with so much serotonin flooding your brain, sex-enhancing chemicals like dopamine and norepinephrine are pushed aside. This is also why many men on antidepressants report trouble getting erections, and many women report discomfort during sex.

As with many medications, you should also avoid drinking alcohol or combining other drugs with SSRIs, for several reasons: Alcohol is a depressant and can work against everything antidepressants do; plus, booze and other drugs can worsen the side effects of some SSRIs, particularly drowsiness, dizziness and coordination problems.

2) Benzyl Alcohol: Onto the inactive ingredients, benzyl alcohol is a common pharmaceutical preservative. In some rare cases, it can cause contact dermatitis and rashes, which are notable side effects of some SSRIs.

3) Butyl Paraben: Another antimicrobial preservative, some studies suggest that parabens can have a negative effect on reproduction, so consider discussing with your doctor if you plan on making babies while on SSRIs.

Also, the scientific community has gone back and forth on whether or not parabens like butyl paraben are carcinogenic. In 2004, molecular biologist Philippa Darbre found small concentrations of parabens in breast cancer cells, which raised concerns about their use in many products. Subsequent studies exploring this connection, however, deemed parabens to be non-carcinogenic. Subsequent studies to those studies found parabens to be (you guessed it) carcinogenic. The debate continues!

4) Carboxymethylcellulose Sodium: Carboxymethylcellulose Sodium is a common disintegrant, helping facilitate the breakup of these tablets in the intestinal tract, increasing their effectiveness. According to the FDA, this substance is generally recognized as safe.

5) Edetate Calcium Disodium: This ingredient functions primarily as a chelating agent, a substance that prevents deterioration and mold growth during processing and storage, by binding the minerals within the product. It has been shown to be completely safe.

6) FD&C Blue No. 1: Artificial colors like this one are commonly considered to be carcinogenic. That said, physician and biochemist Cate Shanahan, author of Deep Nutrition: Why Your Genes Need Traditional Food, told me during my analysis of Doritos that studies arguing this are a bit flawed, since the amounts they use in these experiments are far more than what we actually find in our foods and pills.

Interestingly, blue might not be a random choice, either. See, patients tend to respond to the color of their medications, making assumptions about how they work, and how well they work, based on the color. And in this case, when you consider that the color blue can provoke a sense of calm and ease, a studied and proven phenomenon, it makes sense that manufacturers would choose that color for an antidepressant pill.

7) Gelatin: In pharmaceuticals, gelatin is used to make up the bulk of pills. One thing of note: Gelatin is often derived from various animal parts, so vegetarians and vegans beware.

8) Iron Oxide Yellow: Another artificial color, the same information above applies to iron oxide yellow. In this case, though, the yellow mixes with the blue, forming more of a light blue tone, one of calmness and relaxation.

9) Methyl Paraben: Similar to butyl paraben, methyl paraben is widely used for its antifungal and preservative properties, and the same potential side effects apply here. 

10) Propylparaben: Yet another paraben preservative, propyl paraben is associated with many of the same concerns as the other parabens in these pills. However, because propyl paraben doesn’t seem to accumulate in the body, the FDA generally recognizes it as safe. 

11) Silicone: Similar to gelatine, silicone helps make up the bulk of these pills.

12) Sodium Propionate: Another preservative, sodium propionate prevents the growth of mold and some bacteria, and is safe when added in the right amounts.

13) Sodium Lauryl Sulfate: In pharmaceuticals, sodium lauryl sulfate is used as a carrier in dissolvable pills, seemingly helping the drug disperse in the stomach. It can cause nausea, vomiting and diarrhea when ingested, all of which are possible side effects of SSRIs and why these drugs are generally suggested to be taken with food. 

14) Starch: Starch, which is most likely derived from either corn or potato, serves many purposes in the pharmaceutical industry. In this case, however, it probably helps these tablets dissolve in the stomach.

15) Titanium Dioxide: This basically prevents discoloration. Unfortunately, the European Chemical Agency has concluded that titanium dioxide may cause cancer when inhaled, although the minuscule amounts in SSRIs are most likely harmless. 

The Takeaway

In recent years, SSRIs have been the subject of heated debate, not only because they produce some strange and unpleasant side effects and can be incredibly difficult to kick once you start, but also because nobody can agree exactly how they work — and again, placebos seem to be just as effective in many cases. Likewise, the effects of these drugs vary greatly from person to person.

This is less a fault of the drugs themselves, and more a result of mental health problems like depression and anxiety being extremely complicated and difficult to study. That said, as the stigma surrounding mental health continues to fall, the ways we go about dealing with these problems will surely improve.

So if you feel the need to seek any kind of mental help, including the use of SSRIs, your best bet is to consult with your doctor and go from there. Only they can give a professional opinion on what’s right for you.