SSRIs-Worth the Risks?

[Nocd39]

I’ve just been listening to this podcast about SSRIs with Dr Rangan Chatterjee and Joanna Moncrieff:

https://podcasts.apple.com/gb/podcast/feel-better-live-more-with-dr-rangan-chatterjee/id1333552422?i=1000712300093

It’s a really interesting listen and they discuss research on how SSRIs work (basically we don’t know), whether they are effective, and side effects.

I think it’s pretty worrying that we still don’t understand how the drugs work when there can be serious and ongoing side effects. I wish there was more research into alternatives. And more non-medicinal support for people who are struggling.

AIBU?

Fluoxetine was a game changer for my DD.
It allowed her to function enough to access therapy and education.

Paroxetine has changed my life. I’m incredibly glad I wasn’t fobbed off with “non medicinal support”.

Honestly, I don’t really care how they work. What I care about is that they allow me to function, recover - to a large extent - from the PTSD which crippled me and mean that I can be a present and engaged parent, rather than spending my time planning how to kill myself.

I think the drugs can help but people are given them very easily without other options e.g. therapy that could help them. Personally the medication “worked” for my OCD but has caused really severe side effects so I’m having to come off it. There’s a lack of research into alternatives for those people where SSRIs don’t work for them. I’ve had serious withdrawal effects trying to get off the medication and anecdotally know others who have had the same.

Im not minimising mental health conditions-I’ve had severe OCD which made me actively suicidal. I just don’t think people are necessarily aware of the risks or given alternatives

I’m glad they’ve helped you. I’m not familiar with PTSD but is it similar to OCD where therapy is recommended too?

The risks aren't exactly hidden - they're all over the internet, the packaging and mine were also explained by my GP and the pharmacist who dispensed it.

I needed paroxetine to pull me out of autistic burnout. Otherwise I was just lying in bed, not eating, not functioning and barely looking after myself. It saved my life.

@Nocd39Yes - I’ve had a lot of therapy alongside medication. But without the medication, I couldn’t engage in therapy (I tried).

Honestly, I don’t really care how they work. What I care about is that they allow me to function

Exactly - me too. I need them to survive. I'm also in therapy, but the medication is absolutely essential for me.

I used citalopram during a difficult period of my life. It made me feel numb and although it took the edge off the crashing lows, I couldn’t experience joy either and I felt extremely disassociated as a result.

However they worked for a time until I felt they were masking issues rather than helping.

i tried them as a last resort, and came off them when I decided I was ready to confront life without them.

Everyone responds differently so it’s impossible to advise or advise against without knowing the full picture.

Life changing for me - I am significantly less anxious and much more able to enjoy life. I have gained weight though, which is very difficult to shift (could also link with age as I’m hitting perimenopause). I’m on sertraline.

I took a really long time to resort to tablets and have done years of therapy. They achieved in about 3 weeks what therapy never did.

I don’t love that I’m on them but I’m able to to be a present and engaged parent so I’ll take the risks. At least I’m living now rather than existing

I think they are great if you can take them then come off them. But not everyone does come off them. It's very personal case by case. Also it's far easier to get pills than to real life support or ongoing therapy isn't it? Eg cbt is six weeks on the nhs

I’d argue the risks aren’t hidden but it’s difficult to get a true sense of the pros and cons because there hasn’t been quality research into the likelihood of the side effects and withdrawal symptoms (according to my psychiatrist.) I’d like there to be alternatives available for people for whom SSRIs don’t work or cause problems

Yes I agree with this. No one knows in advance if they will have side effects or problems coming off them. The waiting lists for therapy are long (1year for OCD therapy in my area) and getting support if you have issues is very hard in my experience.

Yes I understand. I wasn’t able to engage with therapy without the SSRI. But now I’m having to come off the medication on medical advice and there’s no alternative on offer

I’m glad it helped you. You weren’t offered any therapy?

@Nocd39Are you specifically talking about SSRIs or anti-depressants? There are alternatives to SSRIs which work better for some people.

I'm a mental health nurse. SSRIs are well tolerated by the vast majority of people. There are numerous randomised control trials looking at their safety. They are the least potent in terms of side effects. There are other drugs to treat depression. The reason SSRIs are first line treatment is because they are the best tolerated and the easiest to withdraw from, in comparison to something like Paroxetine or mood stabilisers like Lithium.

Best practice guidelines is always to prescribe alongside non-pharmacologic treatments.

There isn't support through the NHS for adults with high-functioning autism. I pay over £200 a month for private therapy.

Not a doctor but surely not knowing the side effects that an individual will have is the same for all types of medications ?

the thread is on SSRIs. I can’t speak to other conditions but SSRIs are offered with therapy as the “gold standard” treatment for severe OCD. So far as I’m aware, based on advice from my psychiatrist, there aren’t other well-researched alternative treatments for OCD (I think there may be more on offer for depression and anxiety.) There were SNRIs that came before but these generally cause more side effects. Interested if you are aware of other options though

What alternatives are you imagining?

Ultimately, mental illness isn't something that just goes away on its' own - and while lifestyle changes may help some, for many, the choice is medication or struggle in silence until you have some kind of breakdown.

Sometimes therapy is not immediate enough. I got ptsd, the Paroxetine kicked in after 2 days I will take it until there is a conclusion to what happened, and then worry about coming off it, which I am perfectly aware of being difficult but I couldn't have managed the last four years without it. I had therapy but it wasn't massively helpful and I wouldn't have been able to support my child without the meds.

This just isn't true. As with any drug, all the side effects have been clearly documented in the research. Anecdotally, as someone who works in MH, the most common side effects I see are an upset stomach, nausea, sleep disturbances, head fog, and a 'numb' feeling. They wear off for most people. A quick glance at a database tells me there are also studies looking at withdrawal.