I am curious how they link to suicide and homicide. Antidepressants seem to be most dangerous when they make people just motivated enough to execute maladaptive ideas but not functional enough to become happy productive people.
This is obviously a corner case that doesn't apply to the vast majority of people on antidepressants but it brings up some worthwhile discussions.
It may sound odd, but suicides can happen when the medication is actually working. It gives the patient just enough motivation to finally do what they were unable to do because they were so paralyzed by anxiety and depression. It's really sad.
If you stop taking your SSRI suddenly, your depression is even worse than when you started. This is why doctors strongly urge patients to ween instead of dropping off suddenly. That effect (massive increase in symptoms in cases where patients stop medication suddenly) probably contributes to a significant portion of the risk.
Depression makes it hard to get things done. I heard that the SSRI can eliminate that symptom before it eliminates the desire to die, and that is where a lot of the risk of suicide comes from -- which of course is during the first weeks or months after starting the SSRI.
Your actual perceived "mood" is generally the "last" thing to change with basically all flavors of traditional antidepressant, since it's more or less your calibration of how much life sucks over time, and it takes a while of noticing it sucks less to recalibrate.
So every doctor I've ever had has given me a very similar lecture about being very cautious, because depression is more or less characterized as having reduced or no ability to actually drive yourself to do things, and then you feel like shit as that keeps happening and your frame of mind goes sour. But conversely, if the antidepressant affects the "underlying" problem, your inability to turn thought into deed, it will take time (and possibly therapy) for you to recalibrate again, and then you have a window of "I want to die, nothing will ever improve", coupled with a newfound ability to successfully turn thought into deed.
It's one reason things like ketamine and psilocybin are seen as wild - when they work, both generally improve at once, so you avoid that problem.
Thank you; for all its long-windedness, I've had to explain things about this a lot of times to people who have no frame of reference, similar to having to explain to people who have never experienced a disconnect between intent to do something and doing it that no, it's not simply a matter of actually not wanting to do it, it's that I sit here frustrated, having decided I will do this, and still not doing it, for no evident reason.
Since that's completely outside their experience, they often conclude you're lying, not "people work differently".
I've also heard that some people with unipolar depression might actually be misdiagnosed and have a form of bipolar disorder. SSRIs can potentially invoke manic/mixed states in some individuals with bipolar disorder, which might also account for some of the increased risk in suicide from SSRIs.
Also "brain zaps". Highly recommend listening to your physician with a proper roll off period instead of cold turkey. Also be wary of taking certain recreational drugs (Molly, X) due to seretonin syndrome.
In my experience, you wanna talk to a psychiatrist or in general some who specializes in prescribing drugs for mental health. Your GP just isn't gonna be familiar with all of the ins and outs
Most GPs I have talked to know next to nothing about psychiatric medications. The incompetence runs deep, not limited to psychiatric medications. Just for an example: they know absolutely nothing about seizures caused by withdrawal symptoms of benzodiazpines. In fact, I had a psychiatrist who I had an appointment to after one month, and he knew I was on 2 x 2 mg of alprazolam, well, imagine what would have happened if I could not have gotten my hands on benzodiazpines: seizures. I had them before. No one really cared, my psychiatrist didn't, my GP didn't.
Take a look at many psychoactive substances. Sudden cessation after prolong usage typically presents as symptoms that are the opposite of whatever the substance provided.
No, its pretty unusual for a substance to cause noteworthy harm after sudden cessation. This is distinct from developing a tolerance, which as you note is pretty normal for humans.
What is defined as noteworthy harm? Are we talking about noteworthy short-term effects or as far on the spectrum as death?
I can think of quite a few substance which result in harm with sudden cessation after prolonged usage -- Alcohol, benzodiazapines, antihypertensives, etc.. Perhaps medications like: antipsychotics, anticonvulsants, immunosupressants, etc. as well?
Obviously individual reactions vary and nothing is a guarantee in medicine, but I believe many substances can cause noteworthy issues with sudden cessation that are greater than just the reemergence of the underlying condition being treated. However I am probably more wrong than right on most topics, so (anyone) feel free to correct me if I am mistaken.
Exactly. We know that they DO work, but we don’t know how.
Not a doctor and this is not brain health advice, but SSRIs take several weeks to start working.
If they work because “more serotonin in the brain treatments depression” they should start working instantly. The two week lag indicates that they work based on a secondary effect caused by long term elevation of serotonin.
And it’s maddening that we don’t seem to know what that effect is.
Sometimes an SSRI does start working instantly. That was my experience the first time I took Zoloft; I remember leaving work early that afternoon for a walk in the park, marveling at the way all the colors in the world had become more vivid.
When I tried Zoloft again years later, during another bout of depression, I felt nothing: not right away, not for weeks after, no change at all.
I suspect that there is not really any such ailment as depression, any more than there is any such disease as fever; that is, the pattern of symptoms we see represents a reaction to some underlying problem, and many different kinds of problems may cause similar symptoms, while requiring different solutions.
For me sertaline was way more gradual. And it was never that I suddenly felt right - it's just that after few weeks I noticed my floor on feeling very down for up a bit.
This may sound pedantic but I see this blanket assertion all the time from people who take psych meds and have them work for them. There is a very large group of people for whom they do not work, and others in which they cause serious harm. I’m glad they work for you, but please don’t assume that they work for everyone. They don’t.
"There is a very large group of people for whom they do not work"
- many people are unwilling to wait the proper amount of time "4-6 weeks" for efficacy to manifest *especially* when for the first 2-3 weeks you many times feel much worse than baseline.
First month on Effexor made me feel miserable. More anxious but much, much more irritable and depressed. Then one day a month in I'm sitting at my desk and I suddenly feel high as a kite lol. Melting bliss.
That feeling too fades and then you just feel better than baseline until you build tolerance to current dose. Raise, rinse and repeat.
Better than having to be near an exit whenever inside a structure!
Depending on the population and methodology, anywhere from 10-30% of people diagnosed with major depressive disorder are considered to have "treatment-resistant" depression, which usually means they've failed to respond to at least two antidepressants despite adequate compliance (exact definitions vary as this is not a separate diagnosis) [1].
Doctors I've talked to have said it's 4 to 6 weeks to reach a baseline, where the medication reaches a steady level in the blood and receptor changes in the brain reach a new equilibrium, but even up to 2+ months for the real effect to kick in.
Those 4-6 weeks are when your brain is adapting to an ever increasing serum level of antidepressants, and it takes about ~2 weeks for serotonin receptors to downregulate in response. That time can be very uncomfortable, specifically because SSRIs indirectly activate 5HT2C, leading to dysphoria, anxiety, etc, before the receptor is sufficiently downregulated.
tl;dr: it can take longer than 4-6 weeks for efficacy to manifest
This is what I've heard from those I know that take anti depressants - the time that is suggested before you would be able to look back and say: "I'm doing much better than four weeks ago", is a bit daunting.
First and foremost because you take them at a point in your life where you're, well, depressed (used as a blanket term here). So patiently waiting for the effect to manifest is a burden in itself, in addition to hoping it works and not being sure if you're experiencing a placebo or actual effect.
But what scares me more, personally, is that it takes such a long time to get on and ween off. It seems to fundamentally change something in the human body or brain. As opposed to e.g. amphetamines, and benzos, which may have long lasting effects from prolonged use, but otherwise appear to be pretty straight forward.
Having never needed antidepressants, I'm curious if others who have taken them, worried about this before or afterwards?
At least in my experience, going off traditional SSRIs wasn't fun, but after it's out of your blood and you wait your ~2 weeks for what is essentially serotonin withdrawal to subside, there weren't any lasting effects.
I've experienced worse withdrawals from other drugs, but I've read that some people do get PAWS-like symptoms from SSRI, and especially SNRI, withdrawal.
Well I was talking about how fast they have a noticable effect on people. Not about wether or not someone should take them, nor if they are addictive and to what degree. So I don't see the point in your reply, to be honest.
Interesting that you talk about Effexor. Effexor was the one drug that “worked” for me.
But over time, my thinking and behavior became more and more erratic. I became highly unstable, doing bizarre and unsafe things I never would have considered prior to Effexor. So I needed to come off. Ok, then I had to endure a month of brain shivers, where moving my head made the world stutter like there was a strobe light. After getting through that, I developed dystonia, which lasted for the next fifteen years.
This is why I said that the statement needed clarification. Everyone that had them work for them thinks “they work”. Bullshit. They worked _for you_.
I disagree. It’s not clear from the context. People often generalize their experiences to think they apply to everyone. With psych meds, this is very common. I don’t expect a PSA, just a recognition that “they work” cannot be stated as an absolute. I don’t know what you mean by access being mediated by layers of professionals.
You have to first see a doctor who will prescribe the medication followed by a pharmacist.
I don't see a claim by OP that their experience generalizes absolutely. I'm also having a hard time seriously believing you don't think people are aware that folk can have varied reactions, people become aware of allergies as a concept usually well before psychiatric medication.
Just to be clear - I don't mind you adding in that additional context/reminder, I think additional perspective like that is frequently helpful, but I do resent you demanding others add it in your stead like they've missed an obligation or made a mistake.
In the developed world, yes. In much of the world (perhaps even most of the world) you can simply walk into a small local pharmacy and buy pretty much anything. Antidepressants, valium, antibiotics, whatever. Only uppers tend to have stricter controls, but I've heard you could find them with a bit of legwork.
They work. Not perfect. And tolerance at different dosages build over time. But it's not a placebo effect.