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Mental Health So what's the general consensus on SSRIs? What is your SSRI-experience? Your opinion.

Hanse

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A funny doctor I know is famous in my mind for his quote that SSRIs makes people "lazy, uncaring, and anorgasmic". He says it tongue-in-cheek because it's ostensibly true. This is, in his reasoning, why he does not use that particular antidepressant unless his patients specifically ask for it, or it becomes necessary or if most other options have been exhausted.

Zoloft was intolerable because it made me feel like a zombie. It has stolen 1,5 years of my life. It turns out that SSRI medications can, in fact, cause an apathy/indifference syndrome. So I don't like them ^^

Most prescribers are not aware of this side effect of these drugs. This probably because apathy/indifference sounds a lot like lack of interest in formerly pleasurable activities or lack of energy or lack of motivation? All of these symptoms are also part of major depression. So, it can be hard to know the difference between medication-induced apathy versus inadequately-treated depression. Also, the prescribing information for SSRI medications (which includes the official, FDA-reviewed statement of side effects) does not list apathy or indifference. On the other hand, the prescribing information does include fatigue and decreased libido. These could possibly be manifestations of apathy. Despite the general lack of awareness of this side effect, the medical literature nonetheless contains several case reports and reviews of SSRI-induced apathy. Notably, these reports often mention that the apathy worsens with increased dose of the drug. The presence of such a dose-response relationship supports the notion that the drug actually causes the apathy.
 
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After three days on Lexapro I was unable to crack a nut so I'm scared shitless of them
 
I don't believe they fair much better than the sugar pill in clinical trials, yet they clearly come with astronomically greater risks than the sugar pill. I had a brother who attempted his life after quitting an SSRI, and a co-worker who succeeded after quitting his SSRI. Just the list of side effects these companies are required to list is often more than enough reason for me to never try them. When the side effects are exacerbated symptoms of the condition it's trying to fix, it seems illogical to me.
 
Wellbutrin has really helped me. It definitely does something beyond placebo. If your depressed and it's fucking up your enjoyment of life i think it's worth giving ssri a shot
 
I've never gotten any of the sexual side effects people talk about with ssris. I could jack off fine on Prozac, wellbutrin, and zolof. So not everyone gets those symptoms
 
Recent metanalysis of some antidepressants, whatever that may represent. Certainly you can pick and choose some literature to support various viewpoints.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

Working from a medication prescription perspective (NH healthcare system system now and some from Partners in MA), SSRIs seemed to be viewed as flawed but 'relatively' medically safe options by a good deal of providers, especially primary care. While you hear a lot of horror stories from younger people online, there is significant use in the elderly and older populations (issues SIADH other weird stuff) that isn't quite as well represented. A lot of psychs IME see a mixed picture that can be shaped by particular subfields and population.

Honestly I have an uncertain view. I also had a friend committed to a psych hospital from prozac in his teens, and some horrific withdrawals, but I've known some people who would say their lives have been saved by SSRIs and SNRIs. The experience of particular conditions and reaction to medication can follow trends, but are complex and seem to be educated guesswork not infrequently.

I gotta say, for SSRIs I've known some people with panic hypervigilent anxiety and mixed depression / anxious neurotic apathy who do feel immensely better on some SSRIs. Known someone who has lived on Paxil since the 90s and is entirely functional. So when I get hyper skeptical about a bunch of SSRIs and psychiatric treatments, possible harms, I see that there are some positive responses that should be studied. Over longer periods I have grown more skeptical of long term benzo use and become more gentle on SSRIs, though I remain wary especially in overprescription.

On a personal level SSRIs tended to be ineffective but also limited in side effects- I didn't have any sexual dysfunction that was not from depression (i.e. my lack of interest was from depression and improved some in response to some response to medications) or any significant side effects. No withdrawal from medication was significant, even cold turkey, though I would say that was probably shaded from feeling worse from my depression. A bad period depression was a great deal worse than any medication. Vortioxetine seems to work for me in combination, so there is something in the realm that helps.

Overall I hope for more research and personalization of medication and treatments, to better focus and select what medications/options work optimally for what person and condition. It will take work and psychiatry is a complex field, but there is a lot of promise out there in large-scale sequencing and larger bioinformatics efforts to hopefully better help people who are suffering. Hopefully data from large populations can be combined and accurately analyzed to do so. Still need a lot of work and understanding, biomarkers, accurate statistical representations, and more. Fascinating field.
 
I really hope the pharmaceutical industry will begin working on the next generation of depression drugs soon. So much money to be made from more effective treatments.
 
In my experience, of both having had and knowing many others who've had depression. Which it must be said could be far from a scientific, representative sample.

I don't think they work. They sometimes have side effects, I didn't have any, but some people do. I don't know anyone who's had any lasting benefit. I do know some who've had lasting benefit from some of the SNRI class (still far from impressive success), but not SSRIs.

Whatever the medical consensus is, they still seem to prescribe them and prescribe them as the front line treatment.
 
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I read that commentary actually and thought about it when I was posting the meta-analysis. Ken Gillman has an interesting set of viewpoints and does some work advocating for use of older or 'lesser-used' antidepressants. Certainly posts well about dramatic problems in drug trials such as risperidone. Rightfully the scales used in measuring depression (an amorphous form) and many other conditions are flawed, as is over-extrapolating from the sample group(s) to general guidelines of treatment. Elements of cognitive and functional measures, among others, are not accurately captured in trials, and thus treatment effects and outcomes differ from what is presented.

I would start with the statement regarding 'antidepressants' working via different mechanisms and neurotransmitters as equally effective as implausible...without substantive justification. You could imagine a 'meta-analysis of cancer treatments' and how there would be complex interpretations and necessary pointing toward subgroup effects and need for specialization (i.e. breast vs. prostate vs. neuroendocrine, various classifications). But say a meta-analysis of treatments for diabetes (insulin, SGLT-2, GLP-1, Sulfonylureas, Thiazolidinediones, DPP4) could argue for reconsidering meta-analyses. Diabetic drugs do work through different mechanisms (though they converge on many points) but there are reasons to set a general standard and guidelines of evidence for their usage- parameters for comparison and reasons why you would start with metformin rather than pioglitazone. Safety, effects, tolerability. Even if there are multi-faceted dimensions and subtypes in say Type II diabetes, pooling an aggregate effect or general first start of treatment has some validity. Now whether antidepressants as such compare favorably is another thing. But considering we know even less about mental illness mechanisms in many regards and how to classify them, disregarding meta-analyses fully seems incomplete. Research needs to improve and criticisms are valid, so we have to make do with what we can and not wholly dismiss it.

This is kind of what bugs me with Dr. Gillman, though I do like his pushing for some treatments and skepticism. Some specialists seem to have a viewpoint, with some degree of evidence, that their personal knowledge of mechanisms (and neurotransmitters) and ability to recognize conditions means they can advocate guidelines and methodologies that 'meta-analyses don't capture' or 'that function in a real-world population'. They have some special knowledge that they advocate for, using their understanding of current mechanisms and realized outcomes, that the flawed current state of research doesn't capture or focus on. He even parts on a thought of having a trial of tranylcypromine in psychotic depression, renewing focus on some treatments and subgroups. But he misses one of his points in saying the trial is unnecessary because the treatment effect is so decisive. Going on his logic of the current state of meta-analyses as an issue, in making large statements out of small effects and placebo, such a trial (parnate in psychotic depression) with a documented outcome would give scientific evidence of his viewpoints, would be precisely the antidote. It is the scientific documentation and presentation of a dramatic effect that is necessary in changing the mental illness research ecosystem, not the knowledge or confidence of a person with a particular approach. Essentially, arguing against an appeal to authority (following meta-analysis as guidelines) with an argument of skepticism of general research and appeal to his own authority and experiences. 'You can't trust the industry / drug companies' research so go with my skepticism and trust me. And mirtazapine is fake news, yo.' Exaggerating but I digress.

Honestly I don't know why I made this confusing post and I don't think it makes much sense. I like Dr. Gillman and his advocation for MAOIs. I was on tranylcypromine and methylphenidate after fluoxetine and desipramine and it was beneficial, though I had better effects from other drugs.

Hopefully the glutamatergic era of depression treatments will give some interesting new options. It has been tough over a few years when a lot of mental health pharmacology research areas went more toward the trendy/directly lucrative neurodegenerative disease and neurological side of things. I'm kind of hoping that one of those other avenues will generate a new bipolar treatment beyond the current anti-psychotic boost / drug cocktail era. Perhaps calcium channel modulation or ankyrin protein, or something new and unexpected. GPs/PCPs will still hand out SSRIs as the psychiatric education in general medicine is still limited, research is as it is, and too many insurance companies and systems are pushing GPs/PCPs to treat beyond their level of experience.
 
SSRIs have helped me a lot. Zoloft lifted me out of debilitating anxiety, although I later had to add other medications as my condition worsened and tolerance built up. I've noticed no difference between Zoloft, Prozac, and Lexapro. I'm currently on Lexapro with other antidepressants however the SSRI is the backbone and the entire cocktail would fall apart without it.
 
I had severe depression with psychosis plus severe anxiety/panic attacks and Sertraline (Zoloft) quite literally saved my life. I'm on several other medications as well now, but 10 years on it is still working for me.
 
I have bipolar disorder, anxiety/agoraphobia, ADHD and treatment-resistant depression so SSRIs generally don't work for me. I was so suicidal, I decided to try anything. So now I'm on Effexor XR which is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI)

I've been on Effexor XR for a lil' over a month. Started at 75 mg in the am for the first 10 days, now it's twice a day so I'm at 150 mg which is still low. It felt like it was working at first, but now I'm back to dark thoughts. Like I just know life isn't meant for me, it never was.
I truly believe that.

My granny is in her 80s and even with some physical pain, she's still joyful and loves to socialize. Here I am in my mid-30s, I can't stand myself and the majority of other people, isolation is preferable. Life has shown me that most people are not trustworthy, depression doesn't go away and "love" is a joke. No way I'm gonna make it to old age. I already feel like life is over. I want off this ride, it's exhausting. Thanks.

I'll see my psychiatrist next month. I already told him SSRIs don't really work for me, but I was desperate.
Maybe I'll have to find someone who can prescribe an MAOI. It was the only thing that really worked.

Seems like I only feel truly alive when I'm manic, delusional or high.

Effexor XR killed my sex drive and ability to orgasm. I tried really hard to cum last night even while watching porn, no luck. Horrible.
 
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Lexapro was part of my Cancer TX and worked well with
ambine
Percoset

Got off all then was diagnosed with PTSD !!!!!
back on Lexapro, and very happy with it
Gave me a life back
big Fan
 
A funny doctor I know is famous in my mind for his quote that SSRIs makes people "lazy, uncaring, and anorgasmic". He says it tongue-in-cheek because it's ostensibly true. This is, in his reasoning, why he does not use that particular antidepressant unless his patients specifically ask for it, or it becomes necessary or if most other options have been exhausted.

Zoloft was intolerable because it made me feel like a zombie. It has stolen 1,5 years of my life. It turns out that SSRI medications can, in fact, cause an apathy/indifference syndrome. So I don't like them ^^

Most prescribers are not aware of this side effect of these drugs. This probably because apathy/indifference sounds a lot like lack of interest in formerly pleasurable activities or lack of energy or lack of motivation? All of these symptoms are also part of major depression. So, it can be hard to know the difference between medication-induced apathy versus inadequately-treated depression. Also, the prescribing information for SSRI medications (which includes the official, FDA-reviewed statement of side effects) does not list apathy or indifference. On the other hand, the prescribing information does include fatigue and decreased libido. These could possibly be manifestations of apathy. Despite the general lack of awareness of this side effect, the medical literature nonetheless contains several case reports and reviews of SSRI-induced apathy. Notably, these reports often mention that the apathy worsens with increased dose of the drug. The presence of such a dose-response relationship supports the notion that the drug actually causes the apathy.

Dear OP,

I've been through the mill with SSRI's you name it, ive probably tried it lol. All have sidr effects, all are different and they all effect people differently.

Some kill sex drive, some cause nightsweats, apathy, disassociatimg behaviour etc etc

I've find its trial an error. I give them 2 weeks to settle, longer if I like them and I think the nightmare will pass I.e. Brintalex (I think) zero side effects other than making me vomit randomly, even after the 2 week test drive, venoflaxine, suicidal in 2 days. But Lexepro, Prozac, Lyrica and Cymbalta and prozac have all been good and bad in different ways.

Its sadly trial and error so I wish you the best of luck.

Always read the medication review online

Mie x
 
In my personal experience, both Prozac and Lexapro have helped me for my Obsessive Compulsive disorder but not my depression, and neither has ever lead to sexual disfunction.

There was a time when I was 14 and first got on Prozac that a certain specific type of OCD was ruining my life and once I got on Prozac it completely went away, though it did resurface 9 years later and needed further treatment.

But at the same time...FOR ME....they have been almost completely ineffective for depression or anxiety that DOESN'T come from my OCD, as I also have generalized anxiety disorder and depression.

In my PERSONAL experience, NO drug, SSRI or otherwise, that you take that takes weeks or a month to take effect ever has a profound impact on my depression or anxiety or overall mood.

The only drugs that have ever REALLY helped my anxiety and/or depression and/or mood are the kinds that take a certain amount of time to kick in, like 30-60 minutes, and last from 4-12 hours or so.

If I can't really FEEL A DRUG KICK IN (and to some extent wear off), I don't find it is enough to really help most of my symptoms, and sadly, MOST of the drugs that work that way get a person high and can lead to more addiction and negative side effects, so it all becomes whether or not it is worth them.

BUT...I do have the experience of SSRIs helping me with one specific but nevertheless serious problem when I was much younger.

Overally, I don't think SSRIS or most of the antidepressants out there that takes weeks to take effect are the best drugs for depression or anxiety and I think we need to develop shorter acting but safer drugs for these purposes.

Some that already seem to work in this way include: Ketamine, microdosing of mushrooms, MDMA, and while they come with more side effects than I have found worthwhile.....incredibly helpful drugs like Kratom and Tianeptine.

I think modern medicine needs to start thinking along these lines.

When you REALLY need relief for your symptoms you can't wait weeks to think MAYBE they are helping, you need it FAST and you need to know FOR SURE.
 
K
I really hope the pharmaceutical industry will begin working on the next generation of depression drugs soon. So much money to be made from more effective treatments.
My Dr has prescribed me a ketmime nasal spray (the Racemic Ketamine; not the new Spravato “S-Ketamine” spray) for my treatment resistant depression and it has worked wonders.
 
K

My Dr has prescribed me a ketmime nasal spray (the Racemic Ketamine; not the new Spravato “S-Ketamine” spray) for my treatment resistant depression and it has worked wonders.

Was it hard to get it prescribed?

How did you convince your doctor?

Do you have to be suicidal to get prescribed it?

And how expensive is it?

I've heard it costs an arm and a leg...
 
I really hope the pharmaceutical industry will begin working on the next generation of depression drugs soon. So much money to be made from more effective treatments.

Sorry to drag up an old post, but how was wellbutrin for you? I'm thinking of potentially starting an anti-depressant myself that can also help with me ADHD symptoms.
 
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