Selective serotonin reuptake inhibitors (SSRIs) are among the most widely prescribed medications in the United States, primarily for managing depression. While SSRIs emerged as antidepressants during the late 1970s, it drastically revolutionized the therapeutic practice regarding other psychotrophic agents for various mental illnesses by establishing them as effective yet a good tolerated alternate for antidepressive agents earlier produced. At present, they are often the first pharmacological therapy for depression along with other mental health conditions.

SSRIs, are a type of antidepressant medication designed to alleviate symptoms of depression by increasing serotonin levels in the brain. Serotonin is a chemical neurotransmitter which plays a critical role in mood regulation, memory, sleep, digestion, and sexual function. Often, scientists termed the chemical as the "feel-good" chemical because its release is closely associated with happiness and emotional well-being. Low levels of this chemical have been associated with mood disorders, including depression.

SSRIs are able to work because they selectively inhibit the reabsorption, or reuptake, of serotonin into nerve cells in the brain. The higher level of serotonin that becomes available promotes the betterment of mood and diminishes anxiety. Older antidepressant classes were found to cause many side effects. That's why this new generation is often used and appreciated by both the patients and doctors themselves.

How Do SSRIs Work?

The mechanism of SSRIs is hidden in their name- selective serotonin reuptake inhibition. When serotonin is released by neurons, it transmits signals to other neurons before being reabsorbed. SSRIs block this reabsorption process, making more serotonin available in the brain. This increase in serotonin levels is thought to help regulate mood and enhance responsiveness to complementary treatments, such as CBT.

Conditions Treated by SSRIs

While SSRIs are primarily prescribed for depression, their benefits extend to several other mental health and medical conditions, including:

Generalized Anxiety Disorder (GAD): The reduction of excessive and persistent worry.

Obsessive-Compulsive Disorder (OCD): The reduction of intrusive thoughts and repetitive behaviors.

Panic Disorder: The management of sudden episodes of intense fear and physical symptoms.

Post-Traumatic Stress Disorder (PTSD): The processing and coping with traumatic experiences.

Social Anxiety Disorder: Increasing comfort in social interactions.

Bulimia Nervosa: Controlling binge-eating and purging behaviors.

SSRIs are also prescribed off-label for disorders such as premenstrual syndrome (PMS), fibromyalgia, irritable bowel syndrome (IBS), and symptoms of menopause. They can also be used to treat premature ejaculation and other forms of chronic pain.

Potential Side Effects of SSRIs

As with any medication, SSRIs have the potential for side effects. Most people tolerate them well, but some may experience symptoms, especially during the first few weeks of treatment. Common side effects include:

• Nausea and indigestion
• Headaches
• Drowsiness or insomnia
• Dry mouth
• Sweating
• Dizziness
• Sexual dysfunction (e.g., decreased libido, difficulty achieving orgasm)

Most side effects subside as the body becomes accustomed to the medication. However, patients should contact their healthcare provider if symptoms do not subside or worsen.

Precautions and Contraindications

SSRIs are not appropriate for everyone. People with specific medical conditions or situations need to exercise extreme caution or avoid these medications altogether. These include:

Pregnancy: Most SSRIs are considered safe during pregnancy, but some, such as paroxetine, carry risks, including birth defects, postpartum hemorrhage, and withdrawal symptoms in newborns.

Drug Interactions: SSRIs can interact with other medications, including blood thinners, NSAIDs, and certain supplements.

Preexisting Conditions: People with liver disease, seizure disorders, or bipolar disorder should discuss potential risks with their doctor before starting SSRIs.

Risks of Untreated Depression During Pregnancy

For pregnant individuals, untreated depression poses significant risks, including poor prenatal care, preterm birth, and developmental issues for the baby. A thorough discussion with a healthcare provider can help weigh the benefits and risks of continuing SSRIs during pregnancy.

Starting and Managing SSRI Treatment

When beginning an SSRI, patients are typically started on the lowest effective dose to minimize side effects. Gradual dose adjustments may follow, based on the patient’s response and tolerance. Regular follow-up appointments with a healthcare provider are essential to monitor progress and address any concerns.

One of the challenges with SSRI treatment is that its effects are not instant. The mood and symptoms might take weeks to show significant improvement. Abrupt discontinuation of SSRIs results in withdrawal symptoms, dizziness, irritability, and flu-like sensations. Patients should always consult their doctor before stopping or changing their medication.

SSRIs have changed the landscape of treatment for depression and other mental health disorders. These drugs have brought hope and relief to millions of people all over the world. Although not free of risks and side effects, the benefits often outweigh them if used appropriately. This is because SSRIs increase serotonin levels in the brain, restoring balance to emotions and quality of life. As with all medication, informed discussion with a healthcare provider is critical in ensuring safe and effective treatment.

BMC Pregnancy and Childbirth, https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-14-333

Antidepressant during pregnancy and postpartum hemorrhage: a systematic review

Safety of Selective Serotonin Reuptake Inhibitors in Pregnancy: A Review of Current Evidence, https://link.springer.com/article/10.1007/s40263-016-0338-3

Psychotherapy and Psychosomatics, https://doi.org/10.1159/000516031

Prenatal exposure to antidepressants and increased risk of psychiatric disorders, https://www.bmj.com/content/358/bmj.j3950

A recent study has revealed that 17.4% of college-going women aged 18-25 in Delhi are affected by Polycystic Ovary Syndrome (PCOS), marking the second-highest prevalence rate recorded in the country. The study, partly funded by the Indian Council of Medical Research (ICMR), was published in the peer-reviewed journal BMC Health. It included a cross-sectional survey of 1,164 participants and a systematic review of studies conducted between 2010 and 2024 across India in similar age groups.

PCOS: A Widespread Yet Under-Researched Disorder

Polycystic Ovary Syndrome is a common hormonal disorder among women of reproductive age. It is characterised by a range of symptoms such as irregular menstrual cycles, infertility, excessive hair growth (hirsutism), acne, and obesity. Despite being widespread, the disorder remains under-researched, especially in young women.

The study points out that the pooled prevalence of PCOS across India in this age group, based on similar diagnostic criteria, stood at 8.41%. By comparison, Delhi’s figure of 17.4% is significantly higher, highlighting a concerning urban health trend. Previous data from the Ministry of Science and Technology has shown that PCOS prevalence in India can vary between 3.70% and 22.50%, depending on region, setting, and socio-cultural factors.

Urban Lifestyle and Its Role

The researchers observed a higher prevalence of PCOS in urban areas with heterogeneous and migrating populations. Many young women move to cities like Delhi for academic and career opportunities, which often leads to psychological stress, disrupted sleep cycles, and unhealthy dietary habits. These factors, in turn, may contribute to the increasing incidence of PCOS.

“This displacement and the resulting lifestyle changes — juggling education, work, and home responsibilities — seem to be closely linked to the rise in PCOS cases,” the study noted.

The research was conducted by Apoorva Sharma, Naorem Kiranmala Devi, and Kallur Nava Saraswathy from the Department of Anthropology, Delhi University, along with Dr. Yamini Swarwal from Safdarjung Hospital. According to Prof. Saraswathy, ethical clearance for the fieldwork was obtained from Delhi University, and the data collection process spanned two years.

Diagnosis and Testing

Of the 1,164 women surveyed, 70.3% had already been diagnosed with PCOS, while 29.7% were newly diagnosed during the course of the study. The researchers also facilitated ultrasound testing for women who displayed symptoms but had not yet been diagnosed.

Socio-Demographic and Caste-Based Disparities

The study found that women from upper and upper-middle socioeconomic classes, as per the Modified Kuppuswamy Scale, were at higher risk. Researchers attributed this to a “nutrition transition” involving increased consumption of processed foods, fats, and sugars, alongside reduced physical activity. This shift has led to increased insulin resistance and obesity—factors known to be linked to PCOS.

Interestingly, the highest prevalence of PCOS was recorded among Scheduled Tribes (21.4%), followed by women from the General Category (19.9%), with lower rates among Other Backward Classes (OBC) and Scheduled Castes. The authors suggest that this might reflect broader inequalities in healthcare access and lifestyle, underscoring the urgent need for targeted health interventions and greater awareness.

In a landmark medical feat, doctors at SMS Hospital in Jaipur have successfully removed a 210-centimetre-long trichobezoar—a dense, compact mass of hair—from the stomach of a 14-year-old girl from Barara village in Agra district, Uttar Pradesh. This extraordinary case is believed to be the longest trichobezoar ever removed globally, surpassing the previous world record of 180 cm.

Rare Case Presents Major Surgical Challenge

The case posed significant surgical challenges. The trichobezoar had extended from the stomach into the small intestine, complicating the procedure. Surgeons were determined to extract it in one piece to avoid making multiple incisions in the intestine, which could increase complications.

Despite the complexity of the situation, the surgical team completed the operation within two hours and did not require a blood transfusion. In an impressive display of surgical precision, the entire hairball was removed intact.

Persistent Symptoms Lead to Diagnosis

The girl had been experiencing persistent abdominal pain and vomiting for over a month. Upon arrival at SMS Hospital, doctors noted a hard, elongated mass in her abdomen, stretching from her stomach to the area near her navel. A Contrast-Enhanced CT (CECT) scan revealed an unusually enlarged stomach filled with a foreign substance, prompting immediate intervention.

Pica: The Psychological Root

Doctors diagnosed the young patient with Pica, a psychological disorder in which individuals develop cravings for non-edible substances. Dr. Jeevan Kankaria from the hospital’s surgery department explained that the girl initially started eating chalk in school under peer influence. Over time, this progressed into the consumption of hair and other non-food items.

“During surgery, we found not only hair but also wooden pieces, rubber bands, stones, threads, and other inedible materials entangled in the mass,” said Dr. Kankaria, who led the surgical team.

A Record-Breaking Removal

“When we measured the trichobezoar after removal, it was 210 cm long, which we believe is the longest ever taken out from a human stomach,” Dr. Kankaria stated. The hospital is now in the process of submitting the case to the Guinness World Records for official recognition. Dr. Kankaria already holds four Guinness World Records for previous surgical milestones.

Patient’s Recovery and Future Outlook

The girl, a Class 10 student from a farming family, is currently recovering well under observation at SMS Hospital. Her post-operative condition is stable, and doctors expect to discharge her soon.

This rare case highlights the critical need for early intervention in psychological disorders such as Pica and the importance of awareness among parents and educators. Dr. Kankaria stressed that behavioral and psychological support will be essential in the patient’s long-term recovery to prevent recurrence.

As the medical team awaits potential recognition from the Guinness World Records, this groundbreaking surgery stands as a testament to the precision, planning, and teamwork of doctors at SMS Hospital—and serves as a crucial reminder of the unusual ways psychological disorders can manifest physically.

On World No Tobacco Day, Dr. Sajjan Rajpurohit, Senior Director of Medical Oncology at BLK-Max Super Speciality Hospital, sheds light on how tobacco affects women differently than men. While the overall dangers of smoking are well known, Dr. Rajpurohit emphasizes the need to understand the biological, hormonal, and social dimensions that make women more vulnerable to tobacco-related diseases and challenges in quitting.

Biological Differences Make Women More Sensitive to Nicotine

“Women metabolize nicotine more slowly than men, which results in prolonged exposure to its harmful effects,” says Dr. Rajpurohit. This slower metabolism, combined with hormonal changes across a woman’s life—such as during menstruation, pregnancy, or menopause—can heighten nicotine’s addictive properties.

For instance, estrogen, a key female hormone, may increase sensitivity to nicotine, making it harder for women to quit. “This also explains why withdrawal symptoms might be more severe in women,” he adds.

Higher Risk of Certain Diseases

Women who smoke are more susceptible to certain diseases than their male counterparts, warns Dr. Rajpurohit.

Lung Cancer

Though men historically had higher rates of lung cancer, the gap has narrowed as more women took up smoking. “Women are not only developing lung cancer at younger ages, but they may also face more aggressive forms of the disease,” he says, pointing to biological differences in lung structure and function.

Heart Disease

Smoking significantly raises the risk of heart disease in women, especially those using hormonal contraceptives. “Smoking can cause the arteries to harden and increases the risk of heart attacks and strokes. When combined with birth control pills, the risk becomes even higher,” he explains.

Reproductive and Pregnancy Complications

Smoking affects fertility and reproductive health. It can lead to complications such as ectopic pregnancies, miscarriage, preterm delivery, and low birth weight. “Women in their childbearing years should be especially cautious, as smoking during this period can have lasting effects on both the mother and child,” Dr. Rajpurohit stresses.

He also highlights severe pregnancy-related risks like placental abruption (where the placenta detaches from the uterus) and placenta previa (when the placenta blocks the cervix), both of which can endanger maternal and fetal health.

Hormonal Imbalance and Fertility Issues

Nicotine disrupts hormonal balance, impacting ovulation and menstrual cycles. Women who smoke often report irregular periods and find it more difficult to conceive. “The damage is not just temporary—prolonged tobacco use can lead to long-term reproductive challenges,” says Dr. Rajpurohit.

Why Women Find It Harder to Quit

Quitting smoking can be a more difficult journey for women due to psychological, hormonal, and social factors.

“Many women smoke to manage stress, anxiety, or depression. This emotional dependence can complicate their efforts to quit,” Dr. Rajpurohit explains. Hormonal fluctuations during the menstrual cycle can also influence cravings and mood, making it harder to resist smoking.

Additionally, women may lack adequate support from family or peers. “Social encouragement plays a huge role in smoking cessation, and women often find themselves without the backing they need,” he says.

To help women quit, he recommends a tailored approach involving behavioral therapy, nicotine replacement therapy (NRT), and personalized quit plans. “These strategies must take into account individual stressors, emotional needs, and social settings,” he adds.

Secondhand Smoke and Societal Pressures

Women are often exposed to secondhand smoke in domestic environments, putting them at risk for the same diseases as smokers. “The dangers of passive smoking are real and can lead to respiratory illness, heart disease, and even pregnancy complications,” says Dr. Rajpurohit.

He also draws attention to how societal norms and advertising have historically influenced women’s smoking behavior. “Tobacco companies once marketed cigarettes to women as symbols of empowerment and liberation. Unfortunately, this portrayal led many to underestimate the health risks,” he notes.

In certain cultures, smoking among women may be normalized or not taken seriously, which further prevents intervention and support.

Empowering Women Through Awareness and Support

“Women face unique challenges when it comes to tobacco use, and we must address them with empathy and targeted strategies,” Dr. Rajpurohit concludes. On World No Tobacco Day, he urges women to seek help and become aware of the specific risks they face.

For those struggling with tobacco addiction, he recommends consulting healthcare professionals and exploring support systems that cater specifically to women’s needs. “The goal is not just to quit but to stay tobacco-free for life,” he says.