The Hidden Lessons of SSRIs

I’ve lost count of how many times I’ve sat across from a patient, prescription bottle in hand, eyes filled with hope that the pill inside would erase the storm in their mind. For many, that prescription was an SSRI—fluoxetine, sertraline, citalopram, escitalopram. The names differ, but the story is the same. They were told, “This will help balance your serotonin. This will help you feel like yourself again.”

And yes, sometimes it does. I’ve seen SSRIs lift people out of darkness deep enough to threaten their very lives. For that, I respect them. But here’s the part that too few patients are told: serotonin isn’t just about mood. It’s about your gut, your muscles, your sleep, your hormones, your immune system, your very sense of being alive in your body.

And when you adjust serotonin, you adjust all of it.

I remember one patient in particular. She was only 26, new to antidepressants, relieved to have a plan. Within weeks, her mood had leveled some—but she was back in my office with a new complaint: “My stomach hasn’t been right since I started these pills.” We dug deeper. She was bloated, running to the bathroom unpredictably, losing her appetite.

That’s when I explained what she’d never been told: that 90% of serotonin lives in the gut, not the brain. Her prescription wasn’t just lifting her mood—it was rewriting how her digestive tract moved, how it sensed fullness, even how it processed nutrients.

Another patient confessed that his body felt “muted.” Not just sexually—though that too—but emotionally. He couldn’t cry, couldn’t feel excitement, couldn’t feel much at all. He had traded the crushing lows of depression for the numb plains of emotional flatness. No one had warned him that serotonin, when nudged too far, can muffle dopamine’s reward circuits, muting both pain and pleasure.

I’ve seen clenched jaws and worn teeth from nightly bruxism. I’ve seen restless legs, twitching muscles, and unexplained fatigue. I’ve seen weight climb in ways that felt beyond a patient’s control, leaving them discouraged and ashamed. I’ve seen the brain zaps, the vivid nightmares, the withdrawal storms when someone tried to come off too quickly.

These aren’t rare flukes. They’re part of the territory. But too often, they are left out of the conversation when a prescription is written.

And this is where my role as a nurse becomes more than vitals and lab checks. My role is education. My role is truth-telling.

I tell patients plainly: SSRIs may bring relief, but they are not the cure. They are a tool—sometimes a vital one—but they do not uproot the problem. They don’t teach your brain how to think differently. They don’t challenge the “what if” catastrophes, the self-critical scripts, the deep grooves of fear and shame carved over years.

If anything, SSRIs press pause. They quiet the volume enough that you can begin the real work. But the real work must still be done.

That work is learning to rewire thought processes—through therapy, through mindfulness, through reframing, through deliberate practice of new mental habits. It’s discovering the root causes: unresolved trauma, relentless perfectionism, toxic environments, nutritional imbalances, spiritual emptiness. No pill alone can resolve those.

I don’t say this to discourage. I say this because patients deserve all of the truth. They deserve to know that the fatigue, the numbness, the restless legs, the digestive shifts are not signs of weakness—they are part of how these drugs touch the whole body. And they deserve to know that healing is not found in a capsule, but in the courage to face themselves, retrain their thoughts, and rebuild their lives.

Medication can help you survive. But survival is not living. And living begins the moment you take back the work of your own mind.

- Adam Scott

Original Publish: September 5, 2025