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?

Please don’t invalidate my experience.

It literally ruined my life coupled with being ignored repeatedly when I asked for help and alerted professionals

Thank you.

I thought Chlomiprimine was the drug for OCD?

I’m not diminishing your experience. I was just commenting that not everyone has that reaction and that it’s not a reason for someone else not to give it a go.

If everyone had the reaction it would never have been approved for sale.

However, the manufacturers appear that they did mis report the level of adverse events and if peopld take the time to Google, the information is available online.

You still diminished my experience and it’s something I come across tine and again.

People deserve to know the risks.

It ruined my life. Literally.

For the three weeks thing

I remember reading a study, about 20 years ago, about the original release of SSRIs. There were a lot of psychiatrists speaking against them. It turned out that people who had seen their psych every week for therapy would go on this medication and then stop going to therapy, because the medication helped them properly.

A few psychiatrists were interviewed in the book I was reading and they said things like "patients who went round in circles with the same problems for years were able to finally move forward aftera few weeks of SSRIs".

I found that very interesting in its own right, but it does make me wonder if so many things have been added to the DSM in the following years, because psychiatrists had to classify things as illnesses in order to keep business going.

I wouldn't be alive now if I didn't have them. I certainly wouldn't have a career if I didn't have them. I took them for decades. I no longer need them, but if I have to take them again then I will.

I also wonder if long-term use has altered my neural pathways and that's why I don't need them anymore. This was actually something that my doctor told me when I went on them originally. She said that was one of the possiblities and not to assume that I would need them for life.

I’m sorry you feel that way but it wasn’t my intention - I didn’t say I didn’t believe you or that you didn’t have the experience you did.

I’ve had bad experiences on SSRI’s too but my experience shouldn’t put everyone off.

But TCA’s which are equally if not more effective that SSRi’s have always been available. So I’m not sure why people ‘were going in circles until taking an SSRI.

Amitryptiline is the gold standard and chlomiprimene is meant to be the most effective anti depressant.

Yes, I guess different things work for different people. Im glad medication worked for you. I had EMDR to process a bereavement and it really helped. I don’t think it’s easy to access on the NHS, at least not where I live

I'll be on SNRIs and NASSAs for the rest of my life. Have been taking them since 2001. Fine by me - I'll also be on levothyroxine for life, omeprazole and, if I get diabetes or heart failure, the drugs for them too. I plan to stay on HRT as well, barring things like hormone-sensitive cancer.

Why wouldn't I? Is it because mental health doesn't register with you as "important" enough for continuous medication? The drugs for bipolar disorder and schizophrenia have a hell of a lot more complications than these reuptake inhibitors. No-one fully knows how they work either. Would you urge someone to live with the terrifying effects of these illnesses rather than take the drugs, or is it only depression that doesn't merit chemical support in your view?

There are many, many drugs whose mechanism of action is not understood. One of them is paracetamol.

I don’t think anyone on this thread thinks mental health issues aren’t important, several people on here have had serious and life threatening mental health issues. If medication is working well for you that’s great. However, quite a few of us on this thread aren’t able to take SSRIs and/or have had serious side effects so long term use isn’t an option. As far as I know, there isn’t quality research into any long-term impacts of SSRI use. But if they are helping you and you’re taking them under medical advice no one here is saying you should stop.

Apparently it used to be but has now been superseded by SSRIs

I’m not sure why SSRIs are used more now than TCAs

Me too. I genuinely don’t know where I’d be without mirtazapine, I was such an absolute mess I wouldn’t have been able to engage with any therapy, and that’s assuming I could have got therapy without having to wait for ever.

I've been on sertraline for donkey's years. They do an incredible job of shutting down the very loud, critical voices that crowd my head. I'm not sure whether I'd still be here if it wasn't for the silence.

Thanks, @Nocd39. Surely everyone's taking them under medical advice? You can't get them otherwise (unless you go to a dealer and, if you were doing that, you'd probably want something with a faster effect!)

There is some evidence to suggest that long-term antidepressant use may be linked to some health risks, such as heart problems and diabetes. As with any health management choice, we have to weigh probable benefits against probable risks. There are no exceptions to this. I remember doing it before starting on the Pill, and that was when dinosaurs ruled the planet!

There are other antidepressants with more solidly proven effectiveness, as PPs have mentioned. Their side effects and possible long-term risks are more impactful, however. Everything's a balance.

I’d be very interested if you could share a y links. My psychiatrist advised me there aren’t good long-term studies on side effects, particularly around the incidence of sexual dysfunction nor on long term withdrawal effects. He could have been wrong though

Because the tricyclics have even worse side effects, which affect more people, which are even harder to come off and are more dangerous in overdose.

They would now only be used for depression in rare cases where there is SSRI/SNRI resistance.

SSRIs make me suicidal. I’ve tried quite a few and personally they are not worth the risk. I’m autistic and this is a common experience for autistic people. Although some autistic people find them helpful so it’s not a set rule.

i did psych at uni. It was interesting when we covered SSRIs. Obviously I wasn’t coming at the topic medically, or I was but it wasn’t a medical degree. But they shouldn’t be used long term. They work by blocking the absorption of serotonin. So initially they do make you feel better but over time your body compensates by producing less serotonin essentially leaving you with the same levels you had when starting. So you have to up the dose to get the same effect. Then when you come off them your body has to adjust and make more serotonin to cover the short fall leaving you feeling shit even if the crisis you had that made you need them initially as passed.

im going back a few years but when I was studying it there were a multitude of studies that found the same improvements in people given placebos. Even down to people on the placebo reporting the side effects they could get from the real medication.

so I don’t think they are a good thing at all. Short term yes they have a purpose, to get you through a difficult time like a bereavement or redundancy or break up etc. But you are just kicking the can down the road because you will feel low when you then come off them. This may be better as you can come off them once you have your life more settled and are able to cope with feeling shit. But if it’s a long term issue for a person by far the best treatment leading to the best outcomes was therapy and making life changes. Diet and exercise (I hate that this is bourbon out by science!).

but at the end of the day if you can’t function now and can’t cope with therapy or don’t have access they are better than suicide or being so emotional your kids suffer

Ah thanks for sharing. That makes sense

Thanks for sharing that’s interesting. I’m guessing what you’ve explained about the body adjusting serotonin levels is at least part of the reason why some people suffer horrendous withdrawal effects that can go on for months and even be accidentally confused with their initial MH symptoms? Obviously the tablets aren’t “addictive” in the same way as drugs or alcohol but certainly it makes sense that the body adapts and it can be then harder to live without them. Problem is it’s luck as to whether SSRIs help/cause you serious problems or withdrawal effects etc.

I've been living with a truly horrible family situation for decades that has caused me to be really depressed and looking forward to die to relive the pain and torment.
I've had therapy and group support.
I always resisted antidepressants,...my reasoning being that the problem won't go away.
I started taking ssri's a year ago and I feel sooooo much better. It's almost like an emotional anaesthetic.

I’ve been on and off citalopram since I was 16. Had CBT, had counselling. I’ve tried several times to come off it and I just turn into a weeping mess, it’s like my brain isn’t normal

As someone who has been crippled with anxiety my whole life, prescribed Sertraline in my late 40s, I cannot tell you how much I value these meds. I feel like the holiday me all the time. Life throws stuff at you but I have bandwidth and patience I never had. I’m a better parent, partner, friend. I honestly think I’d have gone mad without it. No side effects I’m aware of otger than slight continual dicky tum. I’ll take that!

what were your side effects Op?

Do you know if it’s your MH problems returning or if you’ve been getting withdrawal effects? I think it’s really hard for people coming off SSRIs and there is very limited medical supervision/emotional support. The advice, if coming off is right for you, is to taper very slowly. It’s not always easy to do that though. I had to fight with my GP to get a liquid to taper slowly.

I can’t go into details because together with the info shared elsewhere it’s very outing and I have friends and colleagues on here. But think going from healthy physically to largely housebound and often bedbound. I have no reason to think my particular side effects are common. However, I’ve had a nightmare coming off this SSRI and one before with awful withdrawal effects. As best I know, most people don’t have withdrawal effects that are serious but given the numbers on SSRIs it’s still probably a significant number of people